Specialized Standards For Intensive Residential Treatment for Children and Youth

PURPOSE: This rule sets forth the standards for intensive residential treatment, including personnel requirements, staff/child ratios, training, treatment plan review, recreation, and safety procedures. (1) In addition to the licensing rules for basic residential treatment for children and youth, an agency seeking to provide intensive residential treatment for children and youth shall meet these additional requirements— (A) Personnel. 1. Program director. The person responsible for the overall treatment program shall be full-time staff with at least the following minimum qualifications: A. A master’s degree in social work or human service field from an accredited college or university or licensed as a clinical social worker; and B. Two (2) years’ experience providing treatment services. One (1) year of this experience must have been in a residential treatment setting. 2. Assessment staff. Staff responsible for developing an initial assessment and treatment plan for each child shall have at least the following minimum qualifications: A. A master’s degree in social work or human service field from an accredited college or university or licensed as a clinical social worker; and B. One (1) year of experience in a residential treatment setting. 3. Professional staff. A. Agencies must have sufficient appropriately qualified professional staff available on a full-time, part-time, or continuing consultative basis, or any combination of these, to address the needs of children in care. B. The professional staffing plan must be in writing and implemented by the agency. C. The professional staff plan must document that the number, qualifications, and responsibilities of professional staff are appropriate to the agency’s size and the scope of its program; (B) Nursing Personnel. The agency shall employ and schedule a licensed nurse for not less than twenty (20) hours per week; (C) Staff/Child Ratios. Staff/child ratios shall be maintained at not less than a one to four (1:4) ratio for children ages birth to age six (6) years when children are awake and one to five (1:5) ratio when children ages birth to age six (6) years are asleep and one to five (1:5) ratio when children/youth ages six (6) to twenty-one (21) years are awake and one to six (1:6) ratio when children and youth ages six (6) to twenty-one (21) years are asleep. Staff shall remain awake on duty during children’s sleeping hours; (D) Training. All staff working with children must receive at least forty (40) hours annually of in-service training at least ten (10) hours of the training must be specifically related to relevant intensive residential treatment issues; (E) Treatment Plan Review. 1. Each child shall have an initial written treatment plan within ten (10) days of admission. 2. Each child’s treatment plan must be reviewed and updated at least every month. 3. If a child shows no progress toward achieving the goals and objectives in the treatment plan since the plan was developed or last reviewed, the reason(s) for continuing secure care shall be included in the child’s record. 4. Appropriate information about the updated treatment plan must be given to the child and the child’s parent(s), guardian, or legal custodian. This must be documented in the child’s record. 5. A minimum of one (1) hour of individual, group, or family counseling sessions shall be provided to each child at least two (2) times a week with other sessions available as needed. 6. If the assessment of a child indicates a need for treatment by a psychiatrist or if the child is currently under psychiatric care, the agency shall provide or arrange for appropriate consultation and treatment; 7. If the assessment of the child indicates a need for a more restrictive environment, the agency shall contact the child’s treatment team, case manager, legal guardian, and legal custodian to plan for the child’s placement in a more appropriate facility. Intensive residential treatment is not meant to replace the need for more restrictive settings such as psychiatric care or incarceration when indicated by psychological evaluation, psychiatric evaluation, or by physician or court order. (F) Recreation. A recreation plan shall be developed by an individual with a degree in recreational therapy or a related field with at least one (1) year’s experience in working with children in a residential treatment setting; (G) Safety-Emergency Evacuation Procedure. Locking hardware is permitted on children’s sleeping room doors if they are equipped with electronic locking-release mechanism approved by the State Fire Marshal or if staff are immediately present, awake, and in possession of a key for the locking device, or both. There shall be a backup system which does not rely on a key, i.e., an electronic release mechanism, as approved by the State Fire Marshal; and (H) Sleeping Area. An agency licensed, or buildings constructed after (effective the date of this amendment) shall house no more than one (1) child in a sleeping room. Reference Chart Age Range Level of Care Direct Care Staff to Resident Ratio Awake Asleep Birth to age six (6) years Intensive Need A minimum of one (1) staff per four (4) children when children are awake and a minimum of one (1) staff per five (5) children when children are asleep. Staff shall remain awake on duty during children’s sleeping hours. Age six (6) years and older Intensive Need A minimum of one (1) staff per five (5) children/youth when children/youth are awake and one (1) staff per six (6) children/youth when children/youth are asleep. Staff shall remain awake on duty during children’s/youth’s sleeping hours. AUTHORITY: sections 210.481, 210.486, and 210.506, RSMo 2000.* This rule originally filed as 13 CSR 40-71.140. Emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Original rule filed Nov. 1, 1993, effective June 6, 1994. Moved to 13 CSR 35-71.140, effective Oct. 30, 2008. Amended: Filed Dec. 16, 2013, effective June 30, 2014. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.