PURPOSE: This rule sets forth the standards for intensive residential treatment, including personnel requirements, staff/child ratios, training, treatment plan review, recreation and safety procedures.

1. (1) In addition to the licensing rules for basic residential care, an agency seeking to provide intensive residential treatment shall meet these additional requirements-

   1. (A) Personnel.

      1. 1. Program director. The person respon-

sible for the overall treatment program shall be full-time staff with at least the following minimum qualifications:

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

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

1. B. Two (2) years’ experience provid-

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

1. 2. Assessment staff. Staff responsible

for developing an initial assessment and treatment plan for each child shall have at least the following minimum qualifications:

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

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

1. B. One (1) year of experience in a res-

idential treatment setting.

1. 3. Professional staff.

   1. A. Agencies 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. B. The professional staffing plan must

be in writing and implemented by the facility.

1. C. The professional staff plan must

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

1. (B) Nursing Personnel. The agency shall employ and schedule a licensed nurse for not less than twenty (20) hours per week;
2. (C) Staff/Child Ratios. Staff/child ratios shall be maintained at not less than a one to six (1:6) ratio at all times. Staff shall remain awake on duty during children’s sleeping hours;
3. (D) 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 specifically related to intensive residential treatment issues;

   1. (E) Treatment Plan Review.

      1. 1. Each child shall have an initial writ-

ten treatment plan within ten (10) days of admission.

1. 2. Each child’s treatment plan must be

reviewed and updated at least every month.

1. 3. 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 reason(s) for continuing secure care shall be included in the child’s record.

1. 4. Appropriate information about the

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

1. 5. Individual, group or family counsel-

ing sessions shall be provided to each child at least two (2) times a week with other sessions available as needed.

1. 6. If the assessment of a child indicates

a need for treatment by a psychiatrist or if the child is currently under psychiatric care, the agency shall provide or arrange for appropriate consultation and treatment;

1. (F) Recreation. A recreation plan shall be developed by an individual with a degree in recreational therapy or a related field with at least one (1) year’s experience in working with children in a residential treatment setting; and
2. (G) Safety—Emergency Evacuation Procedure. Locking hardware is permitted on children’s sleeping room doors if they are equipped with approved electronic lockingrelease mechanism or if staff are immediately present, awake and in possession of a key for the locking device, or both.

AUTHORITY: sections 210.481, RSMo (1986), 210.486 and 210.506, RSMo (Cum. Supp. 1993).* This rule originally filed as 13 CSR 40-71.140. 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- 71.140, effective Oct. 30, 2008. *Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.