PURPOSE: This rule sets forth the requirements for specialized residential treatment, including program director, assessment staff, professional staff, staff/child ratios, training, treatment plan review and locked isolation.

1. (1) In addition to rules for basic residential care, an agency seeking to become licensed to provide residential treatment, shall meet these additional requirements:

   1. (A) Program Director. The person responsible for the overall treatment program must be full-time staff with at least the following minimum qualifications:

      1. 1. A master’s degree in social work or

human service field from an accredited college or university or licensed as a certified social worker; and

1. 2. Two (2) years’ experience providing

treatment services. One (1) year of this experience must have been in a residential setting;

1. (B) Assessment Staff. Staff responsible for developing initial assessment and treatment plan for each child must have at least the following minimum qualifications:

   1. 1. A master’s degree in social work or

human service field from an accredited college or university or licensed as a certified social worker; and

1. 2. One (1) year of experience in a resi-

dential treatment setting;

1. (C) Professional Staff.

   1. 1. The agency must have sufficient,

appropriately qualified professional staff available on a full-time, part-time or continuing consultative basis, or any combination of these to address the needs of children in care.

1. 2. The professional staffing plan must

be in writing and implemented by the facility.

1. 3. The professional staff plan must doc-

ument that the number, qualifications and responsibilities of professional staff are appropriate to the facility’s size and the scope of its program;

1. (D) Staff/Child Ratios.

   1. 1. At least one (1) direct care staff for

every eight (8) children, eight (8) years of age and over, shall be on duty during waking hours.

1. 2. Staff shall be awake during children’s

sleeping hours, staff/child ratios shall be one (1) staff for every sixteen (16) children;

1. (E) Training. All staff working with children must receive at least forty (40) hours annually of in-service training. At least ten

1. (10) hours of the training must be related specifically to treatment issues with emotionally disturbed children;

   1. (F) Treatment Plan Review.

      1. 1. Each child’s treatment plan shall be

reviewed and updated at least every three (3) months.

1. 2. If a child shows no progress toward

achieving the goals and objectives in the treatment plan since the plan was developed or last reviewed, the reasons for continuing the child in the facility’s program must be included in the child’s record.

1. 3. Appropriate information about the

updated treatment plan shall be given to the child and the child’s parent(s), guardian or legal custodian and documented in the child’s record.

1. 4. Individual, group or family counsel-

ing sessions shall be provided to each child at least one (1) time a week with other sessions available as needed; and

1. (G) Locked Isolation.

   1. 1. Written policies for the use of locked

isolation shall be made available to the child’s parent(s), or guardian or legal custodian, or both, and when appropriate, to the child.

1. 2. Agencies utilizing locked isolation

shall submit a plan for the emergency evacuation of isolated residents to the licensing unit.

1. 3. Locked isolation shall be used only as

a management method after all other measures have been exhausted, and never to replace other more positive measures of control.

1. 4. Locked isolation shall be used only

when a child presents a danger to him/herself or others or poses a threat of serious property damage.

1. 5. Locked isolation shall be used in the

shortest intervals possible until the child regains reasonable self-control.

1. 6. The maximum time a child may

remain in locked isolation is two (2) hours, unless extensions are approved at the end of every two (2)-hour period by the administrator or a qualified designee. A child shall not remain in locked isolation more than a twelve (12)-hour period. If the child has not regained control after twelve (12) hours, a medical order shall be obtained.

1. 7. When a child is placed in locked iso-

lation, staff shall physically monitor the child in at least fifteen (15)-minute intervals unless closed circuit television contact is maintained. Staff shall remain in close proximity to the child in locked isolation with no more than one (1) locked door between the staff and the child. Close proximity means that staff are close enough to the child(ren) to be able to hear any sounds the child(ren) might make that would indicate a need for assistance.

1. 8. Not more than one (1) child shall be

in a locked isolation room. A locked isolation room shall not be utilized for any other purpose.

1. 9. The agency shall maintain a record

when locked isolation is used, which shall include:

1. A. The name of the child, the date

and the time the child was placed in locked isolation;

1. B. The circumstances that led to the

placement of the child in locked isolation;

1. C. The name of the staff person who

requested placement of the child in locked isolation, the staff person who approved locked isolation and the name of the staff person who monitored the child while in locked isolation; and

1. D. The amount of time the child

remained in locked isolation, the frequency of monitoring and the time of and reasons for release.

1. 10. For agencies permitting the use of

locked isolation, the administrator shall review its usage at least monthly. The agency shall train all new staff in the use of locked isolation.

1. 11. If the agency does not meet all

requirements for the use of locked isolation, the division shall give written notice of the specific deficiencies and the agency shall not use locked isolation until corrections are made and approved by the division.

1. 12. Locked isolation rooms shall be con-

structed and equipped so that control is maximized, but the risk of suicide or injury to children is minimized. The following shall apply:

1. A. An isolation room shall be con-

structed to allow for both visual and auditory supervision of a child;

1. B. An isolation room shall have one

1. (1) approved locking-against-egress device which shall be used only when staff are immediately present, awake and in possession of a key. There shall be a backup system which does not rely on a key;

   1. C. Potentially dangerous articles shall

be removed from the child prior to placing the child in locked isolation, for example, belts, shoes, matches or contents of pockets;

1. D. An isolation room shall have at

least a seven and one-half foot (7 1/2') ceiling and be of sufficient length and width for the comfort of the child;

1. E. All doors, ceilings and walls shall

be constructed of such strength and noncombustible material that harm to the child is minimized;

1. F. All switches controlling lights, ven-

tilation, and the like, shall be on the outside of the room;

1. G. In order to prevent harm to the

child, windows shall be secured and made of tempered material to prevent shattering;

1. H. No functional electrical outlets

shall be allowed in the room;

1. I. Tamper-resistant, recessed ceiling

lights shall be utilized, and steam or hot water radiators shall be enclosed in a tamperresistant, protective casing;

1. J. The room shall be properly heated,

cooled and ventilated;

1. K. Normal toileting and bathing facil-

ities shall be available during isolation; and

1. L. The agency shall have a schedule

for monthly routine maintenance of the locks.

AUTHORITY: sections 210.481, RSMo (1986), 210.486 and 210.506, RSMo (Cum. Supp. 1993).* This rule originally filed as 13 CSR 40-71.130. Emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Original rule filed Nov. 1, 1993, effective June 6, 1994. Moved to 13 CSR 35- 71.130, effective Oct. 30, 2008. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.