PURPOSE: This rule defines terms and establishes procedures for admission and treatment of clients with aggressive behaviors in facilities operated by the Division of Mental Retardation and Developmental Disabilities.

1. (1) Terms defined in sections 630.005, 632.005 and 633.005, RSMo are incorporated by reference for use in this rule. As used in this rule, unless the context clearly indicates otherwise, the following terms also mean:

   1. (A) Categories of risk are—

      1. 1. Dangerous to others through premed-

itation—A client attempts premeditated harm to others by physical or sexual aggression;

1. 2. Dangerous to others—Presented with

opportunity, a client attempts to harm others by physical or sexual aggression through spontaneous action;

1. 3. Dangerous to self—A client makes

serious threats or serious attempts to commit suicide or demonstrates selfinjurious behaviors ;

1. 4. At risk—Due to lack of safety skills,

a client fails to recognize dangerous situations or is at risk due to a potentially life-threatening medical condition; and

1. 5. Low risk—A client has basic safety

skills, his/her medical conditions are controlled and s/he is not dangerous to self or others, but s/he needs variable levels of supervision.

1. (B) Category of Risk Rating Scale—An instrument used to determine category of risk and to specify level of supervision (see Appendix A);

2. (C) Forensic client—A client who—

   1. 1. Is accused of a criminal act but has

been found incompetent to stand trial; or

1. 2. Has been acquitted after trial by rea-

son of mental disease or defect; and

1. (D) Levels of supervision are—

   1. 1. One-to-one—Assignment of one (1)

staff member to be with the client at all times with special consideration of privacy rights and nature of behaviors. One-to-one supervision shall be noted in the client’s individualized habilitation plan (IHP);

1. 2. Line-of-sight—Staff visual contact

with the client at all times. Special supervisory considerations shall be noted in the client’s IHP, for example, restrictions on distance range between client and staff and limitations on client privacy;

1. 3. High priority—Variable levels of staff

supervision dependent on situations. Staff shall remain aware of the client’s previous behaviors while the client participates in group activities and shall implement appropriate proactive procedures as necessary; and

1. 4. Limited—Staff knowledge of client’s

whereabouts while client has freedom of movement. (2) When individuals arrive at a division facility, the interdisciplinary assessment team shall—

1. (A) Review police reports and criminal charges for aggressive individuals, including those who are forensic;
2. (B) Determine the category of risk, using the Category of Risk Rating Scale;
3. (C) Determine the required level of supervision;
4. (D) Document in the client’s file the category of risk and level of supervision; and
5. (E) Flag the client’s file with appropriate level of supervision.

1. (3) After admission of a client with aggressive behaviors, the interdisciplinary team shall—

   1. (A) Reevaluate the client, including a redetermination of the category of risk and required level of supervision;
   2. (B) Conduct an IHP meeting and implement the IHP according to division policy;
   3. (C) Reevaluate the client at least quarterly. The reevaluation shall include a redetermination of the category of risk and required level of supervision; and
   4. (D) Reevaluate the client, including a redetermination of the category of risk and required level of supervision, within twentyfour (24) hours after a serious incident of aggressive behavior.

2. (4) Division facilities shall provide the following levels of client supervision:

   1. (A) Dangerous to others through premeditation—One-to-one, line-of-sight or high priority;
   2. (B) Dangerous to others—One-to-one, line-of-sight or high priority;
   3. (C) Dangerous to self—One-to-one, lineof-sight or high priority;
   4. (D) At risk—A level considered appropriate, depending on environment and situation; and
   5. (E) Low risk—A level considered appropriate, depending on environment and situation.

3. (5) Individuals committed to the department by a circuit court under Chapter 552, RSMo and then admitted to a division facility shall be considered forensic clients.

   1. (A) Forensic clients who have been determined incompetent to stand trial shall receive competency training.
   2. (B) Forensic clients acquitted after trial by reason of mental disease or defect shall receive habilitation training.
4. (6) Forensic clients and clients determined to be dangerous to self or others shall be 9 CSR 45-3

restricted to the facility campus unless the interdisciplinary team recommends off-campus activity with facility staff approved by the facility head.

1. (7) Clients determined to be dangerous to self or others shall be permitted to have social interaction with other clients only when required levels of supervision are present.

2. (8) If a forensic client or a client considered to be dangerous to self or others is missing from the facility, facility staff shall—

   1. (A) Immediately complete a thorough search of the client’s immediate area;
   2. (B) Notify other facility staff, community public safety personnel and others in accordance with division policy; and
   3. (C) Continue a search of the facility campus.
3. (9) Forensic clients and clients considered to be dangerous to self or others shall be assured the same rights as all other clients unless a restriction of their rights is documented in their IHPs.

AUTHORITY: section 630.050, RSMo 1994.* This rule was previously filed as 9 CSR 50- 1.060. Original rule filed Sept. 1, 1993, effective Jan. 31, 1994. Amended: Filed May 25, 1995, effective Dec. 30, 1995.

*Original authority: 630,050, RSMo 1980, amended 1993. and Developmental Disabilities and Developmental Disabilities