Oregon Bulletin
Rule
Caption: Mental Health Services For
Homeless Individuals.
Adm.
Order No.: MHS 7-2011
Filed with Sec. of
State: 9-26-2011
Certified to be
Effective: 9-26-11
Notice Publication
Date: 7-1-2011
Rules Adopted: 309-032-0301, 309-032-0311, 309-032-0321, 309-032-0331,
309-032-0341, 309-032-0351
Rules Repealed: 309-032-0175, 309-032-0180, 309-032-0185,
309-032-0190, 309-032-0195, 309-032-0200, 309-032-0205, 309-032-0210
Subject: The Addictions and Mental health (AMH) Division is
revising these rules in order that they conform with federal requirements and
accurately reflect AMH practices.
Rules Coordinator: Nola Russell—(503) 945-7652
309-032-0301
Purpose and Scope
These rules prescribe the standards for community-based
programs that serve individuals with a serious mental illness experiencing
homelessness under the Projects for Assistance in Transition from Homelessness
(PATH) program.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
309-032-0311
Definitions
(1) “Co-Occurring Disorders” (COD) means the existence
of at least one diagnosis of a substance use disorder and one diagnosis of a
serious mental illness.
(2) “Community Mental Health Program” (CMHP) means an
entity that is responsible for planning and delivery of services for
individuals with substance use or mental illness diagnoses, operated in a
specific geographic area of the state under an intergovernmental agreement or a
direct contract with the Addictions and Mental Health Division (AMH).
(3) “Division” means the Addictions and Mental Health
Division of the Oregon Health Authority (OHA).
(4) “Eligible Individual” means an individual who, as
defined in these rules:
(a) Is homeless or at imminent risk of becoming
homeless and
(b) Who has, or is reasonably assumed to have, a
serious mental illness.
(c) The individual may also have a co-occurring
substance use disorder.
(5) “Enrolled” means an eligible individual who:
(a) Receives services supported at least partially with
PATH funds and
(b) Has an individual service record that indicates
enrollment in the PATH program.
(6) “Homeless Individual” means an individual who:
(a) Lacks housing without regard to whether the
individual is a member of a family and whose primary residence during the night
is a supervised public or private facility that provides temporary living
accommodations; or
(b) Is a resident in transitional housing that carries
time limits.
(7) “Individual” means an individual potentially
eligible for or who has been enrolled to receive services described in these
rules.
(8) “Individual Service and Support Plan” (ISSP) means
a comprehensive plan for services and supports provided to or coordinated for
an eligible individual that is reflective of the intended outcomes of service.
(9) “Imminent Risk of Homelessness” means that an
individual is:
(a) Living in a doubled-up living arrangement where the
individual’s name is not on the lease;
(b) Living in a condemned building without a place to
move;
(c) In arrears in their rent or utility payments;
(d) Subject to a potential eviction notice without a
place to move; or
(e) Being discharged from a health care or criminal
justice institution without a place to live.
(10) “Individual Service Record” means the written or
electronic documentation regarding an enrolled individual that summarizes the
services and supports provided from point of entry to service conclusion.
(11) “Literally Homeless Individual” means an
individual who lacks housing without regard to whether the individual is a
member of a family, including an individual whose primary residence during the
night is a supervised public or private facility that provides temporary living
accommodations.
(12) “Local Mental Health Authority” (LMHA) means one
of the following entities:
(a) The Board of County Commissioners of one or more
counties that establishes or operates a CMHP;
(b) The tribal council of a federally recognized tribe
of Native Americans that elects to enter into an agreement to provide mental
health services or
(c) A regional LMHA comprised of two or more boards of
county commissioners.
(13) “Outreach” means the process of bringing
individuals into treatment who do not access traditional services.
(14) “Projects for Assistance in Transition from
Homelessness” (PATH) means the Formula Grants, 42 U.S.C. 290cc-21 to 290-cc-35.
(15) “Qualified Mental Health Professional” (QMHP)
means any person who meets one of the following minimum qualifications as
authorized by the LMHA or designee:
(a) A Licensed Medical Practitioner;
(b) A graduate degree in psychology, social work, or
recreational, art or music therapy;
(c) A graduate degree in a behavioral science field;
(d) A bachelor’s degree in occupational therapy and
licensed by the State or Oregon; or
(e) A bachelor’s degree in nursing and licensed by the
State of Oregon.
(16) “Secretary” means the Secretary of the U.S.
Department of Health and Human Services.
(17) “Serious Mental Illness” means a psychiatric
condition experienced by an individual who is 18 years of age or older and who
is:
(a) Diagnosed by a QMHP as suffering from a serious
mental disorder as defined in Oregon Revised Statutes (ORS) 426.495 which
includes, but is not limited to conditions such as schizophrenia, affective
disorder, paranoid disorder, and other disorders which manifest psychotic
symptoms that are not solely a result of a developmental disability, epilepsy,
drug abuse or alcoholism; and which continue for more than one year, or
(b) Is impaired to an extent which substantially limits
the individual’s consistent ability to function in one or more of the following
areas:
(A) Independent attendance to the home environment
including shelter needs, personal hygiene, nutritional needs and home
maintenance;
(B) Independent and appropriate negotiation within the
community such as utilizing community resources for shopping, recreation,
transportation and other needs;
(C) Establishment and maintenance of supportive
relationships; or
(D) Maintained employment sufficient to meet personal
living expenses or engagement in other age appropriate activities.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
309-032-0321
Eligible Services
(1) Effective outreach to engage people in the
following array of services:
(a) Identification of individuals in need;
(b) Screening for symptoms of serious mental illness;
(c) Development of rapport with the individual;
(d) Offering support while assisting with immediate and
basic needs;
(e) Referral to appropriate resources; or
(f) Distribution of information including but not
limited to:
(A) Flyers and other written information;
(B) Public service announcements; or
(C) Other indirect methods of contact.
(2) Methods of active outreach including but not
limited to face-to-face interaction with literally homeless people in streets,
shelters, under bridges and in other non-traditional settings, in order to seek
out eligible individuals.
(3) Methods of in-reach, including but not limited to
placing outreach staff in a service site frequented by homeless people, such as
a shelter or community resource center, where direct, face to face interactions
occur, in order to allow homeless individuals to seek out outreach workers.
(4) Screening and diagnosis.
(5) Habilitation and rehabilitation services.
(6) Community mental health services.
(7) Alcohol or drug treatment services.
(8) Staff training, including the training of those who
work in shelters, mental health clinics, substance abuse programs, and other
sites where homeless individuals require services.
(9) Case management including the following.
(a) Preparing a plan for the provision of community
mental health services to the eligible individual and reviewing the plan not
less than once every three months;
(b) Assistance in obtaining and coordinating social and
maintenance services for the eligible individual, including services related to
daily living activities, personal financial planning, transportation, and
housing services;
(c) Assistance to the eligible individual in obtaining
income support services including housing assistance, food stamps and
supplemental security income benefits;
(d) Referring the eligible individual for such other
services as may be appropriate and
(e) Providing representative payee services in
accordance with section 1631(a)(2) of the Social Security Act [42 U.S.C.
1383(a)(2)] if the eligible individual is receiving aid under title XVI of such
act [42 U.S.C. 1381 et seq.] and if the applicant is designated by the
Secretary to provide such services;
(10) Supportive and supervisory services in residential
settings;
(11) Housing services, which shall not exceed twenty
percent of all total PATH expenses and which may include:
(a) Minor renovation, expansion and repair of housing;
(b) Planning of housing;
(c) Technical assistance in applying for housing
assistance;
(d) Improving the coordination of housing services; (e)
Security deposits;
(f) The costs associated with matching eligible
individuals with appropriate housing situations; or
(g) One time rental payments to prevent eviction; and
(12) Referrals to other appropriate services or
agencies, for those determined ineligible for other PATH services.
(13) Other appropriate services as determined by the
Secretary.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
309-032-0331
Staff Qualifications and Training
Standards
(1) Staff delivering case management and outreach
services to individuals shall have demonstrated ability to:
(a) Identify individuals who appear to be seriously
mentally ill;
(b) Identify service goals and objectives and
incorporate them into an ISSP; and
(b) Refer the individuals for services offered by other
agencies.
(2) All staff delivering PATH services shall have
training, knowledge and skills suitable to provide the services described in these
rules.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
309-032-0341
Rights of Eligible Individuals
(1) In addition to all applicable statutory and
constitutional rights, every eligible individual receiving services has the
right to:
(a) Choose from available services and supports;
(b) Be treated with dignity and respect;
(c) Have all services explained, including expected
outcomes and possible risks;
(d) Confidentiality and the right to consent to
disclosure in accordance with ORS 107.154, 179.505, 192.515 and 42 CFR Part 2
and 45 CFR Part 205.50;
(e) Give informed consent to services in writing prior
to the start of services, except in a medical emergency or as otherwise
permitted by law;
(f) Inspect their Individual Service Record in
accordance with ORS 179.505;
(g) Not participate in experimentation;
(h) Receive medications specific to the individual’s
diagnosed clinical needs;
(i) Receive prior notice of service conclusion or transfer,
unless the circumstances necessitating service conclusion or transfer pose a
threat to health or safety;
(j) Be free from abuse or neglect and to report any
incident of abuse or neglect without being subject to retaliation;
(k) Have religious freedom;
(l) Be informed at the start of services and
periodically thereafter of the rights guaranteed by these rules;
(m) Be informed of the policies and procedures, service
agreements and fees applicable to the services provided, and to have a
custodial parent, guardian or representative assist with understanding any
information presented;
(n) Have family involvement in service planning and
delivery;
(o) Make a declaration for mental health treatment,
when legally an adult;
(p) File grievances, including appealing decisions
resulting from the grievance; and
(q) Exercise all rights described in this rule without
any form of reprisal or punishment.
(2) The provider will give to the individual and if
applicable, to the guardian, a document that describes the preceding individual
rights.
(a) Information given to the individual must be in
written form or, upon request, in an alternative format or language appropriate
to the individual’s need;
(b) The rights and how to exercise them will be
explained and
(c) Individual rights will be posted in writing in a
common area.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
309-032-0351
Enrollment and Record Requirements
(1) An individual’s eligibility shall be determined and
documented at the earliest possible date.
(2) A record shall be maintained for each enrolled
individual receiving services under this rule. The record shall contain the
following:
(a) An enrollment form which includes:
(A) The individual’s name and PATH enrollment date;
(B) A list or description of the criteria determining
the individual’s PATH eligibility; and
(C) The individual’s PATH services discharge date.
(b) A plan defining the enrolled individual’s goals and
service objectives including one or more of the following:
(A) Accessing community mental health services for the
eligible individual, which includes reviewing the plan not less than once every
three months;
(B) Accessing and coordinating needed services for the
eligible individual, as detailed in these rules.
(C) Accessing income and income support services,
including housing assistance, food stamps, and supplemental security income;
and
(D) Referral to other appropriate services.
(c) Progress notes that provide an on-going account of
contacts with enrolled individual, a description of services delivered, and
progress toward the enrolled individual’s service plan goals; and
(d) A termination summary describing reasons for the
enrolled individual no longer being involved in service.
(3) A record shall be maintained for individuals served
but not yet enrolled under the provisions of these rules. The record shall
contain:
(a) A description of the potentially eligible
individual, which may include but not be limited to:
(A) A physical description of the individual;
(B) The location where the individual was served; and
(C) A description of the individual’s personal
belongings.
(b) A preliminary assessment of the potentially
eligible individual’s needs based on available information; and
(c) A record of where and when contacts with the
potentially eligible individual were made and the outcome of those contacts.
(4) Records shall be confidential in accordance with
ORS 179.505, 45 CFR Part 2 and OAR 032-1535 pertaining to individuals’ records.
Stat. Auth.: ORS 413.042 &
430.640
Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f. & cert.
ef. 9-26-11
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.
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