PURPOSE: This rule establishes requirements relative to specialized substance abuse programs for women and children.

1. (1) Eligibility Criteria. The program shall provide treatment, rehabilitation, and other supports solely to women and their children. Services may be offered on a residential or outpatient basis, in accordance with admission and eligibility criteria for those programs and settings specified elsewhere in these rules.

   1. (A) Priority shall be given to women who are pregnant, postpartum, or have children in their physical care and custody. Postpartum shall be defined as up to six (6) months after delivery.

      1. 1. The program shall engage in all activ-

ities necessary to ensure the actual admission of and services to those women who meet priority criteria.

1. 2. Adolescents who meet priority crite-

ria shall be admitted if, in the staff’s clinical judgment, the adolescent can appropriately participate in and benefit from the services and milieu offered.

1. (B) Programs designated for women and children will ensure that treatment occurs in the context of a family systems model. Each 9 CSR 30-3

program will provide therapeutic activities designed for the benefit of children. Thus, it is important that children should accompany their mother, unless contraindicated by medical, educational, family, legal or other reasons which are documented in the client’s record.

1. (2) Therapeutic Issues Relevant to Women. The program shall address therapeutic issues relevant to women and shall address their specific needs.

   1. (A) Therapeutic issues relevant to women shall include, but are not limited to, parenting, relationship issues, self-esteem/selfidentification, domestic violence, sexuality, health, and spirituality.
   2. (B) Residential treatment and communitybased primary treatment shall include planned, supervised activities to promote parent-child bonding.

2. (3) Supervision of Children. Children shall be supervised at all times.

   1. (A) The parent/guardian should be responsible for providing supervision when the child is not attending day care or participating in other scheduled program activities.
   2. (B) Program staff shall assist the parent in providing age-appropriate activities, training and guidance.

3. (4) Availability of Day Care and Staffing Patterns. The program shall ensure that child care/day care is available for children while the mother participates in treatment and rehabilitation services.

   1. (A) The program shall obtain licensure as a day care center, unless an exception is granted by the department.

   2. (B) If an exception is granted, the program shall nevertheless meet any licensure requirements that the department determines to be appropriate or applicable to the program. The program shall—

      1. 1. Employ a full-time staff person to

assume responsibility for day care services. The person shall be qualified by having a minimum of a bachelor’s degree in early childhood education or closely related field;

1. 2. Maintain a staff-to-child ratio at the

following age-related levels:

1. A. Birth through two (2) years.

Groups composed of mixed ages through two (2) years shall have no less than one (1) adult to four (4) children, with no more than eight (8) children in a group;

1. B. Age two (2) years. Groups com-

posed solely of two (2)-year-olds shall have no less than one (1) adult to eight (8) children, with no more than sixteen (16) children in a group;

1. C. Ages three through four (3–4)

years. Groups composed solely of three (3)- and four (4)-year-olds shall have no less than one (1) adult to ten (10) children;

1. D. Ages five (5) and up. Groups com-

posed solely of five (5)-year-olds and older shall have no less than one (1) adult to every sixteen (16) children; and

1. E. Mixed age groups two (2) years

and up. Groups composed of mixed ages of children two (2) years of age and older shall have no less than one (1) adult to ten (10) children with a maximum of four (4) two (2)- year-olds. When there are more than four (4) two (2)-year-olds in a mixed group, there shall be no less than one (1) adult to eight (8) children;

1. 3. If a center has an attendance of more

than fifty (50) children, the center director or individual in charge shall not be included in staff/child ratios except during naptime or on an emergency substitute basis;

1. 4. If a center has an attendance of more

than thirty (30) children at lunch or dinner time, staff shall be provided for meal preparation, serving and cleanup. The staff shall not be included in staff/child ratios during this time; and

1. 5. Individuals employed for clerical,

housekeeping, cleaning and maintenance shall not be included in staff/child ratios while performing those duties.

1. (C) Day care shall not be funded by the division for children who are thirteen (13) or older, unless there has been specific authorization based on clinical utilization review.

1. (5) Therapeutic Issues Relevant to Children. The program shall address therapeutic issues relevant to children and shall address their specific needs. Age-appropriate activities, training and guidance shall be offered to meet the following goals:

   1. (A) To build self-esteem;
   2. (B) To learn to identify and express feelings;
   3. (C) To build positive family relationships;
   4. (D) To develop decision-making skills;
   5. (E) To understand chemical dependency and its effects on the family;
   6. (F) To learn and practice nonviolent ways to resolve conflict;
   7. (G) To learn safety practices such as sexual abuse prevention; and
   8. (H) To address developmental needs.
2. (6) Education for Children. The program shall assist the parent/guardian as necessary to ensure educational opportunities for school age children in accordance with the requirements of the Department of Elementary and Secondary Education.

3. (7) Documenting Services to Children. The program shall document any services provided to children, including day care and community support.

   1. (A) The record shall document the child’s developmental, physical, emotional, social, educational, and family background and current status.
   2. (B) To determine the need for a child to receive services beyond day care and community support, a trained staff member shall complete an initial screening instrument approved by the department. The screening shall include an interview with at least one

4. (1) parent and the child, whenever appropriate.

   1. (C) If indicated by the screening, a qualified staff member will complete an assessment instrument approved by the department. The assessment will determine the appropriateness of therapeutic services and provide information to guide development of an individual plan. The assessment must be completed before a child receives any services beyond day care and community support.
   2. (D) The child’s individual plan and consent for treatment must be signed by the legal guardian.
5. (8) Staff Training. Service delivery staff and program administration shall demonstrate expertise in addressing the needs of women and children. All service delivery staff shall receive periodic training regarding therapeutic issues relevant to women and children.

6. (9) Safety and Health. The program shall maintain a safe, healthy environment which is responsive to the physical and medical needs of women and children.

   1. (A) A registered nurse (one (1) full-time equivalent) shall be available within the program.
   2. (B) At least one (1) staff member shall be on duty at all times who has current training in first aid and cardiopulmonary resuscitation for infants, children and adults.
   3. (C) The program shall demonstrate effective working relationship(s) with a physician, hospital, and/or clinic to provide medical care for women, including pregnant and postpartum women, and their children.

   4. (D) The program shall ensure an evaluation of medical need for each woman and child and shall ensure that each woman and child is medically stable to safely and adequately participate in services. For women, the evaluation of medical need shall include:

      1. 1. Current physical status, including

vital signs; and

1. 2. Any symptoms of intoxication,

impairment or withdrawal.

1. (E) The program shall ensure that recommendations by a physician or licensed health care provider are implemented regarding medical, physical and nutritional needs.
2. (F) If a specialized program for women and children provides detoxification services, it shall comply with applicable standards under 9 CSR 30-3.120 Detoxification. A specialized program for women and children shall not be required to accept applications for ninety-six (96)-hour civil detention of intoxicated persons due to the presence of children within the facility.

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.