{"id":19097,"date":"2022-06-23T17:15:00","date_gmt":"2022-06-24T00:15:00","guid":{"rendered":"https:\/\/www.unsilenced.org\/?p=19097"},"modified":"2022-06-23T17:15:00","modified_gmt":"2022-06-24T00:15:00","slug":"missouri-legislation-report","status":"publish","type":"post","link":"https:\/\/www.unsilenced.org\/missouri-legislation-report\/","title":{"rendered":"Missouri Legislation Report"},"content":{"rendered":"

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As you review this report, please consider donating. Your contribution will help us continue our work advocating for survivors and youth. Every donation makes an impact, no matter the size. Thank you for your support!<\/p>\n<\/div>

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Completed by:<\/p>\n

The Unsilenced Policy Team<\/p><\/h4><\/span>

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Missouri Legislation Report<\/h1><\/span>
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2022<\/h1><\/span>
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2022<\/h1><\/span>
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Introduction<\/h1><\/span>
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The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry\u2019s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.<\/h3><\/span>
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Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts\u2019 individualized education programs, and by parents.<\/p>\n

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.<\/p>\n

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.<\/p>\n

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.<\/p>\n<\/div><\/div><\/div><\/div><\/div>

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Introduction<\/h1><\/span>
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The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry\u2019s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.<\/h3><\/span>
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Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts\u2019 individualized education programs, and by parents.<\/p>\n

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.<\/p>\n

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.<\/p>\n

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.<\/p>\n<\/div><\/div><\/div><\/div><\/div>

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Missouri Legislation<\/h1><\/span>
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<\/i><\/i><\/span>Residential Care Facility<\/span><\/a><\/h4><\/div>
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\n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n
\n General Oversight and Transparency <\/td>\n \n Mo. Code Regs. tit. 13 \u00a7 35-35.140 - Children's Division will accept proof of accreditation as a foster home, residential care facility, or child placing agency by certain accrediting bodies as prima facie evidence of meeting the requirements for licensure as a foster home, residential care facility, or child placing agency<\/a> <\/td>\n <\/tr>\n
\n Oversight Agency <\/td>\n \n Department of Social Services (DSS) - The Children's Division <\/td>\n <\/tr>\n
\n Which state agency oversees investigations? <\/td>\n \n The Children's Division - The division may make such inspections and investigations as it deems necessary to ensure that the individual or organization continues to meet the requirements of licensure, for investigative purposes involving reports of alleged child abuse or neglect, and to address a complaint concerning the health and safety of children which the individual or organization serves.<\/a> <\/td>\n <\/tr>\n
\n Are investigations and outcomes visible to the public online? <\/td>\n \n No Information <\/td>\n <\/tr>\n
\n Is this type of program required to be licensed by the state? <\/td>\n \n Yes with exceptions. The Children\u2019s Division is responsible for the licensing and background checks of child placing agencies and residential care facilities for children and youth in Missouri. HB557 was signed into law in 2021. All license-exempt facilities must register with DSS by October 14, 2021 - The Division must also be notified of any license-exempt residential care facility providing 24-hour care for children that they are operating in Missouri and comply with all requirements according to law. NOTE: Unless specifically exempted by law, private agencies providing residential treatment for children and youth, and child placing agencies that provide foster home and\/or adoption services, must be licensed by the Children\u2019s Division. 210.516. Exceptions to license requirement (6) 2 - On July 14, Governor Parson signed into law HB557. All license-exempt facilities must register with DSS by October 14, 2021. Under DSS's proposed, emergency regulations, all licensed and license-exempt residential care facilities and child placing agencies must ensure that background checks on all new and current employees have been completed by March 31, 2022.The newly signed bill also requires license-exempt residential care facilities to notify DSS of their facility and provide documentation to prove their facility meets specific safety requirements. <\/td>\n <\/tr>\n
\n Is a list of licensed facilities available to the public? <\/td>\n \n Yes<\/a> <\/td>\n <\/tr>\n
\n Are regulations only applicable to facilities receiving public funds? <\/td>\n \n No, some public facilities don't require licensing<\/a> <\/td>\n <\/tr>\n
\n Are there religious exemptions? <\/td>\n \n Yes. 210.258. Religious organizations operating facility, no interference permitted with curriculum, personnel or selection of children \u2014 discipline policies, explanation required for parent. 13 CSR 35-71.025 Exemption of Religious Residential Treatment for Children and Youth Operating Sites PURPOSE: This rule sets forth the requirement that residential treatment for children and youth operating sites must be under the exclusive control of a religious organization in order to qualify for exemption under sections 210.211(5) or 210.516.1(5), RSMo.<\/a> <\/td>\n <\/tr>\n
\n Can complaints be filed online? Is the reporting portal easy to find? <\/td>\n \n Yes<\/a> <\/td>\n <\/tr>\n
\n Does the state conduct unannounced site visits? How many per year? <\/td>\n \n Yes but no specific number. Any and all other information and documentation that the division may determine is reasonably necessary to verify that the individual or organization is accredited in good standing and otherwise meets all of the requirements for licensure.(B) The division in its discretion may conduct on-site visits to verify compliance with licensure requirements before a license is issued.<\/a> <\/td>\n <\/tr>\n
\n Is a full-time licensed clinician required to be on staff? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Does the state require a guardian's consent to all treatment received? <\/td>\n \n Yes. Page 20 - 13 CSR 35-71.060 Social Services Program A written placement agreement between the agency and the child\u2019s parent(s) or guardian must be completed at or before placement. A copy of the placement agreement must be in the child\u2019s record. The placement agreement must include authorization to care for the child and a medical consent form signed and dated by a child\u2019s parent(s) or legal guardian authorized to give consent <\/td>\n <\/tr>\n
\n Does the state require that the guardian be notified of an emergency involving their child within 24-hours of the incident occurring? <\/td>\n \n Yes. Page 26 13 CSR 35-71.075 Health Care 2(D) In the event of the death of a child, the parent(s), guardian, legal custodian, and the division shall be notified immediately <\/td>\n <\/tr>\n
\n Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? <\/td>\n \n Yes. 13 CSR 35-71.060 1 A 4 Social Services Program 4. When a child is self-referred, efforts shall be made to contact the child\u2019s parent(s), guardian or legal custodian within twenty-four (24) hours(E) Except in emergency situations, an agency shall give at least thirty (30) days\u2019 written notice to the parent(s), guardian, or legal custodian before discharging a child from care <\/td>\n <\/tr>\n
\n Does the state require guardian consent to put child on medication? <\/td>\n \n Page 27 13 CSR 35-71.075 Health Care 5. Unless there is a court order to the contrary, the parent(s), guardian or legal custodian of a child shall give prior, informed, written consent to the use of medication. Consent may be given at the time of admission <\/td>\n <\/tr>\n
\n Is medication prescribing and monitoring required to be by a licensed physician used only for a valid diagnosis? <\/td>\n \n Page 27 13 CSR 35-71.075 Health Care(5) Medicine and Drugs. (A) All medication shall be prescribed by a licensed physician, and administered by a licensed nurse or staff who have successfully completed and maintained, at a minimum, the Level <\/td>\n <\/tr>\n
\n Is a licensed clinician required to perform a mental health evaluation upon intake? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Are background checks required, including volunteers? <\/td>\n \n Yes. The implementation of the background checks required in this regulation will immediately enable the Department to conduct background checks and to determine whether individuals are eligible for employment or presence at these institutions. EMERGENCY STATEMENT: Section 210.493, RSMo, of House Bill (HB) 557 (2021) authorizes the Department of Social Services to promulgate regulations, including emergency regulations, to implement new requirements for background checks of officers, managers, contractors, volunteers with access to children, employees, other support staff, and owners of Licensed Residential Care Facilities (LRCF). Page 1919 states that background checks are redone annually <\/a> <\/td>\n <\/tr>\n
\n Does the state require mandatory child abuse response training for all staff working with children in residential settings? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Does the state require de-escalation training for all staff working with children in residential settings? <\/td>\n \n Yes. Page 17 4. Appropriate discipline, crisis intervention, de-escalation techniques, and behavior management techniques<\/a> <\/td>\n <\/tr>\n
\n Does the state require medical response training for all staff working with children in residential settings? <\/td>\n \n Yes. CPR certification #6 pg 17 2. Direct care staff and immediate supervisors must maintain certification in a certified medication training program, crisis management, a current recognized and approved physical restraint program (where applicable), first aid, and cardiopulmonary resuscitation<\/a> <\/td>\n <\/tr>\n
\n Does state require 1:4 staffing ratio or higher? <\/td>\n \n 13 CSR 35-71.050 Staff Qualifications and Requirements #4 - pg 18 - (C) The ratio of direct care staff to children shall be dependent on the needs of the children, but the staff\/child ratio during waking hours shall not be less than one to four (1:4) for children birth to six (6) years of age. (D) The staff\/child ratio during waking hours shall not be less than one to six (1:6) for children six (6) to eight (8) years of age. (E) The staff\/child ratio during waking hours shall not be less than one to ten (1:10) for children eight (8) years of age and over. (F) Staff in agencies serving children ages birth through six (6) years shall be awake during sleeping hours with a ratio of not less than one to six (1:6). (G) For children ages six (6) to eight (8) years of age, the staff\/child ratios during sleeping hours, for staff on duty but asleep, shall not be less than one to ten (1:10). If staff on duty remain awake, a ratio of not less than one to twelve (1:12) shall be required. (H) For children over eight (8) years of age, the staff\/child ratios during sleeping hours, for staff on duty but asleep, shall not be less than one to ten (1:10). If staff on duty remain awake, a ratio of not less than one to twelve (1:12) shall be required.<\/a> <\/td>\n <\/tr>\n
\n Ban on Conversion Therapy for LGBTQA+ youth? <\/td>\n \n No<\/a> <\/td>\n <\/tr>\n
\n Are there admissions requirements? <\/td>\n \n Page 20 13 CSR 35-71.06 (C) Admission Procedures. 1. An admission assessment must be completed for each child indicating that the placement meets the child\u2019s needs and best interests <\/td>\n <\/tr>\n
\n Are the guardian & admitted child required to be informed of their their rights? <\/td>\n \n No. Page 20 is the closest thing 6. Information about the agency must be discussed with the child\u2019s parent(s) or guardian at or before admission. Written material about the agency must be given to the child\u2019s parent(s) or guardian and child when age appropriate. The following information must be included in the discussion and in the written material: A. Rules regarding visits, mail, gifts, and telephone calls; B. Discipline policies; C. Policies regarding religious training; D. Rules regarding recreational activities; E. Policy regarding participation in treatment planning; F. A copy of the treatment plan; G. Copies of all signed and dated releases of information; and H. Health Insurance Portability and Accountability Act.<\/a> <\/td>\n <\/tr>\n
\n Does the state define institutional abuse and neglect? <\/td>\n \n Chapter 210 Child Protection and Reformation\u2003<\/a> <\/td>\n <\/tr>\n
\n Are there civil penalties for violations of institutional child abuse and neglect? <\/td>\n \n No. The license may be suspended\/revoked. Page 13 - Multiple or serious reports of child abuse or neglect which upon investigation results in a substantiated finding of child abuse or neglect; or is found guilty, pleads guilty, or pleads no contest to any crime which would render an individual ineligible for employment or presence at the Licensed Residential Care Facility (LRCF) pursuant to section 210.493, RSMo; Page 8 10) Continuing Obligation to Notify and Expiration of Determination. (A) The division\u2019s decision of eligibility or ineligibility shall be based upon the information that the division receives through the background check process, and any additional information that may be made available to the division during administrative review and appeal. (B) The division\u2019s finding is only valid through the date of the decision and only for the LRCF, LERCF, or Child Placing Agency indicated by the applicant on the application. The applicant may designate more than one LRCF, LERCF, or Child Placing Agency on a single application. (C) The applicant shall be responsible for notifying the division of any change in circumstance which may render the applicant ineligible and shall submit a new application based upon the subsequent information.<\/a> <\/td>\n <\/tr>\n
\n Does a child have access to a telephone to report violations of rights? <\/td>\n \n No, but Page 22-23H. Denial of planned visits, telephone calls, or mail contacts with family shall not be used as a consequence for negative behaviors; I5. The agency shall have written policies and procedures prohibiting discipline which may adversely affect a child\u2019s health or physical or psychological well-being <\/td>\n <\/tr>\n
\n Do the youth have unrestricted access to guardians, legal counsel, welfare advocates, religious clergy, friends and family via telephone? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Are phone calls private from other youth and staff? <\/td>\n \n Page 25- 3. Privacy shall be provided for visits with family members, relatives, and friends, for telephone calls and for written communications unless otherwise indicated by the treatment plan. <\/td>\n <\/tr>\n
\n Does the state prohibit mail censorship? <\/td>\n \n Page 22 13 CSR 35-71.070 Protection and Care of the Child The following forms of discipline shall not be used: H. Denial of planned visits, telephone calls, or mail contacts with family shall not be used as a consequence for negative behaviors; <\/td>\n <\/tr>\n
\n Does the state require that children be allowed visitors in private during normal visiting hours? <\/td>\n \n Page 25 13 CSR 35-71.070 Protection and Care of the Child 3. Privacy shall be provided for visits with family members, relatives, and friends, for telephone calls and for written communications unless otherwise indicated by the treatment plan. <\/td>\n <\/tr>\n
\n Is the facility required to provide an individualized treatment plan? Is the plan reviewed regularly? <\/td>\n \n Page 21-2. A written treatment plan must be developed and documented in the child\u2019s record within fifteen (15) days of admission for each child admitted by plan for placement 6. The progress of a child and his\/her family shall be evaluated at least every ninety (90) days from the date of admission, and the service plan shall be modified when appropriate. In crisis placement, an evaluation shall be conducted at least every thirty (30) days. <\/td>\n <\/tr>\n
\n Is it required that the individualized treatment be evidence-based? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? <\/td>\n \n No Information <\/td>\n <\/tr>\n
\n Are there any regulations against strip searches? <\/td>\n \n No Information <\/td>\n <\/tr>\n
\n Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? <\/td>\n \n Page 19 (7) Educational Staff. An agency operating an on-grounds school shall demonstrate compliance with the Missouri State Department of Elementary and Secondary Education certification requirements for teachers\/administrators\/counselors. Page 25 13 CSR 35-71.070 Protection and Care of the Child (H) Educational Program. The agency shall be responsible for ensuring compliance with Missouri statutes pertaining to the children\u2019s education. <\/td>\n <\/tr>\n
\n Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? <\/td>\n \n Page 26 - (J) Transitional Living Services 5. A basic knowledge in substance abuse prevention, human sexuality, physical and sexual abuse, Human Immunodeficiency Virus prevention and other sexually transmitted diseases; <\/td>\n <\/tr>\n
\n Does the state require a guardian's consent to all treatment received? <\/td>\n \n Page 20 13 CSR 35-71.060 Social Services Program A written placement agreement between the agency and the child\u2019s parent(s) or guardian must be completed at or before placement. A copy of the placement agreement must be in the child\u2019s record. The placement agreement must include authorization to care for the child and a medical consent form signed and dated by a child\u2019s parent(s) or legal guardian authorized to give consent <\/td>\n <\/tr>\n
\n Is the guardian's consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? <\/td>\n \n Yes. 13 CSR 35-71.140 D 4. Appropriate information about the updated treatment plan must be given to the child and the child\u2019s parent(s), guardian, or legal custodian. This must be documented in the child\u2019s record. <\/td>\n <\/tr>\n
\n Is youth consent required for all treatment received? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? <\/td>\n \n Yes. Page 1919 (4) The License. (F) An [licensed residential treatment agency] LRCF for children and youth may request a temporary variance from one (1) or more of the licensing requirements for a specified period of time on a form prescribed by the division that is approved or denied by the division. Approval may be granted by the division only in unusual situations when the division determines that the variance will not negatively impact child health and safety and is not under the purview of another regulatory entity. Examples may include, but are not limited to, time limited deviations in licensed capacity and age range. No variance will be granted for any licensing requirements which involve the health, safety, and welfare of children. Examples include, but are not limited to, compliance with fire and sanitary codes, food safety, building occupancy requirements, and other requirements imposed by law. In the event the licensed residential treatment agency for children and youth does not agree with the decision of the division, it may request administrative review pursuant to 13 CSR 35-71.030.<\/a> <\/td>\n <\/tr>\n
\n Are there any laws banning Aversion Treatment? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Is there regulation for physical restraint? <\/td>\n \n Yes. (E) Physical Restraint. 1. All agencies using physical control techniques must have written policies defining the method of control utilizing a recognized physical restraint training program, approved by the division <\/td>\n <\/tr>\n
\n Is there regulation for chemical restraint? <\/td>\n \n Yes. Page 22-23 The following forms of discipline shall not be used: Chemical restraint <\/td>\n <\/tr>\n
\n Are restraints required to be reported to the state? <\/td>\n \n No <\/td>\n <\/tr>\n
\n Is there regulation for seclusion? <\/td>\n \n Yes. Page 23 5. The agency shall have written policies and procedures prohibiting discipline which may adversely affect a child\u2019s health or physical or psychological well-being. K. Confinement in any space not designed for isolation and observation; The following forms of discipline shall not be used page 22 \u2013 23 N. Locked isolation for the purpose of discipline; Page 33-4. 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\u2019s record. <\/td>\n <\/tr>\n <\/table>\n<\/div>