이 공지에 대해 정의된 댓글 포럼이 없습니다.

The purpose of this notice is to request comments from interested stakeholders on an initial draft of revisions to 12VAC35-210, following a periodic review.

Comments may be submitted to Name: Ruth Anne Walker, Title: Regulatory Coordinator, Address: PO Box 1797, City: Richmond, State: Virginia, Zip: 23218-1797, Telephone: (804) 225-2252, FAX: (804) 786-8623, email address: ruthanne.walker@dbhds.virginia.gov.

Comments must include the commenter's name and address (physical or email) information in order to receive a response to the comment from the agency. Following the close of the comment period, a report the comments received will be posted on the Town Hall.

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

DRAFT as Result of Periodic Review

CHAPTER 210
REGULATIONS TO GOVERN TEMPORARY LEAVE FROM STATE MENTAL HEALTH AND STATE MENTAL RETARDATION FACILITIES

12VAC35-210-10. 권한 및 적용 가능성.

This regulation is adopted pursuant to § 37.2-837 B of the Code of Virginia to establish a process to facilitate community integration and the conditions for granting a trial or home visit to individuals admitted to state hospitals or training centers operated by the Department of Mental Behavioral Health, Mental Retardation and Substance Abuse Developmental Services.

This regulation shall not apply to individuals receiving services in a facility who are committed pursuant to Chapter 9 (§ 37.2-900 et seq.) of Title 37.2, Title 19.2 or Title 53.1 of the Code of Virginia.

12VAC35-210-20. 정의.

The following words or terms when used in this regulation shall have the following meanings unless the context clearly indicates otherwise:

"Authorized representative" or "AR" means a person permitted by law or the State Mental Health, Mental Retardation, and Substance Abuse Services Board's regulations this chapter to authorize the disclosure of information; to or consent to treatment and services, or participation in human research; and to authorize the disclosure of information on behalf of an individual who lacks the mental capacity to make these decisions. The decision-making authority of an authorized representative recognized or designated under this chapter is limited to decisions pertaining to the designating provider. Legal guardians, attorneys-in-fact, or health care agents appointed pursuant to § 54.1-2983 of the Code of Virginia may have decision-making authority beyond such provider.

"Community services board" or “CSB” means the public body established pursuant to § 37.2-501 of the Code of Virginia that provides mental health, mental retardation developmental, and substance abuse services to individuals within each city or county that established it; the term “community services board” shall include administrative policy community services boards, operating community service boards, and local government departments with policy-advisory community services boards. For the purpose of these regulations, community services board also includes a behavioral health authority established pursuant to § 37.2-602 of the Code of Virginia.

"일일 출입증(" )은 직원 동반 없이 국가 시설에서 허가받은 출입을 의미하며, 일반적으로 낮 시간대에 이루어지며 밤을 넘기지 않습니다.

"부서" 는 정신 건강, 정신 지체 및 약물 남용 발달 서비스 부서를 의미합니다.

"Family visit" means an authorized overnight absence from a state hospital or training center that allows an individual to spend time with family members, an authorized representative, or other responsible person or persons.

"개인별 서비스 계획(" )은 주립 병원 또는 훈련 센터에서 서비스를 받고 있는 사람을 의미합니다. 이 용어에는 다음 용어가 포함됩니다: "소비자," " 환자," " 거주자," 및 "고객."

"Individualized services plan" or "ISP" means a comprehensive and regularly updated written plan that includes but is not limited to an describes the individual's needs, the measurable goals and objectives to address those needs, and strategies to reach the individual’s goals.  An ISP is person-centered, empowers the individual, and is designed to meet the needs and preferences of the individual. The ISP is developed through a partnership between the individual and the provider and includes an individual's treatment plan, functional plan, habilitation plan, person-centered plan, or plan of care that meets the needs and preferences of an individual and describes the measurable goals, objectives, and expected outcomes. 

"실종자(" )란 특정 시간과 장소에 있어야 할 사람이 실제로 그곳에 존재하지 않으며, 그 부재의 원인이 확인되거나 설명되지 않은 개인을 의미합니다.

"Responsible person" means an individual's parent, legal guardian, relative, friend, or other person whom the facility director determines is capable of providing the individual with the needed care and supervision, and if the individual has an AR for whom the AR has given written consent to supervise the individual during temporary leave from the state facility. The responsible person has responsibility for the care, custody or control of an incapacitated person by operation of law or has assumed such responsibility voluntarily, by contract, or in fact.

"State facility" or "facility" means a hospital or training center operated by the department for the care and treatment of individuals with mental illness or mental retardation intellectual disability.

"시험 방문(" )은 개인의 퇴원 준비 상태를 평가하기 위해 직원 동반 없이 주 정부 시설에서 허가된 1박 2일 간의 일시적 퇴소를 의미합니다. 시험 방문에는 특별 입원, 시설 주최 여름 캠프 또는 직원 감독이 포함된 기타 시설 주최 활동이 포함되지 않습니다.

12VAC35-210-30. 임시 휴직에 대한 일반적인 요건.

A. 국가 시설의 책임자는 다음 유형의 시설 내 일시적 휴직을 승인하고 시행하기 위한 서면 운영 정책 및 절차를 수립하여야 한다:

1. 일일 이용권 (밤을 넘기지 않는 기간용)

2. Family visits and trial visits for a maximum of 28 consecutive days per episode for individuals in training centers; and

3. Family visits and trial visits for a maximum of 14 consecutive days per episode for individuals in state hospitals.

B. 모든 임시 휴가의 사유는 ISP에 문서화되어야 합니다. 이 문서에는 다음 내용이 포함되어야 합니다:

1. 특정 유형의 휴가를 부여하는 이유;

2. 개인에게 미치는 혜택;

3. How the individual participated in the decision-making related to temporary leave; and

4. How the leave addresses a specific objective or objectives outcome or outcomes in the individual's ISP; and

5. 시설 책임자 또는 그 대리인의 임시 휴가 승인 서명.

C. 휴가 중 책임자.

1. Adults and emancipated minors receiving services in state hospitals who are granted a day pass, family visit, or trial visit may be:

a. Placed in the care of a parent, spouse, relative, legal guardian, friend, or other person determined capable by facility director, or AR, a facility licensed by the department or other responsible person or persons; or

b. Authorized to leave the facility on his own recognizance, when, in the judgment of the individual and the facility director, this leave is appropriate.

2. Individuals in training centers and minors receiving services in any state hospital, who are granted a day pass, family visit, or trial visit shall be placed in the care of:

a. The parent, legal guardian, or LAR AR; or

b. Another relative, friend, or other responsible person or persons, or a facility licensed by the department with the prior written consent of the AR.

D. The state facility granting a trial or family visit to an individual shall not be liable for his expenses during the period of that visit. Expenses incurred by an individual during a trial visit or family visit shall be the responsibility of the person into whose care the individual is entrusted or the appropriate local department of social services of the county or city of which the individual at the time of his admission to the facility, as appropriate, pursuant to § 37.2-837 B of the Code of Virginia.

12VAC35-210-40. Day passes.

Each facility shall have specific policies for day passes that include:

1. Criteria for granting day passes;

2. Designation of staff members who are authorized to issue day passes; and

3. Any forms to be used by the facility regarding the issuance of day passes.

12VAC35-210-50. 체험 방문.

A. The facility and the CSB may arrange trial visits for the purpose of assessing an individual's readiness for discharge from the facility. These trial visits shall be planned during the regularly scheduled review of the ISP or at other times in collaboration with (i) the individual, (ii) the individual's family or AR or (iii) any other person or persons requested by the individual. When trial visits are used in conjunction with discharge planning, the state facility treatment team shall meet with the individual to discuss his preferences for residential settings and give due consideration to his expressed preferences. If the treatment team cannot reasonably accommodate the individual's preferences, a member of the treatment team shall meet with the individual to discuss the reasons for this determination and the options that are available to him. The treatment team shall document in the individual's record that it has met with the individual to consider his preferences and review the available options. All plans for trial visits shall be documented in the ISP and include consideration of the following:

1. 개인의 주거 환경에 대한 선호도; 및

2. The individual's essential support needs for support and supervision requirements.

B. 재판 방문 전에 시설은 해당 개인, CSB 및 관련 책임자와 협력하여 적절한 위기 대응을 보장하기 위한 비상 대응 계획을 수립해야 합니다.

12VAC35-210-60. Family visits.

A. Family visits may include visits with the individual's immediate or extended family, AR, friends, or other persons arranged by the family or AR.

1. Training centers shall plan family visits in collaboration with the individual, his family or AR, and when appropriate, the CSB;

2. State hospitals shall plan family visits in collaboration with the individual and his family or AR, and when appropriate, the CSB.

B. When planning family visits facilities shall:

1. Ensure all identified essential support needs are reviewed with the responsible person or persons;

2. 잠재적인 비상사태나 예기치 못한 사건에 대비하기 위한 계획을 수립하십시오;

2 .3. 방문이 해당 개인의 치료 또는 훈련 일정에 영향을 미치는지 고려하고 적절한 조치를 취하십시오; 그리고

3 .4. 개인의 의료적, 행동적, 정신과적 상태를 고려하십시오.

12VAC35-210-70. 필요한 승인 및 서류.

The facility shall not release individuals for day passes, trial visits, or family visits unless the required authorizations have been obtained and documentation is included in the individual's record.

12VAC35-210-80. Illness or injury occurring during a family or trial visit.

A. When a facility is notified that an individual is injured or ill and requires medical attention while on a day pass, trial, or family visit, the facility director or designee shall notify the (i) facility medical director, (ii) treatment team leader, (iii) risk manager, (iv) facility human rights advocate, and (iv) (v) the CSB. The facility director shall also ensure that all events are reported in accordance with department and facility policy and protocol for risk management.

B. 시설 책임자 또는 그 대리인은 CSB 또는 책임자와 협력하여 해당 개인의 평가 및 치료를 위한 적절한 장소를 선정하는 데 도움을 줄 수 있습니다. 시설 의료 책임자는 해당 개인을 평가하거나 치료하는 의사 및 기타 의료 인력과 상담할 수 있습니다. 그러나 해당 개인은 의료적으로 안정될 때까지 시설로 돌아갈 수 없습니다.

C. 자발적으로 국가 병원에 입원된 후 일시적으로 퇴원 중인 환자가 질병 또는 부상으로 인해 급성 병원 입원이 필요한 경우, 급성 치료 병원에서 퇴원 후에도 입원 기준을 계속 충족하는 경우 자발적으로 국가 병원으로 돌아갈 수 있습니다.

D. 개인이 국가 시설 병원에 법적으로 입원 조치된 경우, 해당 개인의 급성 치료 병원에서의 입원 기간이 국가 시설 병원에 대한 입원 조치 기간을 초과하는 경우, 해당 시설 병원은:

1. CSB와 협력하여 해당 개인을 퇴소시키십시오; 그리고

2. Notify the individual or his AR in writing of the discharge.

E. 시설이 일시적 휴직 중이던 개인이 사망했다는 통지를 받은 경우, 시설장 또는 그 대리인은:

1. Notify the appropriate facility and other department staff, including, the medical director, risk manager, treatment team leader, and human rights advocate;

2. 해당 CSB 및 AR에 통지하십시오.

3. 사망에 대한 적절한 서류를 부서 정책 및 절차에 따라 제출하십시오; 그리고

4. Notify the state medical examiner in writing of the death.

12VAC35-210-90. 훈련 센터로 돌아오지 않은 경우.

A. When an individual fails to return to a training center from any authorized day pass, family visit, or trial visit within two hours of the scheduled deadline, the facility director or designee shall contact the responsible person into whose care the individual was placed to determine the cause of the delay.

B. Upon the request of the responsible person, the facility director may extend the period of a family or trial visit for up to 72 hours beyond the time the individual was scheduled to return when:

1. 비상사태 또는 예기치 못한 사정으로 인해 해당 개인이 훈련 센터로 돌아가는 것이 지연됩니다; 그리고

2. 개인의 AR은 연장 동의에 동의합니다.

Extensions for emergency or unforeseen circumstances shall not be granted in advance of the family visit or trial visit.

C. If an individual does not return to the training center from a day pass, trial visit, or family visit within two hours of the established deadline for his return and the training center is unable to contact the responsible person into whose care the individual was placed, the facility director or designee may extend the period of the visit for up to 24 hours if, in his judgment, the extension is justified. During this period the facility shall continue efforts to contact the responsible person.

D. If an individual does not return to the training center and his absence cannot be accounted for or reasonably explained by the responsible person or a family member, he shall be classified as a missing person, and the facility shall follow the department's policies and procedures for management of individuals who are missing.

E. 긴급 상황이나 예기치 못한 사정이 발생하지 않아 해당 개인이 시설로 돌아가는 것을 방해하지 않는 경우, 그리고 책임자가 해당 개인을 예정된 일정대로 훈련 센터로 돌려보내는 것에 동의하지 않는 경우, 시설 책임자는 CSB에 연락하고 해당 개인을 퇴소시켜야 합니다. 퇴직 통지서는 해당 개인의 AR로 서면으로 발송되어야 합니다.

12VAC35-210-100. 병원으로 돌아가지 않는 경우.

A. When an individual fails to return to a state hospital from any authorized day pass, family visit, or trial visit within two hours of the scheduled deadline, the facility director or designee shall contact the responsible person into whose care the individual was placed to determine the cause of the delay.

B. 책임자의 요청이 있을 경우, 시설 책임자는 다음 경우에 해당될 때 해당 개인이 예정된 귀환 시간으로부터 최대 72 시간까지 방문 기간을 연장할 수 있습니다:

1. 비상사태 또는 예기치 못한 사정으로 인해 환자가 병원으로 돌아가는 것이 지연됩니다; 그리고

2. The individual or his AR agree to the extension.

Extensions for emergency or unforeseen circumstances shall not be granted in advance of the family visit or trial visit.

C. 개인이 시설로 돌아가기로 동의한 경우, 시설장 또는 그 대리인은 필요시 CSB 및 책임자와 협력하여 해당 개인의 귀환을 위한 조치를 지원할 수 있습니다.

D. If an individual is unwilling to return to the facility, the facility director or his designee shall contact the responsible person to determine whether continued hospitalization is appropriate or the individual should be discharged.

1. If there is no evidence that the individual meets the criteria for hospitalization then the facility shall discharge the individual in collaboration with the CSB.

2. If the individual has been legally committed to the hospital and the facility director determines that the individual may require further hospitalization and he currently meets commitment criteria, or that the individual cannot be located, the facility director shall:

a. 약속 주문이 유효한지 확인하십시오;

b. 해당 개인을 실종자로 분류하십시오;

c. Alert the CSB pursuant to the department's policies and procedures for managing of individuals who are missing from state facilities;

d. 버지니아 주법 § 37.2-834 에 따라 해당 개인의 송환을 위한 영장을 발부합니다.

e. 해당 개인이 시설로 돌아올 때 신체 검사를 실시하도록 조치하십시오.

3. If the individual is on voluntary status or the commitment order is no longer valid the facility director, after consulting with the appropriate clinical staff, shall:

a. 해당 개인을 퇴원시키십시오; 그리고

b. 해당 개인의 상태를 CSB에 통보하십시오.

F. 법적으로 해당 시설에 입소된 개인이 시설로 돌아가야 한다는 결정이 내려졌으나 해당 개인이 자발적으로 돌아가지 않을 경우, 시설장 또는 그 대리인은 다음과 같이 조치하여야 한다:

1. 버지니아 주법 § 37.2-834 에 따라 해당 개인의 송환을 위한 영장을 발부하고, 해당 병원으로 송환하도록 명령합니다.

2. 시험 방문이 취소되면 CSB에 연락하십시오.