PURPOSE: This rule sets forth the provisions for protection of the child, including child abuse or neglect, or both, exploitation, confidentiality, discipline and control, physical restraint, transportation, work experience and allowances. Also, provision for the care of the child, including living arrangements, personal hygiene, clothing, food and nutrition, personal possessions, family identity, religious requirements, educational program, recreational and activity programs and transitional living services.

1. (1) An agency shall submit an immediate oral report, to the division followed by a written report, within five (5) working days after the occurrence of an unusual incident, such as the death of a child, alleged child abuse or neglect, or both, or a fire which required the services of the fire department.

   1. (A) Protecting the Child in Care-Child Abuse or Neglect, or Both.

      1. 1. An agency shall have written proce-

dures for any alleged incident of child abuse or neglect, or both, which shall include:

1. A. Reporting the alleged incident as

required by the Child Abuse/Neglect Reporting Law, sections 210.110-210.165, RSMo;

1. B. Conducting an internal investiga-

tion of the alleged incident; and

1. C. Providing a written report to the

licensing unit of the agency’s internal investigation of the alleged incident.

1. 2. If the safety of the children is threat-

ened, as determined by the executive director, no person who is alleged as a perpetrator in an incident of child abuse or neglect, or both, shall work directly with children until an investigation is complete.

1. 3. If the investigation determines reason

to suspect child abuse or neglect, or both, the agency shall submit a written report to the licensing unit, outlining corrective action taken by the agency. If the agency fails to take appropriate action to prevent future abuse or neglect, or both, the division may revoke the license.

1. (B) Exploitation of Children.

   1. 1. Exploitation of children shall be pro-

hibited.

1. 2. As used in these rules, exploitation of

children shall include, but not be limited to:

1. A. The use of a child or his/her pic-

ture or name for solicitation for funds without the written consent of the child’s parent(s), guardian or legal custodian;

1. B. The use of a child to advance an

agency’s religious beliefs; and

1. C. The placement of unreasonable

demands for work upon a child.

1. (C) Confidentiality.

   1. 1. An agency shall have written proce-

dures for the maintenance and security of clients’ records. This shall include a staff review of the procedures for confidentiality and a signed statement indicating that staff have reviewed the procedures. The agency shall secure records against loss, tampering or unauthorized use by-

1. A. Protection of the confidentiality of

records when in use and keeping them under lock when not in use;

1. B. Staff and professional consultants

seeking access only to the records with which they are professionally involved;

1. C. Staff not disclosing or permitting

the disclosure of any information concerning the child or his/her family, directly or indirectly, to any unauthorized person; and

1. D. Staff being informed of the

requirement that they must observe the procedures for protecting confidentiality after termination of employment.

1. 2. Records shall be made available to the

division or its authorized and identified agents, either upon written or verbal request. This includes division staff who are involved in child abuse/neglect reporting/investigation.

1. 3. All requests for access to a child’s

records shall be documented in the record providing the name of the individual making the request, the date and the desired materials. If access was refused, the grounds for refusal shall be documented.

1. 4. A consent for release form signed by

the parent(s), guardian or legal custodian must be provided before records are released to any person other than those specified in these rules. The consent must specify what information may be released, to whom, for what purpose and for what period of time.

1. (D) Discipline and Control.

   1. 1. An agency shall have written policies

regarding discipline and behavior management, which shall be explained and made available to a child’s parent(s), or guardian or legal custodian, or both, staff and to the child. The procedures shall be within each child’s ability to understand and achieve.

1. 2. The policies shall identify the type of

children served, describe the anticipated behavioral problems, set forth acceptable methods of dealing with the behaviors, and detail the required qualifications and training of staff. All discipline shall be consistent with the service plan developed for the resident.

1. 3. All discipline shall be reasonable and

appropriate to the child’s age and level of development. All discipline shall be limited to the least restrictive appropriate method and administered by appropriately trained staff;

1. 4. Encouragement and praise of good

behavior shall be used instead of focusing on unacceptable behavior.

1. 5. The agency shall have written policies

and procedures prohibiting discipline which may adversely affect a child’s health or physical or psychological well-being. A copy shall be given to all residents, families, staff and placing agencies. The following forms of discipline shall not be used:

1. A. Cruel and unusual punishment;
2. B. Excessive or inappropriate work;
3. C. Denial of meals, daily needs and

the program provided by the individual service plan;

1. D. Verbal abuse, ridicule or humilia-

tion;

1. E. Permission for a child to discipline

another child;

1. F. Chemical restraints;
2. G. Mechanical restraints;
3. H. Denial of planned visits, telephone

calls or mail contacts with family;

1. I. The use of foods intended to pro-

duce an adverse reaction;

1. J. Physical or emotional abuse;
2. K. Confinement in any space not

designed for isolation and observation;

1. L. Requirement that a child remain

silent for long periods of time or other unreasonable verbal restrictions;

1. M. Corporal punishment including,

but not limited to, slapping, hitting, spanking, paddling, shaking, belting, marching, standing rigidly in one (1) spot, use of excessive physical exercises such as running laps or doing push-ups or any method which harms or endangers the child;

1. N. Locked isolation for the purpose

of discipline;

1. O. Withholding of an opportunity for

a minimum of eight (8) hours of sleep in a twenty-four (24)-hour period;

1. P. Withholding of shelter, clothing,

essential personal needs, essential program services; or

1. Q. Withholding of meals, mail, allow-

ances or family visits.

1. (E) Physical Restraint.

   1. 1. All agencies using physical control

techniques must have written policies-defining the method of control; identifying persons used in implementing these methods; and establishing the training required for these persons. These policies shall address the use of crisis intervention, including techniques to be used prior to physical restraint and include:

1. A. The use of two (2) staff, one of

whom is fully qualified;

1. B. An immediate notice to the super-

visor; and

1. C. A written report to the administra-

tor.

1. 2. For agencies permitting the use of

physical restraint, the administrator shall review its usage at least quarterly.

1. 3. Physical restraint shall include all

efforts to minimize the possibility of injury to a child.

1. 4. All instances of physical restraint

shall be documented on incident reports and filed in the child’s record.

1. 5. Restraint methods shall be used only

to end disturbances that threaten physical injury to the child, physical injury to others, or to take from a child a dangerous object which the child has threatened to use against him/herself or against others or do serious property damage.

1. 6. An agency shall not use mechanical

restraint.

1. 7. Strap-boards, strait-jackets or home-

made restraint devices such as tape shall not be used.

1. (F) Fire Safety-Emergency Evacuation Procedure.

   1. 1. Each facility shall be inspected bien-

nially and shall be in compliance with the requirements of the State Fire Marshal.

1. 2. Written instructions for fire and other

emergency evacuations shall be posted in a conspicuous place in each facility. Children shall be instructed in evacuation procedures at the time of admission. An evacuation drill shall be held at least monthly, and a record of all drills shall be on file at each agency.

1. 3. The agency shall train staff in fire

prevention and to report fires and shall teach children fire safety.

1. (G) Transportation.

   1. 1. General requirements. 13 CSR 35-71

      1. A. The agency shall provide trans-

portation as indicated by the individual needs of the children, for example, medical and dental appointments, educational or training programs, counseling and family therapy.

1. B. The agency shall be responsible for

the care, safety and supervision of children on field trips or at any time children are transported away from the facility.

1. 2. Vehicle and vehicle operator.

   1. A. Staff transporting children shall

have a valid driver’s license as required by Missouri law.

1. B. All vehicles used to transport chil-

dren shall be licensed and operated in accordance with Missouri law.

1. C. Children shall not be transported

in campers, trailers or in the back of trucks.

1. 3. Safety and supervision.

   1. A. All children shall be seated in a

permanent seat and restrained by seat belts or child restraint devices as required by Missouri law.

1. B. Staff/child ratios shall be main-

tained at any time the agency transports children away from the facility.

1. C. Children shall be required to

remain seated while the vehicle is in motion.

1. D. Doors shall be locked when the

vehicle is moving.

1. E. Order shall be maintained when

the vehicle is moving.

1. F. Children shall not be left unattend-

ed in a vehicle at any time.

1. G. Children shall enter and leave the

vehicle from the curbside unless the vehicle is in a protected area or driveway.

1. H. Children shall be assisted, when

necessary, while entering or leaving the vehicle.

1. I. Head counts shall be taken before

leaving the facility, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the facility.

1. J. When children leave the vehicle,

the vehicle shall be inspected to ensure that no children are left on or under seats.

1. (H) Work Experience.

   1. 1. An agency shall provide the opportu-

nity for work experiences for each child which is appropriate to the age, health and abilities of the individual child.

1. 2. Work experience shall not interfere

with a child’s time for school, study periods, play, sleep, community contacts or visits with his/her family, and shall be designed to serve the child’s interest.

1. 3. If work experience is a part of the

child’s service plan, it shall be identified in the service plan. A schedule shall be maintained for all children who work paying jobs for review by licensing staff.

1. 4. Children shall not be used as substi-

tutes for staff.

1. 5. An agency shall differentiate between

chores children are expected to perform, specific work assignments made as a means of earning money, and jobs performed in or out of the facility to gain vocational training.

1. 6. Work training programs and employ-

ment of children shall be approved by the executive director or designated staff when the child is employed outside a facility.

1. 7. Children shall be given some choice

in their chores and work experiences, and duties shall be changed periodically to provide the child a variety of experience.

1. 8. An agency shall limit the length of

time children spend on regular nonpaid chores to one (1) hour a day during the school year and not more than two (2) hours a day during the summer months for all children.

1. 9. An agency shall comply with the

applicable child labor laws, sections 294.011- 294.140, RSMo. Children working paying jobs shall receive pay in accordance with community rates.

1. 10. A complete record of a child’s earn-

ings and dispersals from this fund shall be maintained and made available upon request to the child, the parent(s), the guardian or legal custodian and the licensing unit.

1. 11. Children shall be provided proper

supervision when working with, or in proximity to, power-driven machinery, upon scaffolding, in the operation of a motor vehicle or in any other occupation which is dangerous to the life or health of a child.

1. (I) Allowances and Money.

   1. 1. If a child does not work and earn

his/her own spending money, each child shall receive a regular allowance. The child shall be allowed to use discretion in spending some of the allowance for items other than basic needs.

1. 2. Money belonging to a child being dis-

charged shall be transferred to the child, the parent(s) or the agency authorized to act as custodian.

1. (2) Care of the Child.

   1. (A) Living Arrangements. Children shall be grouped by their age, level of development and need for supervision.

   2. (B) Personal Hygiene.

      1. 1. An agency shall provide each child

with his/her own toilet articles and with space for their storage.

1. 2. An agency shall provide mirrors or

nonbreakable reflective surfaces in bathrooms at levels easily accessible to all children.

1. (C) Clothing.

   1. 1. An agency shall establish minimum

clothing requirements for each child in care.

1. 2. An agency shall assure that clothes

are provided to each child. Clothes shall be individually selected and fitted, appropriate to the season and kept in a state of good repair and cleanliness. Each child’s clothing shall be identified as his/her own.

1. 3. An agency shall assure shoes are pro-

vided to each child which shall be kept in good repair.

1. 4. When possible, children shall be per-

mitted to participate in the selection and purchase of their own clothing.

1. 5. Donated clothing shall be used only if

it is in good condition.

1. 6. Clothing belonging to and worn by a

child while in residence shall be taken with him/her upon discharge.

1. (D) Food and Nutrition.

   1. 1. Nutritional requirements.

      1. A. An agency shall provide nutrition-

al, appetizing food which meets the daily nutritional requirements of the children in care.

1. B. Consideration shall be given when

planning meals to the religious practices and cultural differences of the children.

1. C. An agency shall provide supple-

mentary foods and modified diets for children with special dietary needs.

1. D. When a dietitian or nutritionist is

not employed by an agency, consultation on menu planning shall be obtained as needed from a city, county or state health agency or through a local resource.

1. E. Variations in the appetites of the

children in care shall be recognized, and the children shall be encouraged, but not forced, to eat.

1. F. Children shall be encouraged to

develop healthy eating habits.

1. G. All milk shall be pasteurized. Dry

or powdered milk shall only be used in meal preparation and not utilized for drinking purposes.

1. 2. Meal service.

   1. A. An agency shall serve meals at rec-

ognized meal times, and at least three (3) times a day, unless children receive their noon meal at school.

1. B. Nutritious between-meal snacks

shall be provided.

1. C. Staff and children who eat togeth-

er shall be served the same food unless contraindicated for medical reasons.

1. (E) Personal Possessions. Each child shall be permitted to bring safe and appropriate personal possessions with him/her and to acquire belongings of his/her own while in residence. A written inventory of the child’s possessions at the time of admission and at the time of discharge shall be on file.

2. (F) Family Identity and Relationships.

   1. 1. An agency shall develop written visi-

tation policies.

1. 2. An agency shall encourage and sup-

port contacts between a child and his/her family while the child is in care, unless the rights of the parent(s) to contact their child have been terminated or restricted by court order. The frequency of contact shall be determined by the child’s parent(s), guardian or legal custodian in consultation with agency staff. An agency shall enable the family to visit and remain involved in their child’s care as well as actively participate in relationship building.

1. 3. Privacy shall be provided for visits

with family members, relatives and friends, for telephone calls and for written communications unless otherwise indicated by the service plan.

1. 4. Flexible visiting hours shall be pro-

vided for the parent(s) or legal guardian.

1. (G) Religious Requirements.

   1. 1. Upon admission, an agency shall pro-

vide a written description of the agency’s religious requirements and practices, which shall be made available to the parent(s), guardian or legal custodian, and, when appropriate, to the child.

1. 2. Upon admission, if the agency

requires mandatory religious observance or mandatory church attendance, consent of the parent(s), or guardian or legal custodian, or both, shall be obtained and explained to the child upon admission.

1. 3. Opportunity for religious experience

shall be made available to each child within the religious preference of his/her family by treatment plan.

1. 4. The child’s parent(s), guardian or

legal custodian shall provide written authorization regarding any change in religious affiliation by the child while s/he is in care.

1. 5. Children shall be permitted to attend

religious activities and services in the community by treatment plan.

1. (H) Educational Program. The administrator shall be responsible for ensuring compliance with Missouri statutes pertaining to the children’s education.

   1. A. An agency shall not admit a child

unless an educational program appropriate to the child’s needs can be obtained.

1. B. The educational progress of a child

shall be continually evaluated and the progress shall be included in the child’s six (6)-month service plan review according to 13 CSR 40-71.080(2)(B).

1. C. Children excluded from school

shall be provided education, training or work experience consistent with their needs and abilities.

1. D. An agency shall maintain contact

and cooperation with involved school systems to provide a coordinated approach to meeting the educational needs of each child.

1. E. An agency shall provide appropri-

ate space, adequate lighting, supervision for quiet study after school hours and access to reference materials and school supplies.

1. F. Children shall be permitted and

encouraged to participate in extracurricular activities such as sports, art and music, to the extent of their interests, abilities and talents.

1. (I) Recreational and Activity Programs/ Leisure Time.

   1. 1. An agency shall involve children in a

variety of age and developmentally appropriate on-site and community activities individually, and in groups, which meet the range of needs specified in their service plan.

1. 2. An agency shall maintain a written

plan and schedule for a recreational program of both general and physically challenging activities which promote health and physical development in accordance with the individual interests, ages and needs of the children. This program shall include procedures by which a child’s involvement and progress shall be regularly reported.

1. 3. An agency shall submit a list of gen-

eral and physically challenging activities which they plan to use in their recreational program which includes a description of the activity, the purposes and goals. This list shall be submitted to the division at licensure or relicensure.

1. 4. An agency shall provide indoor and

outdoor recreational facilities for quiet and active play.

1. 5. Each child shall have some time to be

alone if s/he wishes, and places where the child reasonably will be undisturbed, while under the overall supervision of staff.

1. 6. Recreational and leisure-time activi-

ties shall be included as a planned part of family interventions, provided these activities do not interfere with the safety or security of the child, family or facility.

1. 7. Swimming shall be permitted only

when—

1. A. An adult with a current lifeguard

certificate, including cardiopulmonary resuscitation (CPR) training is present; except

1. B. An adult who has completed a

course in basic water safety, which includes infant/child CPR training, may supervise children under age six (6) when a swimming pool containing a depth of less than fortyeight inches (48") of water is being used.

1. 8. Other water activities, such as fishing

or boating, shall require staff supervision at all times, shall ensure the safety of the children and utilize appropriate equipment.

1. 9. Agencies with onor off-ground

activity programs, which by their nature significantly alter the usual level of resident supervision, shall clearly describe each activity in their recreational plan. These include activities which could be described as physically or otherwise challenging, or those which utilize animals, or those which might involve a level of risk to children. The plan for each activity shall outline the qualifications of staff members involved, special equipment, supervision rules that will be used, and any changes in the usual behavioral rules for residents and staff required by the activity. At a minimum, the plan specifically shall address each of the following:

1. A. Special qualifications of staff.

   1. (I) The agency will confirm in writ-

ing in each staff’s personnel file that the staff has specialized training, or extensive life experience in the recreational activity that qualify staff to supervise the activity.

1. (II) If the agency or specific staff is

certified in a recognized activity area such as ROPES, Project Adventure or Red Cross water safety instructor (WSI), these standards will be evidence of compliance;

1. B. Special safety equipment.

   1. (I) All sports and outdoor equip-

ment used in the program is selected on the basis of safety factors and is regularly checked or tested to insure it is up to the agency’s standards, which comply at a minimum with applicable national standards for the equipment in use.

1. (II) First aid and emergency re-

sponse kits and other emergency supplies and medications needed by participants are under the control of the designated group leader at all times.

1. (III) The agency provides for ade-

quate shelter from the elements, safe and healthful food and water, appropriate clothing and appropriate equipment required for the activities and the environment;

1. C. Special rules for staff and resident

behavior.

1. (I) The agency has a written plan

for coverage and supervision when groups are physically distant from the main location which includes delegation of authority.

1. (II) Personnel designated responsi-

ble for the group must have had first aid or first responder training and at least one (1) staff person with the group shall be certified to provide CPR; and

1. D. Risk management. 13 CSR 35-71

   1. (I) The agency shall have a written

plan which describes unsafe conditions which would restrict or rule out this activity. Safety rules for staff and residents, appropriate clothing and equipment required, and necessary training for staff and residents prior to undertaking the activity shall be specified in the plan. Changes to this plan shall be submitted to the division.

1. (II) The agency shall include in its

plan the level of administrative approval required to authorize the undertaking of any such activity.

1. (J) Transitional Living Services. Agencies serving an adolescent population shall develop and implement a transitional living services component which shall begin at the time of the initial assessment and shall be modified in accordance with the child’s changing needs as new skills are developed. Group and individual counseling should include coping and adjustment issues relating to the child’s transition from residential care. The program shall include development of a planned program in which, at a minimum, residents may acquire skills and practice in the following areas developing:

   1. 1. Skills for independence;
   2. 2. Skills and knowledge of financial

management;

1. 3. Skills necessary for locating, obtain-

ing and maintaining a residence;

1. 4. The basic skills for negotiating suc-

cessfully with community institutions and systems;

1. 5. A basic knowledge in substance abuse

prevention, human sexuality, physical and sexual abuse, Human Immunodeficiency Virus (HIV) prevention and sexually transmitted diseases;

1. 6. Daily life skills;
2. 7. Skills for job preparation, mainte-

nance and retention; and

1. 8. Skills for developing positive peer

relationships and a support system.

AUTHORITY: sections 210.481, RSMo (1986), 210.486 and 210.506, RSMo (Cum. Supp. 1993).* This rule originally filed as 13 CSR 40-71.070. 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 35-71.070, effective Oct. 30, 2008. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.