PURPOSE: This rule sets out requirements for community support services provided by a community psychiatric rehabilitation program.

1. (1) The community psychiatric rehabilitation
2. (CPR) provider shall establish an identifiable unit within the CPR program which coordinates and provides community support services for persons with serious mental illnesses. The unit is organized to perform those functions within the scope of community support services, including critical interventions.
3. (2) The program shall implement a mechanism for the development of a critical intervention plan for community support clients who are judged by the evaluation team to be in need of critical intervention strategies.

4. (3) The CPR provider shall implement policies and procedures to provide adequate, appropriate and effective community support services. Those policies and procedures shall include:

   1. (A) A mechanism to assure the provision of all needed community psychiatric rehabilitation services, as indicated in the client’s current individualized treatment plan;
   2. (B) A mechanism to assure the provision of all needed services in addition to the community psychiatric rehabilitation program, as indicated in the client’s current individualized treatment plan;

   3. (C) The methodology for assignment of clients to community support worker/teams, including:

      1. 1. Procedures to assure that each client

is afforded choices in the selection of community support workers;

1. 2. A mechanism to assure that all admit-

ted clients are assigned to an active caseload of community support worker; and

1. 3. A mechanism to assure compliance

with minimum/maximum caseload requirements;

1. (D) A process to assure an effective transfer and follow-up of a client between or among community support workers or community support teams. Staff shall document client acceptance, rationale and follow-up of the transfer in the clinical record;
2. (E) The determination of increase or deterioration of client functioning through ongoing needs assessment and quality assurance activities;
3. (F) The identification and documentation of unresolved service delivery constraints;
4. (G) Contribution and participation of staff providing community support services in the CPR program’s quality assurance process;
5. (H) Development of suitable revisions to the client’s treatment goal(s) as indicated by growth or deterioration of individual client functioning, condition;
6. (I) Program and aggregate evaluation activities to determine service effectiveness;

7. (J) The program shall assure that there are effective and appropriate interventions during critical situations which pose risk of serious harm to the client or the client’s ability to live outside of an institution or a more restrictive setting.

   1. 1. CPR program staff shall report the

situation and intervention immediately by phone to the staff’s supervisor and the program’s clinical director. The client’s clinical record shall contain documentation of the situation, intervention and require staff contacts.

1. 2. Qualified mental health professional

staff shall monitor the client as frequently as clinically necessary as documented in the client record or in the client’s critical intervention plan, until the situation no longer is judged as critical.

1. 3. Staff shall report, monitor and docu-

ment all subsequent interventions related to the original critical situation; and

1. (K) The programs shall conduct a monthly case review of all critical interventions occurring during the previous month.

1. (4) Critical intervention goals and objectives shall describe or include:

   1. (A) An individualized listing of critical situations precipitating events or actual crises that are known from the client’s recent and long-term history; and
   2. (B) A listing of possible interventions in hierarchical order or restrictiveness, that may be used when identified critical situations are recognized. Interventions may include, for example, the immediate filling of a prescription; use of alternative sleeping arrangements on a temporary basis; daily monitoring; assessment of medications compliance and regimen; outpatient commitment; voluntary or civil involuntary admission to an inpatient psychiatric program.
2. (5) Observation and monitoring of the client shall occur in the client’s place of residence at least quarterly or more frequently as stipulated by the client’s individual treatment plan. Exceptions shall be documented.

3. (6) The CPR provider shall conduct a monthly case review of all critical interventions occurring during the previous month.

   1. (A) The review shall include an evaluation of the etiology of the situation, the adequacy of the critical intervention plan and the appropriateness and effectiveness of all resulting interventions.
   2. (B) The review team shall document findings of the reviews and incorporate the results into the program’s critical intervention planning and evaluation strategies.

AUTHORITY: section 630.655, RSMo 1994.* Original rule filed Jan. 19, 1989, effective April 15, 1989. Amended: Filed Dec. 13, 1994, effective July 30, 1995.

*Original authority: 630.655, RSMo 1980.