Code of Massachusetts Regulations
606 CMR - DEPARTMENT OF EARLY EDUCATION AND CARE
Title 606 CMR 3.00 - Standards for the Licensure or Approval of Residential Programs Servicing Children and Teen Parents
Section 3.06 - Programs and Services
Universal Citation: 606 MA Code of Regs 606.3
Current through Register 1531, September 27, 2024
(1) Case Management. The licensee shall assign to each resident in care more than 72 hours a staff person who shall be responsible for coordinating implementation of the resident's service plan and other services provided. The licensee shall insure continuity of case management responsibilities in the absence of the case manager for an extended period of time such as vacation or leave. The case manager shall:
(a) meet with the child on a regular basis to
ensure that the child's daily needs are being met;
(b) attend and participate in the resident's
service planning, periodic review, and discharge planning meetings as required
by 606 CMR 3.05(4), (5), and (7);
(c) work with persons involved in the
resident's care to assure implementation of the service plan;
(d) collaborate with other agencies who share
responsibilities for the resident's welfare, and utilize appropriate community
resources in providing needed services;
(e) assure that the resident's record is
maintained in compliance with 606 CMR 3.10(1);
(f) carry a reasonable caseload which allows
for an effective and timely performance of the above tasks.
(2) Family Engagement.
(a) Each licensee who
provides care for residents for more than 72 hours shall have a written plan
for family engagement which shall include establishing a professional
relationship and maintaining regular contact with each resident's family for
the purposes of:
1. notifying the family of
the child's whereabouts and obtaining any necessary parental consent;
2. providing crisis intervention services and
assessment as necessary;
3.
facilitating the adjustment process for the child and his or her
family;
4. developing a visiting
plan and encouraging the family's continued interaction with their child in
accordance with the child's service plan;
5. providing the family with a description
and explanation of the program's method of physical restraint, if applicable;
and providing the family with a copy of the program's prevention/restraint
training curriculum;
6. informing
the family of their child's progress;
7. mobilizing parent(s) strengths and
resources to help them participate in planning for their child's return home or
to another community environment.
(b) In programs serving teen parents, the
plan for family work shall include reference to fathers who remain involved
with their children. Whenever possible and appropriate, fathers should share
responsibilities and decision making with the teen mother and others regarding
the child's health and physical care, education, and personal-social-cultural
development and support.
(c) If the
teen mother does not wish to have her family and/or the child's father
involved, the licensee may refrain from engaging in family work provided that
written documentation of the teen mother's objection is maintained in her
record.
(d) If contact with a
resident's family is prohibited by court order or is not clinically
appropriate, the licensee may refrain from engaging in family work provided
that written documentation of such circumstance is maintained.
(e) The licensee may provide family work
services through staff employed directly, or through agreement with another
agency.
(3) Social, Psychological and Psychiatric Services.
(a) The licensee shall provide evidence of
access to emergency mental health services on a 24 hour per day, seven day per
week basis. This evidence may be provided through an agreement with the
Department of Mental Health or another mental health service provider
responsible for evaluation, crisis intervention and facilitation of admission
to an inpatient facility; an agreement with a private psychiatrist who can
provide crisis intervention and facilitate inpatient admission if necessary; an
agreement with an inpatient mental health facility; or an agreement with a
hospital having an inpatient psychiatric unit.
(b) Licensees who provide care for children
for more than 72 hours shall establish and describe in writing a plan for
providing social, psychological and psychiatric services. The plan shall insure
that each resident's needs for such services shall be met and the purpose of
the program accomplished.
(c) As
appropriate to the needs of the residents, the licensee shall provide or
facilitate the provision of a range of social, psychological and psychiatric
services which shall include:
1. crisis
intervention;
2. evaluation and
assessment;
3. therapy and/or
counseling for individuals and groups;
4. clinical consultation with residents,
parents or guardians and staff;
5.
staff development services including specific training geared to address the
needs of residents in the program.
(4) Health Services.
(a) The licensee shall have a written plan
for meeting the health needs of the residents served and which details the
availability of qualified medical care to the program, including medical
emergencies on a 24 hour per day, seven day per week basis.
(b) The licensee shall provide or arrange for
residents in the facility a range of health services including:
1. evaluation and diagnosis;
2. treatment;
3. consultation;
4. preventive health services.
However, in transition to independent living programs and programs serving teen parents, the resident may be responsible for arranging, obtaining and documenting his or her own medical services and those of his or her child.
(c)
At the time of placement, residents shall be provided with emergency
medical/dental/ mental health care if needed.
(d) For each child placed on an emergency
basis who remains in care more than 14 days, the licensee shall ensure that the
child has had a recent medical and dental examination according to Department
of Public Health guidelines.
1. If the child
has had a current exam, the licensee shall attempt to obtain documentation of
it.
2. If such routine medical and
dental exams have not occurred, the licensee shall, within one week, schedule
an appointment for the exams.
(e) Except for children placed on an
emergency basis, the licensee shall insure that at the time of placement each
resident has had a medical examination not more than 30 days prior to admission
where possible or within two weeks after admission. Such physical examination
shall not be required, however, if the licensee obtains documentation of a
physical exam conducted less than one year prior to admission and in accordance
with Department of Public Health guidelines.
(f) The licensee shall insure that the
medical examination at placement includes screening for lead poisoning in
accordance with
105 CMR
460.050: Mandatory Lead Poisoning
Screening and Follow-up Schedule.
(g) Preventive health services for residents
shall include but not be limited to:
1.
routine medical and dental examinations in accordance with Department of Public
Health guidelines. Routine dental examinations should begin at age three and be
scheduled annually thereafter.
a. Medical
examinations may be conducted by a licensed physician, a certified nurse
practitioner or a physician's assistant.
b. Special studies are to be carried out at
the direction of a physician in accordance with the child's needs and
Department of Public Health guidelines.
c. Medical examinations shall include
screening for lead poisoning in accordance with Department of Public Health
regulations at
105 CMR
460.050: Mandatory Lead Poisoning
Screening and Follow-up Schedule;
2. immunizations and TB testing as required
by the Department of Public Health;
3. reporting of communicable diseases and
infections to the local Board of Health as required by M.G.L. c. 111, §
111;
4. family planning
information, and upon request of the resident (with any required consent of
parent or guardian or placement agency), provision of or referral for family
planning devices, medication and services. Any licensee whose conscience
prohibits the provision of such family planning devices, medication or
services, shall notify the resident, parents or referral source that the
facility will not provide such services.
(h) The licensee shall insure that medically
recommended glasses, hearing aids, prosthetic devices, corrective physical or
dental devices or any equipment recommended or treatments prescribed by the
examining physician are provided to the resident, consistent with the terms of
the agreement with the placement agency and purchaser of service, 606 CMR
3.05(2)(d).
(i) The licensee may
not require any child to receive medical treatment or screening when the
parents of such child object on the basis of sincerely held religious beliefs.
However, the program may seek a court order for medical treatment of a child if
it believes such medical treatment is in the child's best interest.
(j) The licensee shall isolate children in
cases of illnesses requiring isolation. Isolation shall include the least
restrictive measures which will prevent the spread of disease while also
addressing a child's emotional well-being.
(k) The licensee shall have written policies
and procedures regarding the prescription and administration of all medication.
These policies and procedures shall include the following:
1.
Administration
Procedures.
a.
Administration by Staff. The licensee shall identify
on a written list all persons authorized by law, regulation and the licensee to
prescribe and/or administer prescription and non-prescription medication to a
resident. The licensee shall also develop procedures to:
i. document the prescription and/or
administration of medication;
ii.
provide notification to attending physicians of significant changes in a
resident's behavior or health that may result from medication;
iii. record
significant side effects of medication.
b.
Self-administration. If the licensee allows a resident
to self-administer medications or administer medications to his or her child,
medication policies shall include the following:
i. a means to assess a resident's ability to
responsibly self-medicate;
ii.
training for residents concerning medications and side effects, administration
procedures, safe storage, and documentation of all medications except
well-child medication, such as vitamins;
iii. the type of supervision and monitoring
provided by staff.
2.
Staff Training.
All staff shall be provided with copies of and trained in the licensee's
policies and procedures regarding administration of medication. Only staff and
residents who have been trained shall administer medications.
3.
Antipsychotic
Medication. Antipsychotic medication shall mean drugs which are
used in treating psychoses and alleviating psychotic states. The licensee shall
not administer or arrange for the administration of antipsychotic medication
except as follows:
a. Any antipsychotic
medication shall be prescribed by a licensed physician for the diagnosis,
treatment and care of the resident, and only after review of his or her medical
record and observation of the resident.
b. If antipsychotic medication is prescribed,
the prescribing physician shall submit a written report to the licensee
detailing the necessity for the medication; the staff monitoring requirements,
if any; potential side effects that may or may not require medical attention;
and the next scheduled clinical meeting or series of meetings with the
resident.
c. No antipsychotic
prescription shall be administered for a period longer than is medically
necessary, as determined by the prescribing physician after meeting with the
resident; reviewing the resident's progress; and examining the resident for
potential side effects. All meetings with the resident after the initial
meeting shall be on a schedule determined by the physician, as sufficient to
monitor the resident while on antipsychotic medication.
d. Except in an emergency, when an unforeseen
combination of circumstances or the resulting state calls for immediate action,
the licensee shall not administer or arrange for prescription and
administration of antipsychotic medication unless informed written consent is
obtained from a parent, if available, or unless judicial approval is received.
The referral source shall be notified of the need for consent.
e. The licensee shall inform a resident 12
years of age and older, consistent with his or her capacity to understand,
about the treatment, risks and any potential side effects of such medication.
The licensee shall have procedures to follow if the resident refuses to consent
to administration of the medication.
f. In an emergency situation antipsychotic
medication may be administered for treatment purposes without parental consent
or prior judicial approval if an unforeseen combination of circumstances or the
resulting state calls for immediate action and there is no less intrusive
alternative to the medication. The treating physician must determine in his or
her professional judgment that medication is necessary to prevent the immediate
substantial and irreversible deterioration of a serious mental illness. If the
treating physician determines that medication should continue informed consent
or judicial approval must be obtained.
(5) Educational Services.
(a) The licensee shall
describe in writing its plan for identifying and meeting the educational needs
of the residents served. The licensee shall arrange for the education of each
resident, in compliance with federal, state and local laws, as appropriate to
the needs of each resident and consistent with the I.E.P.
(b) Each shelter program shall describe in
writing its plan for obtaining information on the educational status of any
child who remains in care more than 72 hours. The plan shall identify the
person responsible for obtaining the information and the timeline for obtaining
it. Information on educational status may be obtained directly from the child
and the parent/guardian, from the school or educational program the child last
attended (with the written consent of the child who is 14 years of age or older
or in the ninth grade, or of the parent/guardian) and from other pertinent
individuals. The licensee shall use the educational information obtained while
the child is still in its care to assist the responsible school district to
provide an appropriate education for the child.
(6) Vocational Preparation Services. The licensee shall describe in writing its plan for meeting the resident's vocational preparation needs. For each child in care more than 45 days, the licensee shall, as appropriate to the child's situation, age and interest, assist the child in assessing his or her vocational needs including locating vocational training or employment.
(a) As appropriate to the needs of the
resident the licensee shall provide, arrange or facilitate vocational services
which include:
1. vocational
evaluation;
2. formulation of
vocational goals for the resident;
3. formulation of a plan to achieve
vocational goals;
4. implementation
of a vocational plan, including vocational counseling, instruction, and
training, and vocational placement or referral to appropriate
services.
(b) The
resident shall be fully involved in his or her vocational evaluation and the
development of a vocational plan.
(7) Recreational Services. Licensees who provide care for children for more than 72 hours shall describe in writing their plan for meeting the recreational needs of the residents served, including the use of community resources where appropriate.
(a) The licensee shall provide or
arrange for individual and group recreational programs appropriate to the age,
interests and needs of each resident.
(b) The licensee shall provide a recreational
program which provides for free, unplanned time for a resident to pursue
individual interests, with supervision as required for his or her
protection.
(c) The licensee shall
assign responsibility for the recreation program to a designated staff person
or persons.
(d) In programs serving
teen parents, if the licensee does not directly provide recreational services,
the plan shall describe the means for monitoring the teen parent's provision of
appropriate recreational experiences to his or her child.
(8) Religious Services. The licensee shall make religious opportunities available to residents upon request and shall respect their religious preferences.
(9) Attendance at Legal Proceedings. The licensee shall insure that no resident attends a judicial or administrative hearing without a representative of the licensee or the referral source.
(10) Research, Fund Raising, or Publicity. The licensee shall not allow residents to participate in any activities unrelated to the resident's service plan without the written consent of the parents or a person other than the parent with custody of the child and the resident if 14 years of age or older. "Activities" shall mean, but not be limited to, the following:
(a)
research and experimentation which involves the resident;
(b) fund raising;
(c) publicity, including photographs and/or
mass media communications.
(11) Unusual or Extraordinary Treatment. Unless granted a variance by the Department prior to implementation, no licensee shall conduct unusual or extraordinary treatment. Unusual or extraordinary treatment shall include:
(a) Any experimental or extraordinary
behavior modification treatment or behavior support program;
(b) Treatment or conditioning that poses
known or unknown risks or involves the infliction of physical or mental pain,
discomfort, or deprivation.;
(c) A
treatment program for a specific resident, a specific group of residents or for
all residents in the facility using a particular extraordinary treatment model,
for example aversive treatment or survival training.
(12) Follow-up Services.
(a) The licensee shall
establish and have in writing a plan to promote the delivery of follow-up
services. The licensee shall, where possible, contact within one month of
discharge each child who was in care for more than 72 hours, to determine
whether needed services are being provided.
(b) The licensee shall, where possible,
arrange for on-going services as necessary to facilitate the resident's
adjustment to his or her new environment, except where the resident was
referred by a placement agency or purchaser of service which is responsible for
the resident.
(c) The licensee must
document its follow-up contacts or efforts at follow-up contact with each child
not receiving follow-up services from the referring or placement
agency.
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