DHS 75.59(16)(a)3.3. Ensure that a patient has ready access to clinical staff, particularly to the patient’s primary counselor. DHS 75.59(16)(a)4.4. Ensure that clinical staff are adequately trained and are sensitive to gender- and culture-specific issues. DHS 75.59(16)(a)5.5. Provide services that incorporate evidence based practice standards for substance use treatment. DHS 75.59(16)(a)6.6. Ensure that patients receive adequate doses of medication based on their individual needs. DHS 75.59(16)(a)7.7. Ensure that all clinical staff are accepting of medication-assisted treatment. DHS 75.59(16)(a)8.8. Ensure that patients understand that they are responsible for complying with all aspects of their treatment, including participating in counseling sessions. DHS 75.59(16)(b)(b) Effort to retain patients. Since treatment duration and retention are directly correlated to rehabilitation success, a service shall make a concerted effort to retain patients within the first year following admission. Evidence of this concerted effort shall include written documentation of all of the following: DHS 75.59(16)(b)4.4. Whether continued treatment is medically necessary in the professional judgement of the service physician. DHS 75.59(16)(c)(c) Referral for further treatment. A service shall refer a patient discharged from the service to a more suitable treatment modality when further treatment is required or is requested by the patient and cannot be provided by the service. DHS 75.59(17)(17) Multiple substance use and co-occurring treatment. DHS 75.59(17)(a)(a) Assessment. A service shall assess a prospective patient for admission during the admission process to distinguish substance use, abuse and dependence, and determine patterns of other substance use and self-reported etiologies, including non-prescription, non-therapeutic and prescribed therapeutic use and mental health problems. DHS 75.59(17)(b)1.1. A service shall provide a variety of services that support cessation by a patient of alcohol and prescription and non-prescription substance use as the desired goal. DHS 75.59(17)(b)2.2. Service objectives shall indicate that abstinence by a patient from alcohol and prescription and non-prescription substance use should extend for increasing periods, progress toward long-term abstinence and be associated with improved life functioning and well-being. DHS 75.59(17)(b)3.3. Service staff shall instruct multiple substance use patients about their vulnerabilities to cross-tolerance, drug-to-drug interaction and potentiation and the risk of dependency substitution associated with self-medication. DHS 75.59(17)(c)1.1. A service shall have the ability to provide concurrent treatment for a patient diagnosed with both a mental health disorder and a substance use disorder. The service shall arrange for coordination of treatment options and for provision of a continuum of care across the boundaries of physical sites, services and outside treatment referral sources. DHS 75.59(17)(c)2.2. When a co-occurring disorder exists, a service shall develop with the patient a treatment plan that integrates measures for treating all alcohol, drug and mental health problems. For the treatment of a patient with co-occurring disorders, the service shall arrange for a mental health professional to help develop the treatment plan and provide ongoing treatment services. The mental health professional shall be available either as an employee of the service or through a written agreement. The mental health professional shall complete a mental health assessment within 3 business days of admission. DHS 75.59(18)(18) Pregnancy. Each OTP shall have written procedures for pregnant patients including the following minimum standards: DHS 75.59(18)(a)(a) Risks. A requirement that each patient admitted to the OTP be informed of the possible risks to herself or to her unborn child from the use of medication-assisted treatment, and be informed that abrupt withdrawal from these medications may adversely affect the unborn child. DHS 75.59(18)(b)(b) Medication-assisted treatment. A requirement that a pregnant patient who has a documented past opioid dependency and who may be in direct jeopardy of returning to opioid dependency with all of its attendant dangers during pregnancy, be informed that they may be placed on a medication-assisted treatment regimen. The service shall also provide a statement that for such pregnant women, evidence of current physiological dependence on opioid drugs is not needed if the medical director or other authorized program physician certifies the pregnancy, determines and documents that the woman may resort to the use of opioid drugs, and determines that medication-assisted treatment is justified in their clinical opinion. DHS 75.59(18)(c)(c) Approval of admission. A requirement that the admission of each pregnant patient to an OTP be approved by the medical director or other authorized program physician prior to admitting the patient to the program. DHS 75.59(18)(d)(d) Coordination of care. A requirement that OTPs develop a form for release of information between themselves and the healthcare provider in care of obstetrical care. This voluntary form should be offered to all pregnant patients for coordination of medical care. DHS 75.59(18)(e)(e) Education. A requirement that each pregnant patient be given education on recognizing the symptoms of neonatal abstinence syndrome near the time of delivery.