# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 07 — Therapeutic Group Homes

#### Regulation .08 TGH Program Model.

*COMAR 10.21.07.08*

A. A TGH provides therapeutic living services:

  (1) For at least four but not more than eight children;

  (2) By providing access to a combination of developmental, diagnostic, and therapeutic mental health services;

  (3) When possible, in the child's community of origin; and

  (4) In a home-like environment.

B. The chief executive officer of a TGH shall assure that a TGH:

  (1) Provides to each child in the TGH mental health care and treatment:

    (a) That can reasonably be expected to benefit the child; and

    (b) By an adequate staff or, under agreement, by a provider of mental health services;

  (2) Has sufficient staff to provide adequate supervision to the children in the TGH, including 24-hour supervision for each resident not participating in a program outside the TGH; and

  (3) Coordinates treatment in the TGH with the appropriate public or nonpublic educational program.

C. The chief executive officer of the TGH shall assure that services are:

  (1) Appropriate to the cultural and psychosocial developmental needs of the child;

  (2) Provided by staff who:

    (a) As determined by the program, are appropriately credentialed and privileged; and

    (b) Organize and manage the therapeutic milieu to:

      (i) Foster clinically appropriate social, cognitive, emotional, and physical growth;

      (ii) Handle aggression in a nonpunitive manner that promotes growth and learning;

      (iii) Reinforce the child's ability to function with peers in a social environment;

      (iv) Model and provide opportunities for children to behave in age-appropriate ways, such as assuming responsibility for carrying out routine activities, exhibiting independence and initiative in planning their own activities, getting along with others, and demonstrating age-appropriate social skills;

      (v) Facilitate the child's awareness of appropriate behavior in a predictable, constructive, and timely manner; and

      (vi) Help children to make choices and to negotiate disagreements among themselves, rather than resolving conflicts for them;

  (3) Provided in an environment that is:

    (a) Consistent with existing standards of program design; and

    (b) Organized consistent with the learning styles and developmental needs of the child; and

  (4) Designed to foster positive relationships between the child and the child's parents or guardians and, if other than a parent, the child's primary caretaker, and the anticipated post-placement caretaker.