Proposed Text
CHAPTER 210
REGULATIONS TO GOVERN TEMPORARY LEAVE FROM STATE MENTAL HEALTH AND STATE
MENTAL RETARDATION FACILITIES
12VAC35-210-10. Authority and applicability Applicability.
This regulation is adopted pursuant to § 37.2-837 B of the
Code of Virginia to establish a process to facilitate community integration and
the conditions for granting a trial or home visit to individuals admitted to
state hospitals or training centers operated by the Department of Mental
Health, Mental Retardation and Substance Abuse Services.
This regulation shall not apply to individuals receiving services in a facility who are committed pursuant to Chapter 9 (§ 37.2-900 et seq.) of Title 37.2, Title 19.2, or Title 53.1 of the Code of Virginia.
12VAC35-210-20. Definitions.
The following words or terms when used in this regulation
chapter shall have the following meanings unless the context clearly
indicates otherwise:
"Authorized representative" or "AR" means
a person permitted by law or the State Mental Health, Mental Retardation,
and Substance Abuse Services Board's regulations regulation to
authorize the disclosure of information; or to consent to
treatment and services, or participation in human research; and to
authorize the disclosure of information on behalf of an individual who lacks
the mental capacity to make these decisions.
"Community services board" or "CSB"
means the public body established pursuant to § 37.2-501 of the Code of
Virginia that provides mental health, mental retardation developmental,
and substance abuse services to individuals within each city or county that
established it. For the purpose of these regulations this chapter,
community services board also includes a behavioral health authority
established pursuant to § 37.2-602 of the Code of Virginia.
"Day pass" means authorized leave from the a
state facility without a staff escort generally occurring during the day
and not extending overnight.
"Department" means the Department of Mental Behavioral
Health, Mental Retardation and Substance Abuse Developmental
Services.
"Family" "Home visit" means
an authorized overnight absence from a state hospital or training center that
allows an individual to spend time with family members, an authorized
representative, or other responsible person or persons.
"Individual" means a person who is receiving services in a state hospital or training center. This term includes the terms "consumer," "patient," "resident," and "client."
"Individualized services plan" or "ISP"
means a comprehensive and regularly updated written plan that includes but
is not limited to an describes the individual's needs, the
measurable goals and objectives to address those needs, and strategies to reach
the individual's goals. An ISP is person-centered, empowers the individual, and
is designed to meet the needs and preferences of the individual. The ISP is
developed through a partnership between the individual and the provider. An
individual's treatment plan, functional plan, habilitation plan, person-centered
plan, or plan of care are all considered individualized services plans
that meets the needs and preferences of an individual and describes the
measurable goals, objectives, and expected outcomes.
"Missing person" means an individual who is not physically present when and where he should be and his absence cannot be accounted for or explained.
"Responsible person" means an individual's parent, spouse,
legal guardian, relative, friend, or other person whom the facility
director determines is capable of providing the individual with the needed care
and supervision, and, if the individual has an AR, for
whom the AR has given written consent to supervise the individual during
temporary leave from the state facility.
"State facility" or "facility" means a state
hospital or training center operated by the department for the care and
treatment of individuals with mental illness or mental retardation intellectual
disability.
"Trial visit" means an authorized overnight absence from a state facility without a staff escort for the purpose of assessing an individual's readiness for discharge. Trial visits do not include special hospitalizations, facility-sponsored summer camps, or other facility-sponsored activities that involve staff supervision.
12VAC35-210-30. General requirements for temporary leave.
A. Directors of state facilities shall develop written operating policies and procedures for authorizing and implementing the following types of temporary leave from the facility:
1. Day passes for periods that do not extend overnight;
2. Family Home visits and trial visits for a
maximum of 28 consecutive days per episode for individuals in training centers;
and
3. Family Home visits and trial visits for a
maximum of 14 consecutive days per episode for individuals in state hospitals.
B. The justification for all temporary leave shall be documented in the ISP. This documentation shall include:
1. The reason for granting the specific type of leave;
2. The benefit to the individual;
3. How the individual participated in the decision-making
related to temporary leave; and
4. How the leave addresses a specific objective or
objectives outcome in the individual's ISP; and
5. The signature of the facility director or designee authorizing the temporary leave.
C. Responsible persons during leave.
1. Adults and emancipated minors receiving services in state
hospitals who are granted a day pass, family home visit, or trial
visit may be:
a. Placed in the care of a parent, spouse, relative,
guardian, a facility licensed by the department or other a
responsible person or persons; or
b. Authorized to leave the facility on his their
own recognizance, when, in the judgment of the individual and the facility
director, this leave is appropriate.
2. Individuals in training centers and minors receiving
services in any state hospital, who are granted a day pass, family home
visit, or trial visit, shall be placed, with the prior written
consent of the AR, in the care of:
a. The parent, legal guardian, or LAR AR; or
b. Another relative, friend, or other responsible person or
persons, or a facility licensed by the department with the prior written
consent of the AR or a responsible person.
D. The state facility granting a trial or family home
visit to an individual shall not be liable for his the individual's
expenses during the period of that visit. Expenses incurred by an individual
during a trial visit or family home visit shall be the
responsibility of the person into whose care the individual is entrusted or the
appropriate local department of social services of the county or city of
in which the individual resided at the time of his admission to
the facility, as appropriate, pursuant to § 37.2-837 B of the Code of Virginia.
12VAC35-210-50. Trial visits.
A. The facility and the CSB may arrange trial visits for the
purpose of assessing an individual's readiness for discharge from the facility.
These trial visits shall be planned during the regularly scheduled review of the
ISP or at other times in collaboration with (i) the individual, (ii) the
individual's family or AR, or (iii) any other person or persons
requested by the individual. When trial visits are used in conjunction with
discharge planning, the state facility treatment team shall meet with the
individual to discuss his the individual's preferences for
residential settings and give due consideration to his the
individual's expressed preferences. If the treatment team cannot reasonably
accommodate the individual's preferences, a member of the treatment team shall
meet with the individual to discuss the reasons for this determination and the
options that are available to him the individual. The treatment
team shall document in the individual's record that it has met with the
individual to consider his the individual's preferences and
review the available options. All plans for trial visits shall be documented in
the ISP and include consideration of the following:
1. The individual's preferences for residential setting; and
2. The individual's essential support needs for
support and supervision requirements.
B. In advance of the trial visit, the facility shall work with the individual, CSB, and responsible persons, as appropriate, to develop an emergency contingency plan to ensure appropriate and timely crisis response.
12VAC35-210-60. Family Home visits.
A. Family Home visits may include visits with
the individual's immediate or extended family, AR, friends, or other persons
arranged by the family or AR.
1. Training centers shall plan family home visits
in collaboration with the individual, his the individual's family
or AR, and when appropriate, the CSB;
2. State hospitals shall plan family home visits
in collaboration with the individual and his, the individual's
family or AR, and when appropriate, the CSB.
B. When planning family home visits, facilities
shall:
1. Ensure all identified essential support needs are reviewed with the responsible person;
2. Develop plans to address potential emergencies or unexpected events;
2. 3. Consider whether the visit has an impact on
the treatment or training schedule for the individual and make
appropriate accommodations; and
3. 4. Give consideration to the individual's
medical, behavioral, and psychiatric status.
12VAC35-210-70. Required authorizations and documentation.
The facility shall not release individuals for day passes,
trial visits, or family home visits unless the required
authorizations have been obtained and documentation is included in the individual's
record.
12VAC35-210-80. Illness or injury occurring during a family
day, home, or trial visit.
A. When a facility is notified that an individual is injured
or ill and requires medical attention while on a day pass, trial visit,
or family home visit, the facility director or designee shall
notify the (i) facility medical director, (ii) treatment team leader, (iii) risk
manager, facility (iv) human rights advocate, and (iv)
(v) the CSB. The facility director shall also ensure that all events are
reported in accordance with department and facility policy and protocol for
risk management and any applicable law or regulation.
B. The facility director or designee may assist the CSB or the responsible person to identify an appropriate setting for the evaluation and treatment of the individual. The facility medical director may also consult with the physician and any other medical personnel who are evaluating or treating the individual. However, the individual shall not return to the facility until he is medically stabilized.
C. Individuals who have been admitted to a state hospital on a voluntary basis and require acute hospital admission for illness or injury while on temporary leave from the state hospital may voluntarily return to the state hospital following discharge from an acute care hospital if they continue to meet the admission criteria.
D. If an individual has been legally committed to a state facility
hospital and his length of stay in an acute care hospital exceeds the
period of commitment to the state facility hospital, the facility
hospital shall:
1. Discharge the individual in collaboration with the CSB; and
2. Notify the individual or his the individual's
AR in writing of the discharge.
E. If the facility is notified that an individual has died while on temporary leave, the facility director or designee shall:
1. Notify the appropriate facility and other department
staff, including, the medical director, risk manager, treatment team
leader, and human rights advocate;
2. Notify the appropriate CSB and AR;
3. File the appropriate documentation of the death in accordance with department policies and procedures; and
4. Notify the state medical examiner in writing of the death in accordance with § 32.1-283 of the Code of Virginia.
12VAC35-210-90. Failure to return to training centers.
A. When an individual fails to return to a training center
from any authorized day pass, family home visit, or trial visit
within two hours of the scheduled deadline, the facility director or designee
shall contact the responsible person into whose care the individual was placed
to determine the cause of the delay.
B. Upon the request of the responsible person, the facility
director may extend the period of a family home or trial visit
for up to 72 hours beyond the time the individual was scheduled to return when:
1. An emergency or unforeseen circumstances delay the individual's return to the training center; and
2. The individual's AR agrees to the extension.
Extensions for emergency or unforeseen circumstances shall not
be granted in advance of the family home visit or trial visit.
C. If an individual does not return to the training center
from a day pass, trial visit, or family home visit
within two hours of the established deadline for his the individual's
return and the training center is unable to contact the responsible person into
whose care the individual was placed, the facility director or designee may
extend the period of the visit for up to 24 hours if, in his judgment, the
extension is justified. During this period the facility shall continue efforts
to contact the responsible person.
D. If an individual does not return to the training center and
his the individual's absence cannot be accounted for or
reasonably explained by the responsible person or a family member, he the
individual shall be classified as a missing person, and the facility shall
follow the department's policies and procedures for management of individuals
who are missing.
E. If no emergency or unforeseen circumstances exist that may prevent the individual's return to the facility, and the responsible person does not agree to the return of the individual to the training center as scheduled, the facility director shall contact the CSB and discharge the individual. Written notification of discharge shall be sent to the individual's AR.
12VAC35-210-100. Failure to return to hospitals.
A. When an individual fails to return to a state hospital from
any authorized day pass, family home visit, or trial visit within
two hours of the scheduled deadline, the facility director or designee shall
contact the responsible person into whose care the individual was placed to
determine the cause of the delay.
B. Upon the request of the responsible person, the facility director may extend the period of the visit for up to 72 hours beyond the time the individual was scheduled to return when:
1. An emergency or unforeseen circumstances delay the individual's return to the hospital; and
2. The individual, or if applicable, his the
individual's AR agree, agrees to the extension.
Extensions for emergency or unforeseen circumstances shall not
be granted in advance of the family home visit or trial visit.
C. If an individual agrees to return to the facility, the facility director or designee may assist the individual to make arrangements for his return in collaboration with the CSB and the responsible person, when necessary.
D. If an individual is unwilling to return to the facility,
the facility director or his facility director's designee shall
contact the responsible person to determine whether continued hospitalization
is appropriate or the individual should be discharged.
1. If Except for an individual receiving services in
a state hospital who is held upon an order of a court for a criminal
proceeding, if there is no evidence that the individual meets the criteria
for hospitalization then the facility shall discharge the individual in
collaboration with the CSB.
2. If the individual has been legally committed to the hospital
and the facility director determines that the individual may require further
hospitalization and he currently meets commitment criteria and requires
further hospitalization, or that the individual cannot be located,
the facility director shall:
a. Ensure that the commitment order is valid;
b. Classify the individual as a missing person;
c. Alert the CSB pursuant to the department's policies and
procedures for managing management of individuals who are missing
from state facilities;
d. Issue a warrant for the individual's return under § 37.2-834 of the Code of Virginia; and
e. Arrange for a physical examination at the time of the individual's return to the facility.
3. If the individual is on voluntary status or the commitment order is no longer valid, the facility director, after consulting with the appropriate clinical staff, shall:
a. Discharge the individual; and
b. Alert the CSB of the individual's status.
F. When it is determined that an individual who has been
legally committed to the facility must be returned to the facility and the
individual refuses to return on his own accord, the facility director or his
designee shall:
1. Issue a warrant for the individual's return under §
37.2-834 of the Code of Virginia to the hospital; and
2. Contact the CSB upon revocation of the trial visit.