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 type of child 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 nonemergency admissions, the

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

1. B. For emergency admissions, the

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

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,

including any current medical problems;

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 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 seventy-two (72) hours 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 after admission. If the examination is done after admission, a copy of the examination report and findings must be in the child’s record within three (3) months of admission.

1. 5. Children must be tested for tubercu-

losis according to the recommendations of the state or local public health authorities.

1. 6. 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 by a child’s parent(s) or legal guardian authorized to give consent.

1. 7. 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. 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; and

1. D. Rules regarding recreational activ-

ities.

1. (2) Evaluation and Planning.

   1. (A) Service Plan.

      1. 1. A preliminary written service plan

must be developed and documented in the child’s record within seventy-two (72) hours 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 service plan must be devel-

oped 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.

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, including plans for reintegration into family and community; and

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

ment team coordinator and a signed and dated attendance sheet of all other participants.

1. 4. A copy or summary of the service

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 social ser-

vices 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 nonparticipation shall be documented.

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

family shall be evaluated at least every three (3) months, 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) Service Plan Review.

   1. 1. The service plan review must include:

      1. A. An evaluation of progress toward

meeting the child’s needs;

1. B. An evaluation of progress toward

family reunification;

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 service plan review with the date

and signature of the treatment team coordinator 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 be accompanied by staff to the parent(s) or legal guardian or an appropriate placement resource.
   4. (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.
   5. (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.

2. (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. 1. The name, address, telephone num-

ber and relationship of the person(s) or agency to whom the child is discharged;

1. 2. A summary of services provided dur-

ing care;

1. 3. A summary of growth and accom-

plishments during care;

1. 4. Reason for discharge; and
2. 5. 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, RSMo (1986) and 210.486 and 210.506, RSMo (Cum. Supp. 1993).* 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, 13 CSR 35-71 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. *Original authority 210.481, RSMo (1982).