(1) In addition to the requirements established in this subchapter, each outpatient crisis response facility shall comply with the requirements established in this rule. The outpatient crisis response facility shall require staff working in the facility:
(a) to be at least 18 years of age;
(b) possess a high school diploma or GED; and
(c) be capable of implementing each client's crisis facility treatment plan.
(2) The facility must ensure the program supervisor and all staff each have a minimum of six contact hours of annual training relating to the service and support needs of individuals with mental illness experiencing a crisis.
(3) The facility must orient direct care staff, prior to their contact with clients, on the following:
(a) the types of mental illness and treatment approaches;
(b) alcohol and drug intoxication treatment approaches;
(c) dependence and addiction treatment approaches;
(d) suicide risk assessment and prevention procedures; and
(e) program policies and procedures, including emergency procedures.
(4) The facility must orient staff within four weeks of employment on the following:
(a) therapeutic communications;
(b) legal responsibilities of mental health service providers;
(c) mental health and substance abuse laws of Montana relating to the rights of consumers;
(d) other services provided by mental health centers and substance abuse providers; and
(e) infection control and prevention of transmission of blood borne pathogens.
(5) The facility must annually train staff in the abdominal thrust maneuver and ensure staff maintain current certification in cardiopulmonary resuscitation (CPR) .
(6) The facility must maintain locked and secured storage for all medications kept on site.
(7) The facility must maintain 24-hour awake staff.
(8) The facility must maintain staff-to-patient ratio dictated by client need.
(9) The facility must establish admission criteria that assess the individual client's needs and the appropriateness of the services to meet those needs. At a minimum, admission criteria must require that the client:
(a) be at least 18 years of age;
(b) be medically stable, with the exception of the person's mental illness or serious mental illness with a co-occurring substance use disorder; and
(c) be in need of frequent observation on an ongoing basis.
(10) The facility must provide each client upon admission, or as soon as possible if not clinically appropriate upon admission with:
(a) a written statement of client rights which, at a minimum, includes the applicable patient rights in 53-21-142 , MCA;
(b) a copy of the crisis response facility grievance procedure; and
(c) the written rules of conduct including the consequences for violating the rules.
(11) The facility must ensure inpatient care is available through a transfer agreement for clients in need of a higher level of care.
(12) The facility must maintain progress notes for each client. The progress notes must be entered following the clinical intake assessment and updated by the end of each shift into the client's clinical record. The progress notes must describe the client's physical condition, mental status, and involvement in treatment services.
(13) The facility must make referrals for services that would help prevent or diminish future crises at the time of the client's discharge. Referrals include, but are not limited to, additional treatment or training or assistance such as securing housing.
(14) The program supervisor and program staff must be trained in the therapeutic de-escalation of crisis situations to ensure the protection and safety of clients and staff. The training must:
(a) include the use of physical and nonphysical methods of managing clients; and
(b) be updated at least annually to ensure that necessary skills are maintained.