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Oregon Bulletin

March 1, 2011

Oregon Health Authority,
Addictions and Mental Health Division: Mental Health Services
Chapter 309

Rule Caption: Repeal rules relating to Early Intervention Services and Intermediate Care Facilities for MR/DD.

Adm. Order No.: MHS 2-2011

Filed with Sec. of State: 2-1-2011

Certified to be Effective: 2-1-11

Notice Publication Date: 1-1-2011

Rules Repealed: 309-041-0200, 309-041-0205, 309-041-0210, 309-041-0215, 309-041-0220, 309-041-0225, 309-041-0230, 309-041-0235, 309-041-0240, 309-041-0245, 309-041-0250, 309-041-0255, 309-043-0000, 309-043-0005, 309-043-0010, 309-043-0015, 309-043-0020, 309-043-0025, 309-043-0030, 309-043-0035, 309-043-0040, 309-043-0045, 309-043-0050, 309-043-0055, 309-043-0060, 309-043-0065, 309-043-0070, 309-043-0075, 309-043-0080, 309-043-0085, 309-043-0090, 309-043-0095, 309-043-0100, 309-043-0105, 309-043-0110, 309-043-0115, 309-043-0120, 309-043-0125, 309-043-0130, 309-043-0135, 309-043-0140, 309-043-0145, 309-043-0150, 309-043-0155, 309-043-0160, 309-043-0165, 309-043-0170, 309-043-0175, 309-043-0180, 309-043-0185, 309-043-0190, 309-043-0195, 309-043-0200

Subject: The Department of Human Services, Seniors and People with Disabilities Division (SPD) is permanently repealing:

OAR 309-041-0200 to 309-041-0255 relating to early intervention services (EIS). SPD no longer provides EIS and the statutory authority for EIS was transferred to the Department of Education (DOE) DOE adopted OAR 581-015-2700 to 581-015-2910 relating to EIS in 1992.

OAR 309-043-0000 to 309-043-0200 relating to intermediate care facilities for mentally retarded and other developmentally disabled persons (ICF/MR) SPD no longer has an ICF/MR to offer and is currently working on statutory revisions to remove references of ICF/MRs.

Rules Coordinator: Christina Hartman—(503) 945-06398

Rule Caption: Amend the “Children’s Emergency Safety Intervention Specialist” (CESIS) rules.

Adm. Order No.: MHS 3-2011

Filed with Sec. of State: 2-4-2011

Certified to be Effective: 2-4-11

Notice Publication Date: 8-1-2010

Rules Adopted: 309-034-0500

Rules Amended: 309-034-0400, 309-034-0410, 309-034-0420, 309-034-0430, 309-034-0440, 309-034-0450, 309-034-0460, 309-034-0470, 309-034-0480, 309-034-0490

Rules Repealed: 309-034-0150, 309-034-0160, 309-034-0170, 309-034-0180, 309-034-0190, 309-034-0205, 309-034-0210, 309-034-0240, 309-034-0250, 309-034-0260, 309-034-0270, 309-034-0290, 309-034-0310, 309-034-0320

Subject: The Addictions & Mental Health Division is amending the “Children’s Emergency Safety Intervention Specialist” (CESIS) rules to reflect changes made to service delivery by the new “Integrated Services & Supports” Rule (ISSR), which has been developed in conjunction with these rule revisions.

Rules Coordinator: Richard Luthe—(503) 947-1186

309-034-0400

Purpose and Statutory Authority

(1) Purpose. These rules prescribe procedures relating to licensing Children’s Emergency Safety Intervention Specialist (CESIS). A licensed CESIS is authorized to order, monitor and evaluate the use of seclusion and personal restraint in certified facilities providing intensive mental health treatment services to individuals under 21 years of age. The CESIS license is for the purpose of licensing Qualified Mental Health Professionals (QMHPs) who are not licensed by any other healthcare licensing board. It is not to be issued as an additional credential to currently licensed practitioners such as licensed clinical social workers, licensed registered nurses, licensed psychologists, licensed professional counselors, licensed marriage and family therapist or licensed physicians.

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

Hist.: MHD 5-2001(Temp), f. & cert. ef. 7-20-01 thru 1-15-02; MHD 1-2002, f. 1-14-02 cert. ef. 1-15-02; MHS 3-2010(Temp), f. & cert. ef. 3-4-10 thru 8-28-10; Administrative correction 9-22-10; MHS 3-2011, f. & cert. ef. 2-4-11

309-034-0410

Definitions

As used in these rules:

(1) “Chemical Restraint” means the administration of medication for the acute management of potentially harmful behavior. Chemical restraint is prohibited in the services regulated by these rules.

(2) “Children’s Emergency Safety Intervention Specialist” (CESIS) means a Qualified Mental Health Professional (QMHP) who is licensed to order, monitor and evaluate the use of seclusion and personal restraint in certified facilities providing intensive mental health treatment services to individuals under 21 years of age.

(3) “Division” means the Addictions and Mental Health (AMH) Division of the Oregon Health Authority.

(4) “Emergency safety intervention” means the use of seclusion and personal restraint under OAR 309-032-1540(9) as an immediate response to an unanticipated threat of violence or injury to an individual or others.

(5) “Emergency Safety Intervention Training” means a Division approved course that teaches students to safely manage emergency safety situations and methods for reducing the need for emergency safety interventions. The minimum requirements for a Division approved course is one that has an established curriculum, includes an identified instructor, requires an identified number of face to face instruction hours, teaches students how to safely manage emergency safety situations, includes methods to de-escalate volatile clients and has an evaluation component to assess the student’s competency of the course materials.

(6) “Emergency safety situation” means an unanticipated resident behavior that places the resident or others at serious threat of violence or injury if no intervention occurs and that calls for an emergency safety intervention as defined in this section.

(7) “Intensive Mental Health Treatment Services” (ITS) means the range of services in the system of care comprised of Psychiatric Residential Treatment Facilities (PRTF) and Psychiatric Day Treatment Services (PDTS) or other services as determined by the Division, that provide active psychiatric treatment for children with severe emotional disorders and their families.

(8) “Mechanical restraint” means any device attached or adjacent to the resident’s body that he or she cannot easily remove that restricts freedom of movement or normal access to his or her body. Mechanical restraint is prohibited in the services regulated by these rules.

(9) “Personal Restraint” means the application of physical force without the use of any device, for the purposes of restraining the free movement of a resident’s body to protect the individual or others from immediate harm. Personal restraint does not include briefly holding without undue force, an individual to calm or comfort him or her or holding an individual’s hand to safely escort him or her from one area to another. Personal restraint can be used only in approved ITS programs as an emergency safety intervention under OAR 309-032-1540(9).

(10) “Qualified Mental Health Professional” (QMHP) means a Licensed Medical Practitioner (LMP) or any other person meeting one or more of the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) Holds any of the following educational degrees:

(A) Graduate degree in psychology;

(B) Bachelor’s degree in nursing and licensed by the State of Oregon;

(D) Graduate degree in a behavioral science field;

(E) Graduate degree in recreational, music or art therapy;

(F) Bachelor’s degree in occupational therapy and licensed by the State of Oregon; and

(b) Whose education and experience demonstrate the ability to:

(A) Conduct an assessment, including identifying precipitating events, gathering histories of mental and physical health, alcohol and other drug use, past mental health services and criminal justice contacts, assessing family, cultural, social and work relationships;

(B) Conducting a mental status examination;

(D) Write and supervise the implementation of a ISSP and provide individual, family or group therapy within the scope of their training.

(12) “Seclusion” means the involuntary confinement of an individual to a room or an area from which the individual is physically prevented from leaving. Seclusion can be used only in approved ITS programs as an emergency safety intervention specified in OAR 309-032-1540(9).

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

309-034-0420

Application for Licensure as a Children’s Emergency Safety Intervention Specialist (CESIS)

In order to obtain a license as a CESIS, an agency that is certified by the Division to provide intensive mental health treatment services for individuals under 21 years of age shall make an application on behalf of the licensure applicant. The Division shall issue a license as a CESIS to each applicant who furnishes satisfactory evidence to the Division that the applicant meets the following qualifications:

(1) Is employed by or providing services under contract with a provider that is certified by the Division to provide intensive mental health treatment services for individuals under 21 years of age;

(2) Meets qualifications established by the Division by rule for Qualified Mental Health Professionals;

(3) Has successfully completed an emergency safety intervention training program approved by the Division within the past 12 months;

(4) Demonstrates the ability to assess the psychological and physical well-being of individuals under 21 years of age;

(5) Demonstrates knowledge of federal and state rules governing the use of seclusion and personal restraint in intensive mental health treatment programs for individuals under 21 years of age.

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

309-034-0430

Scope of Licensure

(1) A licensed CESIS is authorized to:

(a) Order the least restrictive intervention, including seclusion and personal restraint that is most likely to be effective in resolving an emergency safety situation if the treatment team physician is not available.

(b) Provide the federally mandated face-to-face assessment of an individual under 21 years of age’s well-being within one hour of the initiation of the emergency safety intervention; and

(c) Accept verbal orders for seclusion and personal restraint from a physician or licensed practitioner who is authorized to order seclusion and personal restraint.

(2) Exclusions to Licensure:

(a) A licensed CESIS is not authorized to order or receive orders for the use of mechanical or chemical restraint.

(b) A CESIS license is only valid while the licensee is employed or contracted to provide services with the intensive mental health treatment services program that submitted the application on behalf of the licensee.

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

309-034-0440

Application Process

(1) Application for licensure as a CESIS shall be made to the Division and be on forms prescribed by the Division.

(2) Application for licensure shall be accompanied by a formal written request from a provider that is certified by the Division to provide intensive mental health treatment services for individuals under 21 years of age with which the applicant is employed or contracted. The request must include:

(a) Official transcripts and supporting documentation as necessary showing the applicant meets qualifications established by rule for a QMHP;

(b) Verification that an emergency safety intervention course approved by the Division has been successfully completed within the past 12 months;

(d) A signed Background Check Request form as described in OAR chapter 407 division 007. The Criminal Record Check form will request information regarding criminal history and other information;

(e) Verification of employment or contracted services with a provider that is certified by the Division to provide intensive mental health treatment services for individuals under 21 years of age;

(f) A copy of the completed examination or evaluation the provider used to determine the applicant’s competence to assess the psychological and physical well being of individuals under 21 years of age; and

(g) A copy of the completed examination or evaluation the provider used to determine the applicants knowledge of the federal and state rules governing the use of seclusion and personal restraint in intensive mental health treatment programs for individuals under 21 years of age.

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

309-034-0450

Issuance of a License

(1) The Division shall issue a license within 30 days of the submission of a completed application. The license shall state the name of the licensee, the provider and expiration date.

(2) The license shall be placed in the licensee’s personnel file and be easily visible.

(3) An initial license is valid from the time of issuance until the expiration date, which will be September 30th of the following calendar year.

Stat. Auth.: ORS 409.050 & 426.415

Stats. Implemented: ORS 426.415

309-034-0460

Renewal and Expiration of License

(1) A license issued under these rules is subject to renewal every 2 years.

(a) All licenses will expire on September 30th. The issuance date of the licensee’s first license will determine if the license expires on an odd or even year.

(b) At least 30 days prior to the expiration of a license, a reminder notice will be sent by the Division to the licensee and the provider.

(c) A licensee seeking renewal of a license shall have a provider with whom they are employed or contracted submit on their behalf:

(A) Proof of fulfillment of the following requirements;

(i) Verification of current certification in CPR and First aid by a recognized training agency;

(ii) A copy of the evaluation completed within the last year of the applicants competence to assess the psychological and physical well-being of individuals under 21 years of age.

(iii) A copy of the evaluation completed within the last year demonstrating the applicants knowledge of federal and state rules governing the use of seclusion and personal restraint in intensive mental health treatment services programs for individuals under 21 years of age.

(B) Proof of continued employment or contract with a facility certified by the Division to provide intensive mental health treatment services for individuals under 21.

(2) A licensee may not continue to practice as a licensed CESIS after expiration of the license.

(3) A licensee may not continue to practice as a licensed CESIS upon discontinuation of employment or contract with the provider of intensive mental health treatment services specified on the license.

(4) If the person’s previous license has expired, the person must apply and qualify for a new license in the same manner as a person who has never been licensed.

Stat. Auth.: ORS 413.042 & 426.415

Stats. Implemented: ORS 426.415

309-034-0470

Complaint

(1) Any person who believes these rules have been violated may file a compliant with the Division.

(2) The Division shall establish a protocol for investigation of complaints and make that information available to anyone who files a complaint or has a complaint filed against them. Following the Divisions investigation of a complaint, the Division may take action to:

(a) Dismiss the complaint;

(b) Issue a letter of reprimand;

(d) Institute disciplinary action.

Stat. Auth.: ORS 413.042 & 426.415

Stats. Implemented: ORS 426.415

309-034-0480

Denial, Suspension, Revocation or Non-renewal of License

(1) The Division may deny, suspend, revoke or refuse to issue or to renew any license issued under these rules upon proof that the applicant for licensure or the licensee:

(a) Has been convicted of one or more crimes described in the Criminal Records Check under OAR 407-007-0200 through 407-007-0380;

(b) Is unable to perform the duties of a CESIS by reason of mental illness, physical illness, drug addiction or alcohol abuse;

(d) Has violated one or more of the rules of the Division pertaining to the licensure of a CESIS;

(e) Has practiced outside the scope of activities for which the licensee has individual training and qualification; or

(f) Has been disciplined by a state licensing board or program in this or any other state for violation of competency or conduct standards.

(2)(a) The Division may reprimand or impose probation on a licensee upon proof of any of the grounds for discipline provided in subsection (1) of this Section.

(b) If the Division elects to place a licensee on probation, the Division may impose:

(A) Restrictions on the scope of practice of the licensee;

(B) Requirements for specific training;

(D) Other conditions the Division finds necessary for the protection of the public.

Stat. Auth.: ORS 413.042 & 426.415

Stats. Implemented: ORS 426.415

309-034-0490

Appeal Process

(1) An appeal of a denial, suspension, probation or revocation of a license may be requested in writing to the Division from a provider of intensive mental health treatment services for children under 21 years of age on behalf of their employee or contractor.

(2) Within 10 days of the receipt of the appeal, the Division’s Assistant Director or designee shall review all material relating to the denial, suspension, revocation or non-renewal, including any written documentation submitted by the licensee and provider within that time frame. The Division shall determine, based on review of the material, whether to sustain the decision. If the Division does not sustain the decision, the denial, suspension, revocation or non-renewal shall be rescinded immediately. The decision of the Division is subject to a contested case hearing under ORS Chapter 183 if requested within 90 days.

Stat. Auth.: ORS 413.042 & 426.415

Stats. Implemented: ORS 426.415

309-034-0500

Effective Date

OAR 309-034-0400 through 309-034-0490 is prospective as well as retroactive to August 29, 2010. Such prospective and retroactive effect is each severable of the other.

Stat. Auth.: ORS 413.042 & 426.415

Stats. Implemented: ORS 426.415

Hist.: MHS 3-2011, f. & cert. ef. 2-4-11

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.