 New Care, Treatment, and Services Chapter for Behavioral Health
The Joint Commission has revised and renamed the current Provision of Care chapter in the Behavioral Health manual. The new chapter will go into effect January 1, 2011 and will be titled the Care, Treatment, and Services chapter. To view the chapter on the TJC website clik on TJC Care, Treatment, and Services chapter.
According to Mary Cesare-Murphy, Ph.D., executive director for Behavioral Health Care Accreditation, "The new Care, Treatment, and Services chapter addresses many of the changes that have occurred in behavioral health care during the past several years." The new chapter aligns the standards with the wide array of programs and services now available in behavioral health care and also emphasizes the concept of recovery throughout the standards.
As you will see from the summary below, some of the changes to the standards will require changes to your assessment, treatment planning, and service delivery processes. In addition, organizations anticipating surveys in 2011 should pay particular attention to the new requirements and revisions to this chapter. Historically, standards in the Provision of Care chapter have been the top most frequently cited standards on Behavioral Health surveys. It is anticipated that this trend will continue with the new Care, Treatment, and Services chapter and that surveyors will be focusing their attention on the new requirements that go into effect in 2011.
Note: The standards in the Behavioral Health manual (including the new Care, Treatment, and Services chapter) apply to the following types of organizations and programs:
- Freestanding behavioral health organizations
- Partial Hospital programs with a census of 11 clients or more
- Intensive Outpatient programs with a census of 11 clients or more
- Residential treatment programs
- Opioid addiction treatment programs
- Foster care organizations/programs
- Transitional/supportive living programs
A summary of noteworthy changes in the new Care, Treatment, and Services chapter is as follows:
Physical Holding of Children and Youth
There are eleven new standards (CTS.05.05.01 through CTS.05.05.21) and 53 elements of performance that address the physical holding of a child/youth. By contrast, the current Provision of Care chapter has no standards related to physical holding. The only reference to physical holding is in the introduction to the restraint/seclusion standards which defines physical holding of a child for 30 minutes or less as an exception to the restraint/seclusion standards.
The new standards for physical holding of children/youth mirror many of the restraint/seclusion standards in that they require the following:
- Leaders must establish and communicate an organizational philosophy on physical holding.
- Staffing must be set to minimize circumstances that lead to physical holding.
- Staff must be trained to minimize the use of physical holding.
- The initial assessment must include information that would minimize the need for physical holding.
- Staff must be trained in the safe use of physical holding.
- A staff member not doing the hold must be assigned to observe the child's physical well-being.
- The physical hold must be documented in the clinical record.
- Physical holding must be limited to emergencies with imminent risk of harm to self or others.
- A debriefing must occur after each episode of physical holding.
- There must be written policies for physical holding that address all of the requirements listed above.
Time-Out
 There is a revised standard addressing the use of time-out (CTS.05.02.01). Instead of the term "time-out", the new standard uses the term "exclusionary time-out." Exclusionary time-out is not defined but this term typically refers to time-out interventions in which the individual is removed from the immediate environment and restricted to another environment.
The revisions emphasize the education of the individual regarding the conditions under which time-out is used. There is also a new element of performance which requires the organization to have written policies and procedures limiting the use of time-out and to implement these policies.
Restraint/Seclusion
There is a new requirement that the organization's philosophy on the use of restraint/seclusion must be communicated to the individual served (CTS.05.06.01 EP 3).
Psychiatric Advance Directives
There is a new standard regarding psychiatric advance directives (CTS.01.04.01). It applies to organizations that serve adults with serious mental illness and includes the following requirements:
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The organization must document whether the adult has a psychiatric advance directive.
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Upon request, the organization must share with the individual sources of help in formulating a psychiatric advance directive.
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Treating staff must be made aware of the psychiatric advance directive and how to access it.
Screening
There is more latitude in how an organization defines the need for educational, legal and vocational screenings. These screenings are now required to be done "as relevant to the needs preferences, interests, and goals of the individual served." (CTS.02.01.13 - CTS.02.01.17).
Assessment
What are currently two separate standards for psychosocial assessment and emotional/behavioral assessment have been combined into one standard regarding assessment (CTS.02.02.01). New elements to be included in the assessment include the following:
Trauma Assessment
There is a new requirement to identify individuals who have experienced trauma and to educate staff about trauma issues and assessment of trauma. (CTS.02.02.05).
Young Adults
 For organizations that provide service to young adults, there is a new requirement to assist young adults with their "life transitions" (CTS.06.03.01). This includes providing assistance with:Eating Disorders
There are new standards for eating disorder programs (CTS.02.03.09, CTS.04.02.17). These relate to assessment and ongoing clinical monitoring of individuals in these programs.
Outcomes
There is a new requirement for the organization to "evaluate the outcomes of care provided to the population it serves" (CTS.03.01.09). Note: this is in addition to evaluating the progress of the individual client.
Waiting Lists
There is a new requirement to have (and implement) a written procedure for waiting lists, if the organization has a waiting list. (CTS.01.02.01).
Outdoor/Wilderness Programs
There are new standards for outdoor/wilderness programs (CTS.02.01.07, CTS.04.03.23, CTS.04.03.25). These relate to histories and physicals at admission, staff competency and minimizing risks while providing care in these types of programs.
Animal Assisted Therapy
There is a new standard for organizations that provide animal assisted therapy (CTS.04.03.21). It relates primarily to staff training and safety while using animals in therapy.
Please contact Anne Barrins if you have any questions about how the the new requirements in the Care, Treatment, and Services chapter may affect your organization. | 
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