1. (a) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

   1. (1) Admission--The administrative process and procedure performed to accept an offender into a treatment program or facility.
   2. (2) Assessment--a process using a structured or semi-structured interview to determine the nature and extent of a client's chemical dependency.
   3. (3) Chemical Dependency Counselor--A qualified, credentialed counselor or counselor intern working under direct supervision.
   4. (4) Continuum of Care--A system which provides for the uninterrupted provision of essential services to offenders entering, exiting, and within the system.
   5. (5) Counseling--Face-to-face interactions between offenders and counselors to help offenders identify, understand, and resolve their personal issues and problems related to their substance abuse or chemical dependency. Counseling may take place in groups or in individual meetings.
   6. (6) Counselor Intern--A person pursuing a course of training in chemical dependency counseling at a regionally accredited institution of higher education or a registered clinical training institution who has been designated as a counselor. The activities of a counselor intern shall be performed under the direct supervision of a qualified, credentialed counselor in accordance with rules adopted by the Texas Commission on Alcohol and Drug Abuse.
   7. (7) Detoxification--Chemical dependency treatment designed to systematically reduce the amount of alcohol and other toxic chemicals in an offender's body, manage withdrawal symptoms, and encourage the offender to continue ongoing treatment for chemical dependency.
   8. (8) Direct Care Staff--The staff responsible for providing treatment, care, supervision, or other offender services that involve a significant amount of direct contact. (Clerical support staff are not considered direct care staff.)
   9. (9) Discharge--The time when an offender leaves a program or facility and will no longer be receiving chemical dependency treatment from that program or facility.
   10. (10) Discharge Summary--A recapitulation of the offender's progress and participation while in either primary, residential, or outpatient treatment.
   11. (11) Education--Educational instruction; a planned, structured presentation of information which is related to substance abuse or chemical dependency.
   12. (12) Emergency--A situation requiring immediate attention and action to treat or prevent physical, emotional, or mental threat, harm, injury, or illness.
   13. (13) Facility--The physical location of the treatment program operated by, for, or with funding from the TDCJ-CJAD. Some locations may be locked facilities for in-patient treatment; other programs may be offered at locations as outpatient treatment.
   14. (14) Grievance--A formal complaint limited to matters affecting the complaining offender personally and limited to matters for which the facility/program has the authority to remedy through the grievance process.
   15. (15) Primary Counselor--An individual working directly with and being responsible for the treatment of the offender.

   16. (16) Qualified, Credentialed Counselor (QCC)--A licensed chemical dependency counselor (LCDC) or one of the following professionals:

       1. (A) licensed professional counselor (LPC);
       2. (B) licensed master social worker (LMSW);
       3. (C) licensed marriage and family therapist (LMFT);
       4. (D) licensed psychologist;
       5. (E) licensed physician (MD or DO);
       6. (F) certified addictions registered nurse (CARN);
       7. (G) licensed psychological associate; and
       8. (H) advance practice nurse recognized by the Board of Nurse Examiners as a clinical nurse specialist or nurse practitioner with specialty in psyche-mental health (APN-P/MH).
   17. (17) Screening Instrument--a written device administered to an offender to determine the possible existence of chemical dependency.
   18. (18) Senior Counselor/Unit Manager/Unit Supervisor--A supervisory staff member who directs, monitors, and oversees the work performance of subordinate staff members.
   19. (19) Special Needs Populations--Offenders who have significant problems in the areas of mental health, diminished intellectual capacity, or medical needs.
   20. (20) Treatment--A planned, structured, and organized program designed to initiate and promote a person's chemical-free status or to maintain the person free of illegal drugs. It includes, but is not limited to, the application of planned procedures to identify and change patterns of behavior related to or resulting from chemical dependency that are maladaptive, destructive, or injurious to health, or to restore appropriate levels of physical, psychological, or social functioning lost due to chemical dependency.
   21. (21) Use of Force--Graduated levels of use of physical strength or weapons necessary to gain physical compliance and control of an offender whose actions otherwise pose a danger to self or others.
2. (b) Compliance. Compliance with TDCJ-CJAD substance abuse treatment standards is required of all programs that provide substance abuse treatment and are funded or managed by TDCJ-CJAD. Programs and facilities providing only substance abuse education are not subject to these standards.
3. (c) Personnel & Staff Development/Accreditation. The employer shall ensure that employees acquire any credentials, licensing, certifications, or continuing education required to perform their duties. Personnel files for employees shall be maintained to display copies of required documents. Staff will be required to have criminal background checks performed annually. Programs that are not clinical training institutions as defined by the Texas Commission on Alcohol and Drug Abuse must inform all non-credentialed staff of this fact

4. (d) Admissions. There shall be documentation of specific admission criteria and procedures. Offenders are eligible for substance abuse treatment programs:

   1. (1) if the offender's needs are met by the treatment services provided by the program,
   2. (2) if a court orders the offender into the program and the subsequent assessment indicates the need for treatment services; or
   3. (3) if the program allows readmissions and the offender meets the admission criteria. For offenders who are placed in treatment programs who do not meet admission criteria, a mechanism or procedure shall be developed for offender removal. A review and justification explaining the reason the offender does not meet admission criteria shall be required.
5. (e) Intake. There shall be written policies and procedures establishing an intake process for offenders entering a substance abuse treatment program.

6. (f) Initial Assessment Procedures. Acceptable and recognized assessment tools (tests and measurements) shall be used in all substance abuse treatment programs within ten (10) working days from date of admission. Assessment policies and procedures shall require the use of approved clinical measurements and screening tests. If the screening identifies a potential mental health problem, the facility shall obtain a mental health assessment and seek appropriate mental health services when resources for mental health assessments and services are available internally or through referral at no additional cost to the program. Assessment procedures shall include the following:

   1. (1) identification of strengths, abilities, needs and substance preferences of the offenders served;
   2. (2) summarization and evaluation of each offender to develop individual treatment plans;
   3. (3) assessments completed by a Qualified Credentialed Counselor (QCC), or if the assessor is a Counselor Intern, then the documentation must be reviewed and signed by a QCC.

7. (g) Assessments. The assessment shall include:

   1. (1) a summary of the offender's alcohol or drug abuse history including substances used, date of last use, date of first use, patterns and consequences of use, types of and responses to previous treatment, and periods of sobriety;
   2. (2) family information, including substance use and abuse by family members and supportive or dysfunctional relationships;
   3. (3) vocational and employment status, including skills or trades learned, work record, and current vocational plans;
   4. (4) health information, including medical conditions that present a problem or that might interfere with treatment;
   5. (5) emotional or behavioral problems, including a history of psychiatric treatment;
   6. (6) educational achievement level;
   7. (7) intellectual functioning level; and
   8. (8) a diagnostic summary signed and dated by a Qualified Credentialed Counselor (QCC).
8. (h) Orientation. Each program shall establish written policies and procedures for the orientation process. Orientation shall be provided at the onset of treatment and in accordance with the level of treatment to be provided. The orientation shall relay information concerning program rules, the grievance procedure, and the steps necessary for offenders to complete treatment successfully.
9. (i) Offender Rights. The offender's basic rights shall be respected and protected, free from abuse, neglect, exploitation, and discrimination. Each provider shall have written policy and procedure to ensure protection of the offender's rights according to federal and state guidelines.
10. (j) Release of Information. There shall be written policies and procedures for protecting and releasing offender information that conforms to federal and state confidentiality laws. The staff shall follow written policies and procedures for responding to oral and written requests for offender-identifying information.

11. (k) Offender Records. There shall be written policies and procedures regarding the content of offender treatment records. Residential programs shall maintain separate individual treatment records for defendants. Case records, whether residential or outpatient, shall include the following information at a minimum:

    1. (1) initial intake information form;
    2. (2) referral documentation;
    3. (3) case information from referral source, if applicable;
    4. (4) release of information forms;
    5. (5) relevant medical information;
    6. (6) case history and assessment including risk and needs assessment and Strategies for Case Supervision if required;
    7. (7) individual treatment plan;
    8. (8) evaluation and progress reports;
    9. (9) discharge summary; and
    10. (10) court order placing the offender into the program.
12. (l) Offender Records Review Policy. There shall be written policy and procedures to govern the access of offenders to their own substance abuse treatment records in accordance with Texas Health & Safety Code and 42 CFR part 2. This access does not apply to criminal justice records. Restrictions to access to treatment records shall be specified and explained to offenders upon request. Exceptions must involve the potential for harm to the offender or others.

13. (m) Treatment Planning and Review. Initial individual Treatment Plans will be completed within ten (10) working days from the date of an offender's admission to a CCF, CCC or any other substance abuse treatment program or through a similar process approved by the CSCD. Substance abuse treatment shall be based on needs identified through assessments and revised according to the offender's success or lack of progress., Treatment plans shall be reviewed at timely intervals at a minimum of once each month or when major changes occur (e.g., change in phase) and shall ensure:

    1. (1) that the primary counselor meets with the offender as needed to review the treatment plan, evaluating goal progress and revisions; and
    2. (2) that all revised treatment plans be signed and dated by the counselor and the offender.
14. (n) Treatment Progress Notes. There shall be written policies and procedures to require all programs to record and maintain progress notes on all offender case records, to document counseling sessions, and to summarize significant events that occur throughout the treatment process. Progress notes shall be documented at a minimum of once each week.
15. (o) Changes in Treatment Levels. Each treatment program shall develop written criteria for an offender to advance or regress from a level of treatment. An offender must meet the criteria for a change in the level of treatment before such a change or a discharge is implemented. Justification for level changes must be documented.

16. (p) Discharges from Treatment. Discharge from a program shall be based on the following criteria:

    1. (1) the offender has made sufficient progress towards meeting the objectives of the supervision plan and program requirements;
    2. (2) the offender has satisfied a period of placement as a condition of community supervision;
    3. (3) the offender has demonstrated non-compliance with the program criteria or court order;
    4. (4) the offender manifests a medical problem that prohibits participation or completion of the program requirements;
    5. (5) the offender displays symptoms of a psychological disorder that prohibits participation or completion of the program requirements; or
    6. (6) the offender is identified as inappropriate or ineligible for participation in the program as defined by facility eligibility criteria, statute, or standard.

17. (q) Discharge Summary. A discharge summary shall be prepared by the primary counselor for each offender prior to leaving any substance abuse program. The discharge summary shall be sent to the defendant's supervision officer within seven (7) days of discharge and provide a summation of:

    1. (1) clinical problems at the onset of treatment and original diagnosis;
    2. (2) the problems or needs and strengths or weaknesses identified on the master treatment plan;
    3. (3) the goals and objectives established;
    4. (4) the course of treatment;
    5. (5) the outcomes achieved; and
    6. (6) a continuum of care plan/aftercare treatment plan, which must be prepared with the offender prior to discharge.

18. (r) General Program Services Provisions. Specific services shall be required of all substance abuse treatment programs. Written policy and procedures shall ensure the following:

    1. (1) All substance abuse services shall be delivered according to a written treatment plan;
    2. (2) All programs shall employ a Qualified Credentialed Counselor as the Program Director, Clinical Director, Senior Counselor, or the counselor in a similar supervisory position;
    3. (3) The program shall include culturally diverse curriculum applicable to the population served and shall be accomplished through demonstrated, appropriate counseling and instructional materials;
    4. (4) Members of the offender treatment team shall demonstrate effective communications and coordination, as evidenced in staffing, treatment planning and case-management documentation;

    5. (5) There shall be written policies and procedures regarding the delivery and administration of prescription and nonprescription medication which provide for:

       1. (A) conformity with state regulations; and
       2. (B) documentation of the administration of medications, medication errors, and drug reactions.
    6. (6) Chemical dependency education shall follow a course outline that identifies lecture topics and major points to be discussed;
    7. (7) The program shall provide education about the health risks of tobacco products and nicotine addiction;
    8. (8) The program shall provide HIV, Hepatitis B and C and Tuberculosis education based on the Model Workplace Guidelines for Direct Service Providers developed by the Texas Department of Health;

    9. (9) Offenders shall have access to HIV counseling and testing services directly or through referral;

       1. (A) HIV services shall be voluntary, anonymous, and not limited by ability to pay.
       2. (B) Counseling shall be based on the model protocol developed by the Texas Department of Health.
       3. (C) In all TDCJ-CJAD funded facilities, testing, as well as pre- and post-test counseling, is to be provided by the medical department or contracted medical provider. In all facilities, service shall be provided either directly or through referral.

    10. (10) The program shall make testing and information, for tuberculosis and sexually transmitted diseases available to all offenders, unless the program has access to test results obtained during the past year;

        1. (A) Services may be made available directly or through referral.
        2. (B) If an offender tests positive for tuberculosis or a sexually transmitted disease, the program shall refer the offender to an appropriate health care provider and take appropriate steps to protect offenders and staff.
        3. (C) A community corrections facility shall report to the local health department the release of an offender who is receiving treatment for tuberculosis.

    11. (11) The program shall:

        1. (A) refer pregnant offenders who are not receiving prenatal care to an appropriate health care provider and monitor follow-through; and
        2. (B) refer offenders to ancillary services necessary to meet treatment goals.
19. (s) Levels of Treatment. All CCFs providing substance abuse treatment shall designate in the current facility's Community Justice Plan (CJP) program proposal levels of treatment to be provided as described in sections (t) through (x) below. Beginning in fiscal year 2004, level II and level III treatment programs must include a cognitive-behavioral component for medium and high-risk offenders.

20. (t) Level I (Detoxification). Written policies and procedures shall ensure the following:

    1. (1) All offenders admitted to Level I (Detoxification) programs shall need detoxification.

    2. (2) Every offender shall have a completed medical history and physical.

       1. (A) Residential offenders shall have a completed physical and medical history and a physical within 24 hours of admission. If the facility cannot meet this deadline because of exceptional circumstances, the circumstances shall be documented in the offender record. Until an offender's medical history and physical is complete, staff shall observe offenders closely (no less than every 15 minutes) and monitor vital signs (no less than once each hour).
       2. (B) Outpatient offenders shall have the medical history and physical completed before admission.

    3. (3) The program shall provide continuous supervision for offenders.

       1. (A) In residential programs, direct care staff shall be awake and on site 24 hours a day.

          1. (i) During day and evening hours, at least two awake staff shall be on duty for the first 12 offenders, with one more person on duty for each additional one to 16 offenders.
          2. (ii) At night, at least one awake staff member shall be on duty for the first 12 offenders, with one more person on duty for each additional one to 16 offenders.
       2. (B) In outpatient programs, direct care staff shall be awake and on site whenever an offender is on site. Offenders shall have access to on-call staff 24 hours a day.

    4. (4) If the program accepts offenders with acute detoxification symptoms or a history of acute detoxification symptoms, the program shall have:

       1. (A) a licensed vocational nurse or registered nurse on duty during all hours of operation;
       2. (B) a physician on-call 24 hours a day.
    5. (5) Level of observation shall be based on medical recommendations and program design, or not less than that described in (2) (A) above.

    6. (6) A physician shall approve all medical policies, procedures, guidelines, tools, and forms, which shall include:

       1. (A) screening instruments (including a medical risk assessment) and procedures;
       2. (B) treatment protocol or standing orders for each chemical the program is prepared to address in detoxification; and
       3. (C) emergency procedures.
    7. (7) The clinical supervisor shall be a physician, physician assistant, advanced practice nurse, or registered nurse.

    8. (8) The program shall:

       1. (A) ensure continuous access to emergency medical care;
       2. (B) provide offenders access to mental health evaluation and linkage with mental health services when indicated;
       3. (C) use written procedures to encourage offenders to seek appropriate treatment after detoxification.

    9. (9) Direct care staff shall complete detoxification training provided by a physician, physician assistant, advanced practice nurse, or registered nurse that includes instruction in the following areas:

       1. (A) signs of withdrawal;
       2. (B) pregnancy-related complications (if the program admits females of child-bearing age);
       3. (C) observation and monitoring procedures;
       4. (D) appropriate intervention; and
       5. (E) complications requiring transfer.
    10. (10) Staff shall assist each offender in developing an individualized post-detoxification plan that includes appropriate referrals.

21. (u) Level II (Relapse/Intensive Residential Treatment). Written policies and procedures shall ensure the following:

    1. (1) All offenders admitted to Level II (Relapse/Intensive Residential Treatment) shall be medically stable, and able to participate in treatment.
    2. (2) The program shall provide adequate staff for close supervision and individualized treatment with counselor caseloads not to exceed ten (10) offenders.
    3. (3) There shall be direct care staff alert and on site during all hours of operation. There shall be an appropriate number of direct care staff to provide all required program services, maintain an environment that is conducive to treatment, and ensure the safety and security of the offenders, according to the design of the facility and with the approval of the funding source.
    4. (4) For programs 90 days or less counselors shall complete a comprehensive offender assessment and individual treatment plan within five (5) working days of admission. All other programs shall complete a comprehensive offender assessment and individual treatment plan within ten (10) working days.

    5. (5) The facility shall deliver not less than twenty (20) hours of structured activities per week for each offender, including:

       1. (A) ten (10) hours of chemical dependency counseling with a cognitive-behavioral approach with no less than one hour of individual counseling;
       2. (B) seven (7) hours additional education, counseling, life skills, or rehabilitation activities; and
       3. (C) three (3) hours of structured social or recreational activities.
    6. (6) Counseling and education schedules shall be submitted to the funding entity for approval.
    7. (7) Each offender shall have an opportunity to participate in physical recreation at least weekly.
    8. (8) Program staff shall offer chemical dependency education or services to identified significant others.

    9. (9) The program shall provide each offender with opportunities to apply knowledge and practice skills in a structured, supportive environment. Cognitive-Behavioral Programs shall have a published curriculum identified by the authors to contain cognitive, social and behavioral elements. Anyone facilitating a cognitive curriculum must be trained in that specific curriculum. All staff must receive training on the principles of a cognitive behavioral model as it relates to their job duties. This curriculum shall be approved by TDCJ-CJAD and implemented as designed. Components of the cognitive program shall at minimum include:

       1. (A) Ways to identify thinking patterns; and
       2. (B) Social Skills Training Component.

22. (v) Level III (Community Residential Treatment). Written policies and procedures shall ensure the following:

    1. (1) All offenders admitted to level III (Community Residential Treatment) shall be medically stable, able to function with limited supervision and support, and be able to participate in work release or community service/restitution programs.
    2. (2) The program shall have adequate staff to meet treatment needs within the context of the program description, with counselor caseloads not to exceed sixteen (16) offenders.
    3. (3) There shall be direct care staff alert and on site during all hours of operation. There shall be an appropriate number of direct care staff to provide for the safety and security of the offenders, according to the design of the facility and with the approval of the funding.
    4. (4) Counselors shall complete a comprehensive offender assessment and individualized treatment plan within ten (10) working days of admission for all offenders.
    5. (5) The facility shall deliver no less than ten (10) hours of structured activities per week for each offender, including at least five (5) hours of chemical dependency counseling with a cognitive-behavioral approach.
    6. (6) Counseling and education schedules shall be submitted to the funding entity for approval.

    7. (7) The program design and application shall include increasing levels of responsibility for offenders and frequent opportunities for offenders to apply knowledge and practice skills in structured and unstructured settings. Cognitive-Behavioral Programs shall have a published curriculum identified by the authors to contain cognitive, social and behavioral elements. This curriculum shall be approved by TDCJ-CJAD and implemented as designed. Anyone facilitating a cognitive curriculum must be trained in that specific curriculum. All staff must receive training on the principles of a cognitive behavioral model as it relates to their job duties. Components of the cognitive program shall at minimum include:

       1. (A) Ways to identify thinking patterns; and
       2. (B) Social Skills Training Component.

23. (w) Level IV (Outpatient Treatment). Written policies and procedures shall ensure the following:

    1. (1) All offenders admitted to Level IV (Outpatient) programs shall be medically stable, and have appropriate support systems in the community to live independently with minimal structure.
    2. (2) The program shall have adequate staff to provide offenders support and guidance to ensure effective service delivery, safety, and security. Staffing patterns shall be submitted to the funding entity.
    3. (3) The program shall set limits on counselor caseload size to ensure effective, individualized treatment and rehabilitation. Criteria used to set the caseload size shall be documented and approved by the funding entity.
    4. (4) Didactic groups shall not exceed 35 offenders in a group.
    5. (5) Therapeutic groups shall not exceed 16 offenders in a group.
    6. (6) For offenders in supportive outpatient programs, counselors shall complete a comprehensive offender assessment within thirty (30) calendar days of admission for all offenders.
    7. (7) For offenders in intensive outpatient programs, counselors shall complete a comprehensive offender assessment within ten (10) calendar days of admission for all offenders.
    8. (8) Intensive outpatient programs shall deliver no less than ten (10) hours of structured activities per week for each offender, including at least five (5) hours of chemical dependency counseling.
    9. (9) Supportive outpatient programs shall deliver no less than two (2) hours of structured activities per week for each offender, including at least one (1) hour of chemical dependency counseling.
    10. (10) Counseling and education schedules shall be submitted to the funding entity for approval.
    11. (11) The program design and application shall include increasing levels of responsibility for offenders and frequent opportunities for offenders to apply knowledge and practice skills in structured and unstructured settings.
    12. (12) The outpatient treatment levels may be utilized for residents in the work release phase of any residential substance abuse treatment program.

24. (x) Special Populations. Written policies and procedures shall ensure the following:

    1. (1) Programs that address the special mental health, intellectual capacity, or medical needs of offenders must provide appropriate treatment either by program staff or through contracted services.
    2. (2) Admission to a special needs program must be based on a documented mental health, intellectual capacity, or medical need.
    3. (3) When the assessment process indicates that the offender has coexisting disabilities/disorders, the Treatment Plan shall specifically address those issues that might impact treatment, recovery, relapse, and/or recidivism.
    4. (4) Personnel shall be available who are qualified in the treatment of coexisting disabilities/disorders.
    5. (5) Within ninety-six (96) hours of admission to a special needs residential program, offenders shall be administered a medical and psychological evaluation.
    6. (6) Within ten (10) days of admission to a residential program for special needs offenders, the program administrator or designee shall contact the Texas Council on Offenders with Mental Impairments (TCOMI) regarding the offender's status. As soon as discharge date is projected, TCOMI shall be notified in writing of plans for a continuum of care after discharge, regardless of whether or not the discharge is for successful completion of the program.

    7. (7) Residential facilities providing services for special needs populations shall have procedures to provide access to health care services, including medical, dental, and mental health services, under the control of a designated health authority. When this authority is other than a physician, final medical judgments must rest with a single designated responsible physician licensed by the state.

       1. (A) Services/treatment shall be directed toward maximizing the functioning and reducing the symptoms of offenders.

       2. (B) There shall be written policies and procedures regarding the delivery and administration of prescription and nonprescription medication which provide for:

          1. (i) conformity with state regulations;
          2. (ii) documentation of the rationale for use and goals of service/treatment consistent with the individual plan of treatment;
          3. (iii) documentation of the administration of medications, medication errors, and drug reactions; and
          4. (iv) procedures to follow in case of emergencies.
    8. (8) There shall be procedures for documenting that the offender has been informed of medication management procedures.
    9. (9) Offenders shall be actively involved in decisions related to their medications.
    10. (10) Programs for special needs offenders must follow the same staffing for treatment levels as the levels for other offenders, except all residential programs shall maintain caseloads of no greater than sixteen (16) offenders for each counselor.
    11. (11) Programs operating in residential facilities shall ensure that offenders will have no less than ten (10) days of appropriate medication for use after discharge.

Source Note:The provisions of this §163.40 adopted to be effective October 4, 1998, 23 TexReg 9775; amended to be effective June 20, 2002, 27 TexReg 5220; amended to be effective April 17, 2003, 28 TexReg 3065.