PURPOSE: This rule sets forth the policies and procedure requirements for intake and admission, discharge, and social services.

1. (1) Intake and Admission.

   1. (A) Intake Policies.

      1. 1. Intake policies shall be in writing and

shall identify services and programs offered.

1. 2. Admissions shall be limited to chil-

dren for whom the agency’s services are appropriate, with consideration being given to a child’s physical, psychological and emotional needs, social development, interests and past educational history.

1. 3. An agency shall not discriminate in

its intake and services on the basis of race, religion, color, ethnic, or national origin.

1. 4. When a child is self-referred, efforts

shall be made to contact the child’s parent(s), guardian or legal custodian within twenty-four (24) hours. If the parent(s), guardian, or legal custodian cannot be contacted, the agency shall notify the appropriate public agency (division, juvenile court, police department) of the presence of the child. All efforts to notify the appropriate public agency, parent(s), or legal guardian shall be documented in the child’s case record.

1. 5. Whenever possible, an agency shall

arrange for one (1) or more preplacement visits by the child (except in emergency placements), and when appropriate, for at least one (1) or more preplacement visits by the child’s parent(s), guardian, or legal custodian.

1. (B) Admission Policies.

   1. 1. The agency shall have current, clear-

ly written admission policies and criteria describing the age, sex, and emotional/behavioral needs of child/ren served; and

1. 2. A copy of the admission policies must

be submitted to the licensing unit with the application for the initial license and at any time changes are made in the admission policies.

1. (C) Admission Procedures.

   1. 1. An admission assessment must be

completed for each child indicating that the placement meets the child’s needs and best interests—

1. A. For planned admissions, the

admission assessment must be completed before a child is accepted for care;

1. B. For emergency admissions, the

admission assessment must be completed within five (5) days of admission; and

1. C. If the assessment of the child indi-

cates a need for a more restrictive environment, the agency shall contact the child’s treatment team, case manager, legal guardian, and/or legal custodian to plan for the child’s placement in a more appropriate facility.

1. 2. The admission assessment must be in

writing and include specific information on—

1. A. The circumstances which led to

the child’s referral;

1. B. The immediate and long-range

goals of placement;

1. C. The child’s family and his/her

relationship with family members;

1. D. The child’s relationships with

other adults and children;

1. E. The child’s behavior, including

appropriate and maladaptive behavior;

1. F. The child’s medical history, includ-

ing any current medical problems ensuring medical and all health related documentation is held in confidence consistent with applicable federal and state law;

1. G. The child’s developmental history

and current level of functioning;

1. H. The child’s school history includ-

ing current educational level, special achievements, and any school problems;

1. I. The history of any other placements

outside the home, including the reasons for placement;

1. J. An evaluation of the child’s special

needs and strengths in the following areas: physical, familial, educational, social and psychological;

1. K. The parent’s or legal guardian’s

expectations for placement, family involvement, and the duration of the child’s stay in care; and

1. L. The child’s understanding of place-

ment.

1. 3. Children must have a medical exami-

nation that includes tests for communicable diseases including, but not limited to, tuberculosis and hepatitis when recommended by a licensed physician, certified nurse practitioner, advanced practice nurse who is in a collaborative practice agreement with a licensed physician, or a registered nurse under the supervision of a licensed physician, within thirty (30) days before or ten (10) days after admission. A copy of the medical examination report and findings, signed and dated by the physician, must be in the child’s record.

1. 4. Children must have a dental examina-

tion by a licensed dentist within one (1) year before admission or arrangements must be made for an examination within three (3) months after admission.

1. 5. A written placement agreement

between the agency and the child’s parent(s) or guardian must be completed at or before placement. A copy of the placement agreement must be in the child’s record. The placement agreement must include authorization to care for the child and a medical consent form signed and dated by a child’s parent(s) or legal guardian authorized to give consent.

1. 6. Information about the agency must be

discussed with the child’s parent(s) or guardian at or before admission. Written material about the agency must be given to the child’s parent(s) or guardian and child when age appropriate. The following information must be included in the discussion and in the written material:

1. A. Rules regarding visits, mail, gifts,

and telephone calls;

1. B. Discipline policies;
2. C. Policies regarding religious train-

ing;

1. D. Rules regarding recreational activ-

ities;

1. E. Policy regarding participation in

treatment planning;

1. F. A copy of the treatment plan;
2. G. Copies of all signed and dated

releases of information; and

1. H. Health Insurance Portability and

Accountability Act.

1. (2) Evaluation and Planning.

   1. (A) Treatment Plan.

      1. 1. A preliminary written treatment plan

must be developed and documented in the child’s record within fifteen (15) days of admission for each child admitted on an emergency basis. If the child remains in care beyond an initial thirty- (30-) day plan, the plan must be modified to indicate the need for continued placement. The plan must be based on the admission assessment.

1. 2. A written treatment plan must be

developed and documented in the child’s record within fifteen (15) days of admission for each child admitted by plan for placement. The plan must be based on the admission assessment and observations of the child’s adjustment into care. When drafting the treatment plan the agency shall consult with and involve all individuals and institutions which are parties to a juvenile proceeding involving the child or who may be necessary in preparing a treatment plan for the child, including, but not limited to: the child’s legal custodian/guardian, the child’s parent, the child (when appropriate), guardian ad litem, juvenile officer, children’s division case manager, court appointed special advocate, as applicable to the individual child, and staff members who provide direct care, social services, education, recreation, and health services in developing and implementing the treatment plan for the child and family.

1. 3. The service plan must identify and

include:

1. A. The child’s needs in addition to

basic needs for food, shelter, clothing, routine care, and supervision;

1. B. Specific strategies and their fre-

quencies to meet the child’s needs, including instructions to staff;

1. C. Specific strategies and frequencies

for family involvement, including a defined plan for visitation and engaging the family in services for the child;

1. D. Specific strategies to meet the

recreational and developmental needs of the child;

1. E. The estimated length of stay;
2. F. Time limited goals and preliminary

plans for discharge, that address permanency related to family reunification, termination of parental rights and adoption, placement with a fit and willing relative, legal guardianship, or another planned permanent living arrangement; and

1. G. The date and signature of the pro-

gram director/qualified professional staff and a signed and dated attendance sheet of all other participants. Invited participants shall include, but not be limited to:

1. (I) Legal custodian/guardian;
2. (II) Parent;
3. (III) Child, as age/developmentally

appropriate; and

1. (IV) Guardian ad litem/court ap-

pointed special advocate, as applicable to the individual child.

1. 4. A copy or summary of the treatment

plan must be given to the child, when appropriate, and to the child’s parents or legal guardian. If the plan is not shared with the child, the child’s record must reflect justification for this decision.

1. 5. An agency shall provide and docu-

ment in a child’s record, social services to each child at least two (2) times per month as required by treatment plan. Social services shall be provided to the child’s family for whom reunification is the permanency goal and shall begin at placement. The family’s participation or reasons for non-participation shall be documented.

1. 6. The progress of a child and his/her

family shall be evaluated at least every ninety (90) days from the date of admission, and the service plan shall be modified when appropriate. In crisis placement, an evaluation shall be conducted at least every thirty (30) days. Evaluations shall be made by professional staff in consultation with other staff who have significant contact with the child, the parent(s), guardian, or legal custodian.

1. (B) Treatment Plan Review.

   1. 1. The treatment plan review must

include:

1. A. An evaluation of progress toward

meeting the child’s needs;

1. B. An evaluation of progress toward

the permanency goal;

1. C. Any needs identified since the plan

was developed or last reviewed and strategies to meet the needs, including instructions to staff; and

1. D. An update of the estimated length

of stay and discharge plans, if changed.

1. 2. The review of the treatment plan with

the date and signature of the program director/qualified professional staff and a signed and dated attendance sheet of all other participants in the review must be documented in the child’s record.

1. 3. Reports of the evaluations in summa-

rized form shall be included in the child’s record, and shall be shared with the parent(s), guardian, or legal custodian.

1. (3) Discharge from Care.

   1. (A) The following persons must be involved in planning a nonemergency discharge: the child; the child’s parent(s) or legal guardian and agency staff.
   2. (B) The child may be released only to the parent(s) or legal guardian unless there is a court-authorized independent living arrangement.
   3. (C) If a child is discharged because s/he is a danger to him/herself or others, s/he must 13 CSR 35-71

be accompanied by staff to the parent(s) or legal guardian or an appropriate placement resource.

1. (D) The date and circumstances of the child’s discharge must be documented in his/her record. The signature, address and relationship of the adult to whom the child is discharged must be included in the documentation.
2. (E) Except in emergency situations, an agency shall give at least thirty (30) days’ written notice to the parent(s), guardian, or legal custodian before discharging a child from care.
3. (F) The discharge plan must be tied to permanency goals related to family reunification, termination of parental rights and adoption, placement with a fit and willing relative, legal guardianship, or another planned permanent living arrangement.

1. (4) Discharge Summary. When a child in care is discharged, an agency shall complete a written discharge summary within thirty (30) days of the date of discharge. This summary shall be included in the child’s case record, and shall include:

   1. (A) The name, address, telephone number, and relationship of the person(s) or agency to whom the child is discharged;
   2. (B) A summary of services provided during care;
   3. (C) A summary of growth and accomplishments during care;
   4. (D) Reason for discharge; and
   5. (E) An identified aftercare plan which shall include cooperative efforts with the parent(s) or legal guardian to support the child’s transition from placement into the family or community.

AUTHORITY: sections 210.481, 210.486, and 210.506, RSMo 2000.* This rule originally filed as 13 CSR 40-71.060. 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 35-71.060, effective Oct. 30, 2008. Amended: Filed Dec. 16, 2013, effective June 30, 2014. *Original authority 210.481, RSMo (1982).