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016.04.2-XII. TREATMENT STRUCTURE

AR ADC 016.04.2-XIIArkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 04. Division of Behavioral Health
Rule 2. Methadone/Laam Treatment Program Standards
Ark. Admin. Code 016.04.2-XII
016.04.2-XII. TREATMENT STRUCTURE
Currentness
The Program shall provide the patient a full range of treatment and rehabilitative services. The absence of the use of controlled substances, except as medically prescribed; social, emotional, behavior and vocational status; and other individual patient needs shall determine the frequency and extent of the services.
The assessment and treatment team shall consist of a Medical Director, medical staff and counselors who shall assess the patient's needs and, with the patient's input, develop a treatment plan. The primary counselor shall sign the treatment plan. As part of developing a treatment plan, the patient shall have input in establishing or adjusting dosage levels. The assessment and treatment team shall staff each case at least once each thirty (30) days during the first ninety (90) days of treatment and at least once each ninety (90) days thereafter. The Medical Director shall sign off on the initial treatment plan when developed and the comprehensive treatment plan on an annual basis.
Services to each patient shall include individual, group and family counseling at the following minimum levels:
Phase I
Phase I consists of a minimum of a ninety (90) day period in which the patient attends the Program for observation daily or at least six (6) days a week. During the first ninety (90) days of treatment, the take-home supply is limited to a single dose each week. Phase I requires at least four (4) hours of counseling per week. The counseling sessions at a minimum shall consist of two (2) hours of group therapy sessions, one (1) hour of individual counseling, and one (1) hour of twelve step/self help meeting per week. The assessment and treatment team and the patient shall determine the patient's assignment of group therapy attendance. The issues to be discussed in group therapy sessions shall consist of at a minimum but not limited to the following:
(1) Family or Significant Others;
(2) Living Skills;
(3) Methadone Maintenance;
(4) Peer Confrontation;
(5) Positive Drug Screen;
(6) Educational Training;
(7) Vocational Training and/or Employment; and
(8) Acquired Immunodeficiency Syndrome (AIDS) Education as Related to Human Immunodeficiency Virus (HIV).
The assessment and treatment team and the patient shall negotiate a methadone/LAAM detoxification plan with potential target dates for implementation in Phase V. Such a plan may be short-term or long-term in nature based on the patient's need and may include intermittent periods of methadone/LAAM maintenance between detoxification attempts.
Prior to a patient moving to Phase II, the patient shall demonstrate a level of stability as evidenced by the following:
(1) Absence of recent (past thirty (30) days) abuse of drugs (opioid or nonnarcotic), including alcohol;
(2) Clinic attendance as required in phase I;
(3) Absence of serious behavioral problems at the clinic;
(4) Absence of known criminal activity within the last thirty (30) days, e.g., drug dealing;
(5) Stability of the patient's home environment and social relationships;
(6) Length of time in comprehensive maintenance treatment;
(7) Assurance that take-home medication can be safely stored within the patient's home; and
(8) Whether the rehabilitative benefit the patient derived from decreasing the frequency of attendance outweighs the potential risks of diversion.
In addition, the patient shall provide assurance to the Program regarding safe transportation and storage of take-home medication.
Phase II
Phase II Level I
A patient, admitted more than ninety (90) days and successfully completing Phase I, shall attend the Program no less than three (3) times weekly. The Program may issue no more than two (2) take-home doses at a time. A patient must have continuous clean drug screens for the past thirty (30) days, while in Phase I, prior to advancement into Phase II Level 1. A patient must spend a minimum of ninety (90) days in Phase II Level I.
Prior to a patient moving to Phase II Level 2, the patient shall demonstrate a level of stability as evidenced by the following:
(1) Absence of recent (past sixty (60) days) abuse of drugs (opioid or nonnarcotic), including alcohol;
(2) Clinic attendance as required in Phase II, Level I;
(3) Absence of serious behavioral problems at the clinic;
(4) Absence of known criminal activity within the last sixty (60) days, e.g., drug dealing;
(5) Stability of the patient's home environment and social relationships;
(6) Length of time in comprehensive maintenance treatment;
(7) Assurance that take-home medication can be safely stored within the patient's home; and
(8) Whether the rehabilitative benefit the patient derived from decreasing the frequency of attendance outweighs the potential risks of diversion.
Phase II Level 2
A patient, admitted more than one hundred and eighty (180) days and successfully completing Phase II Level 1, shall attend the program no less than two 2 times per week. The Program may issue no more than three (3) take-home doses at a time. A patient must spend a minimum of ninety (90) days in Phase II Level 2.
Prior to a patient moving to Phase II Level 3, the patient shall demonstrate a level of stability as evidenced by the following:
(1) Absence of recent (past ninety (90) days) abuse of drugs (opioid or nonnarcotic), including alcohol;
(2) Clinic attendance as required in Phase II, Level II;
(3) Absence of serious behavioral problems at the clinic;
(4) Absence of known criminal activity within the last ninety (90) days, e.g., drug dealing;
(5) Stability of the patient's home environment and social relationships;
(6) Length of time in comprehensive maintenance treatment;
(7) Assurance that take-home medication can be safely stored within the patient's home; and
(8) Whether the rehabilitative benefit the patient derived from decreasing the frequency of attendance outweighs the potential risks of diversion.
Phase II Level 3
A patient, admitted more than two hundred and seventy (270) days and successfully completing Phase II Level 2, shall attend the program no less than one (1) time per week. The Program may issue no more than six (6) take-home doses at a time. A patient must spend a minimum of ninety (90) days in Phase II Level 3.
During Phase II Level 1
A patient shall attend at least two (2) hours of counseling (one of which shall be individual) and two (2) self-help group meetings per week. For the remainder of Phase II Levels 2 and 3 the patient, primary counselor, medical director and other appropriate members of the treatment team shall determine a patient's counseling and self-help activities provided that the minimum level of service delivery shall be one (1) hour of counseling per month and one (1) self-help group meeting per week.
Phase III
A patient admitted more than one (1) year and successfully completing Phase II, shall attend the Program no less than one (1) time bi-weekly. (Not to exceed 15 calendar days). The Program may issue no more than fourteen (14) take home doses in 15 calendar days at a time. A patient must have at least six (6) months of continuous clean screens, while in Phase II, prior to advancement into Phase III.
Phase III, the patient , primary counselor, and medical director shall determine a patient's counseling and self-help activities provided that the minimum level of service delivery shall be one (1) hour of counseling per month and two (2) self-help group meeting per month. The one (1) hour counseling may be either individual counseling or group therapy, as determined by staff and patient.
Phase IV
The Program may provide a twenty-eight (28) day supply of methadone if a patient, admitted for two (2) years has successfully completed Phase III. A patient must have at least twelve (12) months of continuous clean screens, while in Phase III, prior to advancement into Phase IV.
Phase IV requires at least one (1) hour counseling per month in addition to attendance at one (1) self-help group meetings per month as long as the patient maintains a twenty-eight (28) day take-home medication status.
Phase V
During the above four (4) phases a patient, in consultation with the assessment and treatment team, may elect to enter Phase V.
A. This phase implements the methadone/LAAM detoxification plan. The Program physician determines the take-home dosage schedule for the patient. The primary counselor determines the number of counseling sessions provided during this phase based on the clinical judgment of the primary counselor with input from the patient. At the onset of Phase V, the patient may require an increased level of support services (i.e., increased levels of individual, group counseling, etc.). Prior to successful completion of Phase V the primary counselor and patient shall develop a plan that shall integrate the patient into a drug-free treatment regimen for ongoing support.
B. The patient's use of controlled substances except as medically prescribed, deterioration of social, emotional, vocational or behavioral status; and or other individual needs shall result in increased frequency and extent of treatment and rehabilitation services.
C. The Program shall assess each patient for referral, if appropriate, to Employment Security Division, vocational training and or enrollment in school. The Program shall conduct a follow-up at least every thirty (30) days.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.04.2-XII, AR ADC 016.04.2-XII
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