PURPOSE: This rule supplements other rules under this chapter by setting forth rules which are specific to institutional corrections treatment programs.

1. (1) Program Description. An institutional corrections treatment program shall provide treatment and rehabilitation services to persons with substance abuse problems who are incarcerated by the Missouri Department of Corrections. This rule does not apply to those corrections programs or facilities which provide only educational services regarding substance abuse.

2. (2) Admission Criteria. The program shall provide treatment and rehabilitation for those persons who—

   1. (A) Meet diagnostic criteria for a substance abuse or dependence as described in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association; or
   2. (B) Have been ordered by a court of jurisdiction or by the Board of Probation and Parole to participate in a substance abuse treatment program in an institutional setting under the auspices of the Department of Corrections.

3. (3) Treatment Goals. The program shall provide treatment and rehabilitation in a structured, alcoholand drug-free setting.

   1. (A) Services shall be organized and directed toward the primary goals of—

      1. 1. Stabilizing a crisis situation, where

applicable;

1. 2. Interrupting a pattern of extensive or

severe substance abuse;

1. 3. Restoring physical, mental and emo-

tional functioning;

1. 4. Promoting the individual’s recogni-

tion of a substance abuse problem and its effects on his/her life;

1. 5. Developing recovery skills, including

an action plan for continuing sobriety and recovery; and

1. 6. Promoting the individual’s support

systems and community reintegration.

1. (B) The program shall establish a positive, recovery-oriented, supportive treatment setting that emphasizes personal responsibility and accountability and promotes pro-social interaction.
2. (C) Services shall promote reality-based, cognitive restructuring approaches to address substance abuse and criminality.

1. (4) Performance Indicators. All programs shall collect and review data related to the goals and outcomes for institutional corrections treatment.

   1. (A) Each program shall collect data on key indicators that may include, but are not limited to, the following:

      1. 1. Client satisfaction with services;
      2. 2. Number of persons who successfully

complete institutional corrections treatment;

1. 3. Number of persons who leave against

staff advice or are otherwise unsuccessfully discharged from the program;

1. 4. Number of persons who engage in

continuing treatment in the community;

1. 5. Number of persons who commit fur-

ther offenses in the community upon release 9 CSR 30-3

or are re-incarcerated in a correctional facility;

1. 6. Number of persons maintaining a

drug-free status as determined by laboratory tests to detect the use of alcohol and drugs; and

1. 7. Changes in the functioning of clients

(such as employment and other measures of social and emotional functioning).

1. (B) Each program shall use this data in its quality improvement process.
2. (C) The Department of Corrections may require, at its option, the use of designated indicators or measures in order to promote consistency and the wider applicability of this data.

1. (5) Adapting Other Requirements to Institutional Corrections Treatment Programs and Settings. Requirements referenced under 9 CSR 30-3.022 Certification of Alcohol and Drug Abuse Programs shall be applicable to institutional corrections treatment programs and settings, subject to the modifications and adaptations specified in this rule. The program shall comply with the following requirements without modification or adaptation:

   1. (A) 9 CSR 10-7.010 Treatment Principles and Outcomes;
   2. (B) 9 CSR 10-7.040 Quality Improvement;
   3. (C) 9 CSR 10-7.050 Research;
   4. (D) 9 CSR 10-7.090 Governing Authority and Program Administration;
   5. (E) 9 CSR 10-7.100 Fiscal Management;
   6. (F) 9 CSR 10-7.130 Procedures to Obtain Certification;
   7. (G) 9 CSR 10-7.140 Definitions;
   8. (H) 9 CSR 10-5.190 Criminal Record Review; and
   9. (I) 9 CSR 10-5.200 Report of Complaints of Abuse and Neglect.

2. (6) Service Definitions and Staff Qualifications. Requirements under 9 CSR 30-3.110 Service Definitions and Staff Qualifications are included by reference and are adapted for institutional corrections treatment programs as follows:

   1. (A) The maximum size of educational groups for clients shall be identified in the organization’s policy and procedures manual, approved by its governing authority, and stated in its application for certification.

      1. 1. In no case shall the size of the educa-

tional groups exceed the capacity for comfort, safety and security.

1. 2. Educational groups shall be supple-

mented with methods such as worksheets, homework assignments or small discussion groups to enhance clients’ understanding and internalization of the information presented.

1. (B) Educational groups for family members should be offered which provide information about substance abuse and its effects on the family. These groups may include family members and significant others who have an ongoing relationship with the individual that affects the continuing recovery plan.

1. (7) Service Delivery Process and Documentation. Requirements regarding Service Delivery and Documentation under 9 CSR 10-7.030 and 9 CSR 30-3.100 are included by reference and are adapted for institutional corrections treatment programs as follows:

   1. (A) Individual counseling, group education and counseling, recreation and introduction to self-help groups shall be provided to each client;
   2. (B) Community support, family therapy, and codependency counseling are not required services. However, if these services are offered, service delivery shall be in accordance with applicable standards;

   3. (C) The screening process required under 9 CSR 10-7.030(1) is waived. However, it is the program’s responsibility to identify and to refer individuals to appropriate Department of Correction services. The program shall—

      1. 1. Comply with Department of Correc-

tions’ policy for provision of psychological and medical emergency care; and

1. 2. Coordinate services within the

Department of Corrections to ensure the individual’s safety;

1. (D) The assessment shall be completed by a qualified substance abuse professional within ten (10) working days of admission to the treatment program to ensure identification of the appropriate level of care and to develop the individualized treatment plan;
2. (E) The treatment plan shall be also developed within ten (10) working days of admission to the treatment program and shall accurately reflect the individual’s needs and goals;

3. (F) Treatment plans shall be reviewed and updated as follows, unless a more frequent review is stipulated by the court for an individual:

   1. 1. Programs with an expected length of

stay of six (6) months or less shall review and update treatment plans every forty-five (45) days;

1. 2. Programs with an expected length of

stay of more than six (6) months shall review and update treatment plans every ninety (90) days;

1. (G) Persons involved in the care and treatment of an individual shall participate in a staffing for the purpose of developing, coordinating, and communicating the treatment plan to all applicable parties;
2. (H) The program shall facilitate access to and cooperation with all necessary services within the institution including access to pertinent medical records;
3. (I) The program shall conduct or arrange tests to detect a client’s use of alcohol and drugs in accordance with certification standards or Department of Corrections policy and procedure;

4. (J) The program shall provide an intensive phase of treatment and a less intensive phase including, but not limited to, orientation and work release.

   1. 1. During the intensive phase of treat-

ment, each client shall participate in a minimum of thirty (30) hours of planned, structured, therapeutic activity per week.

1. 2. During the less intensive phase of

treatment, each client shall participate in a minimum of ten (10) hours of planned, structured, therapeutic activity per week;

1. (K) Individual counseling shall be provided to each person as follows:

   1. 1. Programs with an expected length of

stay of six (6) months or less shall provide at least two (2) one-hour sessions per month; and

1. 2. Programs with an expected length of

stay of more than six (6) months shall provide at least one (1) one-hour session per month;

1. (L) Each client shall attend a minimum of two (2) one-hour group counseling sessions per week;
2. (M) A discharge summary shall be completed and entered in the client’s record within fifteen (15) days of discharge or transfer from the program;
3. (N) For each group session, a group log shall document the type of service, summary of the service, date, actual beginning and ending time, clients’ attendance and the signature and title of the staff member providing the service. Group activities may be documented in the client record on a prepared schedule, validated by the initials of the service provider; and

4. (O) There shall be written policies and procedures to assure the quality of client records.

   1. 1. Reviews shall include all applicable

forms and documents.

1. 2. Reviews shall include appropriate

clinical content of the following documentation: comprehensive assessment; individualized treatment plan and updates; progress notes; continuing recovery plans; and discharge summaries.

1. 3. Random reviews shall be conducted

on a quarterly basis.

1. 4. The agency shall maintain a record of

files reviewed and include recommendations, corrective actions, and the status of previously identified problems.

1. 5. Files shall reflect date of review and

title and signature of person conducting the review.

1. (8) Client Rights, Responsibilities and Grievances. Requirements under 9 CSR 10-7.020 Client Rights, Responsibilities and Grievances are included by reference and are adapted for institutional corrections treatment programs as follows:

   1. (A) Each individual shall be entitled to these rights, privileges and procedures except where they conflict with rules or official policy governing the rights and privileges of individuals in the custody of the Department of Corrections;
   2. (B) Any deviations from the rights, privileges and procedures defined in 9 CSR 10- 7.020 which are necessary for all individuals shall be identified in the organization’s policy and procedures manual, approved by its governing authority, and justified in its application for certification;

   3. (C) The following rights enumerated under section 9 CSR 10-7.020(3) may be waived:

      1. 1. To receive services in the least

restrictive environment;

1. 2. To consult with a private, licensed

practitioner at one’s own expense;

1. 3. To be paid for work unrelated to treat-

ment, except that the individual may be expected to perform limited tasks and chores within the program that are designed to promote personal involvement and responsibility, skill building or peer support. Any tasks and chores beyond routine care and cleaning of activity or bedroom areas within the program must be directly related to recovery and treatment plan goals developed with the individual;

1. (D) The right to see one’s own records applies only to treatment records;

2. (E) The following rights enumerated under section 9 CSR 10-7.020(4) may be waived:

   1. 1. To wear one’s own clothes and keep

and use one’s own personal possessions;

1. 2. To keep and be allowed to spend a

reasonable amount of one’s own funds;

1. 3. To have reasonable access to a tele-

phone to make and to receive confidential calls;

1. 4. To be free from seclusion and

restraint;

1. 5. To receive visitors of one’s own

choosing at reasonable hours; and

1. 6. To communicate by sealed mail with

individuals outside the facility;

1. (F) The right to use the telephone and receive visitors is subject to the policies of the Department of Corrections; and
2. (G) The organization shall ensure that all individuals have the same legal rights and responsibilities as any other citizen, unless otherwise limited by law or Department of Corrections policy.

1. (9) Behavior Management. Requirements related to behavior management under 9 CSR 10-7.060 are not applicable to institutional corrections treatment programs.
2. (10) Medications. Requirements under 9 CSR 10-7.070 Medications are included by reference, except that medication requirements do not apply to an institutional dispensary or other medical unit of the facility where services are provided under contractual agreement.

3. (11) Dietary Service. Requirements under 9 CSR 10-7.070 Dietary Service are included by reference with the following modification for institutional corrections treatment programs.

   1. (A) An institutional corrections treatment program shall include, as part of its application for certification, evidence that its dietary staff, services and facility comply with applicable requirements established by the Department of Corrections.
   2. (B) If this documentation is provided, the institutional corrections treatment program shall be considered in compliance with 9 CSR 10-7.070 Dietary Service.

4. (12) Personnel. Requirements under 9 CSR 10-7.100 Personnel are included by reference with additional requirements as follows:

   1. (A) The institutional corrections treatment programs shall have a written plan for professional growth that includes cross training in treatment and corrections, and multi-cultural diversity;
   2. (B) Correctional staff that have direct client contact shall be cross trained in treatment issues and exhibit a philosophy that treatment works; and
   3. (C) Treatment staff shall be cross trained in correction issues and understand that custody and protection of the public, staff and offenders are the first priority of security.

5. (13) Physical Plant and Safety. This section modifies the requirements under 9 CSR 10- 7.110 Physical Plant and Safety for institutional corrections treatment programs. Physical plant and safety standards, which would otherwise be in conflict with Department of Corrections policies and procedures, shall be waived.

   1. (A) The program shall comply with Department of Corrections requirements regarding safety including fire safety and emergency preparedness, security, cleanliness and comfort.
   2. (B) The institutional corrections treatment program shall, upon application for certification, provide evidence that the program meets applicable Department of Corrections requirements in these areas. Where such evidence is provided, the agency shall be considered to be in compliance with environmental standards.
   3. (C) The design and structure of the institutional setting shall be sufficient to accommodate staff, clients and functions of the program.

AUTHORITY: sections 313.842, 630.050 and 630.655, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001.

*Original authority: 313.842, RSMo 1991, amended 1996, 2000; 630.050, RSMo 1980, amended 1993, 1995; and 630.655, RSMo 1980.