# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 26 — Community Mental Health Programs — Residential Crisis Services

#### Regulation .04 Program Model.

*COMAR 10.21.26.04*

A. A provider of RCS shall assure that services are:

  (1) Therapeutic;

  (2) Provided by staff who, as determined by the program, are appropriately credentialed and privileged;

  (3) Available:

    (a) 24 hours per day, 7 days per week;

    (b) On a short-term basis, as needed to resolve an immediate crisis; and

    (c) At a location in the community, unless given a written exemption from the core service agency (CSA).

B. A provider of RCS shall assure that services are adequate to support one or more of the following levels of service:

  (1) Inpatient admission prevention, which provides:

    (a) Services to an individual who, based on the individual's history, as evaluated by a physician or a mental health professional, has a mental disorder and, without RCS, is at risk for inpatient admission or cannot be discharged from an inpatient facility; and

    (b) Staff adequate to support the services under §B(1)(a) of this regulation, as outlined under Regulations .08 and .09 of this chapter;

  (2) Inpatient admission alternative, which provides:

    (a) Services to an individual who, based on an evaluation by a physician or a mental health professional, has a mental disorder, presents a danger to self or others, and would, without RCS, be admitted to or could not be discharged from an inpatient facility; and

    (b) Staff adequate to support the services under §B(2)(a) of this regulation, as outlined under Regulations .08 and .10 of this chapter, including access to a psychiatrist 24 hours per day, 7 days per week; or

  (3) Treatment foster care, which provides:

    (a) Services to an individual who, based on an evaluation by a physician or mental health professional, has a mental disorder, and is in need of a high level of treatment intervention in a family setting; and

    (b) Staff adequate to support services under §B(3)(a) of this regulation, as outlined under Regulations .08 and .11 of this chapter.

C. A provider of RCS shall assure that services are designed to:

  (1) Avert or shorten the length of inpatient admissions;

  (2) Defuse a current crisis, evaluate the nature of the crisis, stabilize the individual to the pre-crisis level of functioning, and intervene to reduce the likelihood of crisis recurrence;

  (3) Assist the individual and members of the individual's natural support system to recognize and take preventive action to resolve situations that lead to crisis;

  (4) Provide counseling, training, and support for crisis prevention, identification, and intervention for individuals and, if appropriate, their families;

  (5) Link individuals with services and supports in the community including, but not limited to, financial, educational, social, medical, and mental health resources that will enable the individual to:

    (a) Return to the individual's previous living situation; or

    (b) Secure an alternative living situation; and

  (6) Offer a home-like environment that provides goal-directed services to facilitate safe discharge from residential crisis services.

D. A provider of RCS shall assure that services are coordinated with, when appropriate:

  (1) An individual's custodial agents;

  (2) Designated psychiatric emergency facilities;

  (3) Psychiatric inpatient facilities;

  (4) Psychiatric rehabilitation programs;

  (5) Outpatient mental health clinics;

  (6) Somatic care providers;

  (7) Schools;

  (8) Other agencies involved with the individual, including, but not limited to:

    (a) Local departments of social services;

    (b) Department of Juvenile Services;

    (c) The local education authority;

    (d) The local coordinating council (LCC);

    (e) The local management board; and

    (f) Criminal justice agencies; and

  (9) Other public and private providers of mental health services to an individual.