SECTION 353.306. Assessment

(a) The juvenile must meet the current DSM criteria for a substance use disorder in order to be eligible for admission to a treatment program. An assessment process appropriate for the target population, juvenile's age, developmental level, culture, and gender shall be used to determine if the juvenile is eligible for the treatment program.

(b) A provider shall conduct and document a comprehensive psychosocial assessment with each client admitted to the treatment program. Documentation shall reflect that the assessment process included consideration of each of the following areas:

(1) presenting problems resulting in admission;

(2) alcohol and other drug use;

(3) psychiatric and substance use treatment;

(4) medical history and current health status, to include an assessment of risk behaviors for tuberculosis, HIV, and other sexually transmitted infections, as permitted by law;

(5) relationships with family;

(6) significant life events, including any trauma;

(7) social and leisure activities;

(8) education and vocational training;

(9) employment history;

(10) legal problems;

(11) mental/emotional functioning; and

(12) strengths and weaknesses.

(c) A comprehensive diagnostic impression, including the client's problems, needs, and strengths, shall be prepared based on the results of the assessment.

(d) If the assessment identifies a previously unidentified mental health issue, the treatment program shall seek appropriate mental health services.

(e) The assessment shall be signed by a QCC and filed in the client record within seven calendar days of admission.

(f) The treatment program may accept an assessment from an outside source if:

(1) the assessment meets the criteria set forth herein;

(2) the assessment was completed during the 30 days preceding admission or is received directly from a treatment program that is transferring the client; and

(3) a provider reviews the information with the client and documents an update.

Source Note: The provisions of this §353.306 adopted to be effective October 1, 2021, 46 TexReg 6408