Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment changes the staffing ratios
for children and youth.
(1)
The Psychosocial Rehabilitation (PSR) program must be accredited by CARF
International, The Joint Commission, Council on Accreditation, or other
accrediting body recognized by the department. If the PSR program is not
accredited, department licensure rules as specified in 9 CSR 40-1 and 9 CSR
40-9 shall apply, as applicable, until accreditation is obtained.
(2) The community psychiatric rehabilitation
(CPR) program shall provide or arrange transportation to and from the PSR site,
and to/from various locations in the community, to provide individuals with
opportunities for off-site training and rehabilitation in realistic
settings.
(3) Policies and
procedures shall be implemented for intake screening, referral, and assignment
of individuals eligible for services.
(A)
Intake policies and procedures shall define referral procedures to be followed
for persons determined ineligible for PSR services.
(B) The maximum wait time from an
individual's initial face-to-face contact with the PSR program to intake
screening shall be ten (10) working days, or sooner, if clinically
indicated.
(C) The intake screening
shall determine the individual's need for PSR, functional strengths and
weaknesses, and transportation needs.
(D) PSR services shall be incorporated into
the individual's treatment plan within forty-five (45) days of admission to the
program.
(4) Policies and
procedures shall ensure program staff document measurable progress for
individuals engaged in key services.
(A) Key
services shall include, but are not limited to-
1. Training/rehabilitation in community
living skills;
2. Development of
personal support systems through a group modality; and
3. Prevocational training/rehabilitation
provided directly by the program or through subcontract, including at a
minimum-
A. Interview and job application
skills;
B. Therapeutic work
opportunities; and
C. Temporary
employment opportunities.
(B) Documentation of key services must
include-
1. A weekly note summarizing
specific services rendered, the individual's involvement in and response to the
services, and relationship of the services to the treatment plan;
2. Pertinent information reported by family
members or other natural supports regarding a change in the individual's
condition and/or an unusual or unexpected occurrence in his or her life;
and
3. Daily attendance records,
including each individual's actual attendance time and the activity or session
attended (this information does not need to be integrated into the individual
record). Attendance records must be available to department staff and other
authorized representatives for audit and monitoring purposes, upon
request.
(5)
PSR services shall be structured and may occur during the day, evening,
weekend, or a combination of these, to effectively address the rehabilitation
needs of individuals served. Services and activities are not limited to the
program location/site.
(A) The program shall
directly provide or ensure the following services available for individuals
served:
1. Opportunities for training and
rehabilitation in daily living skills, including activities associated with
meal preparation and laundry, at a minimum;
2. Off-site training/rehabilitation in
community living skills; and
3.
Opportunities for family members/natural supports and advocates to participate
in the planning, development, and evaluation of the PSR program.
(6) PSR for Adults.
Services are for adults who need age-appropriate, developmentally focused
rehabilitation. A combination of goal-oriented and rehabilitative services
shall be provided in a group setting to assist individuals in developing
personal support systems, social skills, community living skills, and
pre-vocational skills that promote community inclusion, integration, and
independence.
(A) Key service functions shall
include, but are not limited to-
1. Screening
to evaluate the appropriateness of the individual's participation in
PSR;
2. Addressing individualized
program goals and objectives;
3.
Enhancing independent living skills;
4. Addressing basic self-care skills;
and
5. Enhancing use of personal
support systems.
(B) The
director of the program must be a Qualified Mental Health Professional (QMHP)
with two (2) years of relevant work experience.
(C) All direct care staff must have a high
school diploma or equivalent certificate.
(D) Each day program shall have, as a
minimum, a daily direct care staff ratio of one (1) staff person for each
sixteen (16) individuals served (1:16) unless program needs or the needs of
individuals being served require otherwise.
(E) At least one (1) staff person must be on
duty at all times when individuals enrolled in PSR are present at the
program.
(7) PSR for
Children and Youth. A combination of goal-oriented and rehabilitative services
shall be provided in a group setting to improve or maintain the child's ability
to function as independently as possible within their family and/or in the
community. Services are provided according to the individual treatment plan,
with an emphasis on community integration, independence, and resiliency. Hours
of operation are determined by the program based on capacity, staffing
availability, geography, and space requirements, but shall be no more than six
(6) hours daily, per child.
(A) The director
must be a qualified mental health professional (QMHP) with two (2) years of
experience working with children and youth. One (1) full-time mental health
professional must be available during the provision of services.
(B) Staffing ratios shall be based on the
ages and needs of the children being served. For individuals aged eleven (11)
and younger, the staffing ratio shall be one (1) staff to eight (8)
participants (1:8). For individuals aged twelve (12) to seventeen (17), the
staffing ratio shall be one (1) staff to ten (10) participants
(1:10).
(C) Other staff of the PSR
team shall include the following, based on the needs of individuals served:
1. Registered nurse;
2. Occupational therapist;
3. Recreational therapist;
4. Rehabilitation therapist;
5. Community support specialist;
6. Certified family support provider;
and
7. Certified peer
specialist.
(D) Key
service functions shall include but are not limited to-
1. Assisting the child in gaining or
regaining skills for community/family living such as personal hygiene,
completing age-appropriate household chores, and family, peer, and school
activities;
2. Developing
interpersonal skills which provide a sense of participation and personal
satisfaction (opportunities should be age and culturally appropriate daytime
and evening activities which offer the chance for companionship, socialization,
and skill building); and
3.
Assisting the child and family in developing normative behaviors and
expectations of relationships and providing the opportunity to practice
affiliated skills which can be valuable to an individual reestablishing family
and personal support relationships.
(E) Group sessions may be provided for
parents/guardians to develop and enhance parenting skills. In these situations,
the PSR services and expected goals and outcomes must be documented in the
child/youth's treatment plan and clearly relate to the treatment and
rehabilitation goals of the child or youth.
(8) Psychosocial Rehabilitation Illness
Management and Recovery (PSR-IMR). Services promote physical and mental
wellness, well-being, self-direction, personal empowerment, respect, and
responsibility. Services shall be provided in individual and group settings
using curriculum approved by the department. Services must be delivered by
staff who have completed required training.
(A) The maximum group size shall not exceed
eight (8) individuals; however, if there are other curriculum-based approaches
that suggest different group size guidelines, larger groups may be approved by
the department.
(B) Services shall
be person-centered and strength-based including, but not limited to-
1. Psychoeducation;
2. Relapse prevention; and
3. Coping skills training.
(C) CPR programs must be approved
by the department to provide this service.
(D) If a program is accredited by Clubhouse
International and submits its accreditation report to the department, it may be
deemed as a PSR-IMR program by the department.
(E) Required documentation includes a weekly
note summarizing the services rendered and the individual's response to the
services, and pertinent information reported by family members or other natural
supports regarding a change in the individual's condition, or an
unusual/unexpected occurrence in their life, or both.
1. If an individual is participating in
PSR-IMR and PSR, a single, weekly summary progress note must clearly address
the PSR-IMR and PSR sessions and activities during the week, or two (2)
separate summary progress notes must address each type of PSR service provided
during the week.
2. Daily
attendance records or logs clearly identifying and distinguishing PSR-IMR as
the specific type of session/activity, with actual attendance times and
description of service, must also be maintained. The attendance records/logs
must be available for audit and monitoring purposes, but do not need to be
integrated into each clinical record.
*Original authority: 630.655, RSMo
1980.
