Monitoring Residential Facilities
SAMHSA recently released two reports to help Federal
and state policymakers improve procedures for monitoring
the quality of care provided in residential facilities
for adults and children living with mental illness.
State
Regulation of Residential Facilities for Adults with
Mental Illness includes responses from officials
in 34 states and the District of Columbia who provided
information on 63 types of residential facilities. These
include 7,327 facilities that, in total, had 103,393
beds as of September 30, 2003.
State
Regulation of Residential Facilities for Children with
Mental Illness includes responses from officials
in 38 states who reported on 71 types of facilities.
These include 3,628 facilities that, in total, had 50,507
beds as of September 30, 2003.
Using a national survey of state officials, the two
reports present a systematic overview of the states’
regulatory methods.
The reports provide the most accurate national data
available concerning methods that states use to license,
regulate, and monitor residential facilities for children
and adults with mental illnesses.
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Background
Since deinstitutionalization of individuals with mental
illness began in the 1960s, residential facilities for
adults with mental illness have changed substantially.
They are now an important component of state mental health
service systems.
Despite their importance, little comprehensive information
exists on the policies and procedures used by states
to regulate residential treatment facilities for adults
and children with mental illnesses.
As a result, policymakers and program administrators
faced major difficulties in determining both the effectiveness
of current policies and the potential need for new policies
that are responsive to emerging trends in mental health
care.
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The Studies
To be included in the study, residential facilities
for adults and children with mental illness had to be
licensed or certified by the state as providers of therapeutic
services in addition to room and board.
In addition, officials in state departments of mental
health, social services, and health and human services
responded to a structured questionnaire on facility characteristics
and programs, licensing and oversight procedures, and
sources of financing.
The two studies found that states use a variety of methods
to monitor residential facilities for adults and children
with mental illness, and that states vary in the extent
to which they use one method or another.
Typical monitoring methods included onsite inspections,
documentation of staff training and qualifications, record
reviews, resident interviews, critical-incident reports,
standards for resident-to-staff ratios, and educational
levels of facility directors. All states used at least
several of these methods, but few states used all of
them.
The studies also found that the regulatory and monitoring
environment for residential facilities is complex. In
most states, several agencies, each with a different
mission and function, are involved in facility licensing,
funding, and oversight.
Copies of both reports are available online from SAMHSA’s
National Mental Health Information Center at www.mentalhealth.samhsa.gov
or by calling 1 (800) 789-2647 (English and Spanish)
or 1 (866) 889-2647 (TTY).
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Criteria for Residential Facilities
To be part of this study, “residential facilities”
all shared certain characteristics. They:
Specialize in the treatment of individuals with
serious emotional or behavioral disorders, including
those who are dually diagnosed (mental illness
and substance abuse or mental illness and developmental
disability) as long as mental illness was the primary
problem.
Are establishments that furnished (in single or
several facilities) food, shelter, and some treatment
or services to three or more persons unrelated
to the proprietor.
Provide staffing 24 hours per day, 7 days per
week.
Operate under a state authority, such as a state
office granting pertinent licenses or a state mental
health authority.
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Include 50 percent (minimum) of residents whose
need for placement was based on mental illness.
Include individuals with average stays of 30 days
or longer.
Provide at least some onsite therapeutic services
beyond housing (e.g., group therapy, individual
therapy, medication management) either by staff
or under contract.
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