PURPOSE: This rule prescribes requirements for client care, treatment and rehabilitation in day programs serving people who are mentally ill and mentally disordered as required by section 630.710, RSMo.

1. (1) Each licensed day program shall have scheduled activities which are consistent with the identified needs of its clients and which meet the requirements of sections (2)—(4) of this rule.
2. (2) In day programs identified by the department as partial hospitals, comprehensive psychosocial rehabilitation centers or day treatment programs, there shall be an individualized program plan for each client within thirty (30) days of admission. 9 CSR 40-10
3. (3) The person responsible for the implementation of the individual objectives of the program plan shall collect data on its implementation and shall prepare a progress note at least monthly. This monthly progress note may be data-based, anecdotal, subjective, or narrative. The program plan shall be reviewed quarterly and updated annually. The annual update and implementation of the plan shall occur within three hundred sixty-five
4. (365) days after the implementation of the previous plan.
5. (4) The program plan shall be person-centered, developed with the active participation of the client and shall address community membership and involvement, client choice and positive relationships with people who are not paid staff.

6. (5) Day programs which are not identified under section (2) of this rule are not required to have individual program plans for each client. However, each day program so identified shall—

   1. (A) Maintain a calendar of scheduled events and make this calendar available to clients; and
   2. (B) Enter monthly progress/participation notes in each client’s record indicating to what extent each client is utilizing the services offered by the day program and a brief description of the client’s response, adjustment or involvement.
7. (6) Chemical restraints, mechanical restraints, seclusion, time-out or aversive stimuli shall not be used.
8. (7) Physical restraints shall be used only when less restrictive alternatives have failed and only to reduce or eliminate an episode or substantial risk of serious physical harm. Any use of restraint shall conform to the program policies and procedures regarding restraint. Physical restraint shall be applied only by a staff person who has been properly trained.

9. (8) If a facility has a policy prohibiting the use of physical restraint, that policy shall be in writing and stipulate the following:

   1. (A) The day program specifically states in writing that it will never use physical restraint under any circumstances;
   2. (B) The policy prohibiting use of physical restraint is appropriate and realistic for clients being served;
   3. (C) The admission criteria would prohibit admitting any client who would likely need to be physically restrained; and
   4. (D) The day program must describe how it will deal with explosive behavior if physical restraint is not used.
10. (9) Participation in volunteer work shall be documented in the individual program plan.
11. (10) Temporary exclusion or removal of a client as a behavior method, but not as a formal behavior modification procedure, shall be governed by written policies regarding control and discipline, as required by 9 CSR 40-2.075(2)(A)3.E.
12. (11) In programs which have incontinent clients, the program shall insure that clients are kept clean and that clean clothing is available at the program. There shall be a system for either washing or storing soiled clothing and returning it to the client’s home.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Emergency rule filed June 17, 1986, effective July 1, 1986, expired Oct. 29, 1986. Original rule filed June 17, 1986, effective Nov. 13, 1986. Amended: Filed Aug. 18, 1987, effective Nov. 15, 1987. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. *Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.