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 medication administration support, a medication technician or medication aide as defined in 9 CSR 30-4.030;

   8. (H) For community support:

      1. 1. A mental health professional or an

individual with a bachelor’s degree in social work, psychology, nursing or a related field, 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. Equivalent experience in psychiatric and/or substance abuse treatment may be substituted on the basis of one (1) year of experience for each year of required educational training; or

1. 2. A community support assistant with a

high school diploma or equivalent and applicable training required by the department, supervised by a qualified mental health professional as defined in 9 CSR 30-4.030. A community support assistant may receive assignments and direction from a community support worker; and

1. (I) 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 may not exceed one (1) community support worker to twenty (20) clients in the rehabilitation level of care and one (1) community support to twelve (12) children and youth in the rehabilitation level of care.
   2. (B) The supervisory to staff ratio in the rehabilitation level of care should not exceed one (1) qualified mental health professional to seven (7) community support workers.
   3. (C) The supervisory to staff ratio in the rehabilitation level of care should not exceed one (1) qualified mental health professional to two (2) community support assistants.
   4. (D) 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; 9 CSR 30-4

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 providers

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 verbal/physical abuse;

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 verbal/physical/sexual abuse;

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, community support assistants and supervisors in addition to those set out in section (7).

   1. (A) Orientation for community support workers, community support assistants 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. Identification and recognition of crit-

ical situations; and

1. 7. Staff working with children and youth

shall receive additional training 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 and through consultation by a psychiatrist.

1. (9) Each community support worker, community support assistant and supervisor shall complete ten (10) hours of initial training before receiving an assigned client caseload or supervisory caseload.
2. (10) 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.
3. (11) 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 630.050, 630.655 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. 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.

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