PURPOSE: This rule sets forth standards and regulations for the provision of integrated dual disorders treatment services in community psychiatric rehabilitation programs for adults.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) Integrated Dual Disorders Treatment (IDDT) is integrating substance abuse treatment with community psychiatric rehabilitation treatment for individuals with co-occurring psychiatric and substance use disorders. IDDT is a practice based on evidence and research for individuals with serious mental illness and substance use disorders.
2. (2) Agencies certified as Community Psychiatric Rehabilitation (CPR) providers may offer further specialized treatment for co-occurring psychiatric and substance use disorders and shall use the Co-occurring Disorders: Integrated Dual Disorders Treatment (IDDT) Implementation Resource Kit published by the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services at PO Box 42557, Washington, DC 20015 Evaluation Edition 2003, to implement integrated treatment for individuals with co-occurring psychiatric and substance use disorders. A copy of the IDDT Implementation Resource Kit is available at the Division of Comprehensive Psychiatric Services, Missouri Department of Mental Health and a copy may be obtained by contacting the Division of Comprehensive Psychiatric Services. The IDDT Implementation Resource Kit that is incorporated by reference with this rulemaking does not include any later amendments or additions.
3. (3) The agency shall have policies approved by the governing body as defined in 9 CSR 10-7.090 that are consistent with the provision of effective evidence-based interventions to guide the co-occurring services and be consistent with the IDDT model of treatment.

4. (4) Admission Criteria. Persons meeting criteria for this level of service must meet admission criteria as defined in 9 CSR 30- 4.042 and must have a co-occurring substance use disorder.

   1. (A) Individuals shall receive screening for mental health and substance use/abuse disorders using the department-approved screening tools.
   2. (B) If individuals present with both mental health and substance use identified service needs, the individuals shall receive an integrated assessment identifying service needs as well as stage of readiness for change.

5. (5) Personnel and Staff Development. IDDT shall be delivered by a multidisciplinary team responsible for coordinating a comprehensive array of services available to the individual through CPR with the amount of frequency of service commensurate with the individual’s assessed need.

   1. (A) The multidisciplinary team shall include, but is not limited to, the following individuals:

      1. 1. A physician or an advanced practice

nurse;

1. 2. A registered professional nurse;
2. 3. A qualified mental health profession-

al as defined in 9 CSR 30-4.030(2)(HH);

1. 4. Additional staff sufficient to provide

community support, and retain the responsibility for acquisition of appropriate housing and employment services;

1. 5. A qualified substance abuse profes-

sional defined as a person who demonstrates substantial knowledge and skill regarding substance abuse by being one (1) of the following:

1. A. A physician or qualified mental

health professional who is licensed in Missouri with at least one (1) year of full-time experience in the treatment of persons with substance use disorders; or

1. B. A person who is certified or regis-

tered as a substance abuse professional by the Missouri Substance Abuse Counselor’s Certification Board, Incorporated.

1. (B) The multidisciplinary treatment team shall meet regularly to discuss each individual’s progress and goals and provide insights and advice to one another.
2. (C) Multidisciplinary team members shall receive ongoing training in IDDT and shall have a training plan that addresses specific IDDT criteria, including co-occurring disorders, motivational interviewing, stage-wise treatment, cognitive behavioral interventions, and substance use disorders treatment.
3. (D) The number of IDDT teams shall be determined by the needs and number of individuals being supported.

4. (E) Only qualified staff shall provide IDDT treatment services. Qualified staff for each service shall include:

   1. 1. For individual counseling, group

counseling, and assessment, a qualified mental health professional as defined in 9 CSR 30-4.030(2)(HH) or a qualified substance abuse professional defined as a person who demonstrates substantial knowledge and skill regarding substance abuse by being one (1) of the following:

1. A. A physician or qualified mental

health professional who is licensed in Missouri with at least one (1) year of full-time experience in the treatment of persons with substance use disorders; or

1. B. A person who is certified or regis-

tered as a substance abuse professional by the Missouri Substance Abuse Counselor’s Certification Board, Incorporated.

1. 2. For group education, eligible

providers shall have documented education and experience related to the topic presented and either be, or be supervised by, a qualified mental health professional or a qualified substance abuse professional who meets cooccurring counselor competency requirements established by the department; and

1. 3. Qualified mental health professionals

and qualified substance abuse professionals shall meet the co-occurring counselor competency requirements as approved by the department.

1. (6) Treatment.

   1. (A) IDDT shall be delivered according to the IDDT criteria and will be time unlimited with the intensity modified according to level of need and degree of recovery; shall include interventions to promote physical health; and shall target specific services to individuals who do not respond to treatment.

   2. (B) In addition to eligible CPR services, IDDT services include the following:

      1. 1. Co-occurring individual counseling.

A structured goal-oriented therapeutic process in which an individual interacts on a face-to-face basis with a counselor in accordance with the individual’s rehabilitation plan in order to resolve problems related to the individual’s documented mental disorders and substance use disorders that interfere with functioning. Individual co-occurring counseling involves the use of practices such as motivational interviewing, cognitive behavioral therapy, harm reduction, and relapse prevention. Individual co-occurring counseling may include face-to-face interaction with one (1) or more members of the individual’s family for the purpose of assessment or supporting the individual’s recovery;

1. 2. Co-occurring group counseling.

Face-to-face goal oriented therapeutic interaction among a counselor and two (2) or more individuals as specified in individual rehabilitation plans designed to promote individual self-understanding, self-esteem, and resolution of personal problems related to the individual’s documented mental disorders and substance use disorders through personal disclosure and interpersonal interaction among group members. Group size shall not exceed ten (10) individuals;

1. 3. Co-occurring group education. Infor-

mational and experiential services designed to assist individuals, family members, and others identified by the individual as a primary natural support, in the management of the substance use and mental health disorders. Services are delivered through systematic, structured, didactic methods to increase knowledge of mental illnesses and substance use disorders. This includes integrating affective and cognitive aspects in order to enable the participants, consumers as well as family members, to cope with the illness and understand the importance of their individual plan of care. The primary goal is to restore lost functioning and promote reintegration and recovery through knowledge of one’s disease, symptoms, understanding of the precursors to crisis, crisis planning, community resources, recovery management, and medication action and interaction. Group size shall not exceed twenty (20) individuals;

1. 4. Co-occurring assessment supplement.

Individuals suspected of having co-occurring substance use disorders and mental health disorders must receive additional assessments to document the co-occurring disorders and assess the interaction of the co-occurring disorders over time. The completion of the cooccurring assessment shall be documented by the submission to the department of data required by the department and the development of a comprehensive integrated treatment plan to address problems related to the cooccurring disorders;

1. 5. The agency shall arrange for referrals

for detoxification or hospitalization services when appropriate;

1. 6. The agency shall provide housing and

vocational services consistent with the IDDT model; and

1. 7. Other services as appropriate.
2. (C) Staff shall help individuals in the engagement and persuasion stages recognize the consequences of their substance use, resolve ambivalence related to their addiction, and introduce them to self-help principles. Individuals in the active treatment or relapse prevention stage are assisted to connect with self-help programs in the community.
3. (D) Families and significant others shall receive education and, as appropriate, be involved in therapy.

1. (7) Records.

   1. (A) An integrated treatment plan shall be developed by the multi-disciplinary team and shall include participation of the individual receiving services.
   2. (B) The treatment plan shall address mental health and substance abuse treatment strategies that involve building both skills and supports for recovery.
   3. (C) Interventions shall be consistent with, and determined by, the individual’s identified stage of treatment.
2. (8) Quality improvement. The agency’s quality improvement plan shall include monitoring compliance with the provider’s IDDT program; identifying and measuring the individual’s satisfaction and outcomes; and selfassessing fidelity to the IDDT model.

AUTHORITY: section 630.050, RSMo Supp. 2008 and sections 630.655 and 632.050, RSMo 2000.* Original rule filed Sept. 2, 2008, effective April 30, 2009. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 632.050, RSMo 1980.