PURPOSE: This rule sets forth the requirements for personnel practices, including staff qualifications, staff/child ratios, staff training, and nonpaid staff.

1. (1) Employee Qualifications. The facility shall employ staff who are qualified by education, training, and experience for their assigned responsibilities.

2. (2) Administrative and Supervisory Personnel.

   1. (A) The facility shall employ staff to perform administrative, supervisory, service, and direct care functions which may be combined only upon the approval of the division. Staff members who perform combined functions must meet the requirements for each function.
   2. (B) The facility shall employ an administrator or executive director to manage the facility’s operations and direct its activities.
   3. (C) When the position of administrator or executive director is vacated, the facility shall appoint an acting administrator or executive director and notify the division’s licensing unit of the change in personnel within five (5) working days. The facility shall notify the division’s licensing unit immediately after a new executive director is appointed.

3. (3) Qualifications of Administrator or Executive Director and Program Director.

   1. (A) A facility’s administrator or executive director must be at least twenty-five (25) years of age and have one (1) of the following:

      1. 1. A master’s degree or higher in social work, counseling,

social work administration, or a related human service degree, from an accredited school, and two (2) years experience in the management or supervision of child care personnel and programs;

1. 2. A bachelor’s degree in social work or a related human

service area of study from an accredited school and four (4) years experience in the management or supervision of residential treatment personnel and programs; or

1. 3. A bachelor’s degree from an accredited school and two

1. (2) years experience in the management or supervision of child care personnel and programs. In such cases, the facility shall employ a program director to directly oversee the facility’s programs and services who meets the qualifications set forth in subsection (3)(C).

   1. (B) The administrator/executive director shall designate in writing a qualified staff to be in charge when he or she is absent.

   2. (C) The program director shall have one (1) of the following:

      1. 1. A master’s degree in social work or a related human

service area of study from an accredited school; or

1. 2. A bachelor’s degree in social work or a related human

service area or study from an accredited school plus two (2) years experience in residential treatment for children and youth services or other child welfare related field.

1. (4) Professional Personnel.

   1. (A) A facility shall obtain any professional services required for the implementation of the individual service plan of a child when these services are not available from staff.

   2. (B) Professional staff who perform casework, group work tasks, or planning of services for children and their families will have at least a bachelor’s degree or higher in social work, psychology, counseling, or a related field from an accredited college or university. Unless otherwise required by law, professional staff without a bachelor’s degree or higher described in this section may perform casework, group work tasks, or planning of services for children and their families if such person—

      1. 1. Has four (4) years professional experience in casework-

related tasks; and

1. 2. Works under the close supervision and guidance of

professional staff who have a bachelor’s degree or higher as described in subsection (4)(B) and are licensed as required in subsection (4)(C) and who will be responsible for the professional work performed by staff who lack a bachelor’s degree or higher.

1. (C) Fullor part-time professional staff including psychologists, psychiatrists, social workers, counselors, physicians, teachers, and nurses shall meet the licensing or certification requirements of their profession in Missouri.
2. (D) The facility shall have at least one (1) professional staff for every twenty (20) children in care.
3. (E) The facility shall designate a supervisor for professional staff when six (6) or more staff are employed. The supervisor shall have a master’s degree or higher in social work, psychology, counseling, or related human service field of study and at least two (2) years clinical experience.
4. (F) Facilities who, by mission, serve a medically fragile and/or drug and alcohol affected population shall employ or contract with and schedule a licensed or registered nurse qualified to dispense medication and supervise medication management for not less than twenty (20) hours per week. At least one (1) staff shall be present at all times who is trained in infant/child cardiopulmonary resuscitation.

1. (5) Direct Care Staff—Staff/Child Ratios.

   1. (A) Direct care staff shall be responsible, mature individuals of reputable character who exercise sound judgment, display the capacity to provide good care and supervision of children and must demonstrate competence in their duties in the following areas:

      1. 1. Protecting and nurturing children;
      2. 2. Meeting child developmental needs and addressing

child developmental delays;

1. 3. Supporting relationships between children and families;
2. 4. Working as a member of a professional team; and
3. 5. Supporting children with lifetime relationships.

4. (B) Direct care staff shall be at least twenty (20) years of age and shall have at least a high school diploma or high school equivalency certificate.

   1. 1. A facility may seek a variance from the division pursuant

to 13 CSR 35-71.020(4)(E) to place staff under twenty (20) years of age in a direct care role for educational, internship, or work study opportunities when—

1. A. The intern or student under twenty (20) years of age

is working at the facility as part of an educational program of an accredited institution of higher education; and

1. B. The intern or student under twenty (20) years of age

is supervised by an employee of the facility who is qualified without variance as provided in subsection (5)(B) while serving in a direct care role.

1. 2. In no circumstances shall—

   1. A. Any individual less than eighteen (18) years of age be

placed in a direct care role, regardless of participation in an educational program or level of supervision; or

1. B. The division grant any variance for any direct care

staff that do not meet the intern or student requirements described in paragraph (5)(B)1.

1. (C) Direct care staff shall record and maintain shift notes in sufficient detail to ensure consistency of care across all staff who provide care to a child, which shall include any activities, needs, medication management, or problems that may be specific to the child.
2. (D) The ratio of direct care staff to children shall be consistent with the minimum ratios represented on the reference chart in this subsection unless the division requires a higher ratio pursuant to subsection (I) of this section or unless a higher staff ratio is required by 13 CSR 35-71.130 or 13 CSR 35-71.140.

Reference Chart

The ratio of direct care staff to children shall be dependent on the needs of the children.

Age Level of Range Care

Birth to Basic Core six (6) years Six to Basic Core eight (6-8) years

Over Basic Core eight (8) years

1. (E) Facilities must have a minimum of two (2) staff available on-site at all times, even if their staff/child ratio is lower than required above. One (1) staff may be sleeping, but available for emergency situations. When a facility has multiple cottages/ units on campus or in a large congregate care setting, roving staff may serve the purpose of maintaining the required staff/ child ratio by maintaining a presence in the cottages/units on a rotating, regular, and timely basis.
2. (F) Appropriate staff/child ratios must be maintained at all times on campus and during off-grounds group activities. However, transportation of a child to an appointment may be made by one (1) staff as long as the staff can adequately supervise the child without compromising the safety of each child or the staff. The safety needs of each child during transportation shall be assessed individually. Direct Care Staff to Resident Ratio Awake One (1) staff per four (4) children

One (1) staff per six (6) children

One (1) staff per ten (10) children Asleep One (1) staff per six (6) children. Staff must remain awake.. One (1) staff per ten (10) children (If the staff is on duty, but also sleeping).

OR

One (1) staff per twelve (12) children (If staff on duty remain awake). One (1) staff per ten (10) children (If the staff is on duty, but also sleeping).

OR

One (1) staff per twelve (12) children (If staff on duty remain awake).

1. (G) Any children of live-in staff shall be included in the required staff/child ratios.
2. (H) The division may require a higher staff/child ratio if onsite review indicates a need for more supervision to maintain control, discipline, and adequate care, or the division may approve a lower staff/child ratio if on-site review indicates adequate care, discipline, and control can be maintained at a lower staff/child ratio.
3. (I) Facilities employing twelve (12) or more direct care staff shall designate staff to be primarily responsible for supervising, evaluating, and monitoring the daily work and progress of the direct care workers. Such direct care supervisory staff shall meet the minimum qualifications set forth in subsection (5)(B) and two (2) years of direct care experience.

1. (6) Relief Staff. The facility shall provide planned relief for direct care staff and shall have qualified relief staff to substitute for direct care staff during sick leave, vacation, relief time, and other absences from the facility as well as breaks or other temporary absences during shifts.
2. (7) Interns, Students, Work Study Participants. All interns, students, and work study participants at the facility shall be subject to the general personnel policies of the facility, but shall not be considered or used as substitutes for qualified and employed staff.

3. (8) Educational Staff. A facility operating an on-grounds school shall—

   1. (A) Be fully accredited in good standing by the Missouri Department of Elementary and Secondary Education to provide educational services or be administered and supervised by a fully accredited educational institution; and
   2. (B) All personnel providing educational services shall comply with the training and licensure requirements of the Missouri Department of Elementary and Secondary Education.
4. (9) Recreational and Activity Staff. The facility shall develop and coordinate recreational and activity programs and shall assign recreational/activity staff on basis of experience, education, and/or training in working with groups of children whose recreational needs and interests vary. Additional training shall be provided for this staff to enhance his/her ability to perform his/her assigned duties.
5. (10) Clerical Staff. Clerical staff shall be employed as needed for general clerical duties such as typing, recordkeeping, bookkeeping, and filing. Clerical staff shall not supervise or assist in the care of children without being qualified according to these rules.
6. (11) Other Staff. A facility shall employ, as needed, cooks, kitchen helpers, maintenance, custodial, and other support staff to perform housekeeping and maintenance functions. Such other staff shall not supervise or assist in the care of children without being qualified according to these rules.

7. (12) Volunteers. If a facility uses volunteers as part of its program of services, the facility shall have written policies, subject to review and approval by the division, which include—

   1. (A) A clear description of the facility’s purposes and goals;
   2. (B) A clear job description for the individual tasked with overseeing volunteers and for each category of volunteers;
   3. (C) A clear differentiation of functions and activities appropriate for paid staff members and volunteers in policymaking, advocacy, administrative, and direct service roles. If volunteers are counted toward the staff/child ratio, a facility supervisory employee must be present and available at the operating site;
   4. (D) A process for screening and selecting volunteers, who have direct contact with children consistent with section 210.493, RSMo, and 13 CSR 35-71.015;
   5. (E) A defined line of supervision, with clear written expectations of the supervisor and the volunteers;
   6. (F) Orientation, preservice, and in-service training activities in the volunteers’ specified roles;
   7. (G) Procedures for monitoring and evaluating volunteer activities and contributions;
   8. (H) Procedures for observing professional ethics and confidentiality; and
   9. (I) Procedures for handling conflicts between paid staff members and volunteers.

AUTHORITY: sections 207.020, 210.506, 210.511, and 660.017, RSMo 2016.* This rule originally filed as 13 CSR 40-71.050. Original rule filed Nov. 9, 1978, effective Feb. 11, 1979. 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. Moved to 13 CSR 35-71.050, effective Oct. 30, 2008. Amended: Filed Dec. 16, 2013, effective June 30, 2014. Amended: Filed Aug. 12, 2025, effective Feb. 28, 2026. *Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993, 2014; 210.506, RSMo 1982, amended 1993, 1995; 210.511, RSMo 1982; and 660.017, RSMo 1993, amended 1995.