Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment updates terminology and
requirements for adolescent CSTAR programs including age criteria, notification
procedures for registered offenders and juvenile sex offenders, eligibility
criteria, treatment principles, education, and services provided in
schools.
PURPOSE: This rule establishes requirements for
certified/deemed certified CSTAR programs for adolescents.
(1) Other Regulations. Adolescent CSTAR
programs shall comply with 9 CSR 10-7 Core Rules for Psychiatric and Substance
Use Disorder Treatment Programs, 9 CSR 10-5 General Program Procedures, and 9
CSR 30-3 Substance Use Disorder Prevention and Treatment Programs, as
applicable.
(2) Age Criteria. The
program shall provide treatment, rehabilitation, and other services solely to
individuals age nine through seventeen (9-17) and their family members/natural
supports, as appropriate. Services in a residential setting shall be available
for individuals age twelve through seventeen (12-17).
(A) Exceptions to the age requirements may be
authorized through the department's clinical review process.
(3) Registered Sex Offenders and
Youth Identified on the Juvenile County Registry. Prior to admission, program
staff shall verify whether the individual is registered as a juvenile sex
offender in the county in which they reside pursuant to section
211.425, RSMo, or is identified
as an offender on the Missouri State Highway Patrol (MSHP) sex offender
registry pursuant to sections
589.400-589.425, RSMo.
(A) If the individual is an identified
juvenile sex offender on the juvenile county sex offender registry, admission
to the CSTAR program can be considered.
(B) If the individual is an identified
offender on the MSHP sex offender registry, admission to the CSTAR program
shall not be made.
(C) All results
of verification with the county juvenile sex offender registry or MSHP sex
offender registry, as well as decisions related to program admission, shall be
documented and a record of communication to the individual's parent/guardian
and referral source(s), as applicable, shall be maintained by the program.
1. If the parent/guardian disagrees with a
decision of ineligibility for admission, they shall be informed of the
grievance process of the CSTAR program.
(D) If the individual is not admitted to the
program within sixty (60) days after program staff have conducted verification
of the county juvenile sex offender registry, staff are responsible for
rechecking the registry prior to admission. Rechecking the registry is always
an option and should be completed any time there is a concern, even when the
sixty (60) days have not yet passed.
(E) The MSHP registry is updated in real time
and should be checked any time the sixty (60) days has passed.
(4) Eligibility Criteria and Level
of Care. The program shall comply with
9 CSR
30-3.151 Eligibility Determination, Assessment, and
Treatment Planning in CSTAR Programs, to ensure individuals are placed in the
appropriate level of care and receive individualized services.
(5) Treatment Principles and Therapeutic
Issues Relevant to Adolescents. The program shall address therapeutic issues
relevant to adolescents and shall address their specific needs. The following
principles and methods shall be reflected in services delivered to adolescents:
(A) Adolescents are effectively treated in
therapeutic environments that are programmatically and physically separate from
treatment services for adults;
(B)
Services shall maintain individuals in the family and community setting, as
clinically appropriate;
(C)
Services shall involve parents/guardian and other family members/ natural
supports in the treatment and recovery process, when clinically appropriate. If
the caregivers are not available, program staff shall assist in developing
alternate social and family/natural support systems for the
adolescent;
(D) Services to family
members/natural supports shall be directed to understanding and supporting the
adolescent's recovery and resiliency, identifying and intervening with any
behavioral health needs of their caregiver(s), improving parenting skills and
communication skills within the family or with other caregivers/natural
supports, and facilitating improved family function;
(E) A cooperative team approach shall be
utilized in order to provide a consistent therapeutic environment;
(F) Effectively treating substance use
disorders in adolescents requires identifying and treating other cooccurring
conditions they may have;
(G)
Services shall be coordinated with the juvenile justice system, children's
services, and other community agencies to ensure the needs of individuals are
met;
(H) Staff shall possess the
knowledge and expertise to engage adolescents with histories of trauma,
recognize the presence of trauma symptoms, understand the role of trauma in the
lives of adolescents, and conduct themselves in ways that are not
retraumatizing to those being served;
(I) Issues such as violence, child abuse, and
risk of suicide shall be identified and addressed;
(J) Communicable disease counseling and
testing for sexually transmitted infections, such as HIV and hepatitis B and C,
are important aspects of adolescent treatment (refer to
9 CSR
30-3.110(C) for service delivery
requirements). Testing may be waived if parent/guardian consent is not obtained
and is documented, as applicable to the individual served; and
(K) Service delivery shall address
recovery/resiliency skill development including, but not limited to-
1. Substance use prevention and
education;
2. Assertiveness
training;
3. Conflict resolution
skills;
4. Emotional
regulation;
5. Social network
development;
6. Leisure time
management;
7. Problem-solving
skills;
8. Adolescent
development;
9. Sexual health;
and
10. Trauma.
(6) Treatment Setting.
Adolescents may receive substance use disorder treatment services in a variety
of settings including but not limited to the following:
(A) Home of the parent/guardian;
(B) Foster home;
(C) Residential settings operated by the
CSTAR program;
(D) Juvenile
detention (services are not reimbursable by Medicaid);
(E) Other supervised living arrangements;
(F) Independent living;
and
(G) School.
(7) Family Involvement. Each
adolescent's living arrangement and family situation shall be reviewed by
program staff in order to identify needs and to develop treatment goals and
recovery supports for the adolescent and their family members and/or other
natural supports.
(A) This review shall be
conducted by a licensed mental health professional (LMHP) or a qualified
addiction professional (QAP) or qualified mental health professional (QMHP) who
is under the supervision of an LMHP.
(B) Refusal by the caregiver for an in-home
visit shall not constitute automatic denial of treatment services for the
individual.
(C) The program shall
actively involve family members/ natural supports in the treatment process
including educational and counseling sessions and transfer and discharge
planning, unless contraindicated for legal or clinical reasons which are
documented in the individual record. Efforts to involve family members/natural
supports, and any reasons for lack of participation, shall be included in
documentation.
(D) Staff shall
orient the parent or legal guardian regarding-
1. Treatment philosophy and design;
2. Discipline and any emergency safety
interventions used by the program;
3. Availability of staff to conduct
home-based treatment and community support services;
4. Emergency medical procedures;
and
5. Expectations about ongoing
participation by family members/natural supports.
(8) Educational and Vocational
Opportunities. The program shall have established partnerships with local
school district(s) to ensure individuals' academic and vocational needs are met
in accordance with their Individual Education Program (IEP) and/or 504 Plan.
(A) For youth enrolled in American Society of
Addiction Medicine (ASAM) Level 1, Level 2.1, or Level 2.5, certain CSTAR
services may be provided within the school setting. An agreement for the
provision of such services must be arranged by the CSTAR provider and their
local school district(s). The ASAM Criteria: Treatment Criteria for Addictive,
Substance-Related, and Co-Occurring Conditions, 3rd Edition, 2013, is hereby
incorporated by reference and made a part of this rule as published by and
available from The American Society of Addiction Medicine, 11400 Rockville
Pike, Suite 200, Rockville, MD 20852, (301) 6563920. This rule does not
incorporate any subsequent amendments or additions to this
publication.
(B) CSTAR services
delivered in the school setting are limited to three (3) hours, twelve (12)
units per week total.
(C) CSTAR
services that may be delivered in school settings are limited to the following:
1. Comprehensive assessment;
2. Community support;
3. Individual counseling;
4. Group counseling;
5. Group rehabilitative support;
6. HIV pre-testing and post-testing
counseling;
7. Medication services
support;
8. Family
therapy/conference; and
9. Peer
support.
(9)
Privilege System. Any system used by the program that encourages/rewards
appropriate behaviors or restricts privileges in response to an individual
exhibiting impermissible behaviors must be trauma sensitive, defined in
writing, stated in behavioral terms to the extent possible, and applied
consistently to all individuals.
(10) Safety and Health. The program shall maintain a
safe, healthy environment which is responsive to the behavioral and physical
health needs of adolescents.
(A) Adolescents
shall be prohibited from using tobacco or products containing nicotine on the
premises, grounds, and any off-site program functions with the exception of
prescribed nicotine replacement therapies with parent/guardian
consent.
(B) Physical examinations
shall be completed as specified in 9 CSR 303.152.
(C) The program shall demonstrate effective
collaborative working relationship(s) with local healthcare providers,
hospital(s), urgent care clinic(s), and other community resources to provide
physical health care for adolescents, as needed.
(11) Staff Training and Supervision. The
program shall comply with The ASAM Minimum Staffing Standards for Department of
Mental Health, September 2022, hereby incorporated by reference and made a part
of this rule, developed by and available from the Department of Mental Health,
1706 E. Elm St., PO Box 687, Jefferson City MO 65101, (573) 751-4942,
https://dmh.mo.gov/media/pdf/dbh-asam-minimum-staffing-requirements.
This rule does not incorporate any subsequent amendments or additions to this
publication.
(12) Structured
Activities. In addition to treatment services, individuals receiving services
in a residential level of care shall participate in structured activities
during daytime and evening hours such as academic education, completing
assignments, self-help groups, family visits, and positive leisure
activities.
(13) Staffing Patterns
in Residential Levels of Care. Programs shall comply with The ASAM Minimum
Staffing Standards for Department of Mental Health, September 2022, hereby
incorporated by reference and made a part of this rule, developed by and
available from the Department of Mental Health, 1706 E. Elm St., PO Box 687,
Jefferson City MO 65101, (573) 751-4942,
https://dmh.mo.gov/media/pdf/dbh-asam-minimum-staffing-requirements.
This rule does not incorporate any subsequent amendments or additions to this
publication.
(A) If the program serves a
mixed-gender population in residential levels of care, the staffing pattern
shall include at least one (1) female and at least one (1) male staff member
any time individuals are present.
(B) If a residential level of care is
provided only for individuals of the female gender, a female staff member must
be present twenty-four (24) hours per day, seven (7) days per week.
(C) If a residential level of care is
provided only for individuals of the male gender, a male staff member must be
present twenty-four (24) hours per day, seven (7) days per week.
1. Refer to
9 CSR
10-7.010(4)(A) 7. and
9 CSR
10-7.020(3) (A) 4., related to
service delivery practices that are responsive to individual
needs.
*Original authority: 630.050, RSMo 1980, amended 1993,
1995; 630.655, RSMo 1980; and 631.010, RSMo
1980.
