PURPOSE: This rule defines and describes services provided at treatment and rehabilitation programs certified under 9 CSR 30-3.

1. (1) Other Requirements. Services shall be provided in accordance with applicable program rules. Limitations on group size that are specified in this rule shall apply to those services funded by the department or provided through a service network authorized by the department.
2. (2) Available Services. Individual counseling, group education and counseling, community support, and family therapy shall be available to each person participating in substance abuse treatment and rehabilitation in accordance with the individual’s clinical needs. Day treatment shall be provided if indicated by the person’s level of care.

3. (3) Services to Family Members. Services shall be available to family members of those persons participating in substance abuse treatment and rehabilitation funded by the department or provided through a service network authorized by the department.

   1. (A) Available services shall include family therapy and individual and group codependency counseling.
   2. (B) Family members shall be routinely informed of available services, and the program shall demonstrate the ability to effectively engage family members in a recovery process.
4. (4) Services shall be designed and organized to promote peer support and to orient clients and family members to self-help groups.

5. (5) Individual Counseling. Individual counseling is a structured, goal-oriented therapeutic process in which an individual interacts on a face-to-face basis with a counselor in accordance with the individual’s rehabilitation plan in order to resolve problems related to substance abuse which interfere with the person’s functioning.

   1. (A) Key service functions of individual counseling may include, but are not limited to:

      1. 1. Exploration of an identified problem

and its impact on functioning;

1. 2. Examination of attitudes, feelings,

and behaviors that promote recovery and improved functioning;

1. 3. Identification and consideration of

alternatives and structured problem-solving;

1. 4. Decision making; and
2. 5. Application of information presented

to the individual’s life situation in order to promote recovery and improved functioning.

1. (B) Individual counseling shall only be performed by a qualified substance abuse professional or an associate counselor.

1. (6) Family Therapy. Family therapy is a planned, face-to-face, goal-oriented therapeutic interaction with a qualified staff member in accordance with an individual rehabilitation plan. The purpose of family therapy is to address and resolve problems in family interaction related to the substance abuse problem and recovery.

   1. (A) One (1) or more family members must be present at all family therapy sessions. In any calendar month, for fifty percent (50%) of a client’s family therapy, the primary client must be present, in addition to one (1) or more members of the client’s family.

      1. 1. Family members below the age of

twelve (12) may be counted as one (1) of the required family members when the child can be shown to have the requisite social and verbal skills to participate in and benefit from the service.

1. 2. Documentation of family therapy

shall identify the family member(s) present and their relationship to the client.

1. (B) Key service functions of family therapy may include, but are not limited to:

   1. 1. Utilization of generally accepted prin-

ciples of family therapy to influence family interaction patterns;

1. 2. Examination of family interaction

styles and identifying patterns of dysfunctional behavior;

1. 3. Development of a need or motivation

for change in family members;

1. 4. Development and application of skills

and strategies for improvement in family functioning; and

1. 5. Generalization and stabilization of

change to promote healthy family interaction independent of formal helping systems.

1. (C) Family therapy may be provided in either the office or home setting. Family therapy shall not include driving time to and from the home setting.

2. (D) Family therapy shall be performed by a person who—

   1. 1. Is licensed in Missouri as a marital

and family therapist; or

1. 2. Is certified by the American

Association of Marriage and Family Therapists; or

1. 3. Has a doctoral degree or master’s

degree in psychology, social work or counseling and has at least one (1) year of supervised experience in family counseling and has specialized training in family counseling; or

1. 4. Has a doctoral degree or master’s

degree in psychology, social work or counseling and receives close supervision from an individual who meets the requirements of paragraph 1., 2., or 3. of subsection (5)(D); or

1. 5. Is a degreed, qualified substance

abuse professional who receives close supervision from an individual who meets the requirements of paragraph 1., 2., or 3. of subsection (5)(D).

1. (7) Codependency Counseling. Codependency counseling is a planned, face-to-face, goal-oriented therapeutic interaction with an individual or a group to address dysfunctional behaviors and life patterns associated with being a member of a family in which an individual has a substance abuse problem and is currently participating in treatment for substance abuse.

   1. (A) Codependency counseling—

      1. 1. Shall be provided only to a person

who is a member of a client’s family; and

1. 2. May be provided on an individual or

a group basis.

1. (B) Key service functions may include, but are not limited to:

   1. 1. Exploration of the substance abuse

problem and its impact on family functioning;

1. 2. Development of coping skills and

self-responsibility for changing dysfunctional patterns of relationships;

1. 3. Examination of attitudes and feelings

and long-term consequences of living with a person with a substance abuse problem;

1. 4. Identification and consideration of

alternatives and structured problem-solving;

1. 5. Productive and functional decision-

making; and

1. 6. Generalization of newly learned

information and behavior to other life situations in order to promote improved family or personal functioning.

1. (C) The usual and customary size of group codependency counseling sessions shall not exceed twelve (12) family members in order 9 CSR 30-3

to promote participation, disclosure and feedback.

1. 1. In no event shall the size of a group

codependency counseling session that includes only family members exceed an average of twelve (12) persons per calendar month.

1. 2. The program may structure some ses-

sions to include both family members and primary clients up to a maximum of twenty (20) persons.

1. 3. Primary clients participating in such

sessions shall be considered, for funding purposes, to have received either day treatment or group counseling, depending on the client’s level of care.

1. (D) Individual and group codependency counseling shall be provided by a person who meets requirements as a—

   1. 1. Family therapist; or
   2. 2. Qualified substance abuse profession-

al with training in family recovery.

1. (8) Codependency counseling with children services shall be delivered in an age-appropriate manner. Group codependency services shall be provided in groups with similar ages and developmental issues.

   1. (A) Assessments, individual counseling and group counseling services provided to children under age twelve (12) shall be provided by—

      1. 1. A social worker, counselor, psycholo-

gist or physician licensed in Missouri who has at least one (1) year of full-time experience in the assessment and treatment of children; or

1. 2. A graduate of an accredited college or

university with a master’s degree in social work, psychology, counseling, psychiatric nursing or closely related field, who has at least two (2) years of full-time equivalent experience in the treatment and assessment of children.

1. (B) Group codependency services of an educational nature for children under age twelve (12) shall be provided by a graduate of an accredited college or university with a bachelor’s degree in counseling, psychology, social work or closely related field.
2. (C) Codependency counseling for family members below the age of five (5) may only be given when the child can be shown to have the requisite social and verbal skills to participate in and benefit from the service.

1. (9) Group Counseling. Group counseling is face-to-face, goal-oriented therapeutic interaction among a counselor and two (2) or more clients as specified in individual rehabilitation plans designed to promote clients’ functioning and recovery through personal disclosure and interpersonal interaction among group members.

   1. (A) Key service functions of group counseling may include, but are not limited to:

      1. 1. Facilitating individual disclosure of

issues which permits generalization of the issue to the larger group;

1. 2. Promoting positive help-seeking and

supportive behaviors;

1. 3. Encouraging and modeling productive

and positive interpersonal communication; and

1. 4. Developing motivation and action by

group members through peer pressure, structured confrontation and constructive feedback.

1. (B) The usual and customary size of group counseling sessions shall not exceed twelve

1. (12) clients in order to promote client participation, disclosure and feedback. In no event shall the size of group counseling sessions exceed an average of twelve (12) clients per calendar month.

   1. (C) Group counseling services shall be provided by a qualified substance abuse professional or an associate counselor.

2. (10) Group Education. Group education consists of the presentation of general information and application of the information to participants through group discussion in accordance with individualized rehabilitation plans which is designed to promote recovery and enhance social functioning.

   1. (A) Key service functions of group education may include, but are not limited to:

      1. 1. Classroom style didactic lecture to

present information about a topic and its relationship to substance abuse;

1. 2. Presentation of audiovisual materials

which are educational in nature with required follow-up discussion;

1. 3. Promotion of discussion and ques-

tions about the topic presented to the individuals in attendance; and

1. 4. Generalization of the information and

demonstration of its relevance to recovery and enhanced functioning.

1. (B) The usual and customary size of group educational sessions shall not exceed thirty

1. (30) clients in order to promote client participation. In no event shall the size of group education sessions exceed an average of thirty (30) clients per calendar month.

   1. (C) Group education services shall be provided by an individual who—

      1. 1. Is suited by education, background or

experience to teach the information being presented;

1. 2. Demonstrates competency and skill in

educational techniques;

1. 3. Has knowledge of the topic(s) being

taught; and

1. 4. Is present with clients throughout the

group education session.

1. (D) In addition, staff who provide information about human immunodeficiency virus

1. (HIV) and acquired immunodeficiency syndrome (AIDS) shall have completed a department approved or comparable training program.

2. (11) Community Support. Community support consists of specific activities with or on behalf of a particular client in accordance with an individual rehabilitation plan to maximize the client’s adjustment and functioning within the community while achieving sobriety and sustaining recovery, maximizing the involvement of natural support systems, and promoting client independence and responsibility.

   1. (A) Key service functions of community support include:

      1. 1. Participating in the interdisciplinary

team meeting in order to identify strengths and needs related to development of the individual’s rehabilitation plan;

1. 2. Attending periodic meetings with des-

ignated team members and the client, whenever feasible, in order to review and update the rehabilitation plan;

1. 3. Contacting clients who have unex-

cused absence from the program in order to re-engage the person and promote recovery efforts;

1. 4. Arranging and referring for services

and resources and, when necessary, advocating to obtain the services and quality of services to which the person is entitled;

1. 5. Monitoring service delivery by

providers external to the program and ensuring communication and coordination of services;

1. 6. Locating and coordinating services

and resources to resolve a crisis;

1. 7. Providing experiential training in life

skills and resource acquisition;

1. 8. Providing information and education

to an individual in accordance with the person’s rehabilitation plan; and

1. 9. Planning for discharge.

2. (B) The following activities shall not be considered a community support unit of service:

   1. 1. Reviewing a client’s record to ensure

that documentation is complete or to conduct quality assurance or other program evaluation;

1. 2. Preparing documentation for the

department’s management information system or for the client’s record, such as progress notes, assessment reports, rehabilitation plans and updates, and initial service plans;

1. 3. Preparing and making clinical utiliza-

tion review requests;

1. 4. Administering client medications or

observing client’s self-administer medications;

1. 5. Collecting and processing urine or

other specimens for purposes of drug testing;

1. 6. Transporting clients to and from the

program;

1. 7. Transporting clients to appointments

or other locations in the community, unless the presence of the community support worker is required to resolve an immediate crisis or to address a clearly documented need which the client has previously demonstrated an inability to resolve on his/her own;

1. 8. Routinely visiting the client in the

home, unless such visit(s) is clearly and directly related to the rehabilitation plan goals;

1. 9. Meetings with other program staff,

except scheduled meetings to develop the initial treatment plan and scheduled treatment plan reviews; and

1. 10. Discussions with the client regard-

ing treatment issues that would be more appropriately addressed by individual counseling, group counseling or education, or other available services.

1. (C) A client must be reasonably involved in other treatment and rehabilitation services in order to be eligible for community support on an ongoing basis.
2. (D) The program’s staffing pattern and arrangements to provide community support services shall be responsive to the needs, goals and outcomes expected for clients.
3. (E) Community support services shall be provided by a person who has a bachelor’s degree from an accredited college or university in social work, psychology, nursing or a closely related field. Equivalent experience may be substituted on the basis of one (1) year for each year of required educational training.

1. (12) Day Treatment. Day treatment consists of a comprehensive package of services and therapeutic structured activities provided consistent with an individual rehabilitation plan which are designed to achieve and promote recovery from substance abuse and improve functioning.

   1. (A) Key service functions of day treatment include, but are not limited to, the following:

      1. 1. Activities to address the person’s

immediate need to abstain from substance use;

1. 2. Activities and structure which provide

a meaningful, constructive alternative to substance abuse;

1. 3. Activities which promote individual

responsibility for recovery;

1. 4. Activities that enhance life skills;
2. 5. Activities that address functional

skills;

1. 6. Activities that enhance the use of per-

sonal support systems; and

1. 7. Activities which promote develop-

ment of interests and hobbies to constructively use leisure time.

1. (B) Required service components which will be used to achieve key service functions of day treatment include:

   1. 1. Individual counseling;
   2. 2. Group counseling;
   3. 3. Group education; and
   4. 4. Supervision of clients in structured

programming to promote and reinforce a substance-free lifestyle including, but not limited to, organized recreational activities, skill building, structured self-study sessions, promotion of self-help and peer support activities.

1. (C) The ratio of clients to staff for day treatment shall not exceed the maximum established elsewhere in this rule for group counseling and education.

1. (13) Ratio of Qualified Substance Abuse Professionals. A majority of the program’s staff who provide individual and group counseling shall be qualified substance abuse professionals.

2. (14) Supervision of Associate Counselors. If an associate counselor provides individual or group counseling, the person shall be registered with and recognized by the Missouri Substance Abuse Counselor’s Certification Board, Inc. or by an appropriate board of professional registration within the Department of Economic Development. All counselor functions performed by an associate counselor shall be performed pursuant to the supervisor’s control, oversight, guidance and full professional responsibility.

   1. (A) The supervisor shall review and countersign documentation in client records made by the trainee.
   2. (B) Documentation which must be countersigned includes assessments, treatment plans and updates, and discharge summaries.

3. (15) Credentials for Supervisor of Counselors. Unless otherwise required by these rules, supervision of counselors must be provided by a qualified substance abuse professional who has—

   1. (A) A degree from an accredited college in an approved field of study; or
   2. (B) Four (4) or more years employment experience in the treatment and rehabilitation of persons with substance abuse problems.

4. (16) Credentials for Supervisor of Community Support Workers. A community support worker shall be supervised by an individual with—

   1. (A) A master’s degree from an accredited college or university in social work, counseling, psychology or a closely related field and at least one (1) year of full-time equivalent experience in providing community support services; or
   2. (B) A bachelor’s degree from an accredited college or university in social work, counseling, psychology or a closely related field and at least two (2) years of full-time equivalent experience in providing community support services; and
   3. (C) Demonstrated competencies in the areas of supervision and substance abuse treatment and rehabilitation by virtue of experience and/or training.

AUTHORITY: sections 630.050, 630.655 and 631.010, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. *Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.655, RSMo 1980, and 631.010, RSMo 1980.