National Institute on Alcohol Abuse and Alcoholism Classification of Alcoholism Treatment Settings U.S. DEPOSITORY MAY 24 1984 JUL 5 079- U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration ''''CLASSIFICATION OF ALCOHOLISM TREATMENT SETTINGS Richard J. Bast U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Alcohol Abuse and Alcoholism Division of Extramural Research Technical Assistance Branch 5600 Fishers Lane Rockville, Maryland 20857 ''The Author: Richard J. Bast is Director of Special Research, National Clearinghouse for Alcohol Information, and a member of the Technical Staff of the Information Programs Division, Informatics General Corporation. This work was performed by Informatics General Corporation under Professional Services Order No 83M051590701D, dated February 3, 1983, from the National Institute on Alcohol Abuse and Alcoholism. Robert E. Davis, Public Health Advisor, Technical Assistance Branch of the Division of Extramural Research, NIAAA, was the Project Officer in charge. All material appearing in this publication is in the public domain and may be reproduced or copied without permission from the Institute or the author. Citation of the source is appreciated. DHHS Publication No. (ADM) 84-1324 Printed 1984 ''FOREWORD Throughout recorded history, persons suffering from alcoholism have sought aid for their illness in various environments, and as often as not, have met with a variety of rebuffs, stigmatization, and degrading treatment. Concern for therapeutic intervention in the alcoholic's condition has been an historic rarity. In America, the development of treatment and social services for alcoholic persons reflects in great measure society's turning from a punitive, moralistic approach toward the alcoholic man or woman to the recognition of alcohol abuse and alcoholism as a major public health problem. In early America, the alcoholic was frequently held up to public ridicule by being forced to lay in the stocks or be publicly whipped, and was often sent to a local workhouse or jail. Later, the psychopathic ward of the municipal hospital was likely to be selected as the setting appropriate for the treatment of alcoholics.. Beyond punishment, these treatment settings reveal how little hope existed except for taking care of the individual's needs for food and shelter. The decades following Prohibition witnessed the growth of a number of institutions, agencies, and organizations whose major objectives were the provision of services that would assist alcoholics in their attempts to do more than gain temporary sobriety somewhere other than in a health care facility. Human service agencies have had a mixed commitment to serving those who suffer from alcoholism. Old prejudices, moral assumptions, and therapeutic nihilism are only a few of the factors that have prevented alcoholics from entering treatment settings. But the pervasive nature of alcoholism and the hopes and desires of alcoholic people for assistance have prevailed to at least some degree. Few human service agencies exist today that have not, wittingly or unwittingly, been brought into contact with the needs of the alcoholic. Still, while alcoholics requiring care seek help wherever human service agencies exist, needed care is unfortunately sometimes denied them because they are alcoholic. The past few decades have seen a growth in the varieties of treatment settings that are available for persons with alcohol abuse and alcoholism problems. Some are government sponsored and some are operated through a variety of volunteer mechanisms and nonprofit and private venture organizations. One of the most significant influences on the field was the development in 1935 of Alcoholics Anonymous. This organization not only iii ''provided assistance for a substantial number of alcoholics but brought about a new awareness that this was an illness that could be treated. Following World War II, there was a dramatic rise in the development of the volunteer movement in the alcoholism field, and a growing number of State governments exerted efforts to aid the alcoholic person during the 1940s and 1950s. The halfway house emerged in the post-World War II decades as a significant community alternative to institutionalization; labor and industry joined together to develop a variety of alcoholism programs to meet the needs of the employed person beginning in the late 1940s. Perhaps the greatest growth in treatment settings occurred in the 1970s when the Federal Government, through the National Institute on Alcohol Abuse and Alcoholism (NIAAA), provided the financial stimulus for the development of a treatment network of more than 500 community service programs. In the 1980s, a growing number of alcoholism programs provide treatment services using the social model. Social- experiential model programs, Pioneered by recovering alcoholics from Alcoholics Anonymous, infused the AA Philosophy of recovery from alcoholism into their community-based multiservice units. These programs are formal human service agencies, in contrast to AA, and nonprofessional volunteers contribute 20 to 30 percent of staff time. The variety of settings -- as only partially expressed in the Classification -- is indicative of the multiple needs of the alcoholic population and the variety of disciplines and treatment approaches that are often needed to deal with this major health problem. Some settings, while making a major contribution to the alcoholic people they serve, have not been defined in detail because they serve a very circumscribed population. One such setting is represented by domiciliary care. This is long-term care Provided for alcoholic individuals whose alcoholism has permanently rendered them incapable of community existence outside custodial care in an institutional facility such as a State mental hospital or care offered in a home environment. The latter includes single family dwellings or larger facilities seldom housing more than 10 to 15 individuals that provide shelter and personal care services, including 24-hour supervision by the home proprietor, meals, laundry, and other household services. , The growth of treatment settings during the past several decades has Produced a need to identify some of the Major facilities engaged in providing services and to delineate some of their essential characteristics. Health Planners, insurance carriers, treatment personnel, and concerned citizens and other groups have expressed a need to know what different types of treatment settings exist to serve alcoholic persons. To meet this need, the NIAAA has developed this Classification of Alcoholism Treatment Settings, which defines 14 basic settings. It is not intended to be an exhaustive Classification of treatment environments, but rather to provide a framework within which to study major treatment settings. Criteria for describing a setting in the Classification are based on the iv ''existence of a formal organizational structure and a history of significant contribution to the direct provision of treatment services to alcoholics. As with all Classifications of this type, we recognized that such selection criteria may be arbitrary in nature and that we may have omitted some important settings. This document should, therefore, be seen as an initial effort that will have to be updated as new types of settings are developed. We hope this Classification will encourage human service settings not yet involved in alcoholism treatment to join in efforts to assure high quality community services for all alcoholic persons. Lois R. Chatham, Ph.D., Director Division of Extramural Research National Institute on Alcohol Abuse and Alcoholism ''''PREFACE The Fourth Special Report to the U. S. Congress on Alcohol and Health From the Secretary of Health and Human Services emphasizes as a major goal of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) "building a permanent structure that assures the continuation of our national treatment network." In the 1980s, any man, woman, or teenager has a much better chance of finding treatment for his or her alcoholism than would have been the case 10 years ago. A great expansion of the national treatment capacity occurred between the mid-1960s, when even the general hospital was rarely available to the client suffering from problems related to his or her use of alcohol, and 1980, when the National Drug and Alcoholism Treatment Utilization Survey (NDATUS) reported that 4,465 units devoted to the treatment of alcoholism throughout the United States responded to the Survey. Despite the progress being made in expanding treatment capacity, it is not clear that this expansion has been an orderly progression. Likewise, it is unclear -- in light of the absence of a system that integrates and differentiates among the numerous technologies, definitions, and essential characteristics of alcoholism treatment settings -- to what degree this capacity-building effort has corresponded to actual service needs. In the preface to its 1974 edition of Classification of Health Care Institutions, the American Hospital Association (AHA) recognized that "the difficulties encountered in trying to relate and compare data obtained by different agencies using differing terminology and definitions have been apparent for many years. So also have there been problems related to licensure, registration, accreditation, certification of institutions, and the financing of health care." Certainly the alcoholism treatment disciplines have presented similar problems as alcoholism has been recognized as an illness that must be managed within the mainstream of American health care systems. Compilation of the Classification of Alcoholism Treatment Settings has been modeled closely along the approach developed in the AHA classification because the end results sought in both are similar. With this classification, the NIAAA is attempting to effect the following objectives: o Facilitate greater uniformity in data collection and analysis © Develop a guideline to assist States and localities in their licensure, registration, and certification activities vii ''o Provide guidance to third-party reimbursement sources seeking to determine the essential character of specific treatment environments o Aid the public and the professional communities in enlarging their understanding of the types of facilities in which alcoholism treatment services are provided o Strengthen interinstitutional cooperation among various service providers, including facilitating continuity of client care A search of existing data banks reveals a dearth of material related to the classification of alcoholism treatment settings, with little evidence that there is general acceptance of the fragmentary classifications that are available. This classification has, therefore, been developed as an initial attempt to systematize under a single cover the major classes of alcoholism treatment settings and their characteristics. As used herein, Alcohol Treatment Setting refers to any establishment or physical environment that offers medical, psychological, or social services to persons afflicted with alcoholism or alcohol-related problems. These services may be provided at one or several stages from initial diagnosis through all phases of treatment, including outpatient and post-treatment aftercare. Within this context the classification is intended to suggest standards of identity for alcoholism treatment programs that will lead to uniformity in the nomenclature concerned with the therapeutic environment covered. It is hoped that this initial product will succeed in that intention. Certain settings in which alcoholism treatment or support in attaining and maintaining sobriety is provided are purposely not classified. Individual physician care -- an office visit -- is excluded because such care is not generally programmatic in nature. Alcoholics Anonymous, while included in the various characteristics as a community resource, is excluded from classification mainly because AA does not see itself as a treament program. If AA is viewed in a broad health care context, however, it would most likely be seen as a modality or therapeutic adjunct. It should be emphasized that the classification is NOT intended to foster uniformity at the cost of creativity; it should be considered a dynamic tool capable of changing as innovations in alcoholism treatment occur. Likewise, it is NOT the purpose of the document to advance any one treatment setting or modality over another. The classification is divided into four sections: o Glossary contains definitions of the major terms used in the text (and within the definitions themselves). Terms that are defined in the glossary are underlined throughout the text. Definitions were selected from the reference list at the end of the glossary. Where viii ''more than one definition was available in these sources, that which most closely reflected the context of the textual material was selected. Modifications to existing definitions were, for the most part, undertaken as a matter of style. Overview Matrix, designed to give a quick look at the program orientation of the settings, shows selected classification characteristics grouped by type of care as reflected in the client's physical relationship to the treatment program, the level of supervision reflected in terms of the program's medical or other professional orientation, and the general makeup of the staff. Because the matrix parameters are highly selective, programs and especially modules may show similar or identical classificatory characteristics. Differentiating characteristics are provided in the Classification Scheme. Classification Scheme defines the treatment setting and describes those elements that constitute its essential character within the context of the setting definition. To avoid a confusing repetition of definitions and characteristics for what is essentially one main treatment’ setting with several service components -- e.g., "General Hospital" with emergency service or intermediate care components -- the service components are reduced to modules of the main setting and defined. As much as possible, references to alcoholism treatment modalities have been avoided. When they occur, they are used illustratively and not as essential characteristics. References The National Institute on Alcohol Abuse and Alcoholism encourages practitioners in treatment programs for alcoholics and their families to provide it with practical commentary based on their valuable experience. We sincerely hope to use such contributions to update and maintain a useful guideline to alcoholism treatment settings that will benefit both the alcoholic clients and their families and the alcoholism therapeutic community in general. Address comments to: National Institute on Alcohol Abuse and Alcoholism Division of Extramural Research Technical Assistance Branch Room 14-C-20 5600 Fishers Lane Rockville, Maryland 20857 ix ''''ACKNOWLEDGMENTS The consulting editors who provided their technical assistance in the preparation of the Classification are the following: Herman I. Diesenhaus, Ph.D., Chief, Program Development Section, Alcohol and Drug Abuse Division, Colorado Department of Health, Denver, Colorado William T. Tyrrell, Assistant Director, Bureau of Standards and Certification, New York Division of Alcoholism and Alcohol Abuse, Albany, New York The potential utility of this document will result, in large measure, from the technical expertise and effort that these people have lent to improving the content. Their contribution is sincerely appreciated. The National Institute on Alcohol Abuse and Alcoholism acknowledges with appreciation the individuals who reviewed and commented on the draft of this Classification: William P. Daves, Jr., Member, Texas State Board of Insurance, Austin, Texas Leonard Davis, Senior Director, Quality Assurance and Health Care Planning, Blue Cross of Greater Philadelphia, Philadelphia, Pennsylvania Gary D. Graham, M.D., F.A.C.C., Medical Director, Kemper Life Insurance Companies, Long Grove, Illinois Marilyn Jackson-Beeck, Ph.D., Director, Data Services and Research, InterStudy (Interdisciplinary Studies for Policymakers), Excelsior, Minnesota Donald D. Jones, Director, Research and Statistics, Health Insurance Association of America, New York, New York Vicki Paukstys, Blue Cross and Blue Shield Association, Chicago, Illinois xi ''David E. Plotnick, Director of Research and Development, Group Health Association of America, Inc., Washington, D.C. Alex R. Rodriguez, M.D., CDR, MC, USN, Medical Director, Office of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), Department of Defense, Aurora, Colorado Patrice M. Wadleigh, M.S.W., M.P.H., Health Planning Analyst, Planning and Qualifications Policy, Blue Cross of Michigan, Detroit, Michigan Robert W. Wilson, Chief, Health Benefits Division, Public Employees Retirement System, State of California, Sacramento, California (retired). xii ''TABLE OF CONTENTS Foreword Preface Acknowledgments Glossary Glossary References Overview Matrix Classification Scheme 01. GENERAL HOSPITAL An institution that provides -- through an organized medical staff and permanent facilities that include inpatient beds, medical services, and continuous nursing services -- diagnosis and treatment, both surgical and nonsurgical, for patients who have any of a variety of medical conditions, including problems related to alcohol use. 01.01. GENERAL HOSPITAL/EMERGENCY CARE UNIT 01.02. GENERAL HOSPITAL/INTERMEDIATE CARE UNIT 01.03. GENERAL HOSPITAL/EMERGENCY AND INTERMEDIATE CARE UNITS 02. SPECIALIZED ALCOHOLISM HOSPITAL An institution that provides -- through an organized medical staff and/or professional staff and permanent facilities that include inpatient beds, medical services, and continuous nursing services -- diagnosis and treatment for patients suffering from alcoholism or who have other problems related to alcohol use. 02.01. SPECIALIZED ALCOHOLISM HOSPITAL/EMERGENCY CARE UNIT xiii Lii vii xi 12 14 15 15 16 17 17 18 19 ''03. 04. 05. 02.02. SPECIALIZED ALCOHOLISM HOSPITAL/INTERMEDIATE CARE UNIT 20 02.03. SPECIALIZED ALCOHOLISM HOSPITAL/EMERGENCY AND 20 INTERMEDIATE CARE UNITS OTHER SPECIALIZED HOSPITAL 21 An institution that provides -- through an organized medical staff and/or professional staff and permanent facilities that include inpatient beds, medical services, and continuous nursing services -- diagnosis and treatment for patients who have specified medical conditions that may include alcoholism and other problems related to the use of alcohol, or for other special categories of patients. 03.01. OTHER SPECIALIZED HOSPITAL/EMERGENCY CARE UNIT 22 03.02. OTHER SPECIALIZED HOSPITAL/INTERMEDIATE CARE UNIT 23 03.03. OTHER SPECIALIZED HOSPITAL/EMERGENCY AND 23 INTERMEDIATE CARE UNITS HOSPITAL-AFFILIATED INPATIENT CARE CENTER UNDER MEDICAL 24 SUPERVISION An institution -- affiliated with but not necessarily located in a general hospital -- that provides inpatient beds, medical services, and continuous nursing services under the supervision of the medical staff of the hospital for patients who have a variety of medical conditions, including alcoholism and other. problems related to the use of alcohol. HOSPITAL-AFFILIATED ALCOHOLISM EMERGENCY CARE CENTER UNDER 26 MEDICAL SUPERVISION An institution affiliated with a general hospital that provides -- through an organized medical staff and/or professional staff, permanent facilities, triage, medical services, and health-related services -- 24-hour availability to patients who require immediate medical management of a crisis related to the use of alcohol. xiv ''HOSPITAL-AFFILIATED ALCOHOLISM EMERGENCY CARE CENTER WITH MINIMAL MEDICAL INVOLVEMENT An institution affiliated with a general hospital that provides -- through a staff of alcoholism counselors and/or other counselors -- emergency assessment of patients' physical and mental condition and transfer to the hospital for emergency medical care, if required, detoxification, and referral services on 24-hour availability to patients who require immediate intervention for a crisis related to withdrawal from alcohol. DETOXIFICATION CENTER UNDER MEDICAL SUPERVISION An institution located in a hospital, correctional facility, or freestanding facility that provides -- through an organized professional staff and permanent facilities that include resident beds -- triage and short-term treatment services for detoxification of patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. SOCIAL SETTING DETOXIFICATION CENTER An institution located in a hospital, correctional facility, or freestanding facility that provides -- through an organized professional staff and/or staff of alcoholism counselors and permanent facilities that include resident beds -- social setting detoxification services of short duration for patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. RESIDENTIAL ALCOHOLISM TREATMENT FACILITY WITH MINIMAL MEDICAL INVOLVEMENT An institution located in a freestanding facility that provides -- through an organized staff of alcoholism counselors and permanent facilities -- resident beds, ambulatory care, and health-related services for residential post-detoxification treatment of alcoholism, using intensive multimodal therapeutic regimes. 09.01. QUARTERWAY HOUSE ''10. ll. 12. 13. HALFWAY HOUSE/RECOVERY HOME An institution located ina freestanding facility that provides -- through guidance personnel and permanent facilities -- resident beds, structured or supervised peer-group living, and limited health-related services emphasizing social rehabilitation with support and guidance toward the goal of independent living for its patients, who have problems related to the use of alcohol. ALCOHOLISM DAY PROGRAM An institution located in a general, specialized alcoholism, or other specialty hospital or freestanding facility that provides a variety of diagnostic and alcoholism treatment services on both a scheduled and a nonscheduled basis to patients who have problems related to the use of alcohol and to their families, when the patients’ physical and emotional status allows them to function in their usual environment, or if they require assistance in reaching that functional level but do not require inpatient or residential care. 11.01. HEALTH MAINTENANCE ORGANIZATION OUTPATIENT ALCOHOLISM CENTER 11.02. INDUSTRIAL ALCOHOLISM CLINIC HOSPITAL-BASED OUTPATIENT CLINIC An institution, operating under the auspices of a general hospital, that provides a variety of diagnostic and alcoholism treatment services on both a scheduled and a nonscheduled basis in a nonresidential setting to patients who have Problems related to the use of alcohol and to their families, but whose physical and emotional status allows them to function in their usual environment, or who require assistance in reaching that level but do not need inpatient care. FREESTANDING OUTPATIENT ALCOHOLISM CLINIC An institution located in a freestanding facility that provides -- through an organized staff of xvi 36 38 39 39 40 42 ''health care professionals and/or alcoholism counselors and permanent facilities -- limited medical care services and alcoholism treatment services for patients and their families who have problems related to the use of alcohol, but whose physical and emotional status allows them to function in their usual environment without inpatient or residential care. 14. COMMUNITY MENTAL HEALTH CENTER 44 An institution that provides comprehensive treatment and rehabilitation services, including inpatient care, outpatient care, partial hospitalization services, emergency services, court screening, followup, and transitional halfway house services to persons with emotional problems, with major emphasis on providing care in the least restrictive setting to a prescribed community population -- including persons who have problems related to the use of alcohol whose physical and emotional status allows them to function in their usual environment without inpatient or residential care. References 46 xvii ''''GLOSSARY ADMINISTRATOR A person appointed by the governing authority who has responsibility for directing a program and managing its resources for it. (8) AFFILIATION/AFFILIATIVE/AFFILIATED A relationship established by the governing authorities of two organizations and documented by a written agreement or contract under the terms of which specified services, space and/or personnel are provided to one organization by the other. (5) AFTERCARE Care provided to patients who have progressed sufficiently through emergency, inpatient, intermediate, and/or outpatient services to the point in their recovery where they will benefit from a plan of continued scheduled contacts that will support and increase the gains made to date in the treatment process. (7, modified) AL-ANON (AL-ANON FAMILY GROUPS) ALATEEN A fellowship of the relatives of alcoholics, who meet for mutual help and understanding over their common problem of living with an alcoholic. A fellowship of the adolescent children of alcoholics that uses the experience and methods of the independent but allied fellowships of Alcoholics Anonymous and Al-Anon Family Groups to obtain help and understanding in the problem of living with an alcoholic parent. ''ALCOHOLICS ANONYMOUS A fellowship of men and women who have admitted their alcoholism and who derive a sense of common identity, insight, and purpose from recognition of their inability to cope singly with their alcoholism. ALCOHOLISM A state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioral and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence; tolerance May Or may not be present. (The ICD/9 term defined is ALCOHOL DEPENDENCE SYNDROME. ) (12) ALCOHOLISM COUNSELOR An individual who by virtue of special knowledge or training and experience is able to inform, motivate, guide and assist alcoholics and/or those persons affected by problems related to the abuse of alcohol and who meets all applicable State and local requirements such as licensure, certification and training relating to alcoholism counselors in the State in which the alcoholism counseling services are performed. (4) ALCOHOLISM PROGRAM A service program responsible for providing continuity of service to and care of persons with problems associated with the use of alcohol. This program may comprise any combination of program components that may be affiliated internally and/or contractually related and may be drawn from one or more Organizations. (5, modified) ASSESSMENT Those procedures by which a program evaluates an individual's strengths, weaknesses, problems, and needs. (7) AUTHORITY The right and power to determine or judge. (8, modified) ''CONSULTATION The act of providing information and/or technical assistance to a particular group or individual seeking resolution of a specific problem. (5) CONTINUOUS (LY) Available at all times without cessation, break, or interruption. (2) CONTRACT A formal legal document adopted by the governing authority of the alcoholism program and any other organization, agency, or individual that specifies services, personnel, and/or space to be provided to the program as well as the monies to be expended in exchange. (5) COUNSELING The interaction between a skilled counselor and a patient for the purpose of facilitating the patient's better understanding of self and environment. (11) COUNSELOR An individual staff member, including a recovering alcoholic, who by virtue of special knowledge, training, and/or experience is able to inform, motivate, guide, and assist individuals and who meets all applicable State and local requirements such as licensure, certification, and training relating to counselors in the State in which the counseling services are performed. (4, 11, modified) DETOXIFICATION The medical and/or social setting management of alcohol withdrawal. (11) DIAGNOSIS/DIAGNOSE/DIAGNOSTIC Assessment of a person through medical or other approved procedures and/or criteria to determine the nature and extent of a disease and to provide the basis for planning the treatment program for the patient. ''DIETETIC SERVICES The provision of services to meet the nutritional needs of patients who have special dietary needs; for example, patients who are allergic to certain foods or who cannot accept a regular diet. (7) DOCUMENTATION Provision of written, dated, and authenticated evidence to substantiate compliance with standards, e.g., patient records, minutes of meetings, memoranda, schedules, notices, announcements. (5, modified) EMERGENCY CARE The provision of immediate diagnosis and treatment, as well as appropriate referral, to patients with acute alcohol-related problems. (11) EQUIPMENT/EQUIP The fixed and/or major or minor movable machinery, fixtures, articles, vehicles, apparatus, "things," and furniture that have a relatively long useful life and are not consumed in the course of a program. (8) FACILITY (IES) Objects, including the building or physical plant, equipment, or supplies necessary for implementation of services by personnel. (2, modified) FAMILY COUNSELING Guidance services or didactic sessions provided to one or more family members or significant others by alcoholism counselors or health care professionals to inform, motivate, guide, and assist alcoholics and those persons affected by problems related to the abuse of alcohol. Significant others include, for example, the patient's housemate, employer, or probation officer. (4) ''FREESTANDING FACILIITY A service facility that is not an integral part of a hospital, correctional facility, or mental health center. (9, modified) GOVERNING AUTHORITY The individual or group appointed, elected, or otherwise designated in whom is vested the ultimate responsibility and authority for the conduct of the institution. (2, modified) GROUP_COUNSELING Guidance services and therapeutic and didactic sessions provided to a group of patients by an alcoholism counselor or health care professional to inform, motivate, guide, and assist alcoholics and those persons affected by problems related to the abuse of alcohol. (4, 11, modified) HEALTH CARE PROFESSIONAL A person, licensed in the State in which services are performed and/or who meets qualifications and requirements of that jurisdiction, who by custom, training, and common practice is considered a member of one of the recognized helping professions, including physicians, registered nurses, social workers, and psychologists, and who has specific training or experience in alcoholism services. (4, modified) HEALTH-RELATED SERVICES HOSPITAL Services, other than medical, that are performed by qualified personnel and pertain to protective, preventive, personal, and social services and to socialization activities. (2) An institution that provides 24-hour services for the diagnosis and treatment of patients through an organized medical or professional staff, permanent facilities that include inpatient beds, and medical and nursing services. (9) ''HOUSE DIRECTOR The person appointed by the governing authority to implement the general policy of a halfway house and to administer house operations On a day-to-day basis. (1, modified) INDIVIDUAL COUNSELING Guidance services and didactic sessions provided to a patient on a one-to-one basis by an alcoholism counselor or health care professional to inform, motivate, guide and assist alcoholics and those persons affected by problems related to the abuse of alcohol. (4, modified) INPATIENT A patient or pertaining to a patient who stays in a hospital or other suitably equipped medical setting usually in excess of 24 hours. (2) INPATIENT BEDS Accommodations with supporting services, including food, laundry, and housekeeping, for patients who stay in a hospital or other suitably equipped medical setting usually in excess of 24 hours. (2) INPATIENT CARE The provision of medical services and other supporting services, including food, laundry, and housekeeping, for patients who require 24-hour supervision in a hospital or other suitable equipped medical setting for treatment of alcoholism or other Problems related to alcohol use. (6) INSTITUTION A public or private organization of facilities and/or staff established to ensure continuity of a program; a legally established agency or corporation. (2) INTERMEDIATE CARE The provision of care in a full (24-hour) residential treatment setting or a partial (less than 24-hour) residential treatment ''setting for patients who have need of more intensive care and treatment than is available through outpatient settings or who, although not seriously debilitated, would benefit from supportive living arrangements. (5, ll, modified) MEAL SERVICE A service designed to provide the necessary food and nutritional requirements to the recipient of prepared meals. (8) MEDICAL CARE Those diagnostic and treatment services that, under the laws of the jurisdiction in which the program is located, can be provided only by a licensed physician. (5) MEDICAL SERVICES Services performed at the direction of a physician on behalf of patients by physicians, nurses, and other health care professionals and technical personnel. (4) MEDICAL STAFF A formal organization of physicians to which is delegated the authority and responsibility to maintain proper standards of medical care and to plan for continuance and improvement of that care. (2) NURSE A person licensed and/or registered to practice nursing in the State in which he or she practices. (7) NURSING SERVICES Services performed by or under the direct supervision of a nurse licensed in the State in which the services are performed, including rendering skilled nursing care, performing prescribed medical treatments, teaching treatment and health measures, and providing counseling and supportive care. (4, modified) ''ON CALL Prearranged waiting, holding oneself available tor potential demands Or requests for services. (8) OUTPATIENT CARE The process of providing nonresidential evaluative and alcoholism treatment services on both a scheduled and a nonscheduled basis. (5, modified) OUTREACH The process of systematically interacting with the community to identify persons in need of services, alert persons and their families to the availability of services, locate needed services, and enable persons to enter the service delivery system. (7) PATIENT _ Any person who has applied for, is receiving, or has received services in the program. (10, modified) PHARMACIST An individual who has a degree in Pharmacy and is licensed and registered to prepare, preserve, compound, and dispense drugs and chemicals in the State in which he or she practices. (7) PHYSICIAN A doctor of medicine (M.D.) or osteopathy (D.O.) who is fully licensed to practice medicine in all its phases. (5) POLICY A statement of philosophy and direction that guides the conduct of the organization. (8) PROCEDURE A particular series of operational steps to be followed in order to implement a policy. (8) ''PROFESSIONAL STAFF The organization of health care professionals to which is delegated the authority and responsibility to provide proper medical care and/or health-related care and to maintain proper standards for and to plan for continuance and improvement of that care. (2, modified) PROGRAM A general term for an organized system of services designed to address the treatment needs of patients. (7) DSYCHIATRIST A physician who specializes in the assessment and treatment of individuals having psychiatric disorders and who is board certified or qualified by the American Board of Psychiatry and Neurology, Inc., and fully licensed to practice medicine in the State in which he or she practices. (6, modified) PSYCHOLOGIST An individual who holds a doctoral degree in clinical psychology from a training program approved by the American Psychological Association, who has been certified in the appropriate specialty by the American Board of Professional Psychology, who has been licensed or certified by a State examining board, who has been endorsed by the State psychological association through voluntary certification, who is listed in the National Health Registry for Psychologists, or who has the documented equivalent in training and/or experience. (6) REGISTERED PROFESSIONAL NURSE A nurse who is a graduate of an approved school of nursing and who is licensed to practice and registered in the State in which nursing services are performed. (2) REHABILITATION Preparing or training a person to function within the limits of the original or residual disability by the acquisition, return, or accommodation to loss of skills and/or knowledge. (8, modified) ''RESIDENT BEDS Accommodations that include supporting services such as food, laundry, and housekeeping for residents who usually stay in excess of 24 hours. (2) RESIDENTIAL CARE The provision of 24-hour care to patients who live on the Premises of the program. (10, modified) SOCIAL REHABILITATION The process of helping an individual in his/her psychosocial adjustment by learning or relearning social skills. (8, modified) SOCIAL WORKER An individual who has a master's degree from an institution accredited by the Council on Social Work Education, who has been certified by the Academy of Certified Social Workers, or who has the documented equivalent in education, training, and/or experience. (7) STANDARD A state or condition accepted as a minimal or exemplary condition that appears in law, regulation, or policy or that is generally accepted by a profession or group. (8) SUPERVISION/SUPERVISE Direct overseeing and inspection of the act of accomplishing a function or activity. (2) SUPPORT STAFF Employees or volunteers whose primary work activities involve clerical, housekeeping, security, laboratory, record keeping, and other functions necessary for the overall clinical and administrative operation of the facility. (7) - 10 - ''TRANSFER Change of treatment responsibility for a patient from one treatment service or location to another. (7, modified) TRANSPORTATION A service designed to provide the recipient with the means to travel or to move from place to place by auto, bus, or other conveyance. (8) TREATMENT PLAN An individualized plan of care that documents alcohol-related dysfunction, diagnosis, and reason for admission, assesses problems and needs of the patient, formulates goals and care to meet needs, and delineates all services, treatment, and medications to meet the goals established. (4, modified) TREATMENT/TREATMENT SERVICES The broad range of planned and continuing services, including diagnostic assessment, counseling, medical, psychiatric, psychological, and social service care for alcohol-related dysfunction, that may be extended to program patients and that influence the behavior of such individuals toward identified goals and objectives. (11) TRIAGE Prompt assessment of all incoming patients to determine the nature of the problem, the level of urgency, identification of the kind of service needed, and assignment for attention. (5) - {i = ''GLOSSARY REFERENCES 1. Allen, H. E.; Carlson, E. W.; Parks, E. C.; and Seiter, R. P. Halfway Houses. Program Models. Washington, DC: U. Ss. Dept. of Justice, National Institute of Law Enforcement and Criminal Justice, November 1978. p. 15. 2. American Hospital Association. Classification of Health Care Institutions. 1974 Edition. Chicago: AHA, 1974. 3. Health Care Financing Administration. "Guidelines for Grants for Alcoholism Services in Medicare and Medicaid." Unpublished, HCFA, Baltimore, 1980. 4. Health Care Financing Administration. HCFA -- NIAAA Alcoholism Services Demonstration Provider Manual. HCFA-1480. Baltimore: HCFA, 1980. 5. Joint Commission on Accreditation of Hospitals. Accreditation Manual for Alcoholism Programs. Chicago: JCAH, 1974. 6. Joint Commission on Accreditation of Hospitals. Consolidated Standards for Child, Adolescent, and Adult Psychiatric, Alcoholism, and Drug Abuse Programs. 1979 Edition. Chicago: JCAH, 1979. 7. Joint Commission on Accreditation of Hospitals. Consolidated Standards Manual for Child, Adolescent, and Adult Psychiatric, Alcoholism, and Drug Abuse Facilities. 1981 Edition. Chicago: JCAH, 1981. 8. National Institute of Mental Health. Definition of Terms in Mental Health, Alcohol Abuse, Drug Abuse, and Mental Retardation. Mental Health Statistics, Series C, No. 8. DHEW Pub No. (ADM) 74-38. Washington, DC: Supt. of Docs., U. S. Govt. Print. Off., 1973. 9. National Institute on Alcohol Abuse and Alcoholism. National Drug and Alcoholism Treatment Utilization Survey. Executive Report. Rockville, MD: NIAAA, September 1980. 10. National Institute on Alcohol Abuse and Alcoholism. Data Collection Forms and Procedures. National Alcoholism Program Information System (NAPIS) Documentation, Vol. 1. 3d ed. Rockville, MD: NIAAA, 1981. - 12 = ''11. National Institute on Alcohol Abuse and Alcoholism. Program Standards and_ Management Review System. Rockville, MD: NIAAA, March 1982. 12. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. International Classification of Diseases, Vol. 1. Geneva: WHO, 1977. (ICD/9) . -13- ''The figure below shows selected chara These include type of care as ref relationship to the treatment program, terms of the program's medical or other classified. general makeup of the staff. OVERVIEW MATRIX cteristics of the settings lected in the patient's physical the level of supervision reflected in professional orientation, and the L Type of Care / Supervision / Staffing 01. General Hospital 01.01. General Hospital/Emergency Care unit 01.02. General Hospital/Intermediate Care unit 01.03. General Hospital/Emergency and Intermediate Care Units 02. Specialized Alcoholisa Hospital 02.01. Specialized Alcoholisa Hospital/Emergency Care Unit Specialized Alcoholisa Hospital/Intermediate Care unit 02.03. Specialized Alcoholisa Hospital/Emergency and Intermediate Care Units 03. Other Specialized Hospital 03.01. Other Specialized Hospital/Emergency Care Unit 03.02. Other Specialized Hospital/Intermediate Care Unit 03.03. Other Specialized Hospital/Emergency and Intermediate Care Units 04. Hospital-Affiliated Inpatient Care Center Under Medical Supervision Hospital-Affiliated Alcoholism Emergency Care Center Under Medical Supervision Hospital-Affiliated Alcoholism Emergency Care Center With Minimal Medical Involvement 07. Detoxification Center Under Medical Supervision Social Setting Detoxification Center Residential Alcoholism Treatment Facility with Minimal Medical Involvement 09.01. Quarterway House 10. Halfway House/Recovery Home ll. Alcoholism Day Program 11.01. Health Maintenance Organization Outpatient Alcoholism Center 11.02. Industrial Alcoholism Clinic 12. Hospital-Based Outpatient Clinic 13. Freestanding Outpatient Alcoholism Clinic 4. Community Mental Health Center =L4- ''CLASSIFICATION SCHEME1 01. GENERAL HOSPITAL Definition An institution that provides -- through an organized medical staff and permanent facilities that include inpatient beds, medical services, and continuous nursing services -- diagnosis and treatment, both surgical and nonsurgical, for patients who have any of a variety of medical conditions, including problems related to alcohol use. Essential Characteristics for Classification 1. The primary function of the institution is to provide diagnosis and treatment, both surgical and nonsurgical, for patients who have any of a variety of medical conditions, including alcoholism or other problems related to alcohol use. 2. Inpatient care is provided by and inpatient beds are maintained in the institution. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized medical staff to which the governing authority delegates responsibility for maintaining proper standards of medical care. 6. Each patient is admitted on the authority of, and his or her care is under the direction of, a physician who is a member of the medical staff and/or professional staff. 7. A written treatment plan is prepared and maintained for each patient to include a medical assessment, a social/psychological assessment (if required), and a record of progress during the course of treatment. 8. The nursing services are under the direction of a full-time registered professional nurse. layne underscored terms used on pages 15-45 are defined in the Glossary on pages 1-1l. -15 - ''9. Registered professional nurse supervision and other nursing services are continuous. 10, Alcoholism counselors and/or other counselors are available as needed for patient interaction. 11. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. 12. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. 13. Pharmacy services are maintained in or by the institution and supervised by a licensed pharmacist. 14. Diagnostic x-ray services, with facilities and Support staff able to conduct a variety of radiological procedures, are maintained in the institution. 15. Clinical laboratory services, with facilities and Support staff able to conduct a variety of laboratory tests and procedures, are maintained in or by the institution, and anatomical pathology services are regularly and conveniently available. 16. Operating room services, with facilities and professional staff and Support staff, are maintained in the institution. 17. Meal service to patients meets their nutritional requirements, and dietetic services are regularly available. 18. There is documentation verifying that the institution meets licensing laws and regulations, if required. Modules 01.01. GENERAL HOSPITAL/EMERGENCY CARE UNIT The facility and professional staff to provide triage, diagnosis, and - 16 - ''emergency medical care to patients having medically acute physical or mental problems related to alcohol use, including acute intoxication or alcohol poisoning, delirium tremens or other acute alcoholic psychoses, and severe injuries such as concussions, broken bones, knife wounds and similar injuries due to falling or fighting. Appropriate referral for continuing care is also provided. 01.02. GENERAL HOSPITAL/INTERMEDIATE CARE UNIT The facility and professional staff to provide alcoholism treatment services in a full (24-hour) residential treatment setting or a partial (less than 24 hours) residential treatment setting for patients who have need of more intensive care and treatment than is available through outpatient settings or who, although not seriously debilitated, would benefit from supportive living arrangements. 01.03. GENERAL HOSPITAL/EMERGENCY AND INTERMEDIATE CARE UNITS These comprise the units described in both 01.01 and 01.02, above. -17- ''02. SPECIALIZED ALCOHOLISM HOSPITAL Definition An institution that provides -- through an organized medical staff and/or professional staff and permanent facilities that include inpatient beds, medical services, and continuous nursing services -- diagnosis and treatment for patients suffering from alcoholism or who have other problems related to alcohol use. Essential Characteristics for Classification 1. The primary function of the institution is to provide diagnosis and treatment for patients with alcoholism or other problems related to alcohol use. 2. Inpatient care is provided by and inpatient beds are maintained in the institution. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized medical staff and/or professional staff to which the governing authority delegates responsibility for maintaining proper standards of medical care. 6. Each patient is admitted on the authority of, and his or her care is under the direction of, a physician who is a member of the medical staff and/or professional staff. 7. A written treatment plan is prepared and maintained for each patient to include a medical assessment and a social/psychological assessment (if required), and a record of Progress during the course of treatment. 8. The hursing services are under the direction of a full-time registered a professional nurse. 9. Registered professional nurse supervision and other nursing services are a continuous. - 18 - ''10. Alcoholism counselors and other counselors are available as needed for patient interaction. 1l. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. 12. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. 13. Pharmacy services are maintained in or by the institution and are supervised by a licensed pharmacist. 14. Diagnostic and treatment services, with facilities and professional staff and support staff, are maintained in the institution as appropriate for the specified medical conditions for which medical services are provided. If these conditions do not routinely require diagnostic X-ray, laboratory, or operating room services, and any such service is therefore not maintained by the institution, there are affiliative arrangements to make it available when the need arises. 15. There is transportation available or on call for transfer of patients to the affiliated institution for diagnostic X-ray, laboratory, or operating room service, if required. 16. Meal service to patients meets their nutritional requirements, and dietetic services are regularly available. 17. There is documentation verifying that the institution meets licensing laws and regulations, if required. Modules 02.01. SPECIALIZED ALCOHOLISM HOSPITAL/EMERGENCY CARE UNIT The facility and professional staff to provide triage, diagnosis, and emergency medical care to patients having medically acute physical or mental problems related to alcohol use, including acute intoxication or - 19 - ''alcohol poisoning or delirium tremens or other acute alcoholic psychoses. In-house or referral care is provided for severe injuries such as concussions, broken bones, or knife wounds and similar injuries due to falling or fighting. Appropriate continuing care is available or referral for continuing care is provided. 02.02. SPECIALIZED ALCOHOLISM HOSPITAL/INTERMEDIATE CARE UNIT The facility and professional staff to provide alcoholism treatment services in a full (24-hour) residential treatment setting or a partial (less than 24-hour) residential treatment setting for patients who have need of more intensive care and treatment than is available through outpatient settings or who, although not seriously debilitated, would benefit from supportive living arrangements. 02.03. SPECIALIZED ALCOHOLISM HOSPITAL/EMERGENCY AND INTERMEDIATE CARE UNITS These comprise the units described in both 02.01 and 02.02, above. - 20 - ''03. OTHER SPECIALIZED HOSPITAL Definition An institution that provides -- through an organized medical staff and/or professional staff and permanent facilities that include in atient beds, medical services, and continuous nursing services -- diagnosis and treatment for patients who have specified medical conditions that may include alcoholism and other problems related to the use of alcohol, or for other special categories of patients. ‘Essential Characteristics for Classification Ls 2. 3. ds 8. 9. The primary function of the institution is to provide diagnosis and treatment for patients who have specified medical conditions, which may include those that are related to the use of alcohol. Inpatient care is provided by and inpatient beds are Maintained in the institution. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized medical staff and/or professional staff to which the governing authority delegates responsibility for maintaining proper standards of medical care. Each patient is admitted on the authority of, and his care is under the direction of, a physician who is a member of the medical staff or professional staff. A written treatment plan is prepared and maintained for each patient to include a medical assessment, a social/psychological assessment (if required), and a record of progress during the course of treatment. The nursing services are under the direction of a full-time registered professional nurse. Registered professional nurse supervision and other nursing services are continuous. = 21 = ''10. Alcoholism counselors and/or other counselors are available as needed for patient interaction. ll. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing, and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. 12. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. 13. Pharmacy services are maintained in or by the institution and are supervised by a licensed pharmacist. 14. Diagnostic and treatment services, with facilities and professional staff and support staff, are maintained in the institution as appropriate for the specified medical conditions for which medical services are provided. If these conditions do not routinely require diagnostic X-ray, laboratory, or operating room services, and any such service is therefore not Maintained by the institution, there are affiliative arrangements to make it available as the need arises. 15. There is transportation available or on call for transfer of patients to the affiliated institution for diagnostic X-ray, laboratory, or operating room services, if required. 16. Meal service to patients meets their nutritional requirements, and dietetic services are regularly available. 17. There is documentation verifying that the institution meets licensing laws and regulations, if required. Modules 03.01. OTHER SPECIALIZED HOSPITAL/EMERGENCY CARE UNIT The facility and professional staff to provide triage, diagnosis, and emergency medical care to patients having medically acute physical or mental problems related to alcohol use, including acute intoxication or alcohol poisoning or delirium tremens or other acute alcoholic psychoses. = 99 = ''In-house or referral care is provided for severe injuries such as concussions, broken bones, or knife wounds and similar injuries due to falling or fighting. Appropriate referral for continuing care is also provided, if required. 03.02. OTHER SPECIALIZED HOSPITAL/INTERMEDIATE CARE UNIT The facility and professional staff to provide alcoholism treatment services in a full (24-hour) residential treatment setting, or a partial (less than 24-hour) residential treatment setting for patients who have need of more intensive care and treatment than is available through outpatient settings or who, although not seriously debilitated, would benfit from supportive living arrangements. 03.03. OTHER SPECIALIZED HOSPITAL/EMERGENCY AND INTERMEDIATE CARE UNITS These comprise the units described in both 03.01 and 03.02, above. - 23 - ''04. HOSPITAL-AFFILIATED INPATIENT CARE CENTER UNDER MEDICAL SUPERVISION Definition An institution -- affiliated with but not necessarily located in a general hospital -- that provides inpatient beds, medical services, and continuous nursing services under the supervision of the medical staff of the hospital for patients who have a variety of medical conditions, including alcoholism and other problems related to the use of alcohol. Essential Characteristics for Classification 1. The primary function of the institution is to provide diagnosis and nonsurgical treatment for patients who have any of a variety of medical conditions, including problems related to the use of alcohol. 2. Inpatient beds are maintained in the institution. 3. There is a governing authority legally responsible for the conduct of the institution, which operates under the general supervision -- or the direct control -- of the governing authority of the hospital. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized medical staff -- either within the ‘institution or the affiliative hospital -- to which the governing authority delegates responsibility for maintaining proper standards of medical care. 6. Each patient is admitted on the authority of, and his or her care is under the direction of, a physician who is a member of the medical staff or professional staff of either the institution or the affiliative hospital. 7. A written treatment plan is prepared and maintained for each patient to include a medical assessment, a social/psychological assessment (if required), and a record of progress during the course of treatment. 8. The nursing services are under the direction of a full-time registered professional nurse. 9. Registered professional nurse supervision and other nursing services are continuous. 10. Alcoholism counselors and/or other counselors are available as needed for patient interaction. - 24 - ''ll. 12. 13. 14. 15. 16. 17. 18. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. Pharmacy services are maintained in or by the institution and supervised by a licensed pharmacist, or they are available through the affiliative hospital. Diagnostic X-ray services, with facilities and support staff able to conduct a variety of radiological procedures are available through the affiliative hospital. Clinical laboratory services -- with facilities and support staff able to conduct a variety of laboratory tests and procedures and facilities and professional staff and support staff to provide anatomical pathology services -- are available through the affiliative hospital. There is transportation available or on call for transfer of patients to the affiliative hospital for diagnostic X-ray, laboratory, or operating room services, if the need arises. Meal service to patients meets their nutritional requirements, and dietetic services are regularly available. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 25 - ''05. HOSPITAL-AFFILIATED ALCOHOLISM EMERGENCY CARE CENTER UNDER MEDICAL SUPERVISION Definition An institution affiliated with a general hospital that provides -- through an organized medical staff and/or professional staff, permanent facilities, triage, medical services, and health-related services -- 24-hour availability to patients who require immediate medical management of a crisis related to the use of alcohol. Essential Characteristics for Classification 1. 5. 8. The primary function of this institution is to provide 24-hour availability of triage and medical care, supervision by medical staff and/or professional staff until the incapacitating effects of alcohol have dissipated, assessment of medical, psychological, and social needs, and efficient transportation services to patients suffering from a crisis related to the use of alcohol. The institution has permanent facilities and is affiliated with a hospital that is equipped to administer all services that may be required following emergency care. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates full-time responsibility for the operation of the institution in accordance with established policy, which is coordinated with the affiliative hospital. There is an organized medical staff and/or professional staff to which the governing authority delegates responsibility for maintaining proper standards of care. Registered professional nurse supervision and other nursing services are continuous. Supervision by health care professionals and services of other professional personnel appropriate to the function of the institution are continuously available. An emergency record, maintained for each patient, includes information regarding the date and time of arrival, means of arrival, and by whom transported (if known), pertinent history of the current condition, - 26 - ''9. 10. ll. 12. 13. 14. 15. details relative to first aid or emergency care rendered to the patient prior to arrival at the institution, triage and medical care given, condition of the patient on discharge or transfer, and final disposition, including instructions relative to necessary aftercare that are given to the patient or family. Alcoholism counselors and other counselors are available as needed for patient interaction. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. Pharmacy services are maintained in or by the institution and supervised by a licensed pharmacist, or they are available through the affiliative hospital. There is transportation available or on call for transfer of patients to the affiliative hospital, as required. Meal service to patients, if required, meets their nutritional requirements, and dietetic services, if required, are regularly available. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 27 - ''06. HOSPITAL-AFFILIATED ALCOHOLISM EMERGENCY CARE CENTER WITH MINIMAL MEDICAL INVOLVEMENT Definition An institution affiliated with a general hospital that provides -- through a staff of alcoholism counselors and/or other counselors -- emergency assessment of patients’ physical and mental condition and transfer to the hospital for emergency medical care, if required, detoxification, and referral services on 24-hour availability to patients who require immediate intervention for a crisis related to withdrawal from alcohol. Essential Characteristics for Classification 1. The primary function of the institution is to provide 24-hour availability to patients afflicted with an alcohol-related crisis in the areas of emergency care assessment, detoxification, and referral to continuing treatment or aftercare through utilization of a staff of alcoholism counselors and/or other counselors and/or facilitation of alcohol withdrawal by management of the physical and interpersonal milieu. 2. The institution has permanent facilities and is affiliated with a hospital that is equipped to furnish medical care, withdrawal medications, and hospital facilities, if required. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates full-time responsibility for the operation of the institution in accordance with established policy, which is coordinated with the affiliative hospital. 5. There is an organized staff of alcoholism counselors to whom the governing authority delegates responsibility for maintaining proper standards of care. 6. Supervision by alcoholism counselors and services of other counselors appropriate to the function of the institution are continuously available. 7. An emergency record, maintained for each patient, includes information regarding the time of arrival, means of arrival, and by whom transported (if known), pertinent history of the current condition, details relative to first aid or emergency care rendered to the patient prior to arrival at the institution, emergency assessment of the patient's physical and mental - 28 - ''8. 10. ll. 12. 13. condition and treatment given or transfer arranged, condition of the patient on discharge or transfer, and final disposition, including instructions relative to necessary aftercare that are given to the patient or family. Patients are involved in group counseling, individual counseling, family counseling and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing and employment and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. There is transportation available or on call for transfer of patients to the affiliative hospital, as required. There are resident beds available to accommodate patients until the incapacitating effects of alcohol have dissipated, if required. Meal service to patients, if required, meets their nutritional requirements, and dietetic services, if required, are regularly available. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 29 - ''07. DETOXIFICATION CENTER UNDER MEDICAL SUPERVISION Definition An institution located in a hospital, correctional facility, or freestanding facility that provides -- through an organized professional staff and permanent facilities that include resident beds -- triage and short-term treatment services for detoxification of patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. Essential Characteristics for Classification 1. The primary function of the institution is to provide 24-hour availability for triage and short-term treatment services for detoxification of patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. 2. Resident beds are maintained in the institution for patients. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized professional staff to whom the governing authority delegates responsibility for maintaining proper standards of care. This staff includes physicians on a permanent or consultation basis, a pharmacist on site or available, full-time nurses, and alcoholism counselors. Other counselors and support staff are available as needed. 6. Registered professional nurse supervision and other nursing services are available on site or on call for 24-hour coverage. A charge nurse is available or on call to screen all incoming patients, including a vital sign check and taking a brief medical history. Patients who are unconscious, violent, or in severe medical distress or who have obvious psychiatric complications are transferred to appropriate medical or detention facilities, with whom affiliative agreements exist for providing such services. 7. A record is made and maintained for each patient including time of arrival, means of arrival, and by whom transported (if known), pertinent history of the current condition, details relative to first aid or care - 30 - ''8. 9. 10. ll. 12. rendered prior to arrival at the institution, treatment plan and record of treatment rendered, condition on discharge or transfer to a medical or other facility, and instructions relative to necessary aftercare that are given to the patient or family. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing, employment, and medical care (including psychiatric) and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. There is transportation available or on call for transfer of patients to other facilities for medical care, if required. Meal service to patients, if required, meets their nutritional requirements, and dietetic services, if required, are regularly available. There is documentation verifying that the institution meets licensing laws and regulations, if required. «= 3] - ''08. SOCIAL SETTING DETOXIFICATION CENTER Definition An institution located in a hospital, correctional facility, or freestanding facility that provides -- through an organized professional staff and/or staff of alcoholism counselors and permanent facilities that include resident beds -- social setting detoxification services of short duration for patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. Essential Characteristics for Classification 1. The primary function of the institution is to provide 24-hour availability for short-term detoxification services with minimal medical involvement for patients who appear to have no serious physical or medical problems except problems related to the use of alcohol. 2. Resident beds are maintained in the institution for patients. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized professional staff and/or staff of alcoholism counselors to whom the governing authority delegates responsibility for Maintaining proper standards of care. This staff includes alcoholism counselors on a permanent basis, and may include health care professionals on a permanent or a consultation basis. Other counselors and support staff are available as needed. 6. There is a written procedure for emergency transfer of a patient who, in the course of detoxification, develops an alcohol-withdrawal crisis, such as severe alcohol-related hallucinations or delirium tremens, to a hospital with emergency care facilities as defined in Sections 01.01, 02.01, 03.01, or 05, above. There are affiliative agreements with such institutions for providing necessary care. 7. There is a written procedure for transfer to appropriate medical or detention institutions of patients who become unconscious or violent or who develop or are first observed to have severe medical distress and/or obvious psychiatric complications. There are affiliative agreements with such institutions for providing necessary services. = 32 = ''8. 10. ll. 12. 13. A record is made and maintained for each patient including time of arrival, means of arrival, and by whom transported (if known), pertinent history of the current condition, details relative to first aid or care rendered to the patient prior to arrival at the institution, treatment plan and record of treatment rendered, condition on discharge or transfer to a medical or other facility, and instructions relative to necessary aftercare that are given to the patient or family. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing, employment, and medical care (including psychiatric) and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as community mental health centers and Veterans Administration hospitals, of voluntary programs such as halfway houses and recovery homes and the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. There is transportation available or on call for transfer of patients to other facilities for necessary services, if required. Meal service to patients, if required, meets their nutritional requirements and dietetic services, if required, are regularly available. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 33- ''09. RESIDENTIAL ALCOHOLISM TREATMENT FACILITY WITH MINIMAL MEDICAL INVOLVEMENT Definition An institution located in a freestanding facility that provides -- through an organized staff of alcoholism counselors and permanent facilities -- resident beds, ambulatory care, and health-related services for residential post-detoxification treatment of alcoholism, using intensive multimodal therapeutic regimes. Essential Characteristics for Classification Li The primary function of the institution is to provide, in a residential setting, social rehabilitation with support and guidance toward the goal of independent living for patients who have problems related to the use of alcohol but who do not need, or have just emerged from, inpatient care and who are not yet ready to return to home and/or job in the community, even with the support of outpatient care. The institution has permanent facilities that include resident beds. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized professional staff and/or staff of alcoholism counselors to whom the governing authority delegates responsibility for maintaining proper standards of care. Alcoholism counselors are available on a full-time, permanent basis, and health care professionals, if required, are available on a permanent basis or for consultation. A record is made and maintained for each patient, including date and time of admission, source of referral (if known), and admission authority, pertinent history of the current condition including details of care rendered to the patient elsewhere prior to admission to the institution, a treatment plan and record of treatment rendered, condition on discharge or transfer to another facility, and instructions relative to necessary aftercare that are given to the patient or family. - 34 - ''8. There are affiliative agreements with appropriate institutions, programs, and/or individuais for obtaining necessary medical care, health-related services, and/or other professional consultation for patients. 9. Patients are involved in group counseling, individual counseling, family counseling, and/or other approaches designed to motivate them to use suitable community support services and facilities for long-range rehabilitation. Counselors, in one-on-one sessions, assess needs such as housing, employment, and medical care (including psychiatric) and make referrals to the community agency or program whose capabilities most nearly match the individual patient's needs. 10. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as detoxification centers, community mental health centers, and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. ll. There is transportation available or on call for transfer of patients to other facilities for necessary services, if required. 12. Food that meets their nutritional requirements is provided for atients, and dietetic services, if required, are regularly available; meal service to patients, if opted, likewise meets their nutritional requirements. 13. There is documentation verifying that the institution meets licensing laws and regulations, if required. Modules 09.01. QUARTERWAY HOUSE The facility and staff of alcoholism counselors and other counselors to provide patients with short-term intensive multimodal programs of counseling, rehabilitation, occupational therapy, and followup aimed at initiating patients into sobriety and at their reintegration into the home, job, and community. - 35 - ''10. HALFWAY HOUSE/RECOVERY HOME Definition An institution located in a freestanding facility that provides -- through guidance personnel and permanent facilities -- resident beds, structured or supervised peer-group living, and limited health-related services emphasizing social rehabilitation with support and guidance toward the goal of independent living for its patients, who have problems related to the use of alcohol. Essential Characteristics for Classification ls The primary function of the institution is to provide, on a residential basis, social rehabilitation with support and guidance toward the goal of independent living for individuals who require only limited medical supervision but require continued treatment for alcohol-related problems, usually following inpatient care or more intensive intermediate care. The institution has permanent facilities that include resident beds. There is a governing authority legally responsible for the conduct of the institution. There is a house director to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized staff of guidance personnel, including alcoholism counselors, other counselors, and optional health care professionals to whom the governing authority delegates responsibility for maintaining proper standards of care. Each patient is admitted on the direct authority of the house director or on the authority of the house director as recommended by guidance personnel. A written treatment plan is prepared and maintained for each patient to include a medical assessment (if required), a social/psychological assessment, and a record of progress during the course of treatment. Group counseling, individual counseling, and other therapeutic sessions that support the goal of independent living for patients are readily available. - 36 - ''9. 10. ll. 12. There are affiliative agreements with appropriate institutions, programs, and/or individuals for obtaining necessary medical care, health-related services, and/or other professional consultation for patients. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as detoxification centers, inpatient care facilities, community mental health centers and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. Food that meets their nutritional requirements is provided for patients, and dietetic services, if required, are regularly available; meal service to patients, if opted, likwise meets their nutritional requirements. There is documentation verifying that the institution meets licensing laws and regulations, if required. a OF = ''11. ALCOHOLISM DAY PROGRAM Definition An institution located in a general, specialized alcoholism, or other specialty hospital or freestanding facility that provides a variety of diagnostic and alcoholism treatment services on both a scheduled and nonscheduled basis to patients who have problems related to the use of alcohol and to their families, when the patients' physical and emotional status allows them to function in their usual environment, or if they require assistance in reaching that functional level but do not require inpatient or residential care. Essential Characteristics for Classification l. 5. The primary function of the institution is to provide treatment in a nonresidential setting to patients with problems related to the use of alcohol who do not require care in a hospital or other inpatient or residential care facility, but who do need specialized outpatient care more than once per week for elimination of dependency on alcohol and for adjustment to the problems of normal living. The institution has permanent facilities and maintains regularly scheduled hours during which services are provided by a staff that includes alcoholism counselors and other counselors and may include health care professionals on staff or for consultation. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized staff of alcoholism counselors, which may include health care professionals, to whom the governing authority delegates responsibility for maintaining proper standards of care. A record is made and maintained for each patient, including date of admission, source of referral (if known), and admission authority, pertinent history of the current condition including details of care rendered to the patient elsewhere prior to admission to the institution, a treatment plan and record of treatment rendered, condition on discharge or transfer to another facility, and instructions relative to necessary aftercare that are given to the patient or family. - 38 - ''7. Counselors and/or health care professionals prepare a social/psychological assessment of each patient and assign him or her to one or several group counseling sessio.s chat meet regularly -- mostly in night sessions for those occupied durin work hours and in day sessions for those unemployed or unemployable because of alcohol problems. Arrangements can also be made for irregular, unscheduled sessions, including individual counseling sessions. 8. Each regular group is designed to meet a specific therapeutic need through a specified type of treatment, supplemented, if required, by medical care prescribed and administered under affiliative agreements with appropriate institutions, programs, or individuals. 9. Family counseling and/or other approaches designed to motivate patients _and family members to use suitable community support services and facilities for long-range rehabilitation are generally available. 10. The institution coordinates its program with the alcoholism programs of - other organizations operating in the vicinity such as detoxification centers, inpatient and residential care facilities, community mental health centers, and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. 11. Limited meal service or lunch facilities are provided for patient use. 12. There is documentation verifying that the institution meets licensing laws and regulations, if required. Modules 11.01. HEALTH MAINTENANCE ORGANIZATION OUTPATIENT ALCOHOLISM CENTER The facility and professional staff, staff of alcoholism counselors and other counselors, and support staff to provide -- either directly or by contract and for a fixed payment paid periodically -- a variety of diagnostic and primary and/or alcoholism treatment services on both a scheduled and a nonscheduled basis in a nonresidential setting to patients who have problems related to the use of alcohol and to their families, but whose physical and emotional status allows them to function in their usual environment, or who require assistance in reaching that level but do not require inpatient or residential care. 11.02. INDUSTRIAL ALCOHOLISM CLINIC The facility and professional staff, staff of alcoholism counselors and other counselors, and support staff to provide diagnosis, treatment and rehabilitation services on an outpatient basis to employees and their family members with problems related to the use of alcohol. - 39 - ''12. HOSPITAL-BASED OUTPATIENT CLINIC Definition An institution, operating under the auspices of a general hospital, that provides a variety of diagnostic and alcoholism treatment services on both a scheduled and a nonscheduled basis in a nonresidential setting to patients who have problems related to the use of alcohol and to their families, but whose physical and emotional status allows them to function in their usual environment, or who require assistance in reaching that level but do not need inpatient care or residential care. Essential Characteristics for Classification 1. The primary function of the institution is to provide treatment in a nonresidential setting to alcoholic patients who do not require inpatient care, but who need specialized treatment for elimination of dependency on alcohol and for adjustment to the problems of normal living. 2. The institution has permanent facilities and maintains regularly scheduled hours during which services are provided by a staff that includes health care professionals, alcoholism counselors, other counselors, and support staff. 3. There is a governing authority legally responsible for the conduct of the institution. 4. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. 5. There is an organized professional staff and a staff of alcoholism counselors to whom the governing authority delegates responsibility for maintaining proper standards of care. 6. A record is made and maintained for each patient, including date of admission, source of referral (if known), and admission authority, pertinent history of the current condition including details of care rendered to the patient elsewhere prior to admission to the institution, a treatment plan and record of treatment rendered, condition on discharge or transfer to another facility, and instructions relative to necessary aftercare that are given to the patient or family. 7. Each patient is admitted on the authority of and diagnosed by a member of the professional staff and is assigned to one or several group counseling sessions that meet regularly -- mostly in night sessions for those - 40 - ''9. 10. ll. 12. occupied during work hours, but in day sessions for those unemployed or unemployable because of alcohol problems. Arrangements can also be made for irregular, unscheduled sessions, including individual counseling sessions. Each group is designed to meet a specific need through a specified type of treatment, supplemented, if required, by medical care prescribed and administered under medical supervision in other branches of the hospital. Family counseling and/or other approaches designed to motivate patients and family members to use suitable community support services and facilities for long-range rehabilitation are generally available. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as detoxification centers, inpatient and residential care facilities, community mental health centers, and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. Limited meal service or lunch facilities are provided for patient use. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 41 - ''13. FREESTANDING OUTPATIENT ALCOHOLISM CLINIC Definition An institution located in a freestanding facility that provides -- through an organized staff of health care professionals and/or alcoholism counselors and permanent facilities -- limited medical care services and alcoholism treatment services for patients and their families who have problems related to the use of alcohol, but whose physical and emotional status allows them to function in their usual environment without inpatient or residential care. Essential Characteristics for Classfication Le 3. The primary function of the institution is to provide a variety of diagnostic and alcoholism treatment services for patients and all relevant family members both on a scheduled and a nonscheduled basis in a nonresidential setting. The institution has permanent facilities and maintains regularly scheduled hours during which services are provided by a staff that includes alcoholism counselors and other counselors and may include health care professionals on staff or for consultation. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized staff of alcoholism counselors and/or health care professionals to whom the governing authority delegates responsibility for maintaining proper standards of care. A record is made and maintained for each patient, including date of admission, source of referral (if known), and admission authority, pertinent history of the current condition including details of care rendered to the patient elsewhere prior to admission to the institution and a medical assessment (if required), a treatment plan and record of treatment rendered, condition on discharge or transfer to another facility, and instructions relative to necessary aftercare that are given to the patient or family. Counselors and/or health care professionals prepare a social/psychological assessment of each patient, and assign him or her to one or several group = Qi ''9. 10. 11. 12. counseling sessions that meet regularly -- mostly in night sessions for those occupied during work hours and in day sessions for those unemployed or unemployable because of alcohol problems. Arrangements can also be made for irregular, unscheduled sessions, including individual counseling sessions. Each regular group is designed to meet a specific therapeutic need through a specified type of treatment, supplemented, if required, by medical care prescribed and administered under affiliative agreements with appropriate institutions, programs, or individuals. Family counseling and/or other approaches designed to motivate patients and family members to use suitable community support services and facilities for long-range rehabilitation are generally available. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as detoxification centers, inpatient and residential care facilities, community mental health centers and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. Limited meal service or lunch facilities are provided for patient use. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 43 - ''14. COMMUNITY MENTAL HEALTH CENTER Definition An institution that provides comprehensive treatment and rehabilitation services, including inpatient care, outpatient care, partial hospitalization services, emergency care, court screening, followup, and transitional halfway house services to patients with emotional problems, with major emphasis on providing care in the least restrictive setting to a prescribed community population -- including patients who have problems related to the use of alcohol whose physical and emotional status allows them to function in their usual environment without inpatient or residential care. Essential Characteristics for Classification Le 7. Among its primary functions, the institution provides treatment in a nonresidential setting to patients afflicted with alcohol-related problems and to relevant members of their family both on a scheduled and a nonscheduled basis. The institution has permanent facilities and maintains regularly scheduled hours during which services are provided by a staff of health care professionals, which may include alcoholism counselors, other counselors, and support staff. There is a governing authority legally responsible for the conduct of the institution. There is an administrator to whom the governing authority delegates the full-time responsibility for the operation of the institution in accordance with established policy. There is an organized professional staff to whom the governing authority delegates responsibility for maintaining proper standards of care. Each patient is admitted on the authority of, and his care is under the direction of, a health care professional who is a member of the professional staff. Alcoholism counselors and/or other counselors are available on a full-time, permanent basis, and supervision and services by health care professionals appropriate to the functions of the institution are continuously available during the regularly scheduled hours. -~ 44 = ''8. A written record is maintained detailing analysis performed, treatment plan, treatment rendered, progress during the course of treatment, and referrals made for medical, psychiatric, or other services not available at the institution. 9. There is appropriate control of the storage and dispensing of narcotic drugs and other medications, if any. 10. Family counseling and/or other approaches designed to motivate patients and family members to use suitable community support services and facilities for long-range rehabilitation are generally available. 1l. The institution coordinates its program with the alcoholism programs of other organizations operating in the vicinity such as detoxification centers, inpatient and residential care facilities, community mental health centers, and Veterans Administration hospitals, of voluntary programs such as the Salvation Army, and with self-help groups such as Alcoholics Anonymous, Al-Anon, and Alateen. 12. Limited meal service or lunch facilities, if required, are provided for patient use. 13. There is documentation verifying that the institution meets licensing laws and regulations, if required. - 45 - ''REFERENCES Allen, H. E.; Carlson, E. W.; Parks, E. C.; and Seiter, R. P. Halfway Houses. Program Models. Washington, DC: U. S. Dept. of Justice, National Institute of Law Enforcement and Criminal Justice, November 1978. p. 15. American Hospital Association. Classification of Health Care Institutions. 1974 Edition. Chicago: AHA, 1974. Borkman, T. 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New York: Human Sciences Press, 1980. Stedman's Medical Dictionary: Illustrated. 22d ed. Baltimore: Williams & Wilkins, 1972. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. International Classification of Diseases, Vol. 1. Geneva: WHO, 1977. (ICD/9). - 47 - wrU.8. GOVERNMENT PRINTING OFFICE: 1984 421 166 4334 '''''''''' DHHS Publication No. Printed 1984 (ADM) 84-1324 ''€046903596e2 ''''