Missouri Code of State Regulations
Title 9 - DEPARTMENT OF MENTAL HEALTH
Division 30 - Certification Standards
Chapter 3 - Substance Use Disorder Prevention and Treatment Programs
Section 9 CSR 30-3.110 - Service Definitions, Staff Qualifications, and Documentation Requirements for Substance Use Disorder Treatment Programs
Universal Citation: 9 MO Code of State Regs 30-3.110
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule defines and describes services, staff qualifications, and documentation requirements for certified/deemed certified substance use disorder treatment programs.
(1) Service Definitions and Staff Qualifications. Services shall be provided as defined in this rule, in accordance with the organization's certification and contractual status with the department.
(A) Case management-links the
individual and family members with needed services and supports. Key service
functions include, but are not limited to:
1.
Arranging for or referring individuals/family members to appropriate
services/supports and resources;
2.
Communicating with referral sources and coordinating services with other
entities including, but not limited to, physical and behavioral healthcare
providers, the criminal justice system, and social service agencies;
and
3. Assisting individuals in
resolving a crisis situation.
4.
Services shall be provided by-
A. A qualified
addiction professional (QAP);
B. An
associate addiction counselor (AAC); or
C. A staff person with a bachelor's degree in
social work, psychology, nursing, or a closely related field from an accredited
college or university. Equivalent experience may be substituted on the basis of
one (1) year for each year of required educational training.
(B) Collateral
dependent counseling (individual and group)-face-to-face, goal-oriented
therapeutic interaction with an individual, or a group of individuals, to
address dysfunctional behaviors and life patterns associated with being a
family member of an individual who has a substance use disorder and is
currently participating in treatment. Group sessions shall not exceed twelve
(12) family members, which may involve multiple individuals engaged in
treatment.
1. This service shall only be
provided to family members of the individual in treatment when the services are
for the direct benefit of the individual in accordance with his/her needs and
goals identified in the treatment plan, and for assisting in the individual's
recovery.
2. The individual being
served in treatment shall not participate in collateral dependent counseling
sessions.
3. Key service functions
include, but are not limited to:
A.
Exploration of substance use disorders and its impact on the family member's
functioning;
B. Development of
coping skills and personal responsibility for changing one's own dysfunctional
patterns in relationships;
C.
Examination of attitudes, feelings, and long-term consequences of living with a
person with a substance use disorder;
D. Identification and consideration of
alternatives and structured problem-solving;
E. Productive and functional decision-making;
and
F. Development of motivation
and action by group members through peer support, structured confrontation, and
constructive feedback.
4. Counseling for family members age five (5)
and younger shall only be provided when the child is shown to have the
requisite social and verbal skills to participate in and benefit from the
service.
5. This service shall be
provided by a Marital and Family Therapist or QAP practicing within his/her
current competence.
6. Group
services for children under age twelve (12) shall be provided by a graduate of
an accredited college or university with a bachelor's degree in counseling,
psychology, social work, or closely related field.
(C) Communicable disease counseling-assists
individuals in understanding how to reduce the behaviors that interfere with
their ability to lead healthy, safe lives and help them achieve optimal
functioning and desired personal potential. Topics may include, but are not
limited to, disclosing human immunodeficiency virus (HIV), sexually transmitted
infections (STI), tuberculosis (TB) status, and/or substance use to family
members/natural supports, addressing stigma in accessing services, maximizing
healthcare service interactions, reducing substance use and avoiding overdose,
and addressing anxiety, anger, and depressive episodes.
1. The program shall have a working
relationship with the local health department, a physician, or other qualified
healthcare practitioner to provide individuals with necessary testing for HIV,
TB, STIs, and hepatitis.
2. Prior
to an individual being tested for HIV, counseling shall be provided by a staff
person who is knowledgeable about communicable diseases including HIV, STIs,
and TB through training and/or previous employment experience.
3. The program shall make referrals and
cooperate with appropriate entities to ensure coordinated treatment is provided
for individuals with positive test results.
4. Post-test counseling may be provided for
individuals who test positive for HIV or TB. Program staff providing post-test
counseling must be knowledgeable about additional services and care
coordination available through the Department of Health and Senior
Services.
5. Program staff shall
arrange and coordinate post-test followup for individuals who test positive for
a STI or hepatitis.
6. This service
shall be provided by a licensed mental health professional, QAP, or AAC who is
knowledgeable about communicable diseases including HIV, STIs, and TB through
training and/or previous employment experience. Knowledge shall include, but is
not limited to, awareness of risks, disease management/treatment and resources
for care, confidentiality requirements, and therapeutically assisting
individuals in understanding and appropriately responding to test
results.
(D) Community
support-as specified in 9 CSR 30-3.157;
(E) Crisis prevention and
intervention-face-to-face emergency or telephone intervention available
twenty-four (24) hours per day, on an unscheduled basis, to assist individuals
in resolving a crisis and providing support and assistance to promote a return
to routine, adaptive functioning.
1. Minimum
service functions shall include, but are not limited to:
A. Interacting with the identified individual
and his or her family members/natural supports, legal guardian, or a
combination of these;
B. Specifying
factors that led to the individual's crisis state, when known;
C. Identifying maladaptive reactions
exhibited by the individual;
D.
Evaluating potential for rapid regression;
E. Attempting to resolve the crisis;
and
F. Referring the individual for
treatment in an alternative setting when indicated.
2. Documentation must include-
A. A description of the precipitating
event(s)/situation when known;
B. A
description of the individual's mental status;
C. The intervention(s) initiated to resolve
the individual's crisis state;
D.
The individual's response to the intervention(s);
E. The individual's disposition;
and
F. Planned follow-up by
staff.
3. Services must
be provided by a qualified mental health professional (QMHP) or QAP.
Non-licensed or non-credentialed staff providing this service must have
immediate, twenty-four (24) hour telephone access to consultation with a
licensed physician/psychiatrist, licensed physician assistant, licensed
assistant physician, or advanced practice registered nurse (APRN).
(F) Day treatment-combines group
rehabilitative support with medically necessary services that are structured
and therapeutic and focus on providing opportunities for individuals to apply
and practice healthy skills, decision-making, and appropriate expression of
thoughts and feelings.
1. Day treatment shall
be provided in a group setting.
2.
Services shall be designed to assist individuals with compensating for or
eliminating functional deficits and interpersonal and/or environmental barriers
associated with a substance use disorder. Services are intended to restore
individuals to being active and productive members of their family, community,
and/or culture to the fullest extent possible.
3. Key service functions include, but are not
limited to:
A. Promoting an understanding of
the relevance of the nature, course, and treatment of substance use disorders
to assist individuals in understanding their individual recovery needs and how
they can restore functionality;
B.
Assisting in the development and implementation of lifestyle changes needed to
cope with the side effects of addiction, use of prescribed psychotropic
medications, and/or promote recovery from the disabilities, negative symptoms,
and/or functional delays associated with a substance use disorder;
and
C. Assisting with the
restoration of skills and use of resources to address symptoms that interfere
with activities of daily living and community integration.
4. Services shall be provided by a team
consisting of Group Rehabilitation Support Specialists and Day Treatment
Technicians.
(G) Drug
testing-conducted to determine and detect an individual's use of alcohol or
other drugs and/or monitor compliance with a prescribed medication regimen as a
necessary support and adjunct to treatment.
1. Drug testing may be of greater importance
for individuals-
A. With known or suspected
diversion of medication for substance use disorders;
B. Who present in person to the program with
symptoms and signs of intoxication or withdrawal;
C. With a self-reported or otherwise
identified overdose; and
D. With
significantly unstable opioid and/or other substance use disorders.
2. Test results shall be discussed
with persons served in order to intervene with substance use behavior,
including updates to the treatment plan based on test results.
3. Test results and actions taken shall be
documented in the individual record, including the category or type of test
(on-site or laboratory), the number of panels, types of drugs tested for, and
the test results.
4. Drug testing
may be performed on-site or sent to a laboratory. A laboratory which analyzes
specimens must meet all applicable state and federal laws and
regulations.
5. Written policies
and procedures regarding the collection and handling of specimens shall be
implemented. Urine or other specimens shall be collected in a manner that
communicates respect for persons served, while taking reasonable steps to
prevent falsification of samples.
6. The program shall implement written
policies and procedures outlining the interpretation of results and actions to
be taken when the presence of alcohol or other drugs has been
determined.
(H) Family
conference-intervention that enlists the assistance of the individual's support
system through meeting with family members, referral sources, and other natural
supports about the individual's treatment plan, continuing recovery plan, and
discharge plan. The service must include the individual served and be for
his/her direct benefit in accordance with needs and goals identified in the
treatment plan and to assist in his/her recovery.
1. Key service functions include, but are not
limited to:
A. Communicating about issues in
the individual's home that are barriers to achieving his/her treatment
goals;
B. Identifying relapse
triggers and establishing a continuing recovery plan;
C. Assessing the need for family therapy or
other referrals to support the family system; and
D. Participating in continuing recovery and
discharge planning conferences.
2. Services shall be provided by a QAP or
AAC.
3. Documentation must indicate
the relationship of the family members and/or other participants to the
individual in treatment.
(I) Family therapy-face-to-face counseling or
family-based therapeutic interventions (such as role playing or educational
discussions) for the individual served and/or one (1) or more of his/her family
members/natural supports. Services must be for the direct benefit of the
individual served in accordance with his/her treatment needs and goals and to
assist in their recovery.
1. Services shall
address and resolve patterns of dysfunctional communication and interactions
that have become persistent over time, particularly as they relate to alcohol
and/or other drug use.
2. Services
may be offered to members of a single family or members of multiple families
dealing with similar issues.
3.
Services may be provided in an office setting or the individual's home,
depending on those involved.
4. Key
service functions include, but are not limited to:
A. Utilizing generally accepted principles of
family therapy to influence family interaction patterns;
B. Examining family interaction styles,
confronting patterns of dysfunctional behavior, and strengthening communication
patterns that promote healthy family function;
C. Facilitating family participation in
family self-help recovery groups;
D. Developing and applying skills and
strategies for improving family functioning; and
E. Promoting healthy family interactions
independent of formal helping systems.
5. Documentation must indicate the
relationship of the family members/natural supports to the individual engaged
in treatment.
6. In any calendar
month, for fifty percent (50%) of family therapy sessions, the individual
engaged in treatment must be present, in addition to one (1) or more of his/her
family members/natural supports. Family members younger than age twelve (12)
can be counted as one (1) of the required family members when the child is
shown to have the requisite social and verbal skills to participate in and
benefit from the service.
7.
Services shall be provided by a professional who-
A. Is licensed or provisionally licensed in
Missouri as a marital and family therapist; or
B. Has a degree in marriage and family
therapy, psychology, social work, or counseling and-
(I) Has at least one (1) year of supervised
experience in family therapy and has specialized training in family therapy;
or
(II) Receives close supervision
from a professional who meets the requirements of subparagraph (1)(I)7.A. and
B. of this rule; or
C. A
QAP who receives close supervision from an individual who meets the
requirements of subparagraph (1)(I)7.A. and B. of this rule.
(J) Group
counseling-face-to-face, goal-oriented therapeutic interaction between a
counselor and two (2) or more individuals based on needs and goals specified in
their treatment plans. Services shall be designed to promote individual
functioning and recovery through personal disclosure and interpersonal
interaction among group members.
1. This
service can include trauma-related symptoms and cooccurring behavioral health
and substance use disorders.
2.
Evidence-based practices, such as motivational interviewing and cognitive
behavioral therapy, shall be utilized by appropriately trained staff.
3. Some scheduled group sessions may not be
applicable to or appropriate for all individuals, therefore, participation
shall be on a designated or selective basis. Examples of designated or
selective groups include, but are not limited to, parenting skills, budgeting,
anger management, domestic violence, co-occurring disorders, life skills, and
trauma.
4. Key service functions
include, but are not limited to:
A.
Facilitating individual disclosure of addiction-related issues which permits
generalization of the issues to the larger group;
B. Promoting recognition of addictive
thinking and behaviors and teaching strategies that support non-use of alcohol
and/or other drugs that interfere with the individual's functioning;
C. Preparing individuals to cope with
physical, cognitive, and emotional symptoms of craving alcohol and/or other
drugs;
D. Encouraging and modeling
productive and positive interpersonal communication; and
E. Developing motivation and action by group
members through peer influence, structured confrontation, and constructive
feedback.
5. Services
shall be provided by a QAP, QMHP, AAC, or an intern/practicum student as
specified in 9 CSR
10-7.110(5).
6. The usual and customary group size is
twelve (12) individuals. The size of group counseling sessions shall not exceed
an average of twelve (12) individuals during a calendar month, per facilitator,
per group.
7. A group log or
documentation in the individual record (paper or electronic format) shall be
maintained for each session documenting the type of service, summary of the
service, date, actual beginning and ending time of the group, each individual's
in and out time, and the signature and title of the staff member providing the
service. Signature stamps shall not be used.
(K) Group rehabilitative support-facilitated
group discussions based on individual needs and treatment plan goals to promote
an understanding of the relevance of the nature, course, and treatment of
substance use disorders to assist individuals in understanding their recovery
needs and how they can restore functionality.
1. Key service functions include, but are not
limited to:
A. Classroom style didactic
lecture to present information about a topic and its relationship to substance
use;
B. Presentation of
audio-visual materials that are educational in nature with required follow-up
discussion. Instructional aids shall be incorporated into education sessions to
enhance understanding and promote discussion and interaction among individuals.
Aids may include, but are not limited to, DVDs or other electronic media,
worksheets, and informational handouts and shall not comprise more than twenty
percent (20%) of group rehabilitative support sessions;
C. Promotion of discussion and questions
about the topic presented to the individuals in attendance; and
D. Generalization of the information and
demonstration of its relevance to recovery and enhanced functioning.
2. The program shall develop a
schedule and curriculum for delivery of group rehabilitative support that
addresses topics and issues relevant to the individuals served. Individuals
shall attend group sessions that are relevant to their needs and goals based on
the assessment and interventions recommended in their individual treatment
plan.
3. Services shall be provided
by a group rehabilitation support specialist who is present throughout the
session and-
A. Is suited by education,
background, or experience to present the information being discussed;
B. Demonstrates competency and skill in
facilitating group discussions; and
C. Has knowledge of the topic(s) being
taught.
4. Group size
shall not exceed an average of thirty (30) individuals during a calendar month,
per facilitator, per group session.
5. A group log or documentation in the
individual record (paper or electronic format) shall be maintained for each
session documenting the type of service, summary of the service, date, actual
beginning and ending time of the group, each individual's in and out time, and
the signature and title of the staff member providing the service. Signature
stamps shall not be used.
(L) Individual counseling-face-to-face,
structured, and goal-oriented therapeutic counseling designed to resolve issues
related to the use of alcohol and/or other drugs that interfere with the
individual's functioning.
1. Evidence-based
interventions including, but not limited to, motivational interviewing,
cognitive behavioral therapy, and trauma-informed care shall be utilized, when
appropriate.
2. Key service
functions shall include, but are not limited to:
A. Exploration of an identified problem and
its impact on the individual's functioning;
B. Examination of attitudes, feelings, and
behaviors that promote recovery and improved functioning;
C. Identification and consideration of
alternatives and structured problem-solving;
D. Discussion of skills to aid in making
positive decisions; and
E.
Application of information presented in the program to the individual's life
situation to promote recovery and improved functioning.
3. Services shall be provided by a QAP, QMHP,
AAC, or an intern/practicum student as specified in
9 CSR
10-7.110(5).
(M) Individual counseling, co-occurring
disorders-individual, face-to-face, structured and goal-oriented therapeutic
interaction between an individual and a counselor designed to identify and
resolve issues related to substance use and co-occurring mental illness
functioning.
1. This service must be provided
by-
A. A licensed or provisionally licensed
qualified mental health professional (QMHP);
B. An individual holding the Co-Occurring
Disorders Professional or Co-Occurring Disorders Professional/Diplomate
credential from the Missouri Credentialing Board;
C. A non-licensed QMHP who meets the
co-occurring counselor competency requirements established by the department;
or
D. A QAP who meets the
co-occurring counselor competency requirements established by the
department.
(N) Individual counseling, trauma-individual,
face-to-face counseling provided to the individual in accordance with his/her
treatment plan to resolve issues related to psychological trauma in the context
of a substance use disorder. Personal safety and empowerment of the individual
must be addressed.
1. This service must be
provided by a-
A. Licensed or provisionally
licensed mental health professional; or
B. Professional licensed by the Missouri
Division of Professional Registration who is practicing within their current
competence.
2. Qualified
staff must have specialized training on trauma and trauma-informed care and/or
equivalent work experience and shall utilize an evidence-based treatment model
for the delivery of this service.
(O) Medication services-goal-oriented
interaction to assess the appropriateness of medications in an individual's
treatment, periodic evaluation/reevaluation of the efficacy of prescribed
medications, and ongoing management of a medication regimen within the context
of the individual's treatment plan.
1. Key
service functions include, but are not limited to:
A. Assessment of the individual's presenting
condition;
B. Mental status
exam;
C. Review of symptoms and
screening for medication side effects;
D. Review of functioning;
E. Assessment of the individual's ability to
self-administer medications;
F.
Education regarding the effects of medication and its relationship to the
individual's substance use disorder and/or mental illness; and
G. Prescription of medication(s), when
indicated.
2. Services
shall be provided by a licensed physician, or licensed psychiatrist, or
licensed physician assistant, licensed assistant physician, or APRN who is in a
collaborating practice agreement with a licensed physician.
(P) Medication services
support-medical and other consultative services for the purpose of monitoring
and managing an individual's health needs while taking medications.
1. Services must be provided by a registered
nurse (RN) or licensed practical nurse (LPN).
(Q) Peer and family support-coordinated
services within the context of a comprehensive, individualized treatment plan
that includes specific individualized goals. Services are person-centered and
promote the individual's ownership of his/her treatment plan.
1. Services may be provided to the
individual's family/natural supports when the services are for the direct
benefit of the individual served in accordance with his/her needs and goals
identified in the treatment plan and to assist in the individual's
recovery.
2. Key service functions
include, but are not limited to:
A. Planning
in a person-centered manner to promote the development of self-advocacy
skills;
B. Empowering the
individual to take a proactive role in developing, updating, and implementing
his/her person-centered treatment plan;
C. Providing crisis support;
D. Assisting the individual and his/her
family and other natural supports in the use of positive self-management
techniques, problem-solving skills, coping mechanisms, symptom management, and
communication strategies identified in the treatment plan, so the individual
remains in the least restrictive setting, achieves recovery and resiliency
goals, self-advocates for quality physical and behavioral health services, and
has access to strength-based behavioral health and physical health services in
the community;
E. Assisting
individuals and their family members/natural supports in identifying strengths
and personal/family resources to aid recovery, promote resilience, and
recognize their capacity for recovery/resilience;
F. Serving as an advocate, mentor, or
facilitator for resolution of issues and skills necessary to enhance and
improve the health of a child/youth with a substance use and/or co-occurring
disorder; and
G. Providing
information and support to the parent(s)/care-giver(s) of a child who has a
serious emotional disorder so they have a better understanding of the child's
needs, the importance of his/her voice in the development and implementation of
the individual treatment plan, the roles of the various service/support
providers and the importance of the team approach, and assisting in the
exploration of options to be considered as part of treatment.
3. Services shall be provided by a
certified peer specialist or family support provider.
(R) Withdrawal management/detoxification, as
defined in 9 CSR 30-3.120.
(2) Ratio of Qualified Addiction Professionals. A majority of the program's staff who provide individual and group counseling shall be Qualified Addiction Professionals (QAP).
(3) Supervision of Associate Counselors. If an AAC provides individual or group counseling, he/she shall meet the requirements of the Missouri Credentialing Board or the appropriate board of profession- al registration within the Department of Commerce and Insurance. All counselor functions performed by an AAC shall be performed pursuant to the supervisor's authority, oversight, guidance, and full professional responsibility.
(A) The supervisor shall
review and countersign documentation in individual records made by the
AAC.
(B) Documentation which must
be countersigned includes the initial treatment plan, treatment plan updates,
and discharge summaries.
(C) A
training plan must be in place for each AAC and be available for review by
department staff or other authorized representatives.
(4) Credentials for Supervisor of Counselors. Unless otherwise required by these rules, supervision of counselors must be provided by a QAP who has-
(A) A degree from
an accredited college in an approved field of study; or
(B) Four (4) or more years of employment
experience in the treatment and rehabilitation of persons with substance use
disorders.
*Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.655, RSMo 1980, and 631.010, RSMo 1980.
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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