PURPOSE: This rule prescribes personnel policies and procedures for community psychiatric rehabilitation programs.

1. (1) Each agency that is certified shall comply with requirements set forth in Department of Mental Health Core Rules for Psychiatric and Substance Abuse Programs, 9 CSR 10-7.110 Personnel.

2. (2) Only qualified professionals shall provide community psychiatric rehabilitation (CPR) services. Qualified professionals for each service shall include:

   1. (A) For intake/annual evaluations, an evaluation team consisting of, at least, a physician, one (1) other mental health professional, as defined in 9 CSR 30-4.030, and including, for the annual evaluation, the community support worker assigned to each client;
   2. (B) For brief evaluation, an evaluation team consisting of at least, a physician and one (1) other mental health professional, as defined in 9 CSR 30-4.030;
   3. (C) For treatment planning, a team consisting of at least a physician, one (1) other mental health professional as defined in 9 CSR 30-4.030 and the client’s community support worker;
   4. (D) For crisis intervention and resolution, any mental health professional as defined in 9 CSR 30-4.030;
   5. (E) For medication services, a physician, psychiatric pharmacist, or advanced practice nurse as defined in 9 CSR 30-4.030;
   6. (F) For medication administration, a physician, registered professional nurse (RN), licensed practical nurse (LPN), advanced practice nurse, or psychiatric pharmacist;
   7. (G) For metabolic syndrome screening, a registered professional nurse (RN), or licensed practical nurse (LPN);
   8. (H) For psychosocial rehabilitation illness management and recovery, an individual with department-approved training;
   9. (I) For individual and group professional psychosocial rehabilitation, a professional counselor licensed or provisionally licensed under Missouri law and with specialized training in mental health services; or a clinical social worker licensed or master social worker licensed under Missouri law and with specialized training in mental health services; or a psychologist licensed or provisionally licensed or temporary licensed under Missouri law with specialized training in mental health services;

   10. (J) For community support—

       1. 1. A mental health professional or an

individual with a bachelor’s degree in social work, psychology, nursing, or a human services field, which includes, education, criminal justice, recreational therapy, human development and family studies, counseling, child development, gerontology, and rehabilitation counseling; and supervised by a psychologist, professional counselor, clinical social worker, psychiatric nurse, or individual with an equivalent degree as defined in 9 CSR 30-4.030; or

1. 2. At least two (2) years of higher edu-

cation with (2) two years of experience in psychiatric, substance abuse treatment, or developmental disabilities, or any four- (4-) year degree with two (2) years of experience in psychiatric, substance abuse treatment, or developmental disabilities; or

1. 3. Four (4) years of equivalent experi-

ence with consumers and their families receiving psychiatric, substance abuse treatment, or developmental disabilities services to move towards their personal, social, and vocational competency in order to live successfully in the community;

1. (K) For peer support services, a Certified Missouri Peer Specialist with at least a high school diploma or equivalent and applicable training and testing as required by the department, supervised by a qualified mental health professional as defined in 9 CSR 30-4.030;
2. (L) For family support, a family member of a child or youth who had or currently has a behavioral or emotional disorder; has a high school diploma or equivalent and has completed training approved by or provided by the department and supervised by qualified mental health professional as defined in 9 CSR 30-4.030;
3. (M) For child and adolescent family assistance, an individual with a high school diploma and two (2) years experience working with children who have a severe emotional disorder or have experienced abuse and neglect; has completed training approved by or provided by the department; and shall be supervised by a qualified mental health professional as defined in 9 CSR 30-4.030;
4. (N) For day treatment for youth, one (1) qualified mental health professional and one

1. (1) appropriately certified, licensed, or credentialed ancillary staff for children ages three (3) to five (5) years of age; and one (1) qualified mental health professional and, at a minimum, two (2) appropriately certified, licensed, or credentialed ancillary staff for school-aged children. Ancillary staff shall meet at least one (1) of the following criteria:

   1. 1. Occupational therapist;
   2. 2. Physical therapist;
   3. 3. Assistant behavior analyst;
   4. 4. Individual with a bachelor’s degree in

child development, psychology, social work, or education;

1. 5. Individual with an associate degree

with two (2) years experience in related mental health or child-related fields; or

1. 6. Individual with two (2) years of col-

lege and two (2) years experience in related mental health or child-related fields;

1. (O) For psychosocial rehabilitation (PSR) 9 CSR 30-4

for youth, the director shall be a qualified mental health professional with two (2) years experience working with children and youth. One (1) full-time equivalent mental health professional shall be available onsite during the provision of services. The staffing ratios shall be based on the client’s age. For those clients between the ages of three (3) and eleven (11), the staffing ratio shall be one (1) staff to four (4) clients. For those clients between the ages of twelve (12) and seventeen (17), the staffing ratio shall be one (1) staff to six (6) clients. Other staff of the PSR team shall be composed of the following providers as needed by the children:

1. 1. A registered nurse;
2. 2. An occupational therapist;
3. 3. A recreational therapist;
4. 4. A rehabilitation therapist;
5. 5. A community support worker; or
6. 6. A family assistance worker; and
7. (P) For consultation services, a physician, a psychiatric pharmacist, or advanced practice nurse as defined in 9 CSR 30-4.030.

1. (3) The CPR provider shall ensure that an adequate number of appropriately qualified staff is available to support the functions of the program. The department shall prescribe caseload size and supervisory-to-staff ratios.

   1. (A) Caseload size shall vary according to the acuity, symptom complexity, and the needs of the individuals served. However, caseload size should not exceed one (1) community support worker to thirty (30) adults in the rehabilitation level of care and one (1) community support worker to twenty (20) children and youth in the rehabilitation level of care. Should any individual receiving CPR services believe that a community support worker’s caseload size is too large to attend to his or her service needs, that individual or his or her guardian has the right to request an independent review by the CPR program director sufficient to determine the adequacy of the caseload size and to implement an adjustment should one be deemed necessary.
   2. (B) The supervisory-to-staff ratio in the rehabilitation level of care should not exceed one (1) qualified mental health professional to eight (8) total staff.
2. (4) The department may issue waivers and exceptions to the staffing patterns promulgated under this section as it deems necessary and appropriate.

3. (5) Personnel policies and procedures shall comply with all aspects of 9 CSR 10-7.110, shall apply to all staff and volunteers working in the CPR program, and shall include:

   1. (A) Requirements for an annual written job performance evaluation for each employee and procedures which provide staff with the opportunity to review the evaluation; and
   2. (B) Client abuse and neglect and procedures for investigating alleged violations.

4. (6) The provider shall have and implement a process for granting clinical privileges to practitioners.

   1. (A) Each treatment discipline shall define clinical privileges based upon identified and accepted criteria approved by the governing body.
   2. (B) The process shall include periodic review of each practitioner’s credentials, performance, education, and the like, and the renewal or revision of clinical privileges at least every two (2) years.

   3. (C) The provider shall base initial granting and renewal of clinical privileges on—

      1. 1. Well-defined written criteria for qual-

ifications, clinical performance, and ethical practice related to the goals and objectives of the program;

1. 2. Verified licensure, certification, or

registration, if applicable;

1. 3. Verified training and experience;
2. 4. Recommendations from the agency’s

program, department service, or all of these, in which the practitioner will be or has been providing service;

1. 5. Evidence of current competence;
2. 6. Evidence of health status related to

the practitioner’s ability to discharge his/her responsibility, if indicated; and

1. 7. A statement signed by the practition-

er that s/he has read and agrees to be bound by the policies and procedures established by the provider and governing body.

1. (D) Renewal or revision of clinical privileges also shall be based on—

   1. 1. Relevant findings from the provider’s

quality assurance activities; and

1. 2. The practitioner’s adherence to the

policies and procedures established by the provider and governing body.

1. (E) As part of the privileging process, the provider shall establish procedures to—

   1. 1. Afford a practitioner an opportunity

to be heard, upon request, when denial, curtailment, or revocation of clinical privileges is planned;

1. 2. Grant temporary privileges on a time-

limited basis; and

1. 3. Ensure that nonprivileged staff

receive close and documented supervision from privileged practitioners until training and experience are adequate to meet privilege requirements.

1. (7) The CPR provider shall establish, maintain, and implement a written plan for professional growth and development of personnel.

   1. (A) The CPR provider shall provide orientation within thirty (30) calendar days of employment, documented, for all personnel and affiliates, and shall include, but not be limited to:

      1. 1. Client rights and confidentiality poli-

cies and procedures, including prohibition and definition of abuse, neglect, and misuse of funds as defined in 9 CSR 10-5.200;

1. 2. Client management, for example,

techniques which address verbal and physical management of aggressive, intoxicated, or behaviorally-disturbed clients;

1. 3. CPR program emergency policies and

procedures;

1. 4. Infection control;
2. 5. Job responsibilities;
3. 6. Philosophy, values, mission, and

goals of the CPR provider; and

1. 7. Principles of appropriate treatment,

including for staff working with children and youth, principles related to children and youth populations.

1. (B) Staff who are transferred or promoted to a new job assignment shall receive orientation to their new job responsibilities within thirty (30) days of actual transfer.

2. (C) The CPR provider shall provide orientation for volunteers and trainees within thirty (30) calendar days of initial attendance or employment that includes, but is not limited to, the following:

   1. 1. Client rights and confidentiality poli-

cies and procedures, including abuse, neglect, and misuse of funds as defined in 9 CSR 10-5.200;

1. 2. CPR program emergency policies and

procedures;

1. 3. Philosophy, values, mission, and

goals of the CPR provider; and

1. 4. Other topics relevant to their assign-

ments.

1. (D) Staff working within the CPR program also shall receive additional training within six (6) months of employment. This training shall include, but is not limited to:

   1. 1. Signs and symptoms of disability-

related illnesses;

1. 2. Working with families and caretakers

of clients receiving services;

1. 3. Rights, roles, and responsibilities of

clients and families;

1. 4. Methods of teaching clients self-help,

communication, and homemaking skills in a community context;

1. 5. Writing and implementing an individ-

ual treatment plan specific to community psychiatric rehabilitation services, including goal setting, writing measurable objectives, and development of specific strategies or methodologies;

1. 6. Basic principles of assessment;
2. 7. Special needs and characteristics of

individuals with serious mental illnesses;

1. 8. Philosophy, values, and objectives of

community psychiatric rehabilitation services for individuals with serious mental illnesses; and

1. 9. Staff working with children and youth

shall receive additional training in the above areas as it pertains to children and youth.

1. (8) The CPR provider shall develop and implement a written plan for comprehensive training and continuing education programs for community support workers, Certified Missouri Peer Specialists, and supervisors in addition to those set out in section (7).

   1. (A) Orientation for community support workers, Certified Missouri Peer Specialists, and supervisors shall include, but is not limited to, the following items:

      1. 1. Philosophy, values, and objectives of

community psychiatric rehabilitation services for individuals with serious and persistent mental illnesses;

1. 2. Behavioral management, crisis inter-

vention techniques, and identification of critical situations;

1. 3. Communication techniques;
2. 4. Health assessment and medication

training;

1. 5. Legal issues, including commitment

procedures;

1. 6. Recovery and wellness practices;
2. 7. Resources including treatment alter-

natives, employment opportunities, health and wellness, and community resources; and

1. 8. Staff working with children and youth

shall receive additional training approved by the department in the above areas as it pertains to children and youth.

1. (B) The curricula for training shall include a minimum set of topics as required by the department.

1. (9) Each community support worker, Certified Missouri Peer Specialist, and supervisor shall complete ten (10) hours of initial training before receiving an assigned client caseload or supervisory caseload.
2. (10) Qualified staff providing individual and group professional psychosocial rehabilitation, shall complete training as required by the department in addition to training set out in section (7).
3. (11) 9 CSR 10-7.110 requires that all staff shall participate in at least thirty-six- (36-) clock hours of relevant training during a two- (2-) year period. All staff working within the CPR program and services shall receive a minimum of twelve- (12-) clock hours per year of continuing education and relevant training.
4. (12) All training activities shall be documented in employee personnel files, to include the training topic, name of instructor, date of activity, duration, skills targeted/objective of skill, certification/continuing education units (if any), and location.

AUTHORITY: sections 630.655 and 632.050, RSMo 2000, and section 630.050, RSMo Supp. 2011.* 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. Emergency amendment filed June 15, 1994, effective June 25, 1994, expired Oct. 21, 1994. Amended: Filed June 15, 1994, effective Oct. 30, 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. Amended: Filed May 12, 2010, effective Nov. 30, 2010. Amended: Filed Dec. 1, 2011, effective June 30, 2012.

*Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 632.050, RSMo 1980.