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Effective: 7/1/2026

C7.10 Placement in a Congregate Care (Residential Treatment) Setting

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The Family First Prevention Services Act (FFPSA) sets forth guidelines and requirements for the placement of youth in residential treatment facilities, as well as for their ongoing treatment, discharge, and aftercare planning. When residential treatment is being considered, a family team meeting (FTM) should be convened to inform the child’s placement decision-making process and ongoing treatment. 

If placement in residential treatment is necessary, all efforts should be made to secure a program based on the treatment needs of the youth. Placement in proximity to the youth's school and community, and within the county where they have resided with their family, is preferable to promote attachment and positive treatment outcomes. 

To maintain residential facilities that meet a high standard of care, programs must provide trauma-informed treatment modalities, provide family engagement and treatment, have trauma-informed staff, and provide ongoing aftercare for the youth and their family. FFPSA requires that youth be placed in a family-like setting unless their individual treatment needs require a higher level of care (LOC). 

FFPSA designates specialized residential treatment settings that provide tailored services to meet the unique needs of children in special populations​. Regardless of whether the youth falls into a special population category, it is essential to place them in the least restrictive setting that best meets their clinical treatment needs. The FFPSA identifies the following special populations:
  • The youth is pregnant or parenting (including fathers); 
  • The youth is placed in a supervised independent living program and is over the age of eighteen (18); and
  • Victims of, or youth at risk of, sex trafficking.
A therapeutic LOC of three (3) is required for referral to and placement in residential treatment. However, the therapeutic level alone does not determine if residential treatment is the least restrictive intervention to meet the child’s unique needs.

Before accepting a medically complex youth, a private child care (PCC) facility must submit a written plan describing how it will meet that youth's medical needs. The facility submits the plan to the medically complex liaison, who then forwards it to the Medical Support Section. A copy should also be uploaded into the child's TWIST case. 


Practice Guidance

Placement in residential treatment will be based on the youth's treatment needs. All efforts should be made to secure placement in a program designated as a specialized provider for the youth's population. Placement in programs that have not been designated as a specialized provider will be considered only after specialized placement options have been exhausted. The Children's Review Program (CRP) will maintain a list of specialized providers and make placement referrals for residential treatment per the Department for Community Based Services' (DCBS) policy.


Procedure

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No youth shall be referred for placement in a PCC residential treatment program without the necessary approval. The protocol for a youth being considered for residential treatment is as follows.
The SSW:

  1. ​Submits the DPP-121 Referral for Placement in PCC Residential Treatment, including any supporting documentation for approval, based on the age of the youth.
    1. ​Youth age ten (10) and younger submit to the Division of Protection and Permanency (DPP) director or designee;
    2. Youth aged eleven (11) or twelve (12) submit to the service region administrator (SRA);
    3. Youth aged thirteen (13) or older submit to the service region clinical associate (SRCA) or designee.
  2. ​Once required approval has been obtained:
    1. ​​Completes the DPP-886A Application for Referral and Needs Assessment​ in TWIST, including only information that is necessary to provide adequate care and services to the child. Please see SOP C13.10 Preparing the Presentation Summary Packet​ and SOP C13.26 Confidentiality of Closed Agency Adoption Records​ for guidance regarding information sharing and confidentiality specific to cases in which parental rights have been terminated and/or sealed agency adoption records;
    2. Ensures the DPP-1275 Relative​ Exploration Form​​​​ is updated in TWIST;
    3. Uploads all appropriate release of information forms and signed DPP-121 Referral for Placement in PCC Residential Treatment into TWIST; and
    4. Submits the referral packet via TWIST to CRP. 
  3. Convenes a family team meeting (FTM) including the members of the youth’s support system, to inform placement-making decisions and review the ​​​youth's treatment needs. This meeting shall consist of : 
    1. All appropriate family members. Family is used expansively to include the child's natural supports, caregivers, foster parents, and others; 
    2. Relatives and fictive kin; 
    3. Community partners; 
    4. Private child caring (PCC) agency staff; and 
    5. Child-Focused Recruitment Model (CFRM) specialist (if assigned). 
  4. Documents parental/familial input and preferences regarding the placement in the case plan under the appropriateness of placement section of the child/youth action plan. 
    1. ​If a child's placement outcome is different from the wishes of the child's support system, the case plan must outline what informed the placement-making decision. 
  5. Selects the special population indicator in TWIST if any of the following are present, ensuring that designation is considered during placement-making decision: 
    1. Youth is pregnant;
    2. Parenting youth (including fathers);
    3. Victim of labor trafficking; 
    4. Victim of sex trafficking; or 
    5. At risk of sex trafficking as evidenced by the following; 
      1. ​One or more out-of-home care (OOHC) episodes;
      2. A history of child or youth missing from care;
      3. Previous or current allegations of sexual abuse;
      4. Previous or current allegations of human trafficking; or 
      5. Previous or current Department of Juvenile Justice (DJJ) involvement;
  6. ​​Ensures family engagement (including the child's natural supports, relatives, fictive kin, foster family, etc.) in the child's treatment from the time of placement unless the following exists: 
    1. Parental rights have been terminated; or
    2. Written documentation from a qualified mental health professional (QMHP) indicates that participation would be contrary to the best interest of the child. Recommendations should be time-limited and re-evaluated as part of the child's ongoing treatment planning. Documentation detailing the therapeutic recommendation should be uploaded into TWIST. 
  7. Ensures facilitation of family therapy from the time of placement unless the following exists: 
    1. Parental rights have been terminated; 
    2. Court orders are preventing contact; or
    3. Written documentation from a QHMP indicates that participation would be contrary to the best interest of the child. Recommendations should be time-limited and re-evaluated as part of the child's ongoing treatment planning. A copy of the written documentation detailing the therapeutic recommendation should be uploaded into TWIST. 
  8. Updates the child/youth action plan to incorporate the child's treatment goals. 
  9. Assesses the youth’s progress on their short-term and long-term therapeutic goals on a regular basis, including during consultation with FSOS and regional out-of-home (OOHC) consultation; 
  10. Updates the court on the following at every court hearing/review: 
    1. Ongoing assessment of the strengths and needs of the youth in their current setting; 
    2. The youth’s need to remain in the residential setting; 
    3. Specific treatment and service needs are being met by the placement; 
    4. The length of time placement is expected; 
    5. Documentation of agency efforts to prepare the youth for their next placement in the least restrictive setting (i.e., foster family home, relative, or parents); and 
    6. Residential Treatment ​Placement Extension Request signed by the DPP director,  if applicable. 
  11. Consults with the treatment provider prior to discharge in order to ensure appropriate aftercare planning. Aftercare planning shall include referrals to new service providers and identification of community supports available;
  12. Assists with obtaining signatures on releases of information between the PCC agency and a new provider to ensure continuity of care; 
  13. Coordinates with the treatment team to convene an FTM with the youth's support system to discuss the youth’s discharge and treatment recommendations. The new placement provider should be included in the FTM;
  14. Establishes a robust transition plan from a structured, intensive treatment modality (residential treatment) to a family-based setting; 
  15. Ensures that treatment information pertaining to specialized programming is provided if subsequent residential placement is being considered.  
If a youth is placed in residential treatment, the SSW:
  1. Submits justification utilizing the Residential Treatment Placement​ Extension Request to the DPP director for every youth age thirteen (13) and older that is placed in a residential treatment program for twelve (12) consecutive months;
  2. Submits justification utilizing the Residential Treat​ment Extension Request template to the DPP director for every youth under age thirteen (13) that is placed in a residential treatment program for six (6) consecutive months.
Review of long-term residential treatment placement is specific to each placement, meaning that a child/youth may have multiple requests during a removal episode, dependent upon admission history. For additional guidance, please see C7.30 Reunification, Including Extended Visitation, Case Planning and Transitional Supports to Families and Children. ​​

Discharge Planning for Youth Placed in Congregate Care

Planning for discharge begins when a child enters a congregate care setting. For discharge planning, the SSW:

  1. ​Participates in active discharge planning with the child's treatment team and support system from the time of the child's placement in the congregate care setting by doing the following; 
    1. Regularly attending treatment team meetings;
    2. Detailing progress towards identified goals during monthly face-to-face visits, accounting for age and developmental functioning; 
    3. Identifying unmet treatment needs preventing discharge, clearly documenting why needs cannont be met in a less-restrictive setting; and 
    4. Documenting remommendations for post-discharge treatment. 
  2. Ensures that the discharge plan allows sufficient time for the youth to have a therapeutically supported transition to the family setting by completing the following:
    1. Submittingand updated DPP-886A Application for Referral and Needs Assessment in TWIST ninety (90) days before the anticipated discharge date, ensuring to reflect porgress made and recommendation for ongoing treatment; 
    2. Convening an FTM to integrate subsequesnt caregivers into the child's servisces as soon as possible upon identification, including but not limited to:
      1. Visitation; 
      2. Family therapy;
      3. Phone calls; and 
      4. Treatment team meetings.
    3. Collaborating with the child's treatment team and support system to plan a gradual, supported transition to subsequent placement. 
      1. Gradual transitions supported by family therapy allow the child and family to establish expectations and problem-solve anticipated struggles and challenges. 
    4. ​Assist in identifying subsequent treatment providers and referring for services prior to discharge to promote stability upon transition. 
      1. ​Doccument attempts to involve subsequent providers in transition planning and/or barriers preventing such. 
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Documents

Revisions

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