This All Facilities Letter (AFL) notifies all eligible acute psychiatric hospitals (APH) of the enactment of AB 1340 (Chapter 718, Statutes of 2014), which authorizes the establishment of pilot enhanced treatment programs (ETP) as a supplemental service of APHs operated by the Department of State Hospitals (DSH).

Effective July 1, 2015, and subject to available funding, APHs operated by DSH may establish and maintain pilot ETPs for the treatment of patients who are at high risk of most dangerous behavior, as defined, and when safe treatment within a standard treatment environment is not possible. The pilot ETPs will be used to evaluate the effectiveness of concentrated, evidence-based clinical therapy and treatment of patients in these units.

To be approved to offer a pilot ETP as a supplemental service, eligible APHs must apply to the California Department of Public Health (CDPH) Licensing and Certification Program (L&C). An ETP must meet all of the following requirements:

• Maintain a one to five staff-to-patient ratio. Staff, in this context, means licensed nurses and psychiatric technicians providing direct patient care.
• Limit each room to one patient.
• Allow visual access by staff 24 hours per day for each patient room.
• Provide a toilet and sink in each patient room.
• Provide capability to externally lock each patient room.
• Provide emergency egress for ETP patients.
• Follow all state licensing and regulations in the event seclusion or restraints are used.
• Assign to each ETP a full-time independent patients' rights advocate who provides patients' rights advocacy services.
• Adopt and implement policies and procedures necessary to encourage patient improvement, recovery, and a return to standard treatment environment, and create identifiable facility requirements and benchmarks.

CDPH may establish emergency regulations or issue additional All Facility Letters as needed to provide additional guidance on the operation of ETPs.

The information in this AFL is a brief summary of the changes that AB 1340 makes to the HSC. Facilities are responsible for following all applicable laws. CDPH's failure to expressly notify facilities of statutory or regulatory requirements does not relieve facilities of their responsibility for following all laws and regulations. Facilities should refer to the full text of all applicable sections of the Health and Safety Code and the Welfare and Institutions Code.

If you have any questions, please contact your respective L&C District Office.

Sincerely,

Original signed by Jean Iacino

Jean Iacino
Interim Deputy Director