(a) Facilities providing adolescent residential services shall:
  (1) maintain separation between adults and adolescents;
  (2) have separate sleeping areas, bedrooms, and bathrooms for adults and adolescents, and for males and females;
  (3) provide access to education approved by the Texas Education Agency within three school days of admission when treatment is expected to last more than 14 days;
  (4) in addition to the service requirements set forth in §148.903(d)(3), provide five hours of planned, structured activities during evenings and weekends. Recreational and leisure activities shall be included in the structured time. The total number of hours of planned, structured activities must be at least 15. Attendance in school may be counted toward this requirement;
  (5) ensure the direct care staff-to-client ratio is at least 1:8 during waking hours (including program-sponsored activities away from the facility) and 1:16 during sleeping hours;
  (6) ensure clients are under direct supervision at all times. During sleeping hours, staff shall conduct and document hourly bed checks;
  (7) facilitate regular communication between an adolescent client and the client's family and shall not arbitrarily restrict any communications without clear individualized clinical justification documented in the client record; and
  (8) have written procedures addressing notification of parents or guardians in the event an adolescent leaves a residential program without authorization.
(b) Facilities providing outpatient services shall:
  (1) maintain separation between adults and adolescents; and
  (2) provide access to education approved by the Texas Education Agency within three school days of admission when treatment is expected to last more than 14 days, if required by law.
(c) Facilities providing day treatment shall provide at least 15 hours of services per week, comprised of at least:
  (1) one hour of individual counseling; and
  (2) 14 hours of additional counseling, chemical dependency education, life skills training, and relapse prevention education. Attendance in school may not be counted toward this requirement.
(d) All facilities shall:
  (1) ensure the program's treatment services, lectures, and written materials are age-appropriate and easily understood by clients;
  (2) involve the client's family or an alternate support system in the treatment process or document why this is not possible; and
  (3) develop and implement a mechanism to ensure that all direct care staff in adolescent programs have the knowledge, skills, and abilities to provide services to adolescents, as they relate to the individual's job duties. Providers must be able to demonstrate through documented training, credentials and/or experience that all direct care staff are proficient in areas pertaining to adolescent services, including but not limited to areas regarding:
    (A) chemical dependency problems specific to adolescent treatment;
    (B) appropriate treatment strategies, including family engagement strategies; and
    (C) emotional, developmental, and mental health issues for adolescents.
(e) Adolescent programs may serve children 13 to 17 years of age. However, young adults aged 18 to 21 may be admitted to an adolescent program when the screening process indicates the individual's needs, experiences, and behavior are similar to those of adolescent clients.
(f) Adult programs serve individuals 18 years of age or older. However, adolescents aged 17 may be admitted to an adult program when they are referred by the adult criminal justice system or when the screening process indicates the individual's needs, experiences, and behavior are similar to those of adult clients.
(g) Every exception to the general age requirements shall be clinically justified and documented and approved in writing by a QCC.

Source Note: The provisions of this §564.905 adopted to be effective September 1, 2004, 29 TexReg 2020; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; transferred effective April 30, 2024, as published in the Texas Register April 5, 2024, 49 TexReg 2197