PURPOSE: This rule clarifies the terms used in the licensing rules for residential treatment agencies for children and youth.

1. (1) Chemical restraints are drugs which are prescribed or administered to temporarily restrain a child who presents a likelihood of serious physical harm to him/herself or others.
2. (2) Child is any individual under eighteen (18) years of age as defined in section 210.481(1), RSMo.
3. (3) Child abuse/neglect background check is, at a minimum, a search of the family care safety registry for residential treatment agencies for children and youth staff child abuse/neglect history pursuant to sections 210.903 through 210.936, RSMo.
4. (4) Criminal background check is, at a minimum, a search of the family care safety registry for residential treatment agencies for children and youth staff criminal history pursuant to sections 210.903 through 210.936, RSMo.
5. (5) A “critical incident” is an incident involving a child in the care of the agency, in which the child or another person directly involved with the child is placed at significant risk of death, serious physical, mental, or sexual harm. A critical incident may involve conduct of the child, other children, and/or acts or omissions of staff of the agency. Examples of critical incidents include, but are not limited to: injury of a child during physical restraint; serious physical or sexual aggression by or toward the child; significant physical injuries requiring medical attention; allegations of sexual abuse; criminal conduct involving the child; elopement; attempted suicide; fire setting; child death; and information which must be reported to the child abuse and neglect hotline pursuant to 210.115 RSMo. A “critical incident report” is a report documenting a critical incident.
6. (6) Director is the director of the Children’s Division.
7. (7) Division is the Children’s Division of the Department of Social Services of Missouri as defined in section 210.481(3), RSMo.
8. (8) Family care safety registry pursuant to sections 210.903 through 210.936, RSMo, is established to protect children, the elderly, and disabled individuals in the state and to promote community safety by providing information concerning family caregivers as established within the Department of Health and Senior Services. The registry contains information on child-care workers’ and personal-care workers’ background and childcare, elder-care, and personal-care providers as specified in section 210.903.2(1)–(8), RSMo.
9. (9) Good standing refers to a licensed residential treatment agency for children and youth in substantial compliance with Chapter 71 of the Children’s Division residential treatment agencies for children and youth rules and is not under involuntary intake suspension, license denial, license suspension, and/or license revocation.
10. (10) Intensive residential treatment for children and youth is provided in a living unit of an agency for gravely, emotionally disturbed youth that has the capability of providing a highly structured and secure environment to prevent runaway behavior, address the likelihood of rage and physical aggression, and minimize the likelihood of youth injuring themselves or others. Intensive residential treatment for children and youth may be achieved through a combination of staffing patterns, architectural design of the operating site, electronic monitoring of the operating site and its exits, or other means necessary to assure safety.
11. (11) License is the legal document issued to an agency by the division for a period not to exceed two (2) years which authorizes the agency to provide twenty-four- (24-) hour care for children, subject to compliance with sections 2l0.481–210.536, RSMo, and the applicable rules promulgated by the division (section 210.481(6), RSMo).
12. (12) Mechanical restraints are any device, instrument, or physical object used to confine or limit a child’s freedom of movement, except when necessary for orthopedic, surgical, and other medical purposes, or when necessary, to transport a child that may abscond or cause injury during transportation. Support devices used in normal situations to achieve proper body position and balance are not mechanical restraints. 13 CSR 35-71
13. (13) Medical examination is a thorough physical examination conducted by a licensed physician, certified nurse practitioner, advanced practice nurse in a collaborative practice agreement with a licensed physician, or a registered nurse who is under the supervision of a licensed physician. It may include a variety of tests, depending on the age, sex, and health of the person being examined, that includes tests for communicable diseases including, but not limited to, tuberculosis and hepatitis, when recommended by a licensed physician. It should also include a statement of the patient’s mental state as determined by a licensed physician.
14. (14) Operating site is any building of a licensed agency in which children reside.
15. (15) Physical restraint is physical holding involving restriction of a child’s voluntary movement to temporarily restrain an agitated, violent, or aggressive child who presents a likelihood of serious physical harm to him/herself or others.
16. (16) Residential treatment agency for children and youth is an agency providing twenty-four- (24-) hour care and treatment to children who are unrelated to the person operating the agency and who are unattended by a parent or guardian (as defined in section 210.481(10), RSMo, as residential care facility).
17. (17) Social services are planned psycho-social interventions that are intended to lead to increased individual and family self sufficiency and empowerment, and will support the child’s transition from the placement into the family or community. Social services shall include, but shall not necessarily be limited to, individual, family, or group therapy provided in conjunction with other expressive, experiential, and adjunct activities.
18. (18) Staff are persons employed by an agency.
19. (19) Transitional living services are services provided to older adolescents that combine life skills training with opportunities to practice same. The goal of such services is to prepare the youth for successful adult living in the community upon their discharge from residential treatment for children and youth.
20. (20) Variance is a minor, time limited, deviation from a rule that may be requested by a licensed residential treatment for children and youth agency on a form prescribed by the division and approved or denied by the division. Approval may be granted by the division when a variance does not negatively impact child health and safety and is not under the purview of another regulatory entity. Examples include, but are not limited to, time limited deviations in licensed capacity and age range.
21. (21) Volunteer is any person who provides direct services to children within an agency, either on or off the premises, without financial compensation.

22. (22) Well-known religious order, church, and religious organization are defined as follows:

    1. (A) A church, synagogue, or mosque;
    2. (B) An entity that would qualify for federal tax exempt status as a not-for-profit religious organization under section 501(c) of the Internal Revenue Code of 1954; or
    3. (C) An entity where the real property on which the residential treatment for children and youth operating site is located is exempt from local taxation because it is used for religious purposes.

AUTHORITY: section 210.506, RSMo 2000.* This rule originally filed as 13 CSR 40- 71.010. Original rule filed May 9, 1956, effective May 19, 1956. Refiled March 12, 1976. Rescinded and readopted: Filed Nov. 8, 1978, effective Feb. 11, 1979. Rescinded and readopted: Filed Oct. 13, 1982, effective Jan. 13, 1983. Amended: Filed Oct. 7, 1987, effective March 25, 1988. Emergency rescission and emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rescission and emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Rescinded and readopted: Filed Nov. 1, 1993, effective June 6, 1994. Emergency amendment filed July 25, 2008, effective Aug. 4, 2008, expired Jan. 30, 2009. Moved to 13 CSR 35-71.010 and amended: Filed July 25, 2008, effective Jan. 30, 2009. Amended: Filed Dec. 16, 2013, effective June 30, 2014.

*Original authority: 210.506, RSMo 1982, amended 1993, 1995.