<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.21.21.07" title_num="10" subtitle_num="21" chapter_num="21" heading="Rehabilitation and Support Services Provided.">
  <paragraph num="A.">
    <text>Rehabilitation and support services may only be provided:</text>
    <paragraph num="(1)">
      <text>To an individual consistent with the individual's IRP or ITRP; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>By staff who have been determined competent by the program to provide the services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Rehabilitation and Recovery Activities. The program director shall ensure that the program provides rehabilitation activities directed toward the individual's recovery and the improvement or restoration of skills, including:</text>
    <paragraph num="(1)">
      <text>Self-care skills, including personal hygiene, grooming, nutrition, dietary planning, food preparation, and self-administration of medication;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Social skills, including community integration activities, developing natural supports, and developing linkages with and supporting the individual's participation in community activities;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Independent living skills, including:</text>
      <paragraph num="(a)">
        <text>Skills necessary for housing stability;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Community awareness;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Mobility and transportation skills;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Money management;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Accessing available entitlements and resources;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Supporting the individual to obtain and retain employment; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Wellness self-management; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Activities that support the individual's cultural interests.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Medication Services.</text>
    <paragraph num="(1)">
      <text>Administration.</text>
      <paragraph num="(a)">
        <text>An individual licensed to administer medication under Health Occupations Article, Annotated Code of Maryland, may do so.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A licensed practical nurse or a registered nurse may delegate the administration of medication only according to the provisions of COMAR 10.27.11.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Monitoring. A PRP staff member shall provide the following services for psychiatric and somatic medications:</text>
      <paragraph num="(a)">
        <text>Support the individual's self-administration of prescribed medication;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Read the medication label to ensure that each container of medication is clearly labeled with the individual's name, the contents, directions for use, and expiration date;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>To the extent possible, monitor compliance with instructions appearing on the medication label;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Ensure that each individual has secure, appropriate, and accessible space in which to store medications;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Observe and document any apparent reactions to medication and, either verbally or in writing and in a timely fashion, communicate to the prescribing authority any problems that possibly may be related to the medication; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Reinforce, with the individual, education on the role and effects of medication in symptom management.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Health Promotion and Training. PRP staff shall encourage health promotion activities, such as proper nutrition and exercise.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Promotion of Individual Wellness Self Management and Recovery.</text>
    <paragraph num="(1)">
      <text>Staff shall:</text>
      <paragraph num="(a)">
        <text>Provide education and information regarding mental illness and recovery; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Support the individual to identify effective strategies to assist the individual to manage the individual's wellness.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The strategies shall include, at a minimum, the individual's identification of:</text>
      <paragraph num="(a)">
        <text>Potential challenging symptoms;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Warning signs of relapse;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Helpful interventions; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Other people the individual identifies to support the individual's recovery.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The individual's wellness self-management strategies shall be documented and may be incorporated in the individual's IRP, Residential Rehabilitation Program Managed Intervention Plan, as outlined in Regulation .08 of this chapter, mental health advance directive, or any combination of these items.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The strategies shall be reviewed at the time of the IRP review and may be revised or revoked at any time at the request of the individual.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>On-Call and Emergency Response. The program director shall assure that:</text>
    <paragraph num="(1)">
      <text>On-call and crisis intervention services are available 24 hours per day, 7 days per week, by telephone, to an individual who has been admitted to the PRP; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>All relevant staff shall assist the individual to access, as appropriate, the OMHC, mobile crisis, residential crisis services, hospitals, and other service providers that are designated to provide crisis and emergency care and treatment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Linkage with an Individual in a Psychiatric Inpatient Facility or Detention Center.</text>
    <paragraph num="(1)">
      <text>If an individual who is enrolled in a program is admitted to a psychiatric inpatient facility or detention center, the rehabilitation coordinator shall make reasonable efforts to maintain ongoing communication with the individual and the individual's inpatient treatment team.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To the degree permitted by the setting, PRP staff serving the individual shall participate in aftercare or release planning from that setting.</text>
    </paragraph>
  </paragraph>
</regulation>