Administrative Rule 67:42:15 | South Dakota Legislature

(1) "Aftercare services," supportive social services specified in the treatment plan, provided to the child and the child’s family after the child returns home, and designed to help the child adjust to the nontreatment center environment;

(2) "Emergency safety intervention," the use of restraint or seclusion as an immediate response to an emergency safety situation;

(3) "Family services," social rehabilitative services to family members to alleviate problems specified in the treatment plan to enable the child to return home;

(4) "Intensive residential treatment center," "IRTC," or "facility," a facility licensed by the department to care for not less than seven children that provides more intensive and frequent services and supervision of children and individualized treatment to prevent runaway behavior, rage and physical aggression, and the likelihood of children injuring themselves or others;

(5) "Licensed practitioner," a licensed physician's assistant, a certified nurse practitioner, a licensed psychologist, a licensed social worker, a licensed professional counselor, or a qualified mental health professional who meets the requirements of SDCL 27A-1-3;

(6) "Living unit," a grouping in an intensive residential treatment center of not more than 12 children. The grouping is created by the proximity of the children to each other as determined by their living arrangements within the facility or the physical design of the facility which allows services and treatment to be provided to the group as a unit;

(7) "Personal restraint" or "restraint," the application of physical force without the use of any device for the purpose of restraining the free movement of a resident's body. The term does not include briefly holding a resident without undue force in order to calm or comfort the resident or holding a resident's hand for purposes of safely escorting the resident from one area to another;

(8) "Program director," the individual responsible for developing, implementing, supervising, and monitoring the services provided;

(9) "Seclusion," the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving;

(10) "Transitional services," services provided to a child who will be moving from one placement to another to help prepare the child for the new placement;

(11) "Treatment plan," a plan that explains the child's social, psychological, medical, or economic problems, contains solutions to the problems, and describes the necessary steps and schedules to resolve the problems; and

(12) "Treatment team," a group of individuals that plans, provides, and monitors services to a child in care and the child’s family.

Source: 32 SDR 33, effective August 31, 2005; 33 SDR 227, effective July 1, 2007; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:02 Eligibility requirements -- IRTC.

67:42:15:02. Eligibility requirements -- IRTC. Before the department licenses an IRTC, the facility must provide documentation to the department that indicates the facility meets the requirements of a psychiatric residential treatment facility for individuals under the age of 21, pursuant to 42 C.F.R. §§ 441.150 through 441.184 (October 1, 2019) and is accredited by the Council on Accreditation (COA) in the area of residential treatment services, by the Joint Commission in the area of behavioral health care, or by the Commission of Accreditation of Rehabilitation Facilities (CARF) in the area of behavioral health or child and youth services.

The facility must provide the following services:

(1) Psychological services;

(2) Treatment planning;

(3) Case management;

(4) Psychiatric services;

(5) Family services;

(6) Transitional services; and

(7) Aftercare services.

If the child is discharged to the child’s home, a relative’s home, a family foster home, or an adoptive home, the facility must ensure that aftercare services are provided, either directly or through referral, for a minimum of 90 days following discharge from the facility, and at a location agreed to by the family.

Source: 32 SDR 33, effective August 31, 2005; 33 SDR 227, effective July 1, 2007; 34 SDR 200, effective January 30, 2008; 39 SDR 220, effective June 27, 2013; 47 SDR 24, effective September 10, 2020.

General Authority: SDCL 26-6-16(1)(6)(11).

Law Implemented: SDCL 26-6-16(1)(6)(11).

Rule 67:42:15:02.01 Licensed practitioner.

67:42:15:02.01. Licensed practitioner. In any of the federal regulations incorporated under the provisions of this chapter, the term, licensed practitioner, has the meaning specified in § 67:42:15:01.

The licensed practitioner must meet the education and training requirements established in 42 C.F.R. § 483.376 (October 1, 2006). A licensed practitioner does not include a licensed social work associate.

Source: 33 SDR 227, effective July 1, 2007.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:03 Eligibility requirements -- Child. CHAPTER 67:42:15

67:42:15:03. Eligibility requirements -- Child. A child is eligible for placement in an IRTC if there is written documentation that the child did not respond to treatment in a residential treatment center, was denied placement in a residential treatment center, or left a residential treatment center before completing treatment. In any case, the child must also have a documented, chronic history of high level physical or sexual aggression. The IRTC must maintain the written documentation and make it available to the department on request.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:04 Staff qualifications -- Program director.

67:42:15:04. Staff qualifications -- Program director. The program director must have a master’s degree in an accredited behavioral or social science area and at least four years of relevant alternative child care experience or a bachelor’s degree in a behavioral or social science and at least six years of relevant alternative child care experience. The program director may not have on record a substantiated report of child abuse or neglect.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-References: Revocation or refusal to issue or renew license or registration for child abuse or violence, SDCL 26-6-23.1; Screening for substantiated reports of abuse and neglect, § 67:42:01:05.02.

Rule 67:42:15:05 Staff qualifications -- Direct care staff.

67:42:15:05. Staff qualifications -- Direct care staff. At least one of every three staff members on duty in each unit of the facility who supervises children in care, provides direct services, or participates in assessment and service planning processes must have a bachelor’s degree in a behavioral or social science or 48 credit hours of post-high school education and at least one year of experience working with children in a group care setting. The experience must include behavior management and intervention, recreational and therapeutic activities, and participation in the assessment and case planning process. An individual who does not meet these requirements must be under the supervision of a staff member who provides direct care to children and meets the requirements of this section.

The staff member may not have on record a substantiated report of child abuse or neglect.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:06 Staff qualifications -- Case managers.

67:42:15:06. Staff qualifications -- Case managers. A staff member who provides case management services, including planning, securing, coordinating, and monitoring the services for children in care and their families must have a bachelor’s degree in an accredited behavioral or social science area or an equivalent combination of education and experience.

The staff member may not have on record a substantiated report of child abuse or neglect.

Source: 32 SDR 33, effective August 31, 2005; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:07 Staff qualifications -- Counselors and therapists.

67:42:15:07. Staff qualifications -- Counselors and therapists. A staff member who provides counseling or therapy services must have at least a master’s degree in social work, counseling, psychology, or other behavioral science, or a bachelor’s degree in an accredited social or behavioral science and at least three years of experience working with difficult adolescents. The staff member must hold current licensure or certification if such is available in the staff member’s applicable field of practice. For purposes of this section, counseling and therapy services include individual, group, and family therapy; assessment of the needs of children in care; assessment of the needs of the children’s families; and development, review, and revision of the comprehensive treatment plans.

The staff member may not have on record a substantiated report of child abuse or neglect.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:08 Caseloads -- Limits. CHAPTER 67:42:15

67:42:15:08. Caseloads -- Limits. The caseload for a fulltime case manager, counselor, or therapist is limited to 12 children. If providing both therapy and case management services, the caseload may not exceed six children. The caseload for a part-time case manager, counselor, or therapist must be reduced proportionately according to the number of hours worked in relation to fulltime staff.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:09 Treatment team. CHAPTER 67:42:15

67:42:15:09. Treatment team. The facility must establish a treatment team for each child in care. The team must include the following individuals:

(1) The child;

(2) The child’s parent or guardian;

(3) Staff from the IRTC, including the child’s case manager, counselor or therapist, teacher, and psychiatrist;

(4) The psychologist who completed the psychological evaluation of the child following admission to the facility; and

(5) A staff member from the placing agency.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Team developing individual plan of care, 42 C.F.R. § 441.156.

Rule 67:42:15:10 Treatment plan.

67:42:15:10. Treatment plan. Within 14 days after admission to the facility, the child’s treatment team must develop a written treatment plan for the child. Each team member must sign the plan. The plan must contain the following information:

(1) An assessment of the child’s needs, strengths, weaknesses, and problems. The assessment must include a diagnostic evaluation of the medical, psychological, social, behavioral, and developmental needs of the child and reflect the need for intensive residential treatment;

(2) Treatment goals for the child and the child’s family with an integrated program of therapies, activities, and experiences designed to meet the goals, and projected times for achieving the stated goals;

(3) The projected length of stay and the conditions under which the child will be discharged; and

(4) A discharge plan that meets the requirements of § 67:42:15:12.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Individual plan of care, 42 C.F.R. § 441.155.

Rule 67:42:15:11 Review and evaluation of treatment plan.

67:42:15:11. Review and evaluation of treatment plan. When the 30-day review of the child's treatment plan is complete, a progress report must be sent to the child's placement agency. The facility shall send a copy of the monthly report to the child's parent or guardian if the parent or guardian was involved in the child's placement or is actively involved in treatment planning. At least once every three months the treatment plan must be updated. The updated treatment plan must include the progress made toward achieving the goals in the previous plan and any amendments made to the plan. When complete, a copy of the plan amendments must be sent to the child's placement agency and the child's parent or guardian, if applicable. During the month of the quarterly review, the 30-day progress report may be incorporated into the quarterly review and treatment plan amendment.

Source: 32 SDR 33, effective August 31, 2005; 33 SDR 227, effective July 1, 2007; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Individual plan of care, 42 C.F.R. § 441.155.

Rule 67:42:15:12 Discharge plan. CHAPTER 67:42:15

67:42:15:12. Discharge plan. The treatment team must establish a discharge plan for the child. The discharge plan must include the following information:

(1) The projected date of discharge;

(2) The responsibilities of the provider, child, family, and placement agency in the discharge and transition process;

(3) Transitional services to be provided and by whom;

(4) Crisis and emergency plans;

(5) Links with community resources and preparation for how to navigate the adult service system if the child is sixteen years of age or older;

(6) Aftercare services;

(7) A list of responsible persons; and

(8) If the child is Native American, involvement of the child’s tribe in aftercare planning.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:13 Living units. CHAPTER 67:42:15

67:42:15:13. Living units. The facility must provide living units for the children in care. Each unit must have at least one staff member present at all times who is trained in basic first aid and is certified in cardio-pulmonary resuscitation (CPR). Certification in CPR must be through the American Red Cross, the American Heart Association, or another entity that provides hands-on skills testing as part of the training.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:14 Staff-child ratio.

67:42:15:14. Staff-child ratio. During waking hours and whenever children are present, there must be at least one staff member to supervise every three children or fraction thereof. During sleeping hours, there must be at least one staff member present and awake in each living unit to supervise every six children or fraction thereof.

There must be a minimum of two adults on the grounds at all times. Additional child care staff must be on call. A list of the staff members on call must be posted by the facility's telephone in case of an emergency. The facility must have a written plan to ensure that staff, law enforcement, or appropriate emergency responders are available at the center within a reasonable time in the event of an emergency.

The facility must have an arrangement for employing substitute staff to serve children in emergencies, during vacations or illnesses of regular staff, and during the time when regular staff is off duty.

The facility must provide auxiliary staff members to fulfill the facility’s defined purposes. Auxiliary staff members include individuals such as certified special education teachers, mental health professionals, and physical or occupational therapists.

The department may require a higher adult-child ratio if safety needs or treatment concerns indicate a need for more supervision to maintain control and discipline.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:15 Orientation training.

67:42:15:15. Orientation training. The facility must have a written plan for orientation training. The orientation course must include the facility’s functions, services, community resources, and specific job functions. The facility may consider the orientation course a part of the required 50 hours of annual training. An employee shall complete an orientation course within one month after the employee is hired.

Supervision of staff members as they perform their routine tasks is not considered training. The facility must document completion of required training and must keep the documentation in the individual’s personnel file.

Source: 32 SDR 33, effective August 31, 2005; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Annual training, § 67:42:15:16.

Rule 67:42:15:16 Annual training.

67:42:15:16. Annual training. The facility shall have a written plan for annual in-service training. Each staff member providing direct care to children must participate in the training. The written plan must provide for training in the following areas for staff during the first year of employment:

(1) Administrative procedures and overall program goals;

(2) Understanding children's emotional needs and problems which affect and inhibit their growth;

(3) Family relationships and the impact of separation;

(4) Substance abuse, its recognition, prevention, and treatment;

(5) Identification and reporting of child abuse and neglect;

(6) Principles and practices of child care;

(7) Behavior management techniques;

(8) Use of seclusion and personal restraint;

(9) Emergency and safety procedures; and

(10) Cultural sensitivity.

Staff must receive training to become certified in basic first aid and cardiopulmonary resuscitation and must maintain certification throughout employment.

For staff beyond the first year of employment, the plan must provide for competency-based training.

The facility shall provide and each staff member shall attend a minimum of 50 clock hours of training annually.

The annual training must include a minimum of five hours of training in a nationally-recognized program of behavior management techniques and personal restraint and five hours of training in the special areas the facility uses to provide services to children, such as sexual perpetration, highly aggressive and assaultive youth, severe emotional disturbance, and lower functioning individuals.

Training must be competency based and the facility must develop and implement a process that demonstrates the effectiveness of the training in providing the knowledge and expertise required.

Supervision of staff members as they perform their routine tasks is not considered training. The facility shall document completion of required training and shall keep the documentation in the individual’s personnel file.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:17 Compliance with chapter 67:42:07.

67:42:15:17. Compliance with chapter 67:42:07. In addition to the rules contained in this chapter, an IRTC must comply with the standards established in §§ 67:42:07:07 to 67:42:07:26, inclusive.

Source: 32 SDR 33, effective August 31, 2005; 33 SDR 227, effective July 1, 2007

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:18 Written policy requirements.

67:42:15:18. Written policy requirements. In addition to the written policy statements required under chapter 67:42:07, the facility must develop written policies that address:

(1) Intake;

(2) Treatment;

(3) Discharge;

(4) Confidentiality;

(5) Emergency safety interventions;

(6) Emergency and safety procedures;

(7) Family services; and

(8) Aftercare services.

The facility must inform the child's parent or guardian of the facility's policies, including the individuals or agencies to whom required reports must be made. The child's parent or guardian must sign and date a statement that lists the specific policies covered as verification that the facility provided the required information. The facility must make copies of these policies available on request.

Source: 32 SDR 33, effective August 31, 2005; 33 SDR 227, effective July 1, 2007; 34 SDR 200, effective January 30, 2008; 47 SDR 24, effective September 10, 2020.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Protection of residents -- Emergency safety intervention, 42 C.F.R. § 483.356(b).

Rule 67:42:15:19 Psychiatric services.

67:42:15:19. Psychiatric services. An intensive residential treatment center shall ensure that a licensed psychiatrist completes a psychiatric assessment of each child in care within fourteen days after the child is placed into the facility. The assessment must include recommendations for other evaluations to be completed on the child.

Each child in care must receive a minimum of two face to face contacts regarding psychiatric services per month to include medication management, training, and therapy, and consultation relating to the child’s treatment plan.

A psychiatrist must be available in person or on call at all times.

Source: 32 SDR 33, effective August 31, 2005; 34 SDR 200, effective January 30, 2008; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:20 Nursing services. CHAPTER 67:42:15

67:42:15:20. Nursing services. A facility must employ a full-time nurse who holds a current license to practice in South Dakota. The facility must ensure that staff and children in care have 24-hour access to medical care provided by the nurse, a back-up nurse, or a hospital emergency room.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Registered and practical nurses, SDCL ch 36-9.

Rule 67:42:15:21 Repealed.

67:42:15:21. Medication management. Repealed.

Source: 32 SDR 33, effective August 31, 2005; repealed, 34 SDR 200, effective January 30, 2008.

Rule 67:42:15:22 Repealed.

67:42:15:22. Progress report to placement agency. Repealed.

Source: 32 SDR 33, effective August 31, 2005; repealed, 33 SDR 227, effective July 1, 2007.

Rule 67:42:15:23 Compliance with chapters 67:42:01 and 67:42:11. CHAPTER 67:42:15

67:42:15:23. Compliance with chapters 67:42:01 and 67:42:11. A facility licensed under the provisions of this chapter must meet the applicable provisions of chapters 67:42:01 and 67:42:11.

Source: 32 SDR 33, effective August 31, 2005.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Cross-Reference: Provisions and scope of services, ch 67:42:01; Environmental health standards, ch 67:42:11.

Rule 67:42:15:24 Emergency safety intervention -- Face-to-face assessment required.

67:42:15:24. Emergency safety intervention -- Face-to-face assessment required. The face-to-face assessment required under the provisions of 42 C.F.R. § 483.358(f), as amended to January 1, 2007, must be provided by a physician, a licensed practitioner, a registered nurse, or a licensed social work associate who has a bachelor's degree and certification as a trainer in a nationally-recognized program of behavior management personal restraint.

Source: 33 SDR 227, effective July 1, 2007; 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

Rule 67:42:15:25 Emergency safety intervention.

67:42:15:25. Emergency safety intervention. A licensed physician, a licensed practitioner, a registered nurse, or a licensed social work associate who has a bachelor's degree and certification as a trainer in a nationally-recognized program of behavior management and personal restraint is authorized to order and monitor the use of personal restraint. The facility shall conduct a review on a random sampling of orders to ensure that each licensed social work associate providing an order meets the requirements of this section.

Source: 39 SDR 220, effective June 27, 2013.

General Authority: SDCL 26-6-16.

Law Implemented: SDCL 26-6-16.

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