Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 35 - Children's Division
Chapter 71 - Rules for Residential Care Facilities for Children
Section 13 CSR 35-71.130 - Specialized Standards-Residential Treatment for Children and Youth
Universal Citation: 13 MO Code of State Regs 35-71.130
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule sets forth the requirements for specialized residential treatment, including program director, assessment staff, professional staff, staff/child ratios, training, treatment plan review, and locked isolation.
(1) In addition to rules for basic residential treatment for children and youth, an agency seeking to become licensed to provide residential treatment for children and youth, shall meet these additional requirements:
(A) Program Director. The program director
must be a full-time staff dedicated solely to the overall treatment program
with at least the following minimum qualifications:
1. A master's degree in social work or human
service field from an accredited college or university or licensed as a
certified social worker; and
2. Two
(2) years' experience providing treatment services. One (1) year of this
experience must have been in a residential treatment setting;
(B) Assessment Staff. Staff
responsible for developing initial assessment and treatment plan for each child
must have at least the following minimum qualifications:
1. A master's degree in social work or human
service field from an accredited college or university or licensed as a
certified social worker; and
2. One
(1) year of experience in a residential treatment setting;
(C) Professional Staff.
1. The agency must have sufficient,
appropriately qualified professional staff available on a full-time, part-time,
or continuing consultative basis, or any combination of these to address the
needs of children in care.
2. The
professional staffing plan must be in writing and implemented by the
agency.
3. The program director
shall document that the number, qualifications, and responsibilities of
professional staff are appropriate to the agency's size and the scope of its
program.
(D) Staff/Child
Ratios.
1. At least one (1) direct care staff
for every four (4) children, birth to six (6) years of age, shall be on duty
during waking hours.
2. Staff shall
be awake during children's sleeping hours, and maintain staff/child ratios of
one (1) staff for every six (6) children from birth to six (6) years of
age.
3. At least one (1) direct
care staff for every six (6) children, age six (6) years and older shall be on
duty during waking hours.
4. Staff
shall be awake during children's sleeping hours and maintain staff/child ratios
of one (1) staff for every twelve (12) children age six (6) years and older.
Reference Chart
|
Age Range |
Level of Care |
Direct Care Staff to Resident Ratio |
|
|
Awake |
Asleep |
||
|
Birth to six (6) years |
Residential Treatment |
One (1) staff per four (4) children |
One (1) staff per six (6) children. Staff must remain awake. |
|
Age six (6) and older |
Residential Treatment |
One (1) staff per six (6) children |
One (1) staff per twelve (12) children. Staff must remain awake. |
5.
An agency licensed, or buildings constructed after (effective the date of this
amendment) shall have no more than two (2) children in a sleeping
room.
(E) Training. All
staff working with children must receive at least forty (40) hours annually of
in-service training and meet the training requirements in accordance with
13 CSR 35-71.045. At
least ten (10) hours of the training must be related specifically to treatment
issues with emotionally disturbed, mentally ill, behaviorally disordered,
medically fragile, physically disabled, and/or develop-mentally delayed
children. Professional staff providing sexual abuse treatment are required to
have fifteen (15) hours of annual training in investigation, treatment, nature,
extent, and causes of sexual abuse pursuant to section
660.526,
RSMo;
(F) Treatment Plan Review.
1. Each child's treatment plan shall be
reviewed and updated at least every three (3) months.
2. If a child shows no progress toward
achieving the goals and objectives in the treatment plan since the plan was
developed or last reviewed, the reasons for continuing the child in the
agency's program must be included in the child's record.
3. Appropriate information about the updated
treatment plan shall be given to the child and the child's parent(s), guardian,
or legal custodian and documented in the child's record.
4. A minimum of one (1) hour of individual,
group, or family counseling sessions shall be provided to each child at least
one (1) time a week with other sessions available as needed.
(G) Locked Isolation.
1. Prior to the implementation of a locked
isolation room, the agency shall have approval of the State Fire Marshal and
the division.
2. Written policies
for the use of locked isolation shall be made available to the child's
parent(s), or guardian or legal custodian, or both, and when appropriate, to
the child.
3. Agencies utilizing
locked isolation shall submit a plan for the emergency evacuation of isolated
residents to the licensing unit including documentation that staff has included
evacuating residents from locked isolation during fire drills.
4. Locked isolation may be used only as a
management method after all other verbal de-escalation measures have been
exhausted, and never to replace other more positive measures of control.
Documentation of intervention methods used to prevent use of locked isolation
must be in the resident's record.
5. Locked isolation may be used only when a
child presents a danger to him/herself or others.
6. Locked isolation shall be used in the
shortest intervals possible until the child regains reasonable
self-control.
7. The maximum time a
child may remain in locked isolation is thirty (30) minutes, unless extensions
are approved at the end of every thirty (30) minute period by the program
director or a qualified designee. A child shall not remain in locked isolation
more than a two (2) hour period. If the child has not regained control after
two (2) hours, a medical order shall be obtained.
8. When a child is placed in locked
isolation, staff shall physically monitor the child in at least five (5) minute
intervals. Staff shall remain in close proximity to the child in locked
isolation with no more than one (1) locked door between the staff and the
child. Close proximity means that staff are close enough to the child(ren) to
be able to hear any sounds the child(ren) might make that would indicate a need
for assistance.
9. Not more than
one (1) child shall be in a locked isolation room. A locked isolation room
shall not be utilized for any other purpose.
10. Within twenty-four (24) hours of each
locked isolation incident, treatment staff shall debrief the incident with the
resident.
11. The agency shall
maintain a record when locked isolation is used, which shall include:
A. The name of the child, the date, and the
time the child was placed in locked isolation;
B. The circumstances that led to the
placement of the child in locked isolation and efforts to prevent the use of
locked isolation;
C. The name of
the staff person who requested placement of the child in locked isolation, the
staff person who approved locked isolation, and the name of the staff person
who monitored the child while in locked isolation;
D. The amount of time the child remained in
locked isolation, the frequency of monitoring and the time of and reasons for
release;
E. Documented behavioral
observations of the child at each five (5) minute interval;
F. Specific notation of any extension of
locked isolation including reasons for the extension and by whom approval for
extension was given; and
G.
Documentation of results of debriefing that includes recommendations of staff
and resident for avoiding similar situations.
12. For agencies permitting the use of locked
isolation, the treatment team shall review its usage at least weekly and
sign/date the isolation report.
A. Written
policies for the use of locked isolation shall be distributed to staff, and
there shall be documented training provided to staff in the policies and use of
locked isolation, which shall include, but not be limited to:
(I) Directions for the removal of all
dangerous items from the child, including but not limited to, belts, shoelaces,
jewelry, items in pockets, matches, and any other items which represent a
potential hazard during locked isolation; and
(II) Proper written documentation of the use
of locked isolation.
13. If the agency does not meet all
requirements for the use of locked isolation, the division shall give written
notice of the specific deficiencies and the agency shall not use locked
isolation until corrections are made and approved by the division.
14. Locked isolation rooms shall be
constructed and equipped so that control is maximized, but the risk of suicide
or injury to children is minimized. The following shall apply:
A. An isolation room shall be constructed to
allow for both visual and auditory supervision of a child;
B. An isolation room shall have one (1)
approved locking-against-egress device which shall be used only when staff are
immediately present, awake, and in possession of a key. There shall be a backup
system which does not rely on a key, i.e., an electronic locking-release
mechanism, as approved by the State Fire Marshal;
C. Potentially dangerous articles shall be
removed from the child prior to placing the child in locked isolation, for
example, belts, shoes, matches, and/or contents of pockets;
D. An isolation room shall have at least a
seven and one-half foot (7 1/2') ceiling and be of sufficient length and width
for the comfort of the child;
E.
All doors, ceilings, and walls shall be constructed of such strength and
noncom-bustible material that harm to the child is minimized;
F. All switches controlling lights,
ventilation, and the like, shall be on the outside of the room;
G. In order to prevent harm to the child,
windows shall be secured and made of tempered material to prevent
shattering;
H. No functional
electrical outlets shall be allowed in the room;
I. Tamper-resistant, recessed ceiling lights
shall be utilized, and steam or hot water radiators shall be enclosed in a
tamper-resistant, protective casing;
J. The room shall be properly heated, cooled,
and ventilated;
K. Normal toileting
and bathing facilities shall be available during isolation; and
L. The agency shall have a schedule for
monthly routine maintenance of the locks.
*Original authority: 210.481, RSMo (1982), amended 1985 and 210.486 and 210.506, RSMo (1982), amended 1993.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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