Psychosocial Rehabilitation (PSR) in Community Psychiatric Rehabilitation Programs

PURPOSE: This rule provides standards for PSR programs operated as part of a community psychiatric rehabilitation (CPR) program. (1) The Psychosocial Rehabilitation (PSR) program must be accredited by CARF International, The Joint Commission, Council on Accreditation, or other accrediting body recognized by the department. If the PSR program is not accredited, department licensure rules as specified in 9 CSR 40-1 and 9 CSR 40-9 shall apply, as applicable, until accreditation is obtained. (2) The community psychiatric rehabilitation (CPR) program shall provide or arrange transportation to and from the PSR site, and to/from various locations in the community, to provide individuals with opportunities for off-site training and rehabilitation in realistic settings. (3) Policies and procedures shall be implemented for intake screening, referral, and assignment of individuals eligible for services. (A) Intake policies and procedures shall define referral procedures to be followed for persons determined ineligible for PSR services. (B) The maximum wait time from an individual’s initial faceto-face contact with the PSR program to intake screening shall be ten (10) working days, or sooner, if clinically indicated. (C) The intake screening shall determine the individual’s need for PSR, functional strengths and weaknesses, and transportation needs. (D) PSR services shall be incorporated into the individual’s treatment plan within forty-five (45) days of admission to the program. (4) Policies and procedures shall ensure program staff document measurable progress for individuals engaged in key services. (A) Key services shall include, but are not limited to— 1. Training/rehabilitation in community living skills; 2. Development of personal support systems through a group modality; and 3. Prevocational training/rehabilitation provided directly by the program or through subcontract, including at a minimum— A. Interview and job application skills; B. Therapeutic work opportunities; and C. Temporary employment opportunities. (B) Documentation of key services must include— 1. A weekly note summarizing specific services rendered, the individual’s involvement in and response to the services, and relationship of the services to the treatment plan; 2. Pertinent information reported by family members or other natural supports regarding a change in the individual’s condition and/or an unusual or unexpected occurrence in his or her life; and 3. Daily attendance records, including each individual’s actual attendance time and the activity or session attended (this information does not need to be integrated into the individual record). Attendance records must be available to department staff and other authorized representatives for audit and monitoring purposes, upon request. (5) PSR services shall be structured and may occur during the day, evening, weekend, or a combination of these, to effectively address the rehabilitation needs of individuals served. Services and activities are not limited to the program location/site. (A) The program shall directly provide or ensure the following services available for individuals served: 1. Opportunities for training and rehabilitation in daily living skills, including activities associated with meal preparation and laundry, at a minimum; 2. Off-site training/rehabilitation in community living skills; and 3. Opportunities for family members/natural supports and advocates to participate in the planning, development, and evaluation of the PSR program. (6) PSR for Adults. Services are for adults who need ageappropriate, developmentally focused rehabilitation. A combination of goal-oriented and rehabilitative services shall be provided in a group setting to assist individuals in developing personal support systems, social skills, community living skills, and pre-vocational skills that promote community inclusion, integration, and independence. (A) Key service functions shall include, but are not limited to— 1. Screening to evaluate the appropriateness of the individual’s participation in PSR; 2. Addressing individualized program goals and objectives; 3. Enhancing independent living skills; 4. Addressing basic self-care skills; and 5. Enhancing use of personal support systems. (B) The director of the program must be a Qualified Mental Health Professional (QMHP) with two (2) years of relevant work experience. (C) All direct care staff must have a high school diploma or equivalent certificate. (D) Each day program shall have, as a minimum, a daily direct care staff ratio of one (1) staff person for each sixteen (16) individuals served (1:16) unless program needs or the needs of individuals being served require otherwise. (E) At least one (1) staff person must be on duty at all times when individuals enrolled in PSR are present at the program. (7) PSR for Children and Youth. A combination of goal-oriented and rehabilitative services shall be provided in a group setting to improve or maintain the child’s ability to function as independently as possible within their family and/or in the community. Services are provided according to the individual treatment plan, with an emphasis on community integration, independence, and resiliency. Hours of operation are determined by the program based on capacity, staffing availability, geography, and space requirements, but shall be no more than six (6) hours daily, per child. (A) The director must be a qualified mental health professional (QMHP) with two (2) years of experience working with children and youth. One (1) full-time mental health professional must be available during the provision of services. (B) Staffing ratios shall be based on the ages and needs of the children being served. For individuals aged eleven (11) and younger, the staffing ratio shall be one (1) staff to eight (8) participants (1:8). For individuals aged twelve (12) to seventeen (17), the staffing ratio shall be one (1) staff to ten (10) participants (1:10). (C) Other staff of the PSR team shall include the following, based on the needs of individuals served: 1. Registered nurse; 2. Occupational therapist; 3. Recreational therapist; 4. Rehabilitation therapist; 5. Community support specialist; 6. Certified family support provider; and 7. Certified peer specialist. (D) Key service functions shall include but are not limited to— 1. Assisting the child in gaining or regaining skills for community/family living such as personal hygiene, completing age-appropriate household chores, and family, peer, and school activities; 2. Developing interpersonal skills which provide a sense of participation and personal satisfaction (opportunities should be age and culturally appropriate daytime and evening activities which offer the chance for companionship, socialization, and skill building); and 3. Assisting the child and family in developing normative behaviors and expectations of relationships and providing the opportunity to practice affiliated skills which can be valuable to an individual reestablishing family and personal support relationships. (E) Group sessions may be provided for parents/guardians to develop and enhance parenting skills. In these situations, the PSR services and expected goals and outcomes must be documented in the child/youth’s treatment plan and clearly relate to the treatment and rehabilitation goals of the child or youth. (8) Psychosocial Rehabilitation Illness Management and Recovery (PSR-IMR). Services promote physical and mental wellness, well-being, self-direction, personal empowerment, respect, and responsibility. Services shall be provided in individual and group settings using curriculum approved by the department. Services must be delivered by staff who have completed required training. (A) The maximum group size shall not exceed eight (8) individuals; however, if there are other curriculum-based approaches that suggest different group size guidelines, larger groups may be approved by the department. (B) Services shall be person-centered and strength-based including, but not limited to— 1. Psychoeducation; 2. Relapse prevention; and 3. Coping skills training. (C) CPR programs must be approved by the department to provide this service. (D) If a program is accredited by Clubhouse International and submits its accreditation report to the department, it may be deemed as a PSR-IMR program by the department. (E) Required documentation includes a weekly note summarizing the services rendered and the individual’s response to the services, and pertinent information reported by family members or other natural supports regarding a change in the individual’s condition, or an unusual/unexpected occurrence in their life, or both. 1. If an individual is participating in PSR-IMR and PSR, a single, weekly summary progress note must clearly address the PSR-IMR and PSR sessions and activities during the week, or two (2) separate summary progress notes must address each type of PSR service provided during the week. 2. Daily attendance records or logs clearly identifying and distinguishing PSR-IMR as the specific type of session/activity, with actual attendance times and description of service, must also be maintained. The attendance records/logs must be available for audit and monitoring purposes, but do not need to be integrated into each clinical record. AUTHORITY: section 630.655, RSMo 2016.* Original rule filed Jan. 19, 1989, effective April 15, 1989. Amended: Filed Dec. 13, 1994, effective July 30, 1995. Amended: Filed Dec. 1, 2011, effective June 30, 2012. Amended: Filed April 29, 2019, effective Nov. 30, 2019. Amended: Filed March 9, 2022, effective Sept. 30, 2022. Amended: Filed Oct. 18, 2023, effective May 30, 2024. *Original authority: 630.655, RSMo 1980.