SUBJECT: Residential Treatment Units (RTUs) and Day Treatment Programs | PAGE 1 OF 5 . |
NUMBER: 67-MNH-23 | |
ORC/OAC REFERENCE: ORC 5120.01 | SUPERSEDES: 67-MNH-23 dated 03/01/2022 |
RELATED ACA STANDARDS: 5-ACI-6A-38, 6A-39, 6C-12 | EFFECTIVE DATE: April 14, 2025 |
APPROVED:
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Ohio Revised Code 5120.01 authorizes the Director of the Department of Rehabilitation and Correction, as the executive head of the department, to direct the total operations and management of the department by establishing procedures as set forth in this policy.
The purpose of this policy is to establish procedures for residential treatment units (RTUs) and day treatment programs (DTPs).
This policy applies to all persons employed by the Ohio Department of Rehabilitation and Correction (ODRC), all contractors providing direct mental health and medical services to incarcerated persons (IPs), and all IPs confined in institutions operated by or as an agent of the ODRC.
The definitions for the terms below can be found at the top of the policies page on the ODRC Intranet.
It is the policy of the ODRC to maintain residential and day treatment units that are two levels of our Specialized Mental Health Units (SPMH) for each security level that addresses the more intensive mental health level of care needs for IPs than can be provided in a general population environment.
Description of Specialized Mental Health Unit (SPMH)
The mission of the SPMH is to provide a therapeutic treatment milieu for IPs who are unable to adequately take care of themselves as a result of mental illness and are unable to function in an outpatient level of care. The SPMH promotes an environment to facilitate stabilization, an optimal level of functioning, recovery efforts, and mental health care in the least restrictive environment possible. The SPMH shall provide individual treatment plans which will define the types and frequency of contacts with behavioral health staff for persons in the program, safe housing to meet therapeutic needs of the IP, and a transition plan upon discharge.
The referral, admission, treatment requirements, and discharge process are outlined in OCHC Protocol I-9, Residential Treatment Unit and Day Treatment Program Admission, Treatment, and Discharge. Admissions and discharges are approved by Behavioral Health Operations (BHO).
Residential Treatment Units (RTUs)
At the time of admission, an IP shall be assigned to a treatment track by the treatment team.
Acute Care Track:
For IPs with active/acute symptoms requiring short term treatment in a supportive environment.
OSC shall review those in this pathway every ninety (90) days for discharge readiness.
Chronic Care Track:
For IPs with chronic residual symptoms who are unable to function outside of a SPMH unit.
The RTU is a secure treatment environment that has a structured clinical program. Each RTU shall contain five (5) phases of care.
Phase 1 – Crisis and/or assessment.
Phase 2 –Focus on treatment and interventions; the IP is engaged in clinically based groups or individual interventions supplemented by Activity Therapist/Psychiatric Attendant groups (e.g., art activities, hygiene group, recreation groups, socials activities, etc.).
Phase 3 –IPs shall be actively engaged in treatment interventions and meaningful activities with most time being spent out of cell and in programming and treatment. Each IP shall be involved in ten (10) hours of structured and ten (10) hours of unstructured activity per week. Structured and unstructured activities shall be listed on the RTU schedule.
Phase 3 Chronic (3C) - After a period of at least six (6) months, an IP may be classified as a 3C as a result of a serious mental illness (SMI) that requires long term housing in a specialized setting. Programming for this population shall be focused on skill building and
socialization. Any unescorted privileges off-unit may be granted by the treatment team based upon documented clinical abilities.
Phase 4 - A transitional phase in which IPs are out-of-cell and able to move more freely within the unit, as well as leave the unit unescorted (based upon their security level).
Residential Treatment Unit Property, Recreation, Meals, and Housing Guidelines
IPs admitted to the RTU shall advance through the five (5) phases in accordance with their individualized treatment plan and/or behavior management plan.
The person’s clinical condition and behavior in the unit shall dictate the conditions of confinement, privilege status and RTU phase, not the security level.
The following grid outlines conditions for property, recreation, meals, and housing according to each RTU phase. Conditions may be modified during treatment team meetings as clinically appropriate and shall be documented in the electronic health record (EHR).
LEVEL | PROPERTY/ RECREATION | MEALS | HOUSING |
Phase 1: Crisis and Assessment Level | Property limited. Activities on unit. Staff-escort to off-unit services. | Meals served on unit in small groups unless clinically documented to eat in cell. | Single cells which are most visible and accessible to staff. (Cells nearest officer’s station or staff office when able.) Generally located on the first floor near the officer’s station. |
Phase 2: | Property allowances per treatment team. Recreation on unit and in RTU specific areas/times. Staff escorted to off- unit services. Access to outdoor recreation at minimum 3X/week. | Meals served on unit in small groups or staff- escorted to dining hall | Single-celled ; first floor when available. |
Phase 3 & 3C | Property dictated by the general population policy of similar security level. Staff escort for off-unit activities as determined by treatment team. Access to outdoor recreation at minimum 3x/week. | Staff-escort to dining hall. | Shall be double-celled unless contraindicated clinically or by security level. |
Phase 4: Transition to General Population Level or DTP | General population recreation and property privileges. Unescorted to off- unit activities. | Unescorted to institutional dining hall. | Shall be double-celled based on general population norm. |
MH persons being housed in the RTU on a disciplinary status. | Per the disciplinary restrictions and as clinically indicated | Meal served in cell | RTU phase 1-2 shall serve disciplinary sanctions on the RTU RTU phase 3-3C may serve disciplinary sanctions on the RTU if recommended by treatment team staff. RTU phase 4 shall serve disciplinary sanctions consistent with general population. |
Security Review of Incarcerated Persons in a Residential Treatment Unit
A person’s mental illness or treatment needs shall not be used to deny a reduction in security or to increase security level.
IPs assigned to the RTU shall have security reviews in accordance with ODRC Policy 53-CLS-01, Security Classification for Incarcerated Persons Levels 1 - 4. Special security review may be requested as clinically indicated for consideration of security level assessment.
Phases shall not be decreased due to rule infractions. The treatment team shall determine the RTU phase of each individual based on clinical presentation and functioning. Behaviors addressed by the EHR MH Treatment Plan (DRC5197) shall be addressed with interventions, (including but not limited to behavioral plans, group or individual programming addressing behavioral issues).
Day Treatment Program (DTP)
At the time of admission, an IP shall be assigned to a treatment track by the treatment team.
Acute Care Track:
For IPs with active/acute symptoms who require short term treatment in a supportive environment.
OSC shall review those in this track every ninety (90) days for discharge readiness.
Chronic Care Track:
For IPs who have chronic residual symptoms who are unable to function outside of the more supportive environment.
Day Treatment Unit Programming Guidelines
The DTP provides individual treatment plans for those in the program, supportive housing to meet their therapeutic needs, and a transition plan upon discharge.
Each DTP shall have a definite schedule and clinical programming based upon evidence-based practices.
Each DTP shall provide a higher frequency and/or intensity of behavioral health treatment than is available in the general population outpatient mental health.
Supervision and Review Procedures
The MHA/MHM and/or Psych Nurse Supervisor with an SPMH (RTU, DTP) shall conduct rounds in the SPMH at least one (1) time each week with no more than seven (7) days, excluding holidays, between rounds.
The RTU Coordinator shall be responsible for the initial and annual completion of the RTU Officer Training Aid (DRC5136). Completed training aids shall be submitted to the RBHA for review. The RBHA shall be responsible for ensuring the RTU Officer Training Aid is added to the post orders for each RTU.
The RTU Coordinator and/or shift supervisor shall be responsible for reviewing the RTU Officer Training Aid (DRC5136) with each Correction Officer assigned to the RTU or who provides
relief on the RTU at least once per calendar year and additionally as needed. This shall be documented in the electronic logbook by the officer.
Peer Support
IPs trained as peer supports shall be utilized in all SPMH units.
The security level of the SPMH Unit shall not prevent incarcerated peer supporters with a lower security level from providing services on SMPH units.
Release of Incarcerated Persons from SPMHs to the Community
Within twelve (12) months of release to the community from an SPMH, the treatment team shall attempt to engage family/support person(s) in the release planning process, minimally inclusive of allowing family members to participate in treatment team meetings (in person, by phone, virtually, etc.), educating the family/support person(s) about the diagnosis, treatment and support necessary for successful community transition. The engagement shall be individualized based upon the needs of the person and their family/support person(s). Documentation of the contact shall be documented in the EHR.
For IPs needing treatment/housing for intellectual and developmental disabilities, refer to ODRC Policy 67-MNH-22, Incarcerated Persons with Intellectual and Developmental Disabilities: Screening, Evaluation, Treatment and Reentry; and Protocol I-15, Sugarcreek Developmental Unit Operations.
Transportation
Transfer procedures shall follow ODRC Policy 67-MNH-04, Transfer and Discharge of the Mental Health Caseload.
I-9 Residential Treatment Unit and Day Treatment Program Admission, Treatment, and Discharge I-15 Sugar Creek Developmental Unit Operations
53-CLS-01 Security Classification for Incarcerated Persons Levels 1-4 67-MNH-04 Transfer and Discharge of the Mental Health Caseload
67-MNH-22 Incarcerated Persons with Intellectual and Developmental Disabilities
RTU Officer Training Aid DRC5136
Mental Health Treatment Plan DRC5197
