63E-6.002: Definitions
63E-6.003: Admission Criteria
63E-6.006: Program Components
63E-6.012: Residential Substance Abuse Treatment Overlay Services
PURPOSE AND EFFECT: The amendment changes the admission criteria for Sheriff’s Training and Respect (STAR) programs to accommodate youths with specified substance abuse and psychiatric conditions.
SUMMARY: The amended rule expands the admission criteria to include youths with specified substance abuse and psychiatric conditions who may be sent to STAR programs that have the capacity to provide specified services.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 985.4891 FS.
LAW IMPLEMENTED: 985.4891(2)-(4) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Monday, September 24, 2007, 10:00 a.m.
PLACE: DJJ Headquarters, 2737 Centerview Drive, Ste. 3200, General Counsel’s Conference Room, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Lydia Monroe, 2737 Centerview Dr., Ste. 3200, Tallahassee, FL 32399-3100; e-mail, lydia.monroe@djj.state.fl.us
THE FULL TEXT OF THE PROPOSED RULE IS:
63E-6.002 Definitions.
(1) Alternative Training – authorized physical activities, or extra duty assignments, or verbal counseling which are imposed by STAR program staff following a youth’s misconduct. Alternative training is intended to correct a youth’s behavior by imposing minor sanctions.
(2) Critical Life Safety – a condition or conditions in facility buildings and grounds or in the operation of the program that may adversely affect the health or safety of youth and staff.
(3) Designated Health Authority – a Physician licensed under Chapter 458 or 459, F.S. the individual who is responsible for the provision of necessary and appropriate health care to youth in a residential commitment program. Individual Designated Health Authorities must be a physician (MD) or osteopathic physician (DO) who holds a clear and active license pursuant to Chapter 458 or Chapter 459, F.S. respectively, and meet all requirements to practice independently in the State of
(4) Designated Mental Health Authority – a specified licensed mental health professional who, by agreement, employment, contract or other arrangement, provides and/or supervises the provision of mental health care within a detention center or residential program.
(5)(4) Direct Care – means direct contact with youth for the purpose of providing care, supervision, custody, or control of youth in the STAR program.
(6)(5) Extenuating Circumstances – a situation or circumstance beyond the control of the program, including but not limited to hurricanes/Acts of God, facility damage or structural problems, and situations involving a youth prior to his or her admission into the program.
(7)(6) Intensive Mental Health Treatment – treatment for:
(a) Youth with a Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of: Schizophrenia or other Psychotic Disorder; Major Depression, Bipolar Disorder or other Mood Disorder; Generalized Anxiety Disorder or other Anxiety Disorder; Personality Disorder; or
(b) Youth classified as Severely Emotionally Disabled (SED) or Emotionally Handicapped (EH) by the school system; or
(b)(e) Youth who have a psychiatric disorder that requires treatment with psychotropic medication; or
(c)(d) Youth who have a psychiatric disorder (other than Conduct Disorder) and serious impairment in functioning as evidenced by a Global Assessment of Functioning (GAF) Scale rating of 50 or below.
(d) Youth who have a behavioral history of significant anti-social personality traits and features to include: animal cruelty, fire setting, and predatory behavior.
(e) Youth who have a behavior history of sexual deviance.
(8)(7) Minimum Thresholds – defined as at least a 60 percent performance overall rating in the department’s Quality Assurance evaluation system, as referenced in subsection 63E-6.008(1), F.A.C.
(9)(8) Obstacle Course – a strenuous exercise program, which requires youth to overcome a series of barriers and is designed to promote the development of self-confidence and physical endurance.
(10)(9) Physical Training – a series of organized group calisthenics and exercises designed to develop the physical fitness of a youth to an optimum level.
(11)(10) Post-residential Services Counselor – the person supervising the youth’s post-commitment probation or conditional release after residential placement.
(12)(11) Program Director – a STAR program staff member who is responsible for all aspects of the STAR program, including, but not limited to, program content, staff supervision, youth treatment and facility security.
(13)(12) Protective Action Response Policy – the departmental policy governing staff’s use of verbal and physical intervention techniques, mechanical restraints, prohibition of aerosol and chemical agents, and Tasers, as referenced in Rule Chapter 63H-1, F.A.C.
(14)(13) Suicidal Risk History – means youth with any history of: suicide attempt; suicide gesture; intentional self-injurious behavior; suicide ideation or suicide threats; or history of Baker Act or inpatient/psychiatric hospitalization for suicidal issues.
Specific Authority 985.48913091, 985.645405 FS. Law Implemented 985.48913091 FS. History–New 11-19-06, Amended________.
63E-6.003 Admission Criteria.
(1) A youth is eligible for the STAR program if:
(a) He or she is at least 14 years of age but less than 18 years of age at the time of adjudication; and
(b) Has been committed to the department for any offense that, if committed by an adult, would be a felony other than a capital felony, a life felony, or a violent felony of the first degree.
(2) All youth referred to the STAR program shall be screened by the department to determine if they have the physical, psychological and substance abuse profile conducive to successfully completing the rigorous physical aspects and intensive behavioral management inherent in a STAR program. The screening shall include:
(a) A comprehensive physical assessment prior to admission conducted by a physician (M.D., D.O.) or physician assistant (PA) licensed under Chapter 458 or 459, F.S., or an Advanced Registered Nurse Practitioner (ARNP) licensed and certified under Chapter 464, F.S. The assessment shall include a resting electrocardiogram (EKG) to screen for baseline arrhythmias. These assessments shall assist in determining the youth’s fitness for the physical demands of the program and to preliminarily screen out those youth whose health problems would prohibit them from engaging in intensive physical exercise as determined by the program’s physical exercise curricula. Any youth with abnormal EKGs shall be automatically excluded;
(b) The comprehensive physical assessment and all required tests must be completed within 60 days prior to commencement of the STAR program;
(c) A preadmission comprehensive evaluation with the psychological component conducted by a licensed mental health professional or a Master’s level mental health clinical staff person working under the direct supervision of a licensed mental health professional should be completed no more than six months prior to referral to the STAR program. A mental health clinical staff person is a person providing mental health services for DJJ involved youth in a DJJ facility or program who has received training in mental health assessment processes and procedures and mental health treatment strategies and techniques. A Master’s level mental health clinical staff person is a person who holds a Master’s degree from an accredited university or college with a major in psychology, social work, counseling or related human services field. Related human services field is one in which major course work includes the study of human behavior and development, counseling and interviewing techniques, and individual, group or family therapy. Licensed mental health professional means a board certified psychiatrist licensed pursuant to Chapter 458, F.S., a psychologist licensed pursuant to Chapter 490, F.S., a mental health counselor, clinical social worker or marriage and family therapist licensed pursuant to Chapter 491, F.S., or a psychiatric nurse as defined in Section 394.455(23), F.S. This evaluation must be completed prior to admission to screen out those youth whose mental status requires psychotropic medication interventions, who have a developmental disability as defined by an IQ less than 75 or classification as “Educable Mentally Handicapped” or “Intellectual Disabilities,” “Trainable Mentally Handicapped,” need intensive mental health treatment, reveal suicidal risk histories, have a DSM-IV-TR diagnosis of substance abuse, substance dependence, poly substance dependence, substance intoxication or substance withdrawal, or indicate high-risk suicidal tendencies or history of self-injurious behavior. Youth diagnosed with substance abuse or substance abuse dependence disorders may be considered for placement if the STAR program has been designated by the Department as meeting the requirements to provide residential substance abuse treatment overlay services (RSAT Overlay Services) pursuant to Rule 63E-6.012, F.A.C.
(3) Within 24 hours of admission, a preadmission substance abuse screening test must be conducted or ordered by the department, with results of testing reviewed prior to admission to the STAR program.
Specific Authority 985.48913091, 985.645405 FS. Law Implemented 985.4891(2), (7)(a) 3091(2), (7)(a) FS. History–New 11-19-06. Amended________.
63E-6.006 Program Components.
(1) The STAR program shall contain the following program components or services:
(a) Participation in physical training exercises, which are designed to develop optimum physical conditioning of the youth. The physical conditioning may include the use of an obstacle course;
(b) Educational and vocational services, designed to meet youth abilities, specialized needs and interests;
(c) Community service or work assignments of a productive nature;
(d) Personal development counseling, which shall include training in good decision making, development of social adjustment skills, and life and job skills education. Counseling services shall also be provided to replace criminal thinking, beliefs and values with pro-social thinking, beliefs and values;
(e) Mental health and substance abuse counseling and services shall be provided, including alcohol and other drug abuse awareness, education, treatment or referral to treatment for youth in need of such services.; and If a STAR program is designated for residential substance abuse treatment overlay service (RSAT Overlay Services), the STAR program must provide those services in accordance with Rule 63E-6.0012, F.A.C.
(f) Health care services, sick call and acute and chronic medical treatment provided by the Designated Health Authority, a Physician Assistant (PA) licensed under Chapter 458 or 459, F.S., an Advanced Registered Nurse Practitioner (ARNP) licensed and certified under Chapter 464, F.S., or a Registered Nurse licensed under Chapter 464, F.S., at the level appropriate to their training.
(2) While the youth is in the program, assessment shall be made for conditional release, providing for the youth’s transition back to his or her home community.
Specific Authority 985.48913091, 985.645405 FS. Law Implemented 985.4891(3), (4)3091(3), (4) FS. History–New 11-19-06, Amended________.
63E-6.012 Residential Substance Abuse Treatment Overlay Services.
(1) In order for a STAR program to be designated as qualified to provide residential substance abuse treatment overlay services (RSAT Overlay Services), the following requirements must be met.
(2) Residential Substance Abuse Treatment Overlay Services (RSAT Overlay Services), are defined as: substance abuse assessments; substance abuse education; substance abuse treatment activities such as substance abuse counseling, skills training (e.g., substance refusal skills, coping skills, interpersonal problem solving skills) and relapse prevention. These services shall be provided as follows:
(a) Delivered to youth with a diagnosed Substance-Related Disorder and functional impairment associated with substance abuse or substance dependence. The youth may also have a co-occurring mental disorder other than those mental disorders identified in subsection 63E-6.002(6), F.A.C. However, substance abuse must be the primary disorder. Substance abuse services in DJJ facilities must be provided in accordance with subsection 65D-30.003(15), F.A.C.
(b) Clinical Staffing Requirements:
1. Designated Mental Health Authority-The provider shall designate a single licensed mental health professional as the Designated Mental Health Authority. The role and function of the Designated Mental Health Authority shall be clearly articulated in a written agreement between the Provider and the Designated Mental Health Authority. There must be clear organizational lines of authority and communication between the Designated Mental Health Authority and the clinical staff who are delivering on-site mental health and substance abuse services in the program.
2. Qualified Professional – must be on-site at least five days per week wherein services are provided under Chapter 397 licensure as specified in paragraph 65D-30.003(15)(a) or (b), F.A.C.
3. Substance Abuse Clinical Staff: A substance abuse clinical staff person must be on-site 7 days of the week in facilities where services are provided under Chapter 397 licensure as specified in paragraph 65D-30.003(15)(a) or (b), F.A.C. A substance abuse clinical staff must be on-site each day Substance Abuse Overlay Services are billed.
4. Licensed Qualified Professional: must be on-site 7 days of the week in DJJ facilities that are not licensed under Chapter 397, F.S., or where services are not provided by a service provider licensed under Chapter 397, F.S. The licensed qualified professional must be on-site and provide a substance abuse service each day Substance Abuse Overlay Services are billed.
5. Psychiatrist – must be on-site bi-weekly for consultation, medication management and to participate in treatment planning for youths receiving psychotropic medication.
(c) Clinical Staff Qualifications:
1. Qualified Professional – A physician licensed under Chapter 458 or 459, F.S.; a professional licensed under Chapter 490 or 491, F.S.; or a person who is certified through a DCF recognized certification process of substance abuse treatment services and who holds, at a minimum, a bachelor’s degree and meets all the requirements in Section 397.311(25), F.S.
2. Licensed Qualified Profession – a person who is a physician licensed under Chapter 458 or 459, F.S. a psychologist licensed under Chapter 490 or a mental health counselor, clinical social worker or marriage and family therapist licensed under Chapter 491, Florida Statutes.
3. Certified Addiction Professional: A person who is certified through a Department of Children and Families recognized certification process for substance abuse treatment services and who holds, at a minimum, a bachelor’s degree. A person who is certified in substance abuse treatment services by a state-recognized certification process in another state at the time of employment with a licensed service provider in this state must meet the requirements set forth in Section 397.311(25), F.S.
4. Substance Abuse Clinical Staff: A non-licensed substance abuse clinical staff person may provide substance abuse services in a DJJ residential commitment program only as an employee of a service provider licensed under Chapter 397, F.S., or in facility licensed under Chapter 397, Florida Statutes as specified in paragraph 65D-30.003(15)(a) or (b), F.A.C. The non-licensed substance abuse clinical staff person must hold a bachelor’s degree from an accredited university or college with a major in psychology, social work, counseling or related human services field and meet the training requirements provided in Chapter 65D-30, F.A.C., and work under the direct supervision of a qualified professional under Section 397.311(25), F.S.
5. Licensed Mental Health Professional: A psychiatrist licensed under Chapter 458 or 459, F.S., who is board certified in Child and Adolescent Psychiatry or Psychiatry by the American Board of Psychiatry and Neurology or has completed a training program in Psychiatry approved by the American Board of Psychiatry and Neurology for entrance into its certifying examination, a psychologist licensed under Chapter 490, F.S., a mental health counselor, clinical social worker or marriage and family therapy licensed under Chapter 491, F.S., or a psychiatric nurse as defined in Section 394.455(23), F.S.
6. Mental Health Clinical Staff Person: A mental health clinical staff person, if not otherwise licensed, must have, at a minimum, a bachelor’s degree from an accredited university or college with a major in psychology, social work, counseling or a related human services field. Related human services field is one in which major course work includes the study of human behavior and development, counseling and interviewing techniques, and individual, group or family therapy.
7. A non-licensed mental health clinical staff person providing mental health services in the program must meet one of the following qualifications and comply with d.
a. Hold a master’s degree from an accredited university or college in the field of counseling, social work, psychology, or related human services field; or
b. Hold a bachelor’s degree from an accredited university or college in the field of counseling, social work, psychology or related human services field and have two years experience working with (e.g., assessing, counseling, treating) youths with serious emotional disturbance or substance abuse problems; or
c. Hold a bachelor’s degree from an accredited university or college in the field of counseling, social work, psychology or related human services field and have 52 hours of pre-service training prior to working with youths. The 52 hours of pre-service training must include a minimum of 16 hours of documented training in their duties and responsibilities. When pre-service training has been successfully completed, the non-licensed person may begin working with youths, but must be trained for one year by a mental health clinical staff person who holds a master’s degree. Pre-service training must cover, at a minimum: basic counseling skills, basic group skills, program philosophy, therapeutic milieu, behavior management, client rights, crisis intervention, early intervention and de-escalation, documentation requirements, normal and abnormal adolescent development and typical behavior problems.
(d) Required Components. Non-licensed mental health clinical staff person must work under the direct supervision of a licensed mental health professional. Direct Supervision means that the licensed mental health professional has at least one hour per week of on-site face-to-face interaction with the non-licensed mental health clinical staff person for the purpose of overseeing and directing the mental health services that the non-licensed mental health clinical staff person is providing in the facility. The licensed mental health professional must assure that mental health clinical staff working under their direct supervision are performing services that they are qualified to provide based on education, training and experience.
1. Substance abuse screening at the time of admission;
2. Comprehensive substance abuse evaluation or updated evaluation;
3. Substance abuse treatment planning, updating and review;
4. Daily substance abuse services for each youth; (7 days of the week) provided by substance abuse clinical staff;
5. Individual, group and family substance abuse counseling; (substance abuse counseling provided to each youth at least 5 days of the week);
6. Psychiatric services as needed, and is required for youths receiving psychotropic medication A psychiatrist must be on-site bi-weekly to provide psychiatric evaluations, medication management and participate in treatment planning for youths receiving psychotropic medication;
7. Mental health evaluation and treatment for youths with co-occurring mental disorder;
8. Routine and Random urinalysis drug testing with positive tests followed by appropriate clinical intervention and sanctions. This includes drug screening upon the youth’s initial intake into the program;
9. Crisis Intervention and Suicide Prevention services;
10. 24-hour response capability;
11. All provided services must be documented.
Specific Authority 985.4891, 985.645 FS. Law Implemented 985.4891(3) FS. History–New________.