Community Support in Comprehensive Substance Treatment and Rehabilitation (CSTAR) Programs

PURPOSE: This rule establishes the requirements for community support services provided in CSTAR programs. (1) Service Delivery. The CSTAR program shall establish an identifiable unit which coordinates and provides community support services for children, youth, families, and/or adults. The unit shall be organized to perform functions within the scope of community support services, including critical interventions. (2) Policies and Procedures. The CSTAR program shall implement policies and procedures to provide adequate, appropriate, and effective community support services to individuals. Policies and procedures shall include: (A) A mechanism to assure the provision of all needed substance use disorder treatment services, as indicated in the individual’s current treatment plan; (B) A mechanism to assure the provision of all needed services in addition to those provided by the CSTAR program, as indicated in the individual’s current treatment plan; (C) A method for assigning individuals to a community support specialist or team, including: 1. Procedures to assure each individual is afforded an opportunity to express preferences in the selection of a community support specialist; and 2. A mechanism to assure all individuals admitted who need community support are assigned to an active caseload of a community support specialist; (D) A process to assure an effective transfer and follow-up of an individual between or among community support specialists or community support teams. Staff shall document the rationale for the transfer, the individual’s acceptance, and follow-up by the community support specialist in the clinical record; (E) A process for determining overall increase or decrease in the level of functioning for individuals served through ongoing performance improvement activities; (F) A method to assure staff providing community support services in the CSTAR program have the opportunity to participate and contribute to the agency’s performance improvement process; (G) Development of suitable revisions to treatment goal(s) as indicated by growth or deterioration of individual functioning and/or condition; and (H) Program and aggregate evaluation activities to determine effectiveness of services delivered. (3) Staff Requirements. The CSTAR program shall ensure an adequate number of appropriately qualified staff are available to provide community support services and functions. (A) Qualified staff includes: 1. A qualified addiction professional (QAP) as defined in 9 CSR 10-7.140; 2. A qualified mental health professional (QMHP) as defined in 9 CSR 10-7.140; 3. An individual with a bachelor’s degree in a human services field which includes social work, psychology, nursing, education, criminal justice, recreational therapy, human development and family studies, counseling, child development, gerontology, sociology, human services, behavioral science, and rehabilitation counseling; 4. An individual with any four (4) year combination of higher education and qualifying experience; 5. An individual with any four (4) year degree and two (2) years of qualifying experience; 6. An individual with an Associate of Applied Science in Behavioral Health Support degree from an approved institution; or 7. An individual with four (4) years of qualifying experience. (B) Qualifying experience must include delivery of services to individuals with mental illness, substance use disorders, or developmental disabilities. Experience must include some combination of the following: 1. Providing one-on-one or group services with a rehabilitation/habilitation and recovery/resiliency focus; 2. Teaching and modeling for individuals how to cope and manage psychiatric, developmental, or substance use disorder issues while encouraging the use of natural resources; 3. Supporting individuals in their efforts to find and maintain employment and/or to function appropriately in family, school, and community settings; and 4. Assisting individuals to achieve the goals and objectives in their individual treatment plan. (C) It is the responsibility of the CSTAR program to document how staff meet the qualifications based on the criteria in subsections (3)(A) and (3)(B) of this rule. (D) Community support specialists must also complete orientation and training required by the department. (E) Community support specialists must be supervised by— 1. A qualified addiction professional (QAP); 2. A qualified mental health professional (QMHP); 3. Staff possessing a Master’s degree in a behavioral health or related field who has completed a practicum or has one (1) year of experience in a behavioral health field; or 4. Staff who meet the qualifications of a community support specialist with at least three (3) years of populationspecific experience providing community support services in accordance with the key service functions specified in paragraphs (5)(B)1. to 8. of this rule. (F) Community support supervisors who are not a QAP or QMHP must be supervised by a QAP or QMHP. (4) Monitoring. To the extent the individual is able to participate, periodic observation and monitoring shall take place in his/ her home or other community location as stipulated in the individual treatment plan. (A) Observation and monitoring shall be documented including, but not limited to: 1. Assessment of the individual’s mental health status and/ or substance use; 2. Safety and home care; and 3. Functional abilities and skill transference related to activities of daily living including educating, demonstrating, observing, and practicing skills in his/her environment. (5) Service Delivery. Community support is a comprehensive service designed to reduce the individual’s disability resulting from a mental illness, emotional disorder, and/or substance use disorder and restore functional skills of daily living, principally by developing natural supports and solutionoriented interventions intended to achieve recovery/resiliency as identified in the goals and/or objectives in the individual treatment plan. (A) This service may be provided to the individual’s family/ natural supports when such services are for the direct benefit of the individual served, in accordance with the needs and goals identified in the treatment plan, to assist in the individual’s recovery/resiliency. Most contact occurs in community locations where the individual lives, works, attends school, and/or socializes. (B) Key service functions of community support shall include, but are not limited to: 1. Developing recovery goals and identifying needs, strengths, skills, resources, and supports and teaching individuals how to use them to support recovery, identifying barriers to recovery, and assisting individuals in the development and implementation of plans to overcome them; 2. Helping individuals restore skills and resources negatively impacted by their substance use disorder and/or co-occurring mental illness or emotional disorder including, but not limited to: A. Seeking or successfully maintaining employment or volunteering including, but not limited to, communication, personal hygiene and dress, time management, capacity to follow directions, planning transportation, managing symptoms/cravings, learning appropriate work habits, and identifying behaviors that interfere with work performance; B. Maintaining success in school including, but not limited to, communication with teachers, personal hygiene and dress, age appropriate time management, capacity to follow directions and carry out school assignments, appropriate study habits, and identifying and addressing behaviors that interfere with school performance; and C. Obtaining and maintaining housing in the least restrictive setting including, but not limited to, issues related to nutrition, meal preparation, and personal responsibility; 3. Supporting and assisting individuals in a crisis to access needed treatment services to resolve the crisis; 4. Continuing recovery planning and discharge planning with individuals who are hospitalized for a medical or behavioral health condition; 5. Assisting individuals, other natural supports, and referral sources in identifying risk factors related to relapse in mental illness and/or substance use disorders, developing strategies to prevent relapse, and advising and otherwise assisting individuals in implementing those strategies; 6. Promoting the development of positive support systems by providing information to family members/natural supports, as appropriate, regarding mental illness, emotional disorders, and/or substance use disorders and ways they can be of support to their family member’s recovery. Such activities must be directed toward the primary well-being and benefit of the individual served; 7. Developing and advising individuals on implementing lifestyle changes needed to cope with the side effects of psychotropic medications and/or to promote recovery/ resiliency from the disabilities, negative symptoms, and/or functional deficits associated with a mental illness, emotional disorder, and/or substance use disorder; and 8. Advising individuals on maintaining a healthy lifestyle including, but not limited to, recognizing the physical and psychological signs of stress, creating a self-defined daily routine that includes adequate sleep and rest, walking or exercise and appropriate levels of activity and productivity, involvement in creative or structured activities that counteract negative stress responses, learning to assume personal responsibility and care for minor illnesses, and knowing when professional medical attention is needed. (6) Documentation. Documentation must be maintained in the individual record for each community support session, service, or activity in accordance with 9 CSR 10-7.030(13). The following must also be documented: (A) Phone contacts; and/or (B) Pertinent/significant information reported by family members/natural supports regarding a change in the individual’s condition and/or an unusual or unexpected occurrence in his/her life. AUTHORITY: sections 630.050, 630.655, and 631.010, RSMo 2016.* Original rule filed May 28, 2021, effective Dec. 30, 2021. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 631.010, RSMo 1980.