PURPOSE: This rule defines terms and explains usage rules for those terms used in certification procedures and standards developed under section 630.655, RSMo for community psychiatric rehabilitation programs and certain services serving persons with serious mental illnesses and disorders.

1. (1) The terms defined in section 630.005, RSMo are incorporated by reference for use in 9 CSR 30-4.031–9 CSR 30-4.047.

2. (2) As used in 9 CSR 30-4.031–9 CSR 30- 4.047, unless the context clearly indicates otherwise, the following terms shall mean:

   1. (A) Administrative agent—an agency and its approved designee(s) authorized by the Division of Comprehensive Psychiatric Services (CPS) as an entry and exit point into the state mental health service delivery system for a geographic service area defined by the division;
   2. (B) Admission—the process described in 9 CSR 30-4.042;
   3. (C) Advanced practice nurse—as set forth in section 335.011, RSMo, a nurse who has had education beyond the basic nursing education and is certified by a nationally recognized professional organization as having a nursing specialty, or who meets criteria for advanced practice nurses established by the board of nursing;
   4. (D) Affiliate—an organization or person providing psychiatric rehabilitation services through subcontract on behalf of a community psychiatric rehabilitation (CPR) provider;
   5. (E) Applicant—an entity which has applied to the division for certification as a CPR provider;
   6. (F) Brief evaluation—activities including screening, assessment, development and revision of an individual treatment plan, for the purposes of establishing client eligibility in a defined level of care;
   7. (G) CPR director—director of CPR program;
   8. (H) Chemical restraints—as defined in section 630.005, RSMo, drugs which are prescribed or administered in an emergency to restrain temporarily an individual who presents a likelihood of serious physical harm to him/herself or to others;
   9. (I) Class I Neglect—failure of an employee to provide reasonable and necessary services to maintain the physical and mental health of any client when the failure presents either imminent danger to the health, safety or welfare of a client or a substantial probability that death or physical injury would result;
   10. (J) Class II Neglect—failure of an employee to provide reasonable or necessary services to a client or resident according to the individualized treatment plan or to identified acceptable standards of care;
   11. (K) Client—a generic term that includes any individual requesting and receiving CPR services which may include not only the person receiving services but also a legal guardian, unless the context clearly indicates otherwise;
   12. (L) Clinical privileges—authorization to a staff person to provide specific client care and treatment service within well-defined limits based on that individual’s license (if applicable), education, training, experience, competence, clinical judgment and generally accepted standards of treatment or care;
   13. (M) Clinical review—a review conducted by mental health professionals identified by the division to determine client eligibility and authorize reimbursement for services determined to be clinically appropriate for a specific client as required by the division;
   14. (N) Community psychiatric rehabilitation center (CPR provider or CPR program)—an organization which provides or arranges for, at the minimum, the following core services: intake and annual evaluations, crisis intervention and resolution, medication services, consultation services, medication administration, community support and psychosocial rehabilitation in a nonresidential setting for individuals with serious mental illness in conjunction with standards set forth in 9 CSR 30- 4.031–9 CSR 30-4.047;
   15. (O) Community support—as defined in 9 CSR 30-4.043(2)(G);
   16. (P) Community support assistant—an individual with a high school diploma or equivalent and applicable training as required by the department;
   17. (Q) Consultation services—as defined in 9 CSR 30-4.043(2)(C);
   18. (R) Crisis intervention and resolution—as defined in 9 CSR 30-4.043(2)(A);
   19. (S) Critical intervention—actions prescribed by an individual’s treatment plan, to intercede on behalf of a client’s safety in critical situations or circumstances that pose a risk of serious harm to a client or to a client’s ability to live outside of an institution or a more restrictive setting than his/her current residence;
   20. (T) Department—the Department of Mental Health;
   21. (U) Director—director of the Department of Mental Health;
   22. (V) Division—the Division of Comprehensive Psychiatric Services of the Missouri Department of Mental Health;
   23. (W) Eligible client—an individual found to have serious mental illness according to specific diagnostic, disability and durational criteria as set out in 9 CSR 30-4.042(4) and satisfying the admission criteria described in 9 CSR 30-4.042;
   24. (X) Facility—the physical plant or site used by a CPR provider to provide mental health services;
   25. (Y) Improper clinical practices—a level of performance or behavior which constitutes a repeated pattern of negligence or which constitutes a continuing pattern of violations of laws, rules, or regulations enforced by the appropriate professional licensing, funding or certifying entity;
   26. (Z) Intake/annual evaluation—as defined in 9 CSR 30-4.035(7) and (18);
   27. (AA) Intensive community psychiatric rehabilitation (CPR)—as defined in 9 CSR 30-4.045;
   28. (BB) Mechanical restraint—any device, instrument or physical object used to restrict an individual’s freedom of movement except when necessary for orthopedic, surgical and other medical purposes;
   29. (CC) Medication administration—as defined in 9 CSR 30-4.043(2)(D);
   30. (DD) Medication administration support— as defined in 9 CSR 30-4.043(2)(E);
   31. (EE) Medication aide—an individual as defined in 13 CSR 15-13.030 who administers medications;
   32. (FF) Medication services—as defined in 9 CSR 30-4.043(2)(B);
   33. (GG) Medical technician—an individual as defined in 13 CSR 15-13.020 who administers medications;

   34. (HH) Mental health professional—any of the following:

       1. 1. A physician licensed under Missouri

law to practice medicine or osteopathy and with training in mental health services or one (1) year of experience, under supervision, in treating problems related to mental illness or specialized training;

1. 2. A psychiatrist, a physician licensed

under Missouri law who has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program identified as equivalent by the department;

1. 3. A psychologist licensed under Mis-

souri law to practice psychology with specialized training in mental health services;

1. 4. A professional counselor licensed

under Missouri law to practice counseling and with specialized training in mental health services;

1. 5. A clinical social worker licensed

under Missouri law with a master’s degree in social work from an accredited program and with specialized training in mental health services;

1. 6. A psychiatric nurse, a registered pro-

fessional nurse licensed under Chapter 335, RSMo with at least two (2) years of experience in a psychiatric or substance abuse treatment setting or a master’s degree in psychiatric nursing;

1. 7. An individual possessing a master’s

or doctorate degree in counseling and guidance, rehabilitation counseling and guidance, rehabilitation counseling, vocational counseling, psychology, pastoral counseling or family therapy or related field who has successfully completed a practicum or has one (1) year of experience under the supervision of a mental health professional;

1. 8. An occupational therapist certified by

the American Occupational Therapy Certification Board, registered in Missouri, has a bachelor’s degree and has completed a practicum in a psychiatric setting or has one (1) year of experience in a psychiatric setting, or has a master’s degree and has completed either a practicum in a psychiatric setting or has one (1) year of experience in a psychiatric setting;

1. 9. An advanced practice nurse—as set

forth in section 335.016, RSMo, a nurse who has had education beyond the basic nursing education and is certified by a nationally recognized professional organization as having a nursing specialty, or who meets criteria for advanced practice nurses established by the board of nursing; and

1. 10. A psychiatric pharmacist as defined

in 9 CSR 30-4.030;

1. (II) Psychiatric pharmacist—a registered pharmacist in good standing with the Missouri Board of Pharmacy who is a board-certified psychiatric pharmacist (BCPP) through the Board of Pharmaceutical Specialties or a registered pharmacist currently in a psychopharmacy residency where the service has been supervised by a board-certified psychiatric pharmacist;
2. (JJ) Physical abuse—in accordance with 9 CSR 10-5.200;
3. (KK) Physical restraint—physical holding of a client which restricts a client’s freedom of movement to restrain temporarily in an emergency a client who presents a likelihood of serious physical harm to him/herself or to others;
4. (LL) Psychosocial rehabilitation—as defined in 9 CSR 30-4.043(2)(I);
5. (MM) Research—experiments, including intervention or interaction with clients, whether behavioral, psychological, biomedical or pharmacological and program evaluation as set out in 9 CSR 60-1.010(1);
6. (NN) Seclusion—placement alone in a locked room for any period of time;
7. (OO) Sexual abuse—in accordance with 9 CSR 10-5.200;
8. (PP) Time-out—temporary exclusion or removal of a client from the treatment or rehabilitation setting, used as a behavior modifying technique as prescribed in the client’s individual treatment plan and for periods of time not to exceed fifteen (15) minutes each; and
9. (QQ) Verbal abuse—in accordance with 9 CSR 10-5.200.

AUTHORITY: sections 630.050, 630.055 and 632.050, RSMo 2000.* Original rule filed Jan. 19, 1989, effective April 15, 1989. Emergency amendment filed Aug. 27, 1993, effective Sept. 8, 1993, expired Nov. 7, 1993. Emergency amendment filed Oct. 28, 1993, effective Nov. 7, 1993, expired March 6, 1994. Emergency amendment filed Feb. 15, 1994, effective March 6, 1994, expired April 10, 1994. Amended: Filed Aug. 27, 1993, effective April 9, 1994. Amended: Filed Dec. 13, 1994, effective July 30, 1995. Emergency amendment filed Aug. 11, 1999, effective Aug. 22, 1999, expired Feb. 17, 2000. Amended: Filed Aug. 11, 1999, effective Feb. 29, 2000. Amended: Filed Feb. 28, 2001, effective Oct. 30, 2001. Emergency amendment filed Dec. 28, 2001, effective Jan. 13, 2002, expired July 11, 2002. Amended: Filed Dec. 28, 2001, effective July 12, 2002. Amended: Filed July 31, 2002, effective March 30, 2003. *Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.055, RSMo 1980; 632.050, RSMo 1980.