Mo. Code Regs. Ann. tit. 13, § 35-71.070
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, fire safety/emergency preparedness procedures, 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 transitional living services, smoking policy, and prohibition of practices with negative impact on residents.
(12) hours or requires the removal of residents, or any emergency that requires summoning first responders.
(A) Protecting the Child in Care-Child Abuse or Neglect, or Both.
person to read and sign a statement defining child abuse and neglect and outlining responsibilities to report all child abuse and neglect incidents as required by statute.
dures for any alleged incident of child abuse or neglect, or both, which shall include:
required by the child abuse/neglect reporting law, sections 210.110-210.165, RSMo;
tion of the alleged incident; and
licensing unit of the agency’s internal investigation of the alleged incident.
include, but not be limited to:
involved;
report including but 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 section 210.115, RSMo;
interviews with staff and residents(s) to determine the situation;
child(ren); and
action of any licensing violations or agency policy.
completed by an objective third party not involved in the incident, so as to avoid any potential for conflict of interest.
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.
mative finding consistent with current statutory standard of proof 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 deny, suspend, or revoke the license.
a centralized log of all critical incidents.
(B) Exploitation of Children.
hibited.
children shall include, but not be limited to:
ture or name for solicitation for funds without the written consent of the child’s parent(s), guardian or legal custodian;
agency’s religious beliefs; and
demands for work upon a child.
(C) Confidentiality.
dures for the maintenance and security of clients’ records. This shall include a staff review of the procedures for confidentiality and a signed and dated statement indicating that staff have reviewed the procedures. The agency shall secure records against loss, tampering, or unauthorized use by—
records when in use and keeping them under lock when not in use;
seeking access only to the records with which they are professionally involved;
the disclosure of any information concerning the child or his/her family, directly or indirectly, to any unauthorized person; and
ment that they must observe the procedures for protecting confidentiality after termination of employment.
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.
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.
dated by the parent(s), legal guardian, or legal custodian must be provided before a child’s records are released or a child’s photographs are displayed, or any video tape and/or audio recording of a child for the purpose of health, safety, welfare, enhanced supervision, and/or other therapeutic purpose pursuant to the child’s case plan is 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.
(D) Discipline and Control.
regarding discipline, supervision, 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.
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 treatment/safety plan developed for the resident.
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.
behavior shall be used instead of focusing on unacceptable behavior.
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:
the program provided by the individual service plan;
tion;
another child;
calls, or mail contacts with family shall not be used as a consequence for negative behaviors;
duce an adverse reaction;
designed for isolation and observation;
silent for long periods of time or other unreasonable verbal restrictions;
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;
of discipline;
a minimum of eight (8) hours of sleep in a twenty-four- (24-) hour period;
essential personal needs, essential program services; or
allowances, or family visits.
(E) Physical Restraint.
techniques must have written policies defining the method of control utilizing a recognized physical restraint training program, approved by the division. The agency shall identify persons used in implementing these methods; and establish 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:
whom is fully qualified;
visor; and
tor.
physical restraint, the administrator and/or program director shall review its usage at least quarterly.
ized record when physical restraint is used, which shall include:
and time the child was physically restrained;
placement of the child in a physical restraint and the de-escalation attempts used to try to prevent the use of physical restraint;
initiated the physical restraint, the staff person(s) who assisted with the physical restraint, and any other staff and/or residents who witnessed the physical restraint;
remained in the physical restraint, any changes in the staff participation, and the time of and reasons for release;
tions of the child at each five- (5-) minute interval;
of any physical restraints lasting longer than five (5) minutes including reasons for the extension;
debriefing that includes recommendations of staff and resident for avoiding a similar situation; and
care provided to the child.
efforts to minimize the possibility of injury to a child.
shall be documented on incident reports and filed in the child’s record.
management method after all other verbal deescalation measures have been exhausted, never to replace other more positive measures of control. Physical 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.
restraint.
made restraint devices such as tape shall not be used.
physical restraint incident, treatment staff shall debrief the incident with the resident.
physical restraint, the administrator and/or program director shall review its usage at least quarterly.
requirements for the use of physical restraint, the division shall give written notice of specific deficiencies and the agency shall not use physical restraint until corrections are made and approved by the division. 13 CSR 35-71
(F) Fire Safety-Emergency Evacuation Procedure.
biennially and shall be in compliance with the requirements of the State Fire Marshal.
emergency evacuations shall be posted in a conspicuous place in each operating site. 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.
prevention and to report fires and shall teach children fire safety.
preparedness policy, to include but not to be limited to:
emergencies.
(G) Transportation.
1. General requirements.
portation as indicated by the individual needs of the children, for example, medical and dental appointments, educational or training programs, counseling, family therapy, and court proceedings. If the agency cannot, for any reason, transport a child to any required services, the agency shall work with the child’s treatment team members, legal guardian, and/or legal custodian to make appropriate and timely arrangements.
the care, safety, and supervision of children on field trips or at any time children are transported away from the operating site.
2. Vehicle and vehicle operator.
have a valid driver’s license as required by Missouri law.
dren shall be licensed and operated in accordance with Missouri law.
in campers, trailers, or in the back of trucks.
3. Safety and supervision.
permanent seat and restrained by seat belts or child restraint devices as required by Missouri law.
tained at any time the agency transports children away from the operating site.
remain seated while the vehicle is in motion.
vehicle is moving.
the vehicle is moving.
ed in a vehicle at any time.
vehicle from the curbside unless the vehicle is in a protected area or driveway.
necessary, while entering or leaving the vehicle.
leaving the operating site, after entering the vehicle, during a field trip, after taking the children to bathrooms, after returning to the vehicle and when back at the operating site.
the vehicle shall be inspected to ensure that no children are left on or under seats.
(H) Work Experience.
nity for work experiences for each child appropriate to the age, health, and abilities of the individual child.
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.
child’s treatment plan, it shall be identified in the treatment plan. A schedule shall be maintained for all children who work paying jobs for review by licensing staff.
tutes for staff.
chores children are expected to perform, specific work assignments made as a means of earning money, and jobs performed in or out of the operating site to gain vocational training.
ment of children shall be approved by the executive director or designated staff when the child is employed outside the operating site.
in their chores and work experiences, and duties shall be changed periodically to provide the child a variety of experience.
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.
applicable child labor laws, sections 294.011- 294.140, RSMo. Children working paying jobs shall receive pay in accordance with community rates.
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.
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.
(I) Allowances and Money.
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.
charged shall be transferred to the child, the parent(s), or the agency authorized to act as custodian.
withdrawals should be maintained and available for review upon request. At the time of discharge from the agency, documentation shall be made part of the child’s record.
(J) Critical Incident Report.
occurs that includes, but is 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 section 210.115, RSMo, a critical incident report is completed by the agency. When a child is not in Children’s Division custody, the agency shall then verbally notify, within six (6) hours, the regional licensing consultant, the child’s treatment team, case manager, parent, legal guardian, guardian ad litem, and legal custodian and provide them with a copy of the critical incident report within twenty-four (24) hours of the occurrence of the critical incident. In the event a child is in Children’s Division custody, the agency contact, in addition to the regional licensing consultant, is the case manager. The agency contacts the regional licensing consultant and case manager within six (6) hours. The case manger then notifies the other pertinent team members. The agency then provides the regional licensing consultant and case manger with a copy of the critical incident report within twenty-four (24) hours of the occurrence of the critical incident.
(2) Care of the Child.
(B) Personal Hygiene.
with his/her own toiletry articles and with space for their storage.
unbreakable reflective surfaces in bathrooms at levels easily accessible to all children.
(C) Clothing.
clothing requirements for each child in care.
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.
vided to each child which shall be kept in good repair.
mitted to participate in the selection and purchase of their own clothing.
it is in good condition.
child while in residence shall be taken with him/her upon discharge.
(D) Food and Nutrition.
1. Nutritional requirements.
appetizing food which meets the daily nutritional requirements of the children in care.
planning meals to the religious practices and cultural differences of the children.
mentary foods and modified diets for children with special dietary needs.
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.
children in care shall be recognized, and the children shall be encouraged, but not forced, to eat.
develop healthy eating habits.
or powdered milk shall only be used in meal preparation and not utilized for drinking purposes.
2. Meal service.
ognized meal times, and at least three (3) times a day, unless children receive their noon meal at school.
shall be provided.
shall be served the same food unless contraindicated for medical reasons.
(F) Family Identity and Relationships.
tation policies.
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.
with family members, relatives, and friends, for telephone calls and for written communications unless otherwise indicated by the treatment plan.
vided for the parent(s) or legal guardian.
(G) Religious Requirements.
provide 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.
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.
shall be made available to each child within the religious preference of his/her family by treatment plan.
legal custodian shall provide written authorization regarding any change in religious affiliation by the child while s/he is in care.
religious activities and services in the community by treatment plan.
(H) Educational Program. The agency shall be responsible for ensuring compliance with Missouri statutes pertaining to the children’s education.
unless an educational program appropriate to the child’s needs can be made available and provided.
shall be continually evaluated and the progress shall be included in the child’s three- (3-) month treatment plan review according to 13 CSR-71.060(2)(B)1.A.
local community do not meet the needs of the children in care or if a child is excluded from school for behavioral or other reasons, the agency shall work closely with the local school district to provide an appropriate education plan pursuant to section 210.1050, RSMo.
cooperation with involved school systems to provide a coordinated approach to meeting the educational needs of each child.
space, adequate lighting, supervision for quiet study after school hours, and access to reference materials and school supplies.
encouraged to participate in extracurricular activities such as sports, art and music, to the extent of their interests, abilities, and talents.
child’s educational records/file shall follow the child.
tional services shall meet the certification criteria established by the Department of Elementary and Secondary Education.
(I) Recreational and Activity Programs/Leisure Time.
variety of age and developmentally appropriate on site and community activities individually, and in groups, which meet the range of needs specified in their respective treatment plan.
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.
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 initial licensure or license renewal.
outdoor recreational facilities for quiet and active play. 13 CSR 35-71
alone if s/he wishes, and places where the child reasonably will be undisturbed, while under the overall supervision of staff.
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 operating site.
limited to, swimming, wading, fishing, or boating shall be permitted only when—
certificate, including cardio pulmonary resuscitation training is present; except
course in basic water safety, which includes infant/child cardio pulmonary resuscitation training, may supervise children when a swimming pool containing a depth of less than twenty-four inches (24") of water is being used; and
ing or boating shall require staff supervision at all times. The agency shall ensure the safety and supervision of the children and utilize appropriate equipment.
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:
A. Special qualifications of staff.
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.
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;
B. Special safety equipment.
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.
response kits and other emergency supplies and medications needed by participants are under the control of the designated group leader at all times.
quate shelter from the elements, safe and healthful food and water, appropriate clothing, and appropriate equipment required for the activities and the environment;
behavior.
for coverage and supervision when groups are physically distant from the main location which includes delegation of authority.
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 cardio pulmonary resuscitation; and
D. Risk management.
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.
plan the level of administrative approval required to authorize the undertaking of any such activity.
(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 youth’s changing needs as new skills are developed. This component should compliment any other life skills program/training in which the youth is involved. Group and individual counseling should include coping and adjustment issues relating to the youth’s transition from residential treatment. 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:
management;
ing, and maintaining a residence;
cessfully with community institutions and systems;
prevention, human sexuality, physical and sexual abuse, Human Immunodeficiency Virus prevention and other sexually transmitted diseases;
nance, and retention; and
relationships and a support system.
AUTHORITY: sections 210.481, 210.486, and 210.506, RSMo 2000.* 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. Amended: Filed Dec. 16, 2013, effective June 30, 2014. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.