<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.21.18.06" title_num="10" subtitle_num="21" chapter_num="18" heading="Treatment and Support Services.">
  <paragraph num="A.">
    <text>Therapies. The therapeutic nursery program shall provide the following therapies:</text>
    <paragraph num="(1)">
      <text>If required by the ITP, individual therapy:</text>
      <paragraph num="(a)">
        <text>With the therapeutic nursery mental health professional staff;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>With the community psychotherapist who is currently treating the child; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>By referral;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For children in Program A, conjoint therapy involving an individual child or groups of children with their primary caretakers;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Milieu therapy that uses the environment as a tool to assist the child, in keeping with routine developmental expectations, to manage behavior and function appropriately and cooperatively with peers and adults.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Daily Activities. The therapeutic nursery program shall implement, on a consistent, regular basis, a plan for daily activities that:</text>
    <paragraph num="(1)">
      <text>Incorporate a variety of experiences with language, music, art, science, dramatic play, block play, and equipment and materials that promote large and small muscle development;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Allow for self-selected and planned as well as individual and small group activities; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Include safe, regular, and developmentally appropriate outdoor play, with supervision consistent with the staff-to-child ratio required under Regulation .08D of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Services for Families. The therapeutic nursery program shall provide services to families, including but not limited to:</text>
    <paragraph num="(1)">
      <text>As indicated by the ITP, counseling or therapy:</text>
      <paragraph num="(a)">
        <text>With the therapeutic nursery mental health professional staff;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>With the community psychotherapist who is currently treating the child; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>By referral;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Orientation for parents, guardians, or primary caretakers to the specialized treatment interventions that are designed to facilitate the child's continued development;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Mental health support groups; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Therapeutic home visits.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Interagency Consultation and Referral.</text>
    <paragraph num="(1)">
      <text>Services to Center. If the therapeutic nursery is included within another early childhood program, the therapeutic nursery staff shall provide those services to the early childhood program that the therapeutic nursery staff determine to be appropriate, including, but not limited to:</text>
      <paragraph num="(a)">
        <text>Staff development and training;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Mental health consultation regarding specific clinical interventions to be used in relating to therapeutic nursery children;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Classroom consultation, including observation and feedback; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>When necessary, psychoeducational strategic consultation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Referral Services. For those services indicated in a child's ITP and not provided by the therapeutic nursery staff, the program shall have a policy and procedure for referral for:</text>
      <paragraph num="(a)">
        <text>Therapy, pursuant to §§A(1)(c) and C(1)(c) of this regulation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Evaluative or support services, including but not limited to:</text>
        <paragraph num="(i)">
          <text>Speech and language;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Vision and hearing;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Special instruction, special education, or other early intervention;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Somatic care;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Occupational therapy assessment and treatment; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Psychological testing.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>