Standards for public agencies

2020 Edition

Residential Treatment Services (PA-RTX) 15: Substance Abuse Services

The agency provides coordinated substance use prevention, treatment, and recovery services based on the residents’ assessed needs and goals.
NA The agency does not provide substance use services.
2020 Edition




Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behavior, improve functioning and well-being, and return to a stable living arrangement in the community.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for communication/collaboration among team members
  • Criteria for determining the level of care
  • Procedures for providing detoxification services
No On-Site Evidence
  • Interviews may include:
    1. Clinical/Medical director
    2. Relevant personnel
    3. Residents
  • Review case records

Fundamental Practice

PA-RTX 15.01

A qualified team of health professionals, with experience, training, and competence in engaging, diagnosing, and treating persons with substance use disorders provide services, including:
  1. administering or reviewing diagnostic, toxicological, and other health related examinations;
  2. determining the optimal level and intensity of care, including clinical and community support services;
  3. evaluation for psychotropic medications and medication-assisted treatment;
  4. prescribing and managing medication, including appropriate management of pharmacotherapy for individuals with co-occurring conditions;
  5. review of complicated cases where co-occurring substance use, health, and mental health conditions intersect; and
  6. coordinating care with other service providers, including primary care and mental health providers, when appropriate and with the consent of the service recipient.


Element (c) does not apply to detoxification treatment programs.


PA-RTX 15.02

The agency directly provides a comprehensive range of prevention and treatment services, including:
  1. individual and group therapy;
  2. illness management and psychoeducation interventions;
  3. medication education;
  4. clinical monitoring and drug screening;
  5. coping skills training;
  6. relapse prevention;
  7. acute care; and
  8. support groups and self-help referrals.
Examples: Other prevention and treatment services may include detoxification, inpatient care, intensive outpatient care, medical care, psychiatric rehabilitation, and targeted case management services.


PA-RTX 15.03

Therapeutic services help residents develop the knowledge, skills, and supports necessary to:
  1. manage mental health and/or substance use disorders;
  2. develop and practice prosocial behaviors;
  3. cultivate and sustain positive, meaningful relationships with peers, family members, and the community;
  4. develop self-efficacy; and
  5. promote recovery, resilience, and whole-person wellness.


Recovery is a holistic process of change where individuals learn to overcome or manage their diagnosed symptoms and conditions in order to improve overall well-being and achieve optimal health.


PA-RTX 15.04

Residents and their families, when possible, are connected with peer support services appropriate to their request or need for service.
Examples: Peer support services can help to promote resiliency and recovery and are provided by individuals who have shared, lived experience. They can include peer recovery groups, peer-to-peer counseling, peer mentoring or coaching, family and youth peer support, or other consumer-run services.


PA-RTX 15.05

Qualified personnel determine the need for and appropriate level of detoxification care and treatment for the individual using diagnostic criteria according to clinical decision support tools.
NA The agency does not provide detoxification treatment.
Examples: Agencies can utilize clinical practical guidelines such as the American Society of Addiction Medicine (ASAM) criteria to determine the appropriate level of care.

Examples: Residential Detoxification programs reviewed can include programs that are:
  1. Clinically-Managed: Clinically-managed residential programs, also referred to as non-medical or social detox, emphasize peer and social support. Services are primarily provided by appropriately trained, non-medical personnel.
  2. Medically-Monitored: In medically-monitored residential/inpatient programs, 24-hour medically-supervised detoxification services are provided by an interdisciplinary staff under the direction of a licensed physician.
Note: COA does not accredit medically-managed intensive inpatient detoxification programs. Medically-managed programs involve 24-hour medically-directed evaluation and withdrawal management and require an appropriately trained and licensed physician to provide and manage all diagnostic and treatment services. Programs are provided in acute inpatient care settings, such as hospitals, and are specifically designed for individuals with symptoms that require primary medical and nursing care services.

Fundamental Practice

PA-RTX 15.06

Residents receive detoxification services provided by a qualified team of appropriately trained and licensed professionals, including:
  1. assessment and evaluation;
  2. stabilization; and
  3. preparation for entry into substance use treatment.
NA The agency does not provide detoxification treatment.
Examples: Staffing may vary depending on the intensity of the services offered. For example, agencies providing medically-monitored detoxification will typically employ an interdisciplinary staff of nurses, counselors, social workers, addiction specialists and/or other health and technical personnel, whom all work under the supervision of a licensed physician.