Sec. 10.21.07.14. Staff

A. Required Staff. The governing body of a TGH shall assure that TGH staff is sufficient in numbers and qualifications to:

(1) Carry out the TGH program service plan described in Regulation .05C of this chapter and program model described in Regulation .08 of this chapter;

(2) Provide the services, including supervision and staff-to-child ratio, required under Regulations .12 and .13 of this chapter; and

(3) Carry out the requirements of the ITPs of the TGH residents.

B. Chief Executive Officer. The governing body shall employ a TGH chief executive officer who:

(1) Meets the qualifications and experience required under COMAR 14.31.06.06A;

(2) Is on duty at the TGH for the amount of time necessary to carry out the duties outlined in this chapter and, at a minimum, 20 hours per week;

(3) Is responsible for credentialing and privileging staff;

(3-1) Is responsible for administrative oversight for, at a minimum:

(a) Fulfilling the administrative requirements under COMAR 14.31.05;

(b) Assuring compliance with this chapter;

(c) Maintaining sufficient staff, including recruiting, hiring, training, scheduling, and terminating;

(d) Assuring the availability, 24 hours per day, 7 days per week, of a TGH psychiatrist;

(e) In collaboration, when appropriate, with the clinical coordinator, assuring that all staff are appropriately supervised;

(f) In collaboration with the clinical coordinator and program staff, identifying staff training needs and the provision of inservice training, as required under COMAR 14.31.06.05F, and, in addition, assuring a minimum level of staff competence in at least the following:

(i) Understanding mental disorders and treatment modalities, including medication;

(ii) Use of seclusion, restraint, and quiet room, as governed by COMAR 10.21.12 and 10.21.13;

(iii) Verbal de-escalation and aggression management techniques and procedures;

(iv) Appropriate response to communicable diseases and use of universal precautions;

(v) Emergency preparedness and evacuation plan; and

(vi) Implementation of children's rights;

(g) Quality management;

(h) Developing and implementing the budget;

(i) Maintaining the physical plant; and

(j) Keeping the governing body informed of, at a minimum, the program's licensure status and performance;

(4) May carry out the duties of the clinical coordinator, as described under §C of this regulation, if the chief executive officer is:

(a) A mental health professional;

(b) On duty at the TGH at least 40 hours per week, 20 hours of which must be during times when the children or adolescents are normally on-site; and

(5) If carrying out the duties of the clinical coordinator, shall hire an additional mental health professional for an additional 20 hours per week to assist with the duties described under §C of this regulation.

C. Clinical Coordinator. If the chief executive officer is not the clinical coordinator, the chief executive officer shall hire a clinical coordinator who is:

(1) A mental health professional;

(2) On duty at the TGH at least 20 hours per week during times when the children or adolescents are normally on-site; and

(3) Responsible for, at a minimum:

(a) Development of treatment procedures, including admission and discharge procedures;

(b) Development of the ITP and ITP reviews, including appropriate coordination with a child's:

(i) IEP;

(ii) ITP developed by the providers of mental health treatment; and

(iii) Medical care providers;

(c) Interpreting the children's assessments and evaluations to staff;

(d) Establishing and maintaining linkage with schools and community treatment providers;

(e) Establishing protocols for medical and psychiatric emergencies and crisis response plans;

(f) Providing clinical supervision of staff; and

(g) If assigned by the TGH chief executive officer, maintenance of the therapeutic milieu described in Regulation .08C(2)(b) of this chapter.

D. TGH Psychiatrist. The chief executive officer shall assure the availability of a psychiatrist who:

(1) Has completed a residency in child psychiatry in an accredited program;

(2) As specified in the employment or consultant contract, is available:

(a) For the amount of time necessary to carry out the duties outlined in §D(3) of this regulation; and

(b) To respond to emergencies 24 hours per day, 7 days per week; and

(3) Is responsible for:

(a) Participation in the screening, assessment, admission, and discharge processes;

(b) Formulating and documenting a diagnosis, according to Regulation .11B of this chapter;

(c) Participation in the development and signing of a child's ITP and ITP reviews;

(d) Clinical supervision of those cases requiring face-to-face medical review;

(e) Consulting with staff regarding the maintenance of the therapeutic milieu;

(f) Review of medication utilization and corrective feedback when utilization is found to be inappropriate; and

(g) Medical aspects of quality management.

E. Case Coordinator. The TGH chief executive officer shall employ a sufficient number of case coordinators, each of whom is:

(1) Either a:

(a) Mental health professional; or

(b) Residential care specialist who:

(i) Has a minimum of a high school diploma or equivalent; and

(ii) Is supervised by a mental health professional;

(2) Available to be with the child, on site in the TGH, at least 4 days per week; and

(3) Responsible for the duties delineated under Regulation .12A of this chapter.

F. Residential Care Specialist. The TGH chief executive officer shall employ a sufficient number of residential care specialists who:

(1) As determined by the chief executive officer, have sufficient qualifications and experience to carry out the duties of the position;

(2) Have training applicable to the service, including, at a minimum, training outlined in §B(3)(g) of this regulation;

(3) As permitted under the Health Occupations Article, Annotated Code of Maryland, and as privileged by the program, are available to carry out the residential services delineated under Regulation .13 of this chapter.

G. Program Coordinator. The TGH chief executive officer may employ a program coordinator, who shall be a mental health professional, to manage the therapeutic milieu as outlined in §C(3) of this regulation.