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<regulation prefix="Regulation" num=".14" citation="COMAR 10.21.07.14" title_num="10" subtitle_num="21" chapter_num="07" heading="Staff.">
  <paragraph num="A.">
    <text>Required Staff. The governing body of a TGH shall assure that TGH staff is sufficient in numbers and qualifications to:</text>
    <paragraph num="(1)">
      <text>Carry out the TGH program service plan described in Regulation .05C of this chapter and program model described in Regulation .08 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the services, including supervision and staff-to-child ratio, required under Regulations .12 and .13 of this chapter; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Carry out the requirements of the ITPs of the TGH residents.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Chief Executive Officer. The governing body shall employ a TGH chief executive officer who:</text>
    <paragraph num="(1)">
      <text>Meets the qualifications and experience required under COMAR 14.31.06.06A;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Is responsible for credentialing and privileging staff;</text>
    </paragraph>
    <paragraph num="(3-1)">
      <text>Is responsible for administrative oversight for, at a minimum:</text>
      <paragraph num="(a)">
        <text>Fulfilling the administrative requirements under COMAR 14.31.05;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assuring compliance with this chapter;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Maintaining sufficient staff, including recruiting, hiring, training, scheduling, and terminating;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Assuring the availability, 24 hours per day, 7 days per week, of a TGH psychiatrist;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>In collaboration, when appropriate, with the clinical coordinator, assuring that all staff are appropriately supervised;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>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:</text>
        <paragraph num="(i)">
          <text>Understanding mental disorders and treatment modalities, including medication;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Use of seclusion, restraint, and quiet room, as governed by COMAR 10.21.12 and 10.21.13;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Verbal de-escalation and aggression management techniques and procedures;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Appropriate response to communicable diseases and use of universal precautions;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Emergency preparedness and evacuation plan; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Implementation of children's rights;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Quality management;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Developing and implementing the budget;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Maintaining the physical plant; and</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Keeping the governing body informed of, at a minimum, the program's licensure status and performance;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>May carry out the duties of the clinical coordinator, as described under §C of this regulation, if the chief executive officer is:</text>
      <paragraph num="(a)">
        <text>A mental health professional;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Clinical Coordinator. If the chief executive officer is not the clinical coordinator, the chief executive officer shall hire a clinical coordinator who is:</text>
    <paragraph num="(1)">
      <text>A mental health professional;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>On duty at the TGH at least 20 hours per week during times when the children or adolescents are normally on-site; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Responsible for, at a minimum:</text>
      <paragraph num="(a)">
        <text>Development of treatment procedures, including admission and discharge procedures;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Development of the ITP and ITP reviews, including appropriate coordination with a child's:</text>
        <paragraph num="(i)">
          <text>IEP;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>ITP developed by the providers of mental health treatment; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Medical care providers;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Interpreting the children's assessments and evaluations to staff;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Establishing and maintaining linkage with schools and community treatment providers;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Establishing protocols for medical and psychiatric emergencies and crisis response plans;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Providing clinical supervision of staff; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>If assigned by the TGH chief executive officer, maintenance of the therapeutic milieu described in Regulation .08C(2)(b) of this chapter.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>TGH Psychiatrist. The chief executive officer shall assure the availability of a psychiatrist who:</text>
    <paragraph num="(1)">
      <text>Has completed a residency in child psychiatry in an accredited program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As specified in the employment or consultant contract, is available:</text>
      <paragraph num="(a)">
        <text>For the amount of time necessary to carry out the duties outlined in §D(3) of this regulation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>To respond to emergencies 24 hours per day, 7 days per week; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Is responsible for:</text>
      <paragraph num="(a)">
        <text>Participation in the screening, assessment, admission, and discharge processes;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Formulating and documenting a diagnosis, according to Regulation .11B of this chapter;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Participation in the development and signing of a child's ITP and ITP reviews;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Clinical supervision of those cases requiring face-to-face medical review;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Consulting with staff regarding the maintenance of the therapeutic milieu;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Review of medication utilization and corrective feedback when utilization is found to be inappropriate; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Medical aspects of quality management.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Case Coordinator. The TGH chief executive officer shall employ a sufficient number of case coordinators, each of whom is:</text>
    <paragraph num="(1)">
      <text>Either a:</text>
      <paragraph num="(a)">
        <text>Mental health professional; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Residential care specialist who:</text>
        <paragraph num="(i)">
          <text>Has a minimum of a high school diploma or equivalent; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Is supervised by a mental health professional;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Available to be with the child, on site in the TGH, at least 4 days per week; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Responsible for the duties delineated under Regulation .12A of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Residential Care Specialist. The TGH chief executive officer shall employ a sufficient number of residential care specialists who:</text>
    <paragraph num="(1)">
      <text>As determined by the chief executive officer, have sufficient qualifications and experience to carry out the duties of the position;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have training applicable to the service, including, at a minimum, training outlined in §B(3)(g) of this regulation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>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.</text>
  </paragraph>
</regulation>