Sec. 10.21.18.08. Program Staff

A. Based on the complexity of the services provided and the number of enrollees in the therapeutic nursery, a therapeutic nursery program shall provide sufficient staff to maintain the staff-to-child ratio provided in §E of this regulation and to carry out the therapeutic goals of the therapeutic nursery.

B. Therapeutic Nursery Staff. A provider of therapeutic nursery services shall ensure that the therapeutic nursery staff includes, at a minimum:

(1) A program director who:

(a) Is a mental health professional or has a master's degree in a health services administration field;

(b) Is on a site of the therapeutic nursery at least 50 percent of the operating hours of the therapeutic nursery program;

(c) If a therapeutic nursery program operates in more than one site, has contact with each site each week; and

(d) Is responsible for operational oversight for, at a minimum:

(i) Fulfilling the administrative requirements under COMAR 10.21.17;

(ii) Recruiting, hiring, and providing administrative supervision of staff;

(iii) Developing and implementing the budget;

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

(v) Recruiting and enrolling program participants;

(2) A clinical director who:

(a) Is a mental health professional;

(b) Is on a site of the therapeutic nursery at least 50 percent of the operating hours of the therapeutic nursery program;

(c) If a therapeutic nursery program operates in more than one site, has contact with each site each week;

(d) If the clinical director is also the program director, is on a site at the therapeutic nursery program on a full-time basis during the operating hours of the therapeutic nursery program; and

(e) Is responsible for oversight for, at a minimum, the following:

(i) Development of the ITP;

(ii) Providing clinical supervision of staff, including the educational staff of a therapeutic nursery program that is not affiliated with an educational preschool program;

(iii) Development of therapeutic strategies that may be used in the classroom;

(iv) Development of treatment programs;

(v) Quality improvement; and

(vi) Inservice training;

(3) A therapeutic nursery physician who:

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

(b) As specified in the employment or consultant contract, is available on a therapeutic nursery site for the amount of time necessary to carry out the duties outlined in §B(3)(c) of this regulation, and, at a minimum:

(i) If 25 or fewer children are enrolled in the therapeutic nursery program, for a minimum of 2 hours per week; and

(ii) For 1 additional hour per week for every additional one to ten children who are enrolled in the therapeutic nursery program; and

(c) Is responsible for, at a minimum, the following:

(i) Establishing and maintaining appropriate standards for treatment, including therapeutic modalities and prescribing practices;

(ii) Unless carried out by other staff qualified under the provisions of Health Occupations Article, Annotated Code of Maryland, as required under the provisions of Regulation .05B and C of this chapter, diagnostic formulation and participation in the development and signing of the ITP and the ITP 3-month reviews;

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

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

(v) Medical aspects of quality improvement; and

(4) A staff psychologist or psychologist consultant who:

(a) As specified in the employment or consultant contract, is available on the site or sites of the therapeutic nursery program for the amount of time necessary to carry out the duties outlined in §B(4)(b) of this regulation; and

(b) Is responsible for, at a minimum, the following:

(i) Unless carried out by other staff qualified under the provisions of Health Occupations Article, Annotated Code of Maryland, as required under the provisions of Regulation .05B and C of this chapter, diagnostic formulation and participation in the development and signing of the ITP and the ITP 3-month reviews;

(ii) As needed, performing psychological assessment and testing; and

(iii) Making appropriate referral for those cases requiring face-to-face medical review.

C. Treatment Coordinator. The program director shall assign to each child who is admitted to a therapeutic nursery a treatment coordinator who is a mental health professional.

D. Educational Staff. If the therapeutic nursery is not affiliated with an educational preschool program, the therapeutic nursery educational staff shall:

(1) Be sufficient to carry out the educational programs provided by the therapeutic nursery and the classroom strategies described in the ITPs; and

(2) Meet the qualifications required under COMAR 13A.09.09.05C.

E. Staff-to-Child Ratio. The therapeutic nursery program shall ensure that the following required treatment or education staff-to-child ratio is maintained at all times:

(1) For Program A, a staff-to-child ratio of at least one staff member for every five enrollees; and

(2) For Program B:

(a) If the therapeutic nursery is not affiliated with an educational preschool program, a staff-to-child ratio of at least one staff member for every four enrollees; and

(b) If the therapeutic nursery is affiliated with an educational preschool program, a staff-to-child ratio of at least one therapeutic nursery treatment staff member for every 10 preschool children, provided that not more than four children are therapeutic nursery enrollees.