9 CSR 30-4.045 - [Effective until 09/30/2022] Intensive Community Psychiatric Rehabilitation (ICPR) (2023)

PURPOSE: This change updates the terminology and adds additional service components for ICPR.

OBJECTIVE: This standard establishes rules and regulations for the provision of ICPR services.

(1)Intensive Psychiatric Rehabilitation (ICPR). Services are designed to help people with a serious psychiatric illness by alleviating or eliminating the need to place them in a psychiatric inpatient facility or restrictive living environment. ICPR is a temporary, comprehensive community service for people experiencing symptoms that affect individual or family life in a highly disabling way.

(A)The ICPR should:

1.people who would be hospitalized without the provision of intensive community intervention;

2.people with prolonged or repeated hospitalizations;

3.people with crisis episodes;

4.people who are at risk of being removed from their home or school to more restrictive settings; Y

5.People who need support to transition from a very restrictive environment to a community-based alternative, particularly people who have been discharged from inpatient mental health facilities, which requires commitment and assertive outreach.

(B)Care teams provide services that keep people in families and meaningful support systems, helping them meet basic life needs and age-appropriate developmental needs.

(2)Eligibility criteria. To be eligible for ICPR, the individual must meet the eligibility criteria defined in 9 CSR30-4.005and at least one (1) of the following criteria:

(A)Is discharged from an apartment or a bed financed by the department;

(B)In the past six (6) months, you had prolonged or repeated psychiatric hospitalizations or crisis episodes;

(C)Due to his mental disorder, he did several internships abroad; either

(D)You risk being removed from your current home, school, or living situation.

(3)staff requirements. A care team coordinates the full range of services available to individuals through the CPR program.

(A)The treatment team is supervised by a Qualified Mental Health Professional (QMHP) and includes the following:

1.personnel required to provide specific services detailed in the individual treatment plan; Y

2.The person receiving services and family members or other natural supports when developmentally appropriate.

(4)Treatment.

(A)The ICPR must include the following:

1.Multiple face-to-face contacts with the individual on a weekly basis, which may require daily contacts, depending on the needs of each type of service;

2.Services available twenty-four (24) hours a day, seven (7) days a week; Y

3.Crisis response services that can be coordinated with an existing crisis system.

(B)A full range of CPR services as defined in9 CSR 30-4.043, will be available to each individual based on identified needs.

1.disclosure and engagement;

2.behavior aide/family aide;

3.Management of specific cases;

4.Clinical interventions aimed at stabilizing the individual offered twenty-four (24) hours a day and seven (7) days a week;

5.expand services to support people in drug stabilization;

6.use natural services and supports necessary to maintain the individual in the community;

7.day treatment.

(C)The scope and frequency of services are based on the individual's vision and estimated needs.

(D)A crisis prevention plan should be developed for each individual, including clinical issues that may affect the transition to less intensive services.

(MI)People no longer need ICPR if

1.Severe symptoms are reduced; Y

2.They can work without intensive services; either

3.They refuse to receive more intensive services.

(5)documentation requirements. ICPR services are acc9 CSR10-7.030(13), and as specified in this rule.

(A)For individuals currently enrolled in the CPR program, the following documentation is required upon admission to the ICPR:

1.verification of compliance with admission criteria;

2.degree of sharpness; Y

3.Update the treatment plan with an indication of the highest level of service you will receive.

(B)For individuals newly admitted to ICPR directly from the community, a comprehensive behavioral health assessment must be completed to verify visual acuity and admission criteria.

1.Each person must undergo a psychiatric evaluation on admission. For people discharged from ICPR accommodation, a psychiatric report made at the department/hospital is initially accepted.

2.The comprehensive evaluation must be completed within thirty (30) days of admission, except for those provisionally admitted.

3.Treatment plans should be developed at the time of admission and updated as necessary.

(C)Treatment plans should be reviewed as needed for each type of service and documented in the individual record with a summary progress note, including treatment plan updates, as appropriate.

(D)When changing ICPR service, a transition summary must be documented in a nursing grade transition summary and reflected in an updated treatment plan. it must be completed by a QMHP and included in an updated treatment plan.

(6)ICPR for children and youth. Services are medically necessary to support a child with Serious Emotional Disturbance (SED) in their natural home or to support a child with Serious Mental Illness or EDS in a community setting who has failed in various community settings in the past, and/or the presence of a continuing risk of harm to self or others, which would otherwise require long-term psychiatric hospitalization. Clinical interventions are performed daily by a multidisciplinary care team, and interventions must be available twenty-four (24) hours a day, seven (7) days a week for stabilization purposes. The child's family and other natural supports may receive services if they are of direct benefit to the child in accordance with their individual treatment plan.

(A)Services include but are not limited to:

1.medication administration/medication administration;

2.Ongoing behavioral health assessment and diagnosis;

3.Surveillance to ensure individual safety;

4.Individual and group counselling; Y

5.community support.

(B)The ICPR multidisciplinary team should include the following equipment based on the needs of the person being cared for:

1.physician, psychiatrist, child psychiatrist, psychiatric resident physician, or advanced practice nurse (APRN);

2.QMHP;

3.RN;

4.NPL;

5.Community Support Specialist; Y

6.Individuals with a high school diploma or equivalent under the direction and supervision of a QMHP.

(C)Services are limited to ninety (90) days. Exceptions may be approved by the department and must be documented in the personnel file.

(7)Intensive domestic help for children and young people. Intensive therapeutic interventions are provided to improve the child's functioning and prevent removal from their natural home and placement in a more restrictive living environment due to EDS.

(A)Services are intended for children whose therapeutic needs cannot be met in their natural home or who require an alternative therapeutic setting to return home or a less restrictive setting.

(B)Providers must complete extensive and specialized training required by the department and meet the department's credentialing requirements under 9 CSR 40-6.

(C)The provider must participate in pre-placement and ongoing meetings with the child's CPR care team and help develop the treatment plan. The provider is responsible for implementing the treatment plan and communicating with the child's biological parent/legal guardian and completing documentation required by the department.

(D)Services and supports are individualized and strength-based to meet the needs of the child and family in all areas of life to promote success, safety, and stability at home, school, and in the community. Therapeutic interventions target the child's serious mental health problems and promote positive development and healthy family functioning.

(MI)Children must meet CPR eligibility criteria and their behavior must be sufficiently controlled to live safely in a community setting with appropriate support.

(F)CPR program staff supervising the child's care must be available twenty-four (24) hours a day, seven (7) days a week to assist the provider in a crisis situation.

(GRAMS)The location, duration, and intensity of services are based on the specific needs of each child as identified in the MO HealthNet CPR Provider Manual, available from the Department of Social Services, 615 Howerton Court, PO Box 6500, Jefferson City, MO 65102-6500, etc. in the fixed department contract. The referenced document does not include any subsequent revisions or updates.

(8)Evidence-Based Practices (EBP) for young people. Services include proven treatment supports for children and adolescents to address specific behavioral health needs. The EBP selected is based on individual needs and desired results as determined in the treatment plan.

(A)The EBP must be approved by the department.

(B)Activities related to the Service include, but are not limited to:

1.Extensive monitoring and data collection;

2.Training in specific skills in a prescribed or natural environment; Y

3.Prescribed responses to a psychiatric crisis and/or frequent contact with the individual and/or family in addition to scheduled therapy sessions.

(9)ICPR for adults and youth in transition. Teams provides the Services through one (1) of the following methods:

(A)Linkage and transition of people from acute or long-term services to less intensive care. The service time is approximately 90 (ninety) days or less, but varies according to the needs of each person;

(B)Assertive Modified Community Treatment (ACT) as approved by the department. The timeframe varies based on individual needs; either

(C)Intensive and comprehensive stabilization services for people with significant mental health needs who might otherwise require hospitalization. The expected commitment period is approximately ninety (90) days or less, but will vary based on individual needs.

(D)The teams can be dedicated exclusively to people in ICPR or they can be mixed teams that care for people in ICPR and rehabilitation services.

(MI)A functional evaluation approved by the department and documented in the individual file must be carried out monthly.

(10)Intensive domestic help for adults. Medically Necessary Services/Supports are provided to adults with serious mental illness who are transferred from a psychiatric inpatient hospital to the community or who are at risk of returning to hospital care due to their medical condition or need for further support. Services and supports are provided in the person's place of residence under the supervision of a QMHP. The home/program is structured to meet individual needs to ensure safety and prevent the person from returning to a more restrictive setting for care.

(A)Personnel providing services/support must be at least eighteen (18) years of age and have at least a high school diploma or equivalent. Two (2) years of direct healthcare experience or a bachelor's degree in behavioral science is preferred.

(B)Staff should be routinely trained to provide intensive interventions and supports to reduce symptoms of mental illness and to intervene and redirect people in psychiatric crisis who engage in behavior that is potentially dangerous to themselves or others. There should be a training plan for each employee, setting out specific topics and the frequency of refresher training on each topic, including documentation of course completion.

(C)Support and rehabilitation services related to activities of daily living and crisis prevention and intervention should be provided.

(D)CPR programs that provide services for adults must be approved by the department to provide intensive home services.

(MI)Documentation should reflect direct (face-to-face) service delivery and support, such as: B. Daily progress summary notes, group notes, individual progress notes documenting interventions including crisis response, conflict management , behavior redirection, and hints or sticky notes.

(11)hospitalization of the child. A full range of intensive clinical services is offered to children/adolescents in a highly structured therapeutic environment. Services are designed to return the child to a previous level of functioning, reduce the risk of injury, and prevent transition to a more restrictive environment.

(A)Emergency services must be available on or near the site.

(B)A psychiatrist must oversee the performance of a multidisciplinary treatment team.

(C)Licensed nursing staff must be available every day.

(D)Licensed occupational and recreational therapists must be available based on individual needs.

(MI)Service delivery is limited to certified or deemed certified pediatric CPR programs. The service must be accredited by a national accreditation body approved by the department.

(12)Diversion of adult hospitalization. A full range of intensive clinical services is offered to adults in a highly supervised and structured therapeutic environment. Services are designed to return people to a previous level of functioning, reduce the risk of harm, and prevent transition to a more restrictive environment.

(A)Emergency services must be available on or near the site.

(B)Services must be provided in a coordinated manner under the direction of a psychiatrist. Other members of the treatment team include registered nurses, licensed psychologists, social workers, counselors, mental health rehabilitation specialists, and other trained support staff.

(C)Services include but are not limited to:

1.Caution;

2.community support;

3.psychosocial rehabilitation; Y

4.Counseling for co-occurring disorders and other evidence-based services.

(D)Service offerings are limited to adult CPR programs. The service must be accredited by a national accreditation body approved by the department.

Walnuts

9 RSE 30-4.045

AUTHORITY: Section630.050, RSMo Comp. 2010 and sections630.655mi632.050, RSMo 2000.* Emergency rule filed December 28, 2001, effective January 13, 2002, expired July 11, 2002. Original rule filed December 28, 2001, effective July 12, 2002. Emergency Amendment filed June 14, 2010, effective July 1, 2010, expires February 24, 2011. Modified: Archived June 14, 2010, effective February 24, 2011.Modified byMissouri Register October 15, 2019 / Volume 44, Number 19, effective30.11.2019

*Original Authority: 630.050, RSMo 1980, modified 1993, 1995, 2008; 630,655, RSMo 1980; and 632,050, RSMo 1980.

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