(1) In addition to the requirements specified in ARM 37.97.141, TGH providers must meet staffing requirements specified in this rule to provide a therapeutic environment and treatment interventions identified in the youth's individual treatment plan.
(2) A TGH with four or fewer youth must have a ratio of youth to direct care staff of no more than 2:1 present for 15 hours each day between 7:00 a.m. and 7:30 a.m., or beginning at some other reasonable morning half hour which is approximately 15 hours prior to the bedtime of the youth.
(3) A TGH with five or more youth must have a minimum of two direct care staff present for 15 hours each day between 7:00 a.m. and 7:30 a.m., or beginning at some other reasonable morning half hour which is approximately 15 hours prior to the bedtime of the youth.
(4) Exceptions to youth to direct care staff ratio:
(a) During regular school hours when youth are not normally present, at least one on-call staff must be available only if there are no other staff in the facility. Staff must report to work at the TGH within 30 minutes of notification that they are needed.
(b) If no more than two youths do not attend school and remain in the TGH, the program manager may be counted in the direct care staff ratio.
(c) The program manager may be counted in the direct care ratio during the morning hours between 6:00 a.m. and 8:00 a.m., or beginning at some other reasonable two-hour time frame prior to the youth leaving for school.
(5) A minimum of one direct care staff must be present and awake nine hours each night at or between 10:00 p.m. and 7:00 a.m., or no earlier than 15 hours from the time daytime staffing start working. In addition, one on-call staff must be available each night and report to work within 30 minutes of notification that they are needed.
(6) A TGH must employ a program manager who is responsible for no more than 16 youth. The program manager may not be counted in the direct care staffing to youth ratio except as provided in (4)(b) and (c).
(7) A TGH must employ or contract with a mental health professional as defined in ARM 37.97.102(13). Services must be provided on-site or as specified in the treatment model. The mental health professional must not be counted in the direct care staffing to youth ratio.
(8) Program managers and mental health professionals may be the same employee as long as they meet the minimum qualifications of both positions and have sufficient time to carry out the functions of both positions.
(9) The mental health professional shall be responsible for the supervision and overall provision of treatment services to youth in the TGH. The mental health professional must not be counted in the direct care staff to youth ratio.
(10) The TGH must have nursing services available 24 hours a day seven days a week as described in the TGH's treatment model.
(11) Adequate staff must be employed to implement each youth's individualized treatment plan.