Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 21 - MENTAL HYGIENE REGULATIONS
Chapter 10.21.18 - Community Mental Health Programs-Therapeutic Nursery Programs
Section 10.21.18.08 - Program Staff
Universal Citation: MD Code Reg 10.21.18.08
Current through Register Vol. 51, No. 19, September 20, 2024
A. Based on the complexity of the services provided and the number of enrollees in the therapeutic nursery, a therapeutic nursery program shall provide sufficient staff to maintain the staff-to-child ratio provided in §E of this regulation and to carry out the therapeutic goals of the therapeutic nursery.
B. Therapeutic Nursery Staff. A provider of therapeutic nursery services shall ensure that the therapeutic nursery staff includes, at a minimum:
(1) A program director who:
(a) Is a mental health professional or has a
master's degree in a health services administration field;
(b) Is on a site of the therapeutic nursery
at least 50 percent of the operating hours of the therapeutic nursery
program;
(c) If a therapeutic
nursery program operates in more than one site, has contact with each site each
week; and
(d) Is responsible for
operational oversight for, at a minimum:
(i)
Fulfilling the administrative requirements under COMAR 10.21.17,
(ii) Recruiting, hiring, and providing
administrative supervision of staff,
(iii) Developing and implementing the
budget,
(iv) Keeping the governing
body informed of, at a minimum, the program's approval status and performance,
and
(v) Recruiting and enrolling
program participants;
(2) A clinical director who:
(a) Is a mental health
professional;
(b) Is on a site of
the therapeutic nursery at least 50 percent of the operating hours of the
therapeutic nursery program;
(c) If
a therapeutic nursery program operates in more than one site, has contact with
each site each week;
(d) If the
clinical director is also the program director, is on a site at the therapeutic
nursery program on a full-time basis during the operating hours of the
therapeutic nursery program; and
(e) Is responsible for oversight for, at a
minimum, the following:
(i) Development of the
ITP,
(ii) Providing clinical
supervision of staff, including the educational staff of a therapeutic nursery
program that is not affiliated with an educational preschool program,
(iii) Development of therapeutic strategies
that may be used in the classroom,
(iv) Development of treatment
programs,
(v) Quality improvement,
and
(vi) Inservice
training;
(3)
A therapeutic nursery physician who:
(a) Has
completed a residency in child psychiatry in an accredited program;
(b) As specified in the employment or
consultant contract, is available on a therapeutic nursery site for the amount
of time necessary to carry out the duties outlined in §B(3)(c) of this
regulation, and, at a minimum:
(i) If 25 or
fewer children are enrolled in the therapeutic nursery program, for a minimum
of 2 hours per week, and
(ii) For 1
additional hour per week for every additional one to ten children who are
enrolled in the therapeutic nursery program; and
(c) Is responsible for, at a minimum, the
following:
(i) Establishing and maintaining
appropriate standards for treatment, including therapeutic modalities and
prescribing practices,
(ii) Unless
carried out by other staff qualified under the provisions of Health Occupations
Article, Annotated Code of Maryland, as required under the provisions of
Regulation .05B and C of this chapter, diagnostic formulation and participation
in the development and signing of the ITP and the ITP 3-month
reviews,
(iii) Clinical supervision
of those cases requiring face-to-face medical review,
(iv) Review of medication utilization and
corrective feedback when utilization is found to be inappropriate,
and
(v) Medical aspects of quality
improvement; and
(4) A staff psychologist or psychologist
consultant who:
(a) As specified in the
employment or consultant contract, is available on the site or sites of the
therapeutic nursery program for the amount of time necessary to carry out the
duties outlined in §B(4)(b) of this regulation; and
(b) Is responsible for, at a minimum, the
following:
(i) Unless carried out by other
staff qualified under the provisions of Health Occupations Article, Annotated
Code of Maryland, as required under the provisions of Regulation .05B and C of
this chapter, diagnostic formulation and participation in the development and
signing of the ITP and the ITP 3-month reviews,
(ii) As needed, performing psychological
assessment and testing, and
(iii)
Making appropriate referral for those cases requiring face-to-face medical
review.
C. Treatment Coordinator. The program director shall assign to each child who is admitted to a therapeutic nursery a treatment coordinator who is a mental health professional.
D. Educational Staff. If the therapeutic nursery is not affiliated with an educational preschool program, the therapeutic nursery educational staff shall:
(1) Be sufficient to carry out the
educational programs provided by the therapeutic nursery and the classroom
strategies described in the ITPs; and
(2) Meet the qualifications required under
COMAR 13A.09.09.05C.
E. Staff-to-Child Ratio. The therapeutic nursery program shall ensure that the following required treatment or education staff-to-child ratio is maintained at all times:
(1) For Program A, a
staff-to-child ratio of at least one staff member for every five enrollees;
and
(2) For Program B:
(a) If the therapeutic nursery is not
affiliated with an educational preschool program, a staff-to-child ratio of at
least one staff member for every four enrollees, and
(b) If the therapeutic nursery is affiliated
with an educational preschool program, a staff-to-child ratio of at least one
therapeutic nursery treatment staff member for every 10 preschool children,
provided that not more than four children are therapeutic nursery
enrollees.
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