PURPOSE: This rule prescribes requirements for client care, treatment and habilitation in day programs as required by section 630.710, RSMo.

1. (1) The head of the program shall assure that the client and the client’s parent or guardian participate in the development of the individual program plan unless documented that these individuals are unable or unwilling to participate.
2. (2) 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.
3. (3) The person responsible for implementation of individual objectives of the program plan shall collect data on its implementation and shall prepare a monthly summary. The program plan shall be reviewed at least quarterly by a designated member of the interdisciplinary team and updated annually by the interdisciplinary team. The annual update and implementation of the plan shall occur within three hundred sixty-five (365) days after the implementation of the previous plan.
4. (4) Chemical restraints, mechanical restraints, seclusion or adversive stimuli shall not be used.
5. (5) Physical restraint 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 trained in its use.

6. (6) The day program shall use a time-out only as follows:

   1. (A) A client is placed in time-out only under conditions set out in a written behavior modification program incorporated in his/her program plan;
   2. (B) The client’s program plan identifies the precise behavior which may precipitate the time-out and identifies staff persons authorized to implement time-out procedures;
   3. (C) A single time-out period does not exceed fifteen (15) minutes;
   4. (D) The date, time and duration of each time-out period shall be documented in the client’s file; and
   5. (E) The client is not placed alone in a locked room.
7. (7) 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.
8. (8) Mechanical supports shall be prescribed by a licensed physician, designed and applied under the supervision of a registered occupational therapist, registered nurse (RN), physical therapist or physician who shall issue an order indicating how often clients shall be checked for proper body alignment, circulation, position change and other bodily functions which might be affected by use of mechanical supports. These orders shall be reviewed at least quarterly by the physician, occupational therapist, physical therapist or RN. Clients in mechanical supports shall be checked, at a minimum, twice daily, upon application of the supports and upon their removal unless more frequent checks are required by the order.
9. (9) A notation of all checks of a person in time-out or in mechanical supports shall be entered in the client’s records.

10. (10) The day program shall not use a protective device unless—

    1. (A) It is necessary to protect the client from serious physical injury;
    2. (B) Less restrictive alternatives have failed;
    3. (C) It is applied by staff trained in the use of protective devices; Are Mentally Retarded and Developmentally Disabled
    4. (D) It is applied in a way that will not cause physical injury, bodily discomfort or psychological trauma to the client; and
    5. (E) It has been authorized by a prior order from a physician and approved by the head of the program and, except in emergencies, the interdisciplinary team. Physician’s orders for protective devices shall be reviewed every ninety (90) days.
11. (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).* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. 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.