Transcript Slide 1

State of Washington
Department of Social and Health Services
Behavioral Health Services Integration Administration
Division of Behavioral Health and Recovery
Transforming lives
Washington State Department of Social &
Health Services
Presenters
Amie Roberts, CPM, LMHC
– Mental Health Program Administrator, DBHR
[email protected] 360-725-3813
Melena Thompson
– Regional Support Network Oversight Manager,
DBHR
[email protected] 360-725-3758
Transforming lives
Washington State Department of Social &
Health Services
What is a Recovery Support
Service and How can I provide any
of them at my agency?
Become a Licensed
Behavioral Health Agency
http://www.dshs.wa.gov/dbhr/CertLicensing.shtml
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Washington State Department of Social &
Health Services
Behavioral Health Agency
Mental Health
Services
Outpatient
Services
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Crisis Services
Chemical
Dependency
Services
Recovery
Support
Services
Washington State Department of Social &
Health Services
Problem
Gambling
Services
Mental Health Services
• Personnel requirements, credentials, training,
background checks, job descriptions, etc.
• Facility and Quality Management
requirements.
• Services are provided by, or under the
supervision of a mental health professional.
 Initial Assessments
 Individual Service Plans
 Clinical Record Content and Documentation
* See Appendix B
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Washington State Department of Social &
Health Services
BEHAVIORAL HEALTH AGENCY
WAC 388-877
Mental Health Services
WAC 388-877A
Outpatient Services
• Individual Therapy
• Brief Therapy
• Group Therapy
• Family Therapy
• Case Management
• Psychiatric Medication
• Day Support
• Less Restrictive Alternative
• Residential Treatment
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Washington State Department of Social &
Health Services
BEHAVIORAL HEALTH AGENCY
WAC 388-877
Mental Health Services
WAC 388-877A
Crisis Services
• Crisis Telephone Support
• Crisis Outreach
• Crisis Stabilization
• Crisis Peer Support
• Emergency Involuntary Detention
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Washington State Department of Social &
Health Services
BEHAVIORAL HEALTH AGENCY
WAC 388-877
Mental Health Services
WAC 388-877A
Recovery Support Services Requiring Program Specific
Certification
• Employment *
• Peer Support *
• Wraparound Facilitation
• Medication Support *
• Applied Behavior Analysis
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Washington State Department of Social &
Health Services
Employment Services *
These services assist in training, job search, and
placement services in order to help individuals
find competitive jobs in their local communities.
•
•
•
•
•
Vocational assessment
Individualized job plan
Assist in finding job opportunities
Document coaching, outreach and support
Educate employer about ADA
* See Appendices C and D
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Washington State Department of Social &
Health Services
Peer Support Services *
If you become an agency that provides peer
counseling, you must ensure the peer
counselor:
• Is qualified (has attended the training and passed the
test)
• Is supervised by a mental health professional
• Practicing within their scope of training and credential
(from Department of Health)
• Receives annual training relevant to their unique work
environment
* See Appendices A, E, F, G and H
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Washington State Department of Social &
Health Services
Medication Support Services *
When providing medication support services, you must
either…
1. Also be certified to provide psychiatric medication
services, or
2. Have an agreement with another licensed behavioral
health agency who provides psychiatric medication
services.
• Observe and encourage medication compliance
• Communicate compliance with psych/med agency
• Can take place at any location (clinically necessary)
* See Appendices I, J, K, L, M, and N
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Washington State Department of Social &
Health Services
“Two roads diverged in a yellow wood…”
OPTION 1
ONLY provide the
recovery support
service(s) and have
an AGREEMENT
with another BHA
who provides an
outpatient service
OPTION 2
Outpatient Services
• Individual Therapy
• Brief Therapy
• Group Therapy
• Family Therapy
• Case Management
Provide a recovery
support service(s)
AND an outpatient
service at your
agency
Either way, to provide a Recovery Support Service, your agency
MUST BE licensed as a Behavioral Health Agency (WAC 388-877)
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Washington State Department of Social &
Health Services
OPTION 1
Option 1
The agreement must specify:
ONLY provide the
recovery support
service(s) and have
an AGREEMENT
with another BHA
who provides an
outpatient service
• The responsibility for initial assessments,
• The determination of appropriate
services,
• Individual service planning, and
• The documentation of these
requirements.
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Washington State Department of Social &
Health Services
Option 1 Con’t
When providing any recovery support service requiring
program-specific certification, an agency must:
• Have an assessment process to determine the
appropriateness of the agency's services, based on the
individual's needs and goals.
• Refer an individual to a more intensive level of care when
appropriate.
• With the consent of the individual, include the
individual's family members, significant others, and other
relevant treatment providers, as necessary to provide
support to the individual.
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Washington State Department of Social &
Health Services
Option 1 Checklist
 Meet the Behavioral Health Agency requirements in
WAC 388-877
 Submit an application to DBHR with all required
documentation specified on the application
 Submit policies and procedures to DBHR for WAC 388877 and the recovery support service(s) for which you
seek certification, found in WAC 388-877A-Section 3
 Submit the AGREEMENT your agency has with another
BHA that specifies:
–
–
–
–
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The responsibility for initial assessments,
The determination of appropriate services,
Individual service planning, and
The documentation of these requirements.
Washington State Department of Social &
Health Services
OPTION 2
Option 2
Provide a recovery
support service(s)
AND an outpatient
service at your
agency
In addition to the Recovery Support
Service(s), your agency also provides one or
more:
•
•
•
•
•
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Individual Therapy
Brief Intervention Treatment
Group Therapy
Family Therapy
Case Management
Washington State Department of Social &
Health Services
Option 2
Outpatient Treatment Options
Individual Treatment Services
Brief Intervention Treatment Services
Group Therapy Services
Family Therapy Services
Case Management Services
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Washington State Department of Social &
Health Services
Individual Treatment Services
Individual treatment services are services
designed to assist an individual in attaining
the goals identified in the individual service
plan. The treatment services are conducted
with the individual and any natural supports
as identified by the individual.
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Washington State Department of Social &
Health Services
Outpatient
Services
Option 2 Outpatient Services
Individual Therapy Services
WAC 388-877A-0138
An agency providing individual treatment services must ensure treatment is
provided by a:
(1) Mental health professional (MHP) who has documented coursework,
continuing education, and/or training that specifically address individual
therapy theories and techniques;
(2) Person under the supervision of an MHP (the MHP must meet the
requirements in (1) of this section);
(3) Clinician who is licensed by department of health to practice
independently; or
(4) Licensure candidate under the supervision of an approved supervisor, as
defined in chapter 246-809 WAC, for their respective license.
Transforming lives
Washington State Department of Social &
Health Services
Brief Intervention Treatment Services
Brief intervention treatment services are
solution-focused and outcome-oriented
cognitive and behavioral interventions,
intended to resolve situational disturbances.
These services do not require long term
treatment, and do not include ongoing care,
maintenance, or monitoring of the
individual’s current level of function or
assistance with self-care or life skills training.
Transforming lives
Washington State Department of Social &
Health Services
Outpatient
Services
Option 2 Outpatient Services
Brief Intervention Treatment Services
WAC 388-877A-0140
(1) An agency providing brief intervention treatment services to
individuals must meet the individual service plan requirements in
WAC 388-877-0620 and ensure the individual service plan identifies a
course of treatment to be completed in six months or less.
(2) The additional assessment and individual service plan requirements
in WAC 388-877A-0130 and 388-877A-0135 do not apply to brief
intervention treatment.
(3) An individual may move from brief intervention treatment to longer
term outpatient mental health services at any time.
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Washington State Department of Social &
Health Services
Group Therapy Services
Group therapy services are provided to an
individual in a group setting to assist the
individual in attaining the goals described in
the individual service plan.
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Washington State Department of Social &
Health Services
Outpatient
Services
Option 2 Outpatient Services
WAC 388-877A-0150 Group Therapy Services
An agency providing group therapy services must:
(1) Have a written description of each group’s purpose.
(2) Ensure group services are provided with a staff ratio of one staff member for every
twelve individuals.
(3) Ensure a group does not contain more than twenty-four individuals.
(4) Ensure any nonmental health professional facilitating a group receives supervision by a
mental health professional.
(5) Ensure any group containing more than twelve individuals has at least one facilitator or
co-facilitator that is a mental health professional.
(6) Ensure group notes are recorded in each individual’s clinical record before the next
group meeting.
Transforming lives
Washington State Department of Social &
Health Services
Family Therapy Services
Family therapy services are services
provided for the direct benefit of an
individual, with family members and/or
other relevant persons in attendance.
Interventions must identify and build
competencies to strengthen family
functioning in relationship to the individual’s
identified goals. The individual may or may
not be present.
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Washington State Department of Social &
Health Services
Outpatient
Services
Option 2 Outpatient Services
Family Therapy Services WAC 388-877A-0155
An agency providing family therapy services must:
(1) Ensure the services are provided by:
(a) A mental health professional who has documented coursework,
continuing education and/or training that specifically address family
systems theories and techniques in family therapy; or
(b) A staff member under the supervision of a mental health professional.
The staff member must have documented training in family therapy.
(2) With the individual’s written consent, provide information and education
about the individual’s illness to family members or other relevant persons in
order to assist the individual in managing the mental illness.
Transforming lives
Washington State Department of Social &
Health Services
Case Management Services
Case management services are services that
meet the ongoing assessment, facilitation,
care coordination and advocacy for options
and services to meet an individual’s needs
through communication and available
resources, to promote quality and effective
outcomes.
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Washington State Department of Social &
Health Services
Outpatient
Services
Option 2 Outpatient Services
Case Management Services WAC 388-877A-0170
(1) An agency must provide case management services that:
(a) Assist an individual to achieve the goals stated in the plan;
(b) Support consumer employment, education and/or participation in other daily
activities appropriate to the individual’s age, gender and culture; and
(c) Assist an individual to resolve crises in the least restrictive setting.
(2) Rehabilitative case management services include specific rehabilitative services
provided to:
(a) Assist in an individual’s discharge from an inpatient facility; and
(b) Minimize the risk of readmission to an inpatient setting.
Transforming lives
Washington State Department of Social &
Health Services
Option 2 Checklist
Meet the Behavioral Health Agency
requirements in WAC 388-877
Submit an application to DBHR with all
required documentation specified on the
application
Submit policies and procedures to DBHR for
WAC 388-877 and the outpatient and
recovery support service(s) for which you
seek certification, found in WAC 388-877ASections 1 and 3
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Washington State Department of Social &
Health Services
You’ve decided…
You want to become a
Licensed Behavioral Health Agency
and provide a Recovery Support
Service requiring program specific
certification!
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Washington State Department of Social &
Health Services
To Do List
Application to become a BHA
Attachments:
 Policies and procedures
 Hiring policy
 Quality Management plan/process
 Facility check (accessibility barrier checklist)
 Sample clinical record for each service
 Personnel list with job descriptions, background checks, and
DOH licenses
 Application fee
 Master business license
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Washington State Department of Social &
Health Services
Application Assistance:
Darrel Streets, Provider Request
Manager, DBHR
[email protected]
360.725.3819
To Do List Con’t
After you apply and pay:
o Policy and Procedure approval with DBHR
o Facility and Personnel review with DBHR
o Receive an initial license for 6 months – 1 year
o Within 1 year, a clinical record review by DBHR
o Full licensure/certification
o DBHR will conduct on-site reviews, usually about
once every three years
Transforming lives
Washington State Department of Social &
Health Services
WACs
Behavioral Health Services Administrative Requirements
• WAC 388-877
Outpatient Mental Health Services
• WAC 388-877A-Section 1
Recovery Support Services Requiring Program Specific
Certification
• WAC 388-877A-Section 3
Transforming lives
Washington State Department of Social &
Health Services
How can I make providing these
services a reality?
Medicaid Mental Services for people who meet the
Access to Care Services are paid for through contracts
with the Regional Support Networks.
Regional Support Networks are limited by the services
allowed under the Medicaid State Plan and cannot pay
Room and Board/Rent with these funds
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Washington State Department of Social &
Health Services
Are there other options?
DSHS is developing a proposal to add Supported Housing
and Support Employment to the Medicaid State Plan.
The Legislature in Senate Bill 6312 calls out these
recovery support services and will be investing in some
pilot sites for supported housing in the future.
A licensed as a community mental health agency for
other services such as peer support or medication
monitoring these services can be provided in a housing
program using Medicaid funds.
Some RSNs have local funds from tax dollars or county
appropriations that they use to contract for housing
services.
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Washington State Department of Social &
Health Services
How do I become a contracted
provider?
Regional Support Networks are required to have network
of licensed provider agencies to provide all of the
Medicaid State Plan services.
RSN’s are not however required to contract with all
licensed providers.
The best option is to contact your RSN and talk with them
about the services you would like to provide. This will
help them to give you a realistic idea about what they can
purchase and what the rate for the services.
Remember that the Medicaid funds can only be used for
services and not for rent, room or board.
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Washington State Department of Social &
Health Services
QUESTIONS
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Washington State Department of Social &
Health Services
Appendices
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Washington State Department of Social &
Health Services
WAC 388-865-0107 Peer counselor certification.
1. In order to be certified as a peer counselor, all applicants must meet the
following requirements:
(a) Be a self-identified consumer of mental health services, as defined;
(b) Maintain registration as a counselor under chapter 18.19 RCW;
(c) Complete specialized training provided or contracted by the mental health
division; and
(d) Successfully pass an examination administered by the mental health division
or an authorized contractor.
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2.
The training requirement specified in (2)(c) of this subsection is waived for consumers who
were trained prior to October 1, 2004 by trainers approved by the mental health division,
provided that all of the other requirements are met by January 31, 2005.
3.
A consumer whose request for certification is denied has the right to contest this decision
by submitting a written request to the mental health division within twenty-eight calendar
days of the date of notification:
(a) The request should include the consumer's name, address, and telephone number and a
brief explanation of the issue and resolution being requested;
(b) The consumer also has the right to use the state administrative hearing process as
described in chapter 388-02 WAC;
(c) A consumer who completes the administrative hearing process may request
reconsideration in accordance with chapter 388-02 WAC but does not have recourse to
review by the DSHS board of appeals.
Washington State Department of Social &
Health Services
Mental Health Services are provided by, or under the supervision of a
Mental Health Professional:
(1) A psychiatrist, psychologist, psychiatric nurse or social worker as
defined in chapters 71.05 and 71.34 RCW;
(2) A person with a masters degree or further advanced degree in
counseling or one of the social sciences from an accredited college or
university. Such person shall have, in addition, at least two years of
experience in direct treatment of persons with mental illness or
emotional disturbance, such experience gained under the supervision
of a mental health professional;
(3) A person who meets the waiver criteria of RCW 71.24.260, which
was granted prior to 1986;
(4) A person who had an approved waiver to perform the duties of a
mental health profession that was requested by the regional support
network and granted by the mental health division prior to July 1, 2001;
or
(5) A person who has been granted a time-limited exception of the
minimum requirements of a mental health professional by the mental
health division consistent with WAC 388-865-0265.
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Washington State Department of Social &
Health Services
Employment Services *
WAC 388-877A-0330 These services assist in training, job search, and
placement services in order to help individuals find competitive jobs in
their local communities.
(1) An agency providing employment services must have knowledge of
and provide individuals access to employment and education
opportunities by coordinating efforts with one or more entities that
provide other rehabilitation and employment services, such as:
(a) The department's division of vocational rehabilitation;
(b) Community, trade, and technical colleges;
(c) The business community;
(d) WorkSource, Washington state's official site for online
employment services;
(e) Washington state department of employment security; and
(f) Organizations providing job placement within the community.
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Washington State Department of Social &
Health Services
Employment Services Con’t*
(2) An agency providing employment services must:
(a) Ensure all staff members providing direct services for employment are
knowledgeable and familiar with services provided by the department's
division of vocational rehabilitation.
(b) Conduct and document a vocational assessment in partnership with the
individual that includes work history, skills, training, education, and
personal career goals.
(c) Assist the individual to create an individualized job and/or career
development plan that focuses on the individual's strengths and skills.
(d) Assist the individual to locate employment opportunities that are
consistent with the individual's skills, goals, and interests.
(e) Document any outreach, job coaching, and support at the individual's
worksite, when requested by the individual and/or the individual's
employer.
(f) If the employer makes a request, provide information regarding the
requirements of reasonable accommodations, consistent with the
Americans with Disabilities Act (ADA) of 1990, and the Washington state
anti-discrimination law.
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Washington State Department of Social &
Health Services
Peer Support Services *
WAC 388-877A-0340
(2) An agency providing peer support services must
ensure peer support counselors;
(a) Meet the requirements of WAC 388-865-0107.
(b) Provide peer support services:
– (i) Under the supervision of a mental health professional;
and
– (ii) Within the scope of the peer counselor's training and
department of health credential.
(c) Receive annual training relevant to their unique
working environment.
(3) An agency providing peer support services must
document the frequency, duration, and expected
outcome of all peer support services in the
individual service plan.
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Washington State Department of Social &
Health Services
Peer Support
• Washington State's Peer Support Program has trained and qualified mental
health consumers as Certified Peer Counselors since 2005. A "consumer" is
someone who has applied for, is eligible for, or who has received mental
health services. This also includes parents and legal guardians when they
have a child under the age of 13, or a child 13 or older and they are involved
in their treatment plan (WAC 388-865-0150).
• Peer Counselors work with their peers, adults and youth, and the parents of
children receiving mental health services. Certified Peer Counselors draw
upon their experiences to help their peers find hope and make progress
toward recovery. Because of their own life experience, they are uniquely
equipped to provide support, encouragement and resources to those with
mental health challenges.
• The peer support program is managed by the Office of Consumer
Partnerships (OCP). The OCP is guided by adult, youth and family
representatives with behavioral health concerns.
For more information contact:
Bonnie Staples - Peer Support Program Administrator
(360) 725-1883
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Washington State Department of Social &
Health Services
What are the requirements to become a Peer Counselor?
• To qualify, a consumer must submit an application to the Peer Support Program. Once
approved, the applicant will be placed on the waiting list for training.
• After completing the training, each applicant must pass the certification exam. The
exam is typically offered three weeks after the training and contains both an oral and
written portion. Applicants have three attempts to pass the exam, after which they
may request to be re-trained. Additional training is not guaranteed.
• Once an applicant successfully completes the training and passes the exam they
become qualified as a Peer Counselor. Those who work for licensed community
mental health centers may be required by their employer to seek a counselor
credential from the Washington State Department of Health, as a funding
requirement for Medicaid-paid Peer Support.
• What types of trainings are available and when are they offered?
• Trainings sponsored by DBHR are typically offered 4-6 times per year. Some Regional
Support Networks (RSNs) also offer training. Contact the RSN in your area to find out
about their trainings: http://www.dshs.wa.gov/dbhr/rsn.shtml#dbhr. All trainings are
40 hours and uses a state-approved curriculum.
• There are currently three types of Certified Peer Counseling trainings available:
standard training, family and youth training, and Spanish training. All trainings are for
the same certification. There is a box on the application form to indicate your
preference.
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Washington State Department of Social &
Health Services
How do I apply for a Peer Counselor training?
Please use the following process to submit an application:
• Print the application form and carefully read and follow all instructions.
• All questions must be answered completely. Incomplete applications will be returned.
• All applications are submitted to DBHR, including applications for the Youth and
Family training.
• Applications are read and scored as described in the application instructions.
Applicants will receive a letter informing them whether their application has been
approved.
• Once approved, applicants are placed on a waiting list for trainings. Trainings are filled
by priority and application date, and invitations are issued about a month before each
training.
• Applicants may not request to be enrolled in specific trainings. Some trainings are
offered for people in specific regions, and some are available statewide. It is not
possible to predict when a training opportunity will be available. Wait times for
training can be a year or longer. Applicants should ensure their contact information
remains updated.
• DBHR can only notify applicants when they are being invited to a training. However, if
you have not been invited to a training within a year, please contact Bonnie Staples at
(360) 725-1883 to ensure your contact information is correct.
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Washington State Department of Social &
Health Services
Medication Support Services *
WAC 388-877A-0360
(1) Medication support services are certified by the
department's division of behavioral health and
recovery only when the agency:
(a) Is also certified to provide program-specific
psychiatric medication services (see WAC 388-877A0180); or
(b) Has an agreement with another behavioral health
agency certified to provide psychiatric medication
services. The agreement must specify the
responsibility for medication support services, and
the documentation of the requirements.
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Washington State Department of Social &
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Medication Support Con’t *
(2) Medication support services occur face-to-face
and:
(a) Include one-on-one cueing, observing, and
encouraging an individual to take medication as
prescribed.
(b) Include reporting any pertinent information related
to the individual's adherence to the medication back
to the agency that is providing psychiatric medication
services.
(c) May take place at any location and for as long as it is
clinically necessary.
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Washington State Department of Social &
Health Services
Medication Support Con’t *
(d) Are provided to any individual who:
(i) Has a history of low medication adherence;
(ii) Is newly on medication; or
(iii) Is new to the specific medication prescribed.
(3) An agency providing medication support
services must:
(a) Ensure services are provided by or under the
supervision of a mental health professional.
(b) Ensure that the staff positions responsible for
providing medication monitoring and/or delivery
services are clearly identified in the agency's
medication support services policy.
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Washington State Department of Social &
Health Services
Medication Support Con’t *
(c) Have appropriate policies and procedures in place when
the agency providing medication support services
maintains and/or delivers medication to the individual.
The policies and procedures must address:
(i) The maintenance of a medication log documenting medications
that are received, prescribed, and dispensed.
(ii) Reasonable precautions that need to be taken when
transporting medications to the intended individual and to
assure staff safety during the transportation.
(iii) The prevention of contamination of medication during delivery,
if delivery is provided.
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Washington State Department of Social &
Health Services
Medication Support Con’t *
(d) Ensure that all medications kept by staff in the agency are safely and
securely stored as follows:
(i) Medication must be maintained in locked cabinets within a well-illuminated,
locked, and properly ventilated room.
(ii) Medication kept for individuals on medication administration or selfadministration programs must be clearly labeled and stored separately from
medication samples kept on site.
(iii) Medication marked "for external use only" must be stored separately from
oral or injectable medications.
(iv) Refrigerated food or beverages used in the administration of medications
must be kept separate from the refrigerated medications by the use of trays
or other designated containers
(v) Syringes and sharp objects must be properly stored and disposed of safely.
(vi) Refrigerated medications must be maintained at the required
temperatures.
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Washington State Department of Social &
Health Services
Medication Support Con’t *
(e) Ensure that outdated medications are disposed of in
accordance with the rules of the state board of pharmacy,
and ensure that no outdated medications are retained.
(f) Ensure that the individual's clinical record contains:
(i) The individual service plan, including
(ii) Documentation of observations on the individual's
behavior indicating the effects, interactions, and side effects
of the prescribed medication, as necessary.
(iii) Documentation of regular reviews of the individual's
adherence to the medication support plan as reflected in the
individual service plan.
(iv) Documentation of reports to the prescriber about
medication adherence and/or side effects.
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Washington State Department of Social &
Health Services
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