Definitions

PURPOSE: This rule defines terms used in the certification of psychiatric and substance abuse programs. (1) The definitions included in this rule shall apply to: (A) 9 CSR 10-7 Core Rules for Psychiatric and Substance Abuse Programs; (B) 9 CSR 30-3 Certification Standards for Alcohol and Drug Abuse; and (C) 9 CSR 30-4 Certification Standards for Mental Health Programs. (2) Unless the context clearly indicates otherwise, the following terms shall mean: (A) Abstinence, the non-use of alcohol and other drugs; (B) Admission, entry into the treatment and rehabilitation process after an organization has determined an individual meets eligibility criteria for receiving its services; (C) Adolescent, a person between the ages of twelve through seventeen (12–17) years inclusive; (D) Agency, this term may be used interchangeably with organization. See the definition of organization; (E) Alcohol or drug-related traffic offense, an offense of driving while intoxicated, driving with excessive blood alcohol content, or driving under the influence of alcohol or drugs in violation of state law; (F) Alcohol or drug treatment and rehabilitation program, a program certified by the Department of Mental Health as providing treatment and rehabilitation of substance abuse in accordance with service and program requirements under 9 CSR 30-3.100 through 9 CSR 30-3.199; (G) Applicant, an organization seeking certification from the department under 9 CSR 30; (H) Assessment, systematically collecting information regarding the individual’s current situation, symptoms, status and background, and developing a treatment plan that identifies appropriate service delivery; (I) Associate substance abuse counselor, a trainee that must meet requirements for registration, supervision, and professional development as set forth by either— 1. The Missouri Substance Abuse Counselors Certification Board, Inc.; or 2. The appropriate board of professional registration within the Department of Economic Development for licensure as a psychologist, professional counselor, or social worker; (J) Certification, determination and recognition by the Department of Mental Health that an organization complies with applicable rules and standards of care under 9 CSR; (K) Client, this term may be used interchangeably with individual. See the definition of individual; (L) Clinical utilization review, a process of service authorization and/or review established by the department and conducted by credentialed staff in order to promote the delivery of services that are necessary, appropriate, likely to benefit the individual, and provided in accordance with admission criteria and service definitions; (M) Compulsive gambling, the chronic and progressive preoccupation with gambling and the urge to gamble. This term may be used interchangeably with pathological gambling; (N) Co-occurring disorders, presence of both substance and psychiatric disorders which impede the individual’s functioning or ability to manage daily activities, consistent with diagnostic criteria established in the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association; (O) Corporal punishment, purposeful infliction of physical pain upon an individual for punitive or disciplinary reasons; (P) Crisis, an event or time period for an individual characterized by substantial increase in symptoms, legal or medical problems, and/or loss of housing or employment or personal supports; (Q) Day, a calendar day unless specifically stated otherwise; (R) Deficiency, a condition, event or omission that does not comply with a certification rule; (S) Department, the Department of Mental Health; (T) Director, the Department of Mental Health director or designee; (U) Discharge, the time when an individual’s active involvement with the program concludes in accordance with treatment plan goals, any applicable utilization criteria, and/ or program rules; (V) Discharge planning, an activity to assist an individual’s further participation in services and supports in order to promote continued recovery upon completion of a program or level of care; (W) Facility, physical plant or site used to provide services; (X) Family/family members, persons who comprise a household or are otherwise related by marriage or ancestry and are being affected by the psychiatric or substance abuse problems of another member of the household or family; (Y) Improper clinical practices, performance or behavior which constitutes a repeated pattern of negligence or which constitutes a continuing pattern of violations of laws, rules, or regulations; (Z) Individual, a person/consumer/client receiving services from a program certified under 9 CSR 30; (AA) Least restrictive environment and set of services, a reasonably available setting or program where care, treatment, MENTAL HEALTH and rehabilitation is particularly suited to the type and intensity of services necessary to implement a person’s treatment plan and to assist the person in maximizing functioning and participating as freely as feasible in normal living activities, giving due consideration to the safety of the individual, other persons in the program, and the general public; (BB) Licensed independent practitioner, a person who is licensed by the state of Missouri to independently perform specified practices in the health care field; (CC) Medication, a drug prescribed by a physician or other legally authorized professional for the purpose of treating a medical condition; (DD) Medication (self-administration under staff observation), actions wherein an individual takes prescribed medication, including selection of the appropriate dose from a properly labeled container. The individual has primary responsibility for taking medication as prescribed, with the staff role to ensure client access to their personal medication in a timely manner and to observe clients as they select and ingest medication; (EE) Mental health, a broad term referring to disorders related to substance abuse, mental illness and/or developmental disability; (FF) Mental illness, impairment or disorder that impedes an individual’s functioning or ability to manage daily activities and otherwise meets eligibility criteria established by the Division of Comprehensive Psychiatric Services; (GG) Neglect (Class I), in accordance with 9 CSR 10-5.200; (HH) Neglect (Class II), in accordance with 9 CSR 10-5.200; (II) Nonresidential, service delivery by an organization that does not include overnight sleeping accommodations as a component of providing twenty-four (24) hour per day supervision and structure; (JJ) Organization, an agency that is incorporated and in good standing under the requirements of the Office of the Secretary of State of Missouri and that provides care, treatment or rehabilitation services to persons with mental illness or substance abuse; (KK) Outcome, a specific measurable result of services provided to an individual or identified target population; (LL) Peer support, mutual assistance in promoting recovery offered by other persons experiencing similar psychiatric or substance abuse challenges; (MM) Performance indicator, data used to measure the extent to which a treatment principle, expected outcome, or desired process has been achieved; (NN) Physical abuse, in accordance with 9 CSR 10-5.200; (OO) Primary diagnosis, a diagnosis of a mental illness, disability, or substance abuse disorder that is not due to a co-existing illness. A person with a primary diagnosis would still meet full criteria for that diagnosis in the absence of any co-existing disorder. A person may have several primary diagnoses, and a primary diagnosis is not necessarily the diagnosis causing the most severe impairment. (PP) Program, an array of services designed to achieve specific goals for an identified target population in accordance with designated procedures and practices; (QQ) Qualified mental health professional—any of the following: 1. A physician licensed under Missouri law to practice medicine or osteopathy and with training in mental health services or one (1) year of experience, under supervision, in treating problems related to mental illness or specialized training; 2. A psychiatrist, a physician licensed under Missouri law who has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program identified as equivalent by the department; 3. A psychologist licensed under Missouri law to practice psychology with specialized training in mental health services; 4. A professional counselor licensed under Missouri law to practice counseling and with specialized training in mental health services; 5. A clinical social worker licensed under Missouri law with a master’s degree in social work from an accredited program and with specialized training in mental health services; 6. A psychiatric nurse, a registered professional nurse licensed under Chapter 335, RSMo with at least two (2) years of experience in a psychiatric setting or a master’s degree in psychiatric nursing; 7. An individual possessing a master’s or doctorate degree in counseling and guidance, rehabilitation counseling and guidance, rehabilitation counseling, vocational counseling, psychology, pastoral counseling or family therapy or related field who has successfully completed a practicum or has one (1) year of experience under the supervision of a mental health professional; 8. An occupational therapist certified by the American Occupational Therapy Certification Board, registered in Missouri, has a bachelor’s degree and has completed a practicum in a psychiatric setting or has one (1) year of experience in a psychiatric setting, or has a master’s degree and has completed either a practicum in a psychiatric setting or has one (1) year of experience in a psychiatric setting; 9. An advanced practice nurse—as set forth in section 335.011, RSMo, a nurse who has had education beyond the basic nursing education and is certified by a nationally recognized professional organization as having a nursing specialty, or who meets criteria for advanced practice nurses established by the Board of Nursing; and 10. A psychiatric pharmacist as defined in 9 CSR 30-4.030; (RR) Qualified substance abuse professional, a person who demonstrates substantial knowledge and skill regarding substance abuse by being one (1) of the following: 1. A physician or qualified mental health professional licensed or provisionally licensed in Missouri; or 2. A person who is certified or registered as a substance abuse professional by the Missouri Credentialing Board; (SS) Quality improvement, an approach to the continuous study and improvement of the service delivery process and outcomes in order to effectively meet the needs of persons served; (TT) Recovery, continuing steps toward a positive state of health that includes stabilized symptoms of mental illness, substance abuse or both, meaningful and productive relationships and roles within the community, and a sense of personal well-being, independence, choice and responsibility to the fullest extent possible; (UU) Rehabilitation, a process of restoring a person’s ability to attain or maintain normal or optimum health or constructive activity by providing services and supports; (VV) Relapse, recurrence of substance abuse in an individual who has previously achieved and maintained abstinence for a significant period of time beyond detoxification; (WW) Relapse prevention, assisting individuals to identify and anticipate high risk situations for substance use, develop action steps to avoid or manage high risk situations, and maintain recovery; (XX) Research, in accordance with 9 CSR 60-1.010 this term is defined as experimentation or intervention with or on individuals, including behavioral or psychological research, biomedical research, and pharmacological research. Excluded are those instances where the manipulation or application is intended solely and explicitly for individual treatment of a condition, falls within the prerogative of accepted practice and is subject to appropriate quality assurance review. Also excluded are activities limited to program evaluation conducted by staff members as a regular part of their jobs, the collection or analysis of management information system data, archival research or the use of departmental statistics; (YY) Residential, service delivery by an organization that includes overnight sleeping accommodations as a component of providing twenty-four (24) hour per day supervision and structure; (ZZ) Restraint, restricting an individual’s ability to move by physical, chemical or mechanical methods in order to maintain safety when all other less restrictive interventions are inadequate; (AAA) Restraint (chemical), medication not prescribed to treat an individual’s medical condition and administered with the primary intent of restraining an individual who presents a likelihood of physical injury to self or others; (BBB) Restraint (mechanical), the use of any mechanical device that restricts the movement of an individual’s limbs or body and that cannot be easily removed by the person being restrained; (CCC) Restraint (physical), physically holding an individual and restricting freedom of movement to restrain temporarily for a period longer than ten (10) minutes an individual who presents a likelihood of physical injury to self or others; (DDD) Screening, the process in which a trained staff member gathers and evaluates relevant information through an initial telephone or face-to-face interview with a person seeking services in order to determine that services offered by the program are appropriate for the person; (EEE) Seclusion, placing an individual alone in a separate room with either a locked door or other method that prevents the individual from leaving the room; (FFF) Sentinel event, a serious event that triggers further investigation each time it occurs. It is typically an undesirable and rare event; (GGG) Service, the provision of prevention, care, treatment, or rehabilitation to persons affected by mental illness or substance abuse; (HHH) Sexual abuse, in accordance with 9 CSR 10-5.200; (III) Staff member/personnel, an employee of a certified organization or a person providing services on a contractual basis on behalf of the organization; (JJJ) Substance, alcohol or other drugs, or both; (KKK) Substance abuse, unless the context clearly indicates otherwise, a broad term referring to alcohol or other drug abuse or dependency in accordance with criteria established in the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association; (LLL) Supports, array of activities, resources, relationships and services designed to assist an individual’s integration into the community, participation in treatment, improved functioning, or recovery; (MMM) Treatment, application of planned procedures intended to accomplish a change in the cognitive or emotional conditions or the behavior of a person served consistent with generally recognized principles or practices in the mental health field; (NNN) Treatment plan, a document which sets forth individualized care, treatment, and rehabilitation goals and the specific methods to achieve these goals for persons affected by mental illness or substance abuse, and which details the individual’s treatment program as required by law, rules, and funding sources; (OOO) Treatment principle, basic precept or approach to promote the effectiveness of care, treatment and rehabilitation services and the dignity and involvement of persons served; and (PPP) Verbal abuse, in accordance with 9 CSR 10-5.200. (3) Singular terms include the plural and vice versa, unless the context clearly indicates otherwise. AUTHORITY: section 630.050, RSMo Supp. 2013, and section 630.055, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. Amended: Filed April 15, 2002, effective Nov. 30, 2002. Amended: Filed Aug. 31, 2006, effective April 30, 2007. Amended: Filed March 3, 2016, effective Oct. 30, 2016. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.055, RSMo 1980.