# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-02.1 — Clinically Managed Low-Intensity Residential Care - Adolescent ASAM Level III.1

### § 75-09.1-02.1-01. Definition.

As used in this chapter "clinically managed low-intensity residential care" means a substance
abuse treatment program that provides an ongoing therapeutic environment for clients requiring some
structured support in which treatment is directed toward applying recovery skills, preventing relapse,
improving emotional functioning, promoting personal responsibility, and reintegrating the client into the
world of work, education, and family life, adaptive skills that may not have been achieved or have been
diminished during the client's active addiction. Such programs must offer at least five hours per week of
low-intensity treatment, the focus of which will be on issues in ASAM dimensions four, five, and six, as
well as ASAM dimension three if appropriate mental health services are available onsite or by
contractual arrangement. Clinically managed low-intensity residential care is also designed for the
adolescent requiring extended treatment to sustain and further therapeutic gains made at a more
intensive level of care because of the client's functional deficits such as developmental immaturity,
greater than average susceptibility to peer influence, or lack of impulse control. This level is also
sometimes warranted as a substitute for or supplement to the deficits in the adolescent's recovery
environment such as chaotic home situation, drug-using caretakers or siblings, or a lack of daily
structured activities such as school. The residential component of clinically managed low-intensity
residential care may be combined with low-intensity outpatient, intensive outpatient, or day treatment.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02.1-02. Provider criteria.

1. A clinically managed low-intensity residential care program shall maintain a safe, comfortable,
alcohol-free, and drug-free environment.
2. A clinically managed low-intensity residential care program shall provide to clients a full meal
service that meets established nutritional guidelines.
3. A clinically managed low-intensity residential care program shall implement written referral
procedures and agreements with providers of services to enable clients to receive necessary
aftercare, other therapeutic services, vocational rehabilitation and educational instruction such
as general educational development preparation and literacy training and attendance at local
support groups for clients not having completed high school.
4. A clinically managed low-intensity residential care program shall provide to an adolescent still
enrolled in school onsite staff or onsite or offsite contractors for the provision of accredited
educational services or short-term educational services linked to home school designed to
maintain current learning.
5. A clinically managed low-intensity residential care program shall provide staff twenty-four
hours per day.

6. A clinically managed low-intensity residential care program shall offer a minimum of five hours
a week of professionally directed treatment in addition to other treatment services a client may
receive such as partial hospitalization or intensive outpatient treatment. Professionally directed
treatment must include two support or two group sessions a week.
7. A clinically managed low-intensity residential care program shall collaborate with care
providers to develop an individual treatment plan for each client with time-specific goals and
objectives.
8. A clinically managed low-intensity residential care program shall maintain a record of each
client's progress and activities in the program.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02.1-03. Program criteria.

1. A clinically managed low-intensity residential care program shall provide services designed to
improve a client's ability to structure and organize the tasks of daily living and recovery.
2. A clinically managed low-intensity residential care program shall provide educational and
informational programming to enhance client recovery.
3. A clinically managed low-intensity residential care program shall provide family and caregiver
treatment.
4. A clinically managed low-intensity residential care program shall provide activities to promote
a client's social skill development.
5. A clinically managed low-intensity residential care program shall provide to clients support
group meetings available onsite or transportation assistance to offsite support group meetings.
6. A clinically managed low-intensity residential care program shall provide transportation
assistance to clients so that they may use offsite rehabilitation services.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02.1-04. Admission criteria.

Before a clinically managed low-intensity residential care program may admit a client, the client
must:
1. Meet diagnostic criteria for a substance-related disorder of the DSM; and
2. Meet specifications in each of the six ASAM dimensions. Specifically, the client;
a. Must not be in need of detoxification from alcohol or drugs nor have any signs or
symptoms of withdrawal that cannot be safely managed by the program;
b. Must not have a physical condition or complication impacting immediate safety or
well-being requiring twenty-four-hour medical or nursing interventions and be capable of
self-administering any prescribed medications but has a biomedical condition that
distracts from recovery efforts and requires limited residential supervision to ensure
adequate treatment or to provide support to overcome the distraction; or continued

substance use would place the adolescent at risk of serious damage to the client's health
because of the biomedical condition or an imminently dangerous pattern of high-risk use;
c. Must not have an emotional, behavioral, or cognitive condition or complication that
impacts immediate safety or well-being requiring twenty-four-hour medical or nursing
interventions unless in a dual diagnosis program but does have problems in the areas of
dangerousness or lethality to self or others; interference with addiction recovery efforts;
social functioning; ability for self-care; or course of illness;
d. Must be at a stage of readiness to change in which the client requires limited
twenty-four-hour supervision to promote or sustain progress through the stages of
change and is cooperative and likely to engage in treatment at this level of care;
e. Is in danger of relapse because of a lack of monitoring or is in danger of relapse because
supervision between treatment encounters at a less intensive level of care has been a
major barrier to abstinence; recovery skills are not yet sufficient to overcome
environmental triggers such as peer pressure; or a history of chronic substance use,
repeated relapse, or resistance to treatment predicts continued use or relapse without
residential containment;
f. Has been living in an environment in which there is a high risk of neglect or initiation or
repetition of physical, sexual, or severe emotional abuse; has a family member or other
household member with an active substance use disorder; substance use is endemic in
the home environment; has a social network that is too chaotic or ineffective to support or
sustain treatment goals; or has logistical impediments such as distance from a treatment
facility or lack of transportation that precludes participation at a less intensive level of
care; and
g. Is able to cope for limited periods of time outside of the residential structure to pursue
clinical, vocational, educational, and community activities.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
