<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.21.29.07" title_num="10" subtitle_num="21" chapter_num="29" heading="Rehabilitation and Support Services Provided.">
  <paragraph num="A.">
    <text>PRP services may only be provided to a minor if identified in the minor's IRP and referred for PRP services by:</text>
    <paragraph num="(1)">
      <text>A licensed mental health professional who is providing inpatient, residential treatment center, or outpatient mental health services to the minor; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Staff who have been privileged by the program to provide the services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Rehabilitation Activities. The program director shall ensure that the program provides rehabilitation activities directed toward the development or restoration of skills including:</text>
    <paragraph num="(1)">
      <text>Age-appropriate self care skills, including:</text>
      <paragraph num="(a)">
        <text>Personal hygiene;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Grooming;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Nutrition;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Dietary planning;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Food preparation; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Self-administration of medication;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Social skills, including community integration activities, developing natural supports, and developing linkages with and supporting the minor's participation in community activities;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Independent living skills, including:</text>
      <paragraph num="(a)">
        <text>Maintenance of the minor's living environment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Community awareness;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Mobility skills;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Money management; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Accessing available entitlements;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Activities that support the minor's cultural interests;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Conflict resolution;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Anger management;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Interactive skills with peers and authority figures;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Maintaining personal living space;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Maintaining age-appropriate boundaries;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Maintaining personal safety in a social environment; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Time management, including constructive use of structured and unstructured time.</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:</text>
      <paragraph num="(a)">
        <text>Support the individual's self-administration, as appropriate, 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>Promotion of Illness Self Management.</text>
    <paragraph num="(1)">
      <text>As is age appropriate, staff shall provide education and information regarding mental illness.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The program director shall ensure that the minor's rehabilitation coordinator collaborates with the minor to identify effective strategies to assist the minor to manage the minor's illness.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The strategies identified under §D(2) shall include, at a minimum, the minor's identification of:</text>
      <paragraph num="(a)">
        <text>Potential problematic 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 individuals the minor identifies to resolve the situation in order for the minor to remain in service or to seek treatment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The minor's illness self management strategies shall be documented and may be incorporated in the minor's IRP, ITP, mental health advance directive, or any combination of them.</text>
    </paragraph>
    <paragraph num="(5)">
      <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 minor.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>On-Call and Emergency Response. The program director shall assure that:</text>
    <paragraph num="(1)">
      <text>On-call and emergency response services are available by a licensed mental health professional to an individual who has been admitted to the PRP:</text>
      <paragraph num="(a)">
        <text>Face-to-face during the hours that the PRP is open; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>By telephone, on an on-call basis, 24 hours per day, 7 days per week, during the hours the PRP is not open:</text>
        <paragraph num="(i)">
          <text>Through the PRP; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Through an agreement with another mental health crisis service provider;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>PRP staff provide to a minor:</text>
      <paragraph num="(a)">
        <text>Intensive support and assistance, as authorized, including but not limited to:</text>
        <paragraph num="(i)">
          <text>Providing one-to-one staff support for the minor, if necessary;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Escorting the minor while accessing needed assistance or services; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Obtaining input from the mental health professional who is providing outpatient mental health services to the minor;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Information regarding needed services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>If necessary, referral for appropriate health care.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>If emergency care is necessary, all relevant staff shall:</text>
    <paragraph num="(1)">
      <text>Have access to the names, addresses, and telephone numbers of providers, including the hospital, that are designated to provide emergency care and treatment to the minors served; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be appropriately trained to link minors to emergency care, as needed.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Linkage with a Minor in a Psychiatric Inpatient Facility, Residential Treatment Center (RTC), or Detention Center.</text>
    <paragraph num="(1)">
      <text>If a minor who is enrolled in a program is admitted to a psychiatric inpatient facility, RTC, or detention center, the rehabilitation coordinator shall make reasonable efforts to maintain ongoing communication with the minor and the minor's inpatient treatment team.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To the degree permitted by the setting, PRP staff serving the minor shall participate in aftercare or release planning from that setting.</text>
    </paragraph>
  </paragraph>
</regulation>