4.51.1 Placement in a Congregate Care (Residential Treatment) Setting

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The Family First Prevention Services Act (FFPSA) sets forth guidelines and requirements for the placement of youth in residential treatment facilities, in addition to their ongoing treatment, discharge, and aftercare planning. FFPSA mandates the creation of a family and permanency team (FPT) who will inform the child’s qualified residential treatment program (QRTP) assessment and placement decision-making process. In order to identify residential facilities that meet a high standard of care, FFPSA requires states to recognize the designation of QRTP. These 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). In order to determine the appropriateness of a child’s placement in residential treatment, an evidenced-based assessment will be conducted by a qualified individual within the first thirty (30) calendar days of the youth’s placement in a residential setting, or sooner if possible.

Practice Guidance

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

The QRTP assessment should be initiated as soon as residential treatment is being considered for a child. It is best practice that the QRTP assessment informs placement decisions. Utilizing the clinical recommendations in the QRTP assessment to inform placement decisions prior to placement will minimize disruptions in treatment and trauma to the child.

Procedure

​​​If a youth is being considered or referred for residential treatment, or if the youth is placed in a residential treatment program, the SSW:
  1. ​Submits a referral for the thirty (30) calendar day QRTP assessment by: 
    1. Completing the DPP-886A Application for Referral and Needs Assessment​ in TWIST, including only information which is necessary to provide adequate care and services to the child;1
    2. Ensuring the DPP-1275 Relative Exploration Form​ is updated in TWIST;
    3. Uploading all appropriate release of information forms; and2
    4. Submitting the referral packet via TWIST to CRP. 
  2. Identifies members of the youth’s FPT. This team shall consist of : 
    1. All appropriate family members; 
    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). 
  3. Convenes a family team meeting (FTM), including members of the youth’s FPT and the CRP QRTP assessor. This FTM will be utilized to provide input during the thirty (30) calendar day QRTP assessment process; 2 
  4. Receives from CRP the QRTP assessment, including recommendations, within thirty (30) calendar days of the date of QRTP placement; 
  5. Submits the QRTP Hearing Request Form​ to the court within five (5) working days of the child’s placement in a QRTP in order to: 
    1. Notify the court that the youth was placed in a QRTP; and 
    2. Request a court review to occur no later than sixty (60) calendar days from the youth entering the QRTP to advise the court of the QRTP assessment’s recommendations. 
  6. Provides the QRTP assessment recommendations to the court no later than thirty-five (35) calendar days from the date of placement; 3 4
  7. Ensures selection of the special population indicators in TWIST if any of the following are present: 
    1. Victim of labor trafficking; 
    2. Current or previous allegations of sex trafficking; 
    3. AWOL history; 
    4. Pregnant youth; and/or 
    5. Parenting youth (including fathers).
If placement in a QRTP is not recommended in the QRTP assessment, the SSW:
  1. Submits an updated DPP-886A and treatment recommendations to the recruitment and certification (R&C) team for a new placement search. If there are no DCBS homes available, the search will be sent to the CRP placement gatekeeper for further search; 5 
  2. Collaborates with the child’s placement and the identified relative, fictive kin, or foster placement to facilitate a transition of the youth within thirty (30) calendar days of the QRTP assessment; and 
  3. Notifies the court that the QRTP hearing is no longer needed.
​If QRTP placement is recommended in the QRTP assessment, the SSW:
  1. Provides a copy of the QRTP assessment report, including the QRTP assessment findings and abbreviated CANS assessment, to the QRTP provider as soon as possible; 
  2. Ensures that a court review is scheduled for judicial review of the QRTP assessment recommendations, including both short-term and long-term treatment goals. The court will make a determination regarding the youth’s placement or continued placement in the QRTP. 6  If the youth will be moved from the QRTP, SSW will follow the steps above regarding transition to a new placement; 
  3. Invites the FPT to an FTM during a time that is convenient to the family members. During this FTM, the team will update the case plan to include recommendations from the QRTP assessment no later than the periodic case plan review due date. ​8​  The following shall be documented on the case plan: 
    1. List of team members invited and whether they attended; 
    2. Updated copy of the DPP-1275 attached to case plan; 
    3. If the goal is return to parent, whether the parent(s) had input in the plan, and their feedback related to placement preference; and 
    4. Consideration to sibling relationships, (i.e., family treatment, visitation). 
  4. Ensures family engagement in the child's treatment from the time of placement unless the following exists: 10
    1. Parental rights have been terminated; or
    2. Participation would be contrary to the best interest of the child. 11
  5. Ensures facilitation of family therapy from the time of placement unless the following exists: 10
    1. ​Parental rights have been terminated; or
    2. Participation would be contrary to the best interest of the child. 11​
  6. ​Assesses the youth’s progress on their short-term and long-term goals recommended in the  QRTP assessment on a regular basis, including during monthly consultation with FSOS and regional out-of-home (OOHC) consultation; 
  7. 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 being met by the placement; 
    4. Length of time placement expected; 
    5. Documentation of agency efforts to prepare the youth for their next placement in a least restrictive setting, (i.e., foster family home, relative, or parents); and 
    6. Residential Treatment Placement Extension Request signed by the Division of Protection and Permanency (DPP)director,  if applicable. 
  8. Consults with the treatment provider prior to discharge in order to ensure appropriate aftercare planning. Aftercare planning shall include: 
    1. Referrals to new service providers; and 
    2. The plan for the QRTP’s monthly contact with the family and new service providers.12 
  9. Coordinates with the treatment team to convene an FTM with the FPT to discuss the youth’s discharge and treatment recommendations. The new placement provider should be included in the FTM. 13 14 16
If a youth is placed in residential treatment, the SSW:
  1. Submits justification utilizing the Residential Treatment Placement Extension Request to the Division of Protection and Permanency (DPP) director for every youth age thirteen (13) and older that is placed in a residential treatment program for twelve (12) consecutive months or eighteen (18) non-consecutive months; 15
  2. Submits justification utilizing the Residential Treatment 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) months. 15

For additional guidance, please see SOP 4.35 Reunification, Including Extended Visitation, Case Planning, and Transitional Supports to Families.​

Placement of Children Twelve and Under in Congregate Care

The SSW shall not refer a child twelve (12) or under for placement in a PCC residential treatment program except under special circumstances, and with the necessary approval. The SSW:

  1. ​Submits a special request to the SRA to request an exception if it is determined that a child aged twelve (12) or under is in need of PCC residential treatment. This request includes: 
    1. A brief explanation of child and family's current situation; and 
    2. A justification for residential treatment being the least restrictive setting that most closely meets the child's treatment needs. 
  2. Submits a special request through the SRA to the director of DPP to request an exception if it is determined that a child aged ten (10) or under needs PCC residential treatment. This request includes: 
    1. A brief explanation of child and family's current situation; and 
    2. A justification for residential treatment being the least restrictive setting that most closely meets the child's treatment needs. 
  3. Submits a special request through the SRA to the director of DPP to request an exception if it is determined that a child ages three (3) to six (6) needs PCC residential treatment. The request includes: 
    1. Documentation from the residential PCC facility staff that there is no less restrictive placement available to meet the child’s mental health, physical, or behavioral needs; and 
    2. Verification that the residential child-caring facility: 
      1. Is also licensed to provide emergency shelter services; 
      2. Provides adequate space for the child that is protected from children who are age ten (10) and older; 
      3. Provides sight and sound segregation of the child from children who are age ten (10) and older while the child engages in: 
        1. Sleeping; 
        2. Personal hygiene; and 
        3. Toiletry. 
    3. Provides staff supervision that supports the child’s individual treatment plan. 
  4. Places a hardcopy of the exception approval/denial in the case file and uploads the document into TWIST.

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 FPT from the time of the child's placement in the congregate care setting;
  2. Ensures discharge plan allows sufficient time for the youth to have a therapeutically- supported transition to the family setting. ​16 17


Contingencies and Clarifications

  1. A therapeutic LOC of three (3) is required for referral to and placement in residential treatment. The therapeutic level alone is not sufficient to determine whether residential treatment is the least restrictive intervention to meet the child’s unique needs.
  2. FFPSA identifies the following specialized populations: 
    1. The youth is pregnant or parenting (including fathers); 
    2. The youth is placed in a supervised independent living program and is over the age of eighteen (18); 
    3. The youth has had previous allegations involving sex trafficking (regardless of confirmation/outcome); 
    4. The youth has had a history of absence from care or runaway behaviors; and 
    5. The youth has current or previous Department for Juvenile Justice (DJJ) commitment. 
  3. FFPSA designates specialized residential treatment settings providing tailored services to meet the unique needs of children belonging to a special population as identified by the Act. 
  4. QRTP assessments are required for all children being referred for or placed in residential treatment settings with the following exception: 
    1. Children in a specialized population placed in a corresponding specialized treatment program as an emergency after hours placement and without a referral through CRP. 14
    2. If a child is identified as belonging to a specialized population and is placed in a corresponding specialized treatment program, a court review is not required; 
    3. Whether or not the youth falls into a special population category, it is imperative that the youth be placed in the least restrictive setting most appropriate to meet their clinical treatment needs;16
    4. If placement in residential treatment is necessary, all efforts should be made to secure a program based on the treatment needs of the youth. 
    5. Prior to PCC facilities accepting a medically complex youth, they are required to submit a written plan addressing how they will meet the medical needs of the youth. This plan is submitted to the medically complex liaison, who forwards it to the Medical Support Section. A copy is also placed in the child’s case file.

Footnotes

  1. Please see SOP 13.10 Preparing the Presentation Summary Packet and SOP 13.30 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. SSW will ensure that the appropriate parties sign the assessor’s releases of information. 
  3. If the QRTP assessment does not recommend placement in a QRTP for the youth, a court review is not required.
  4. Neither the supplemental abbreviated CANS assessment nor the final section of the QRTP assessment report entitled “QRTP Assessment Findings” are submitted to the court as part of the QRTP Assessment and Recommendations. It is a violation of HIPAA to share the QRTP assessment findings and abbreviated CANS assessment with the court. The findings and CANS assessment are intended to inform case and treatment planning for the youth. If the judge wants a copy of this documentation, it is best practice that they write an order to CRP requesting a copy. 
  5. Placement within close proximity to the youth’s school, community, and within the county they have resided with their family is preferable to promote attachment and positive outcomes in treatment. 
  6. The order related to the QRTP determination must be signed and dated by the judge on the AOC DNA 16 within sixty (60) calendar days of QRTP placement. The SSW should document the court review in TWIST by entering within ten (10) calendar days of the sixty (60) calendar day hearing, the judicial decision in the OOHC QRTP/CRP screens, and uploading documentation of the courts’ determination, dated and signed by the judge, upon receipt. ​
  7. If the judge’s determination is contradictory with the recommendations of the QRTP assessment, staff may consult with regional management and central office for further guidance. 
  8. TWIST will provide data surrounding the short-term and long-term recommendations upon the completion of the QRTP assessment. It is best practice to hold an FTM as soon as possible to modify the case plan to reflect these recommendations. 
  9. SSW will document parental input and preferences regarding the placement in the case plan under the appropriateness of the placement section of the child/youth action plan. If a child’s QRTP assessment outcome is different than the wishes of the FPT, the case plan must also outline why the assessment does not recommend those preferences. 
  10. Family is used expansively to include the child’s natural supports, relatives, caregivers, foster family, etc. 
  11. If family engagement and/or family therapy is therapeutically contraindicated, the SSW ensures written documentation of therapeutic recommendation is included in the child’s case file. Recommendations should be time-limited and re-evaluated as a part of the child’s treatment planning ongoing. 
  12. QRTP providers are required to provide monthly aftercare support upon the youth’s discharge to a lower LOC, which will include documentation in TWIST. This may be phone contact if distance is a barrier. SSW may need to assist with releases of information between the PCC agency and a new provider to ensure continuity of care. 
  13. If placement in a residential treatment program is being considered, SSW should include the CRP QRTP assessor in any FTM scheduled to discuss a youth’s discharge and treatment recommendations. 
  14. If a child transitions from one QRTP to another, a new QRTP assessment and sixty (60) calendar day court review are required. 
  15. Review of long-term residential treatment placement is not specific to each placement, meaning that the time spans across placements in residential treatment during a removal episode. 
  16. ​If SSW is aware that residential treatment is being considered for a child, SSW may initiate the QRTP assessment process and provide a copy of the DPP-1275​ as soon they begin to plan for the child’s next steps, but no later than the time of placement. When possible, the QRTP assessment should be completed prior to placement in a residential treatment program. The SSW may advocate with the child’s discharging placement to negotiate an extended notice in order to allow time for the QRTP assessment to be completed prior to the child’s transition.​​​​​
  17. Transition from a structured, intensive treatment modality (residential treatment) to a family-based setting for children and youth. Gradual transitions supported by family therapy allow the child and family to establish expectations and problem-solve anticipated struggles and challenges. 







Revisions

​7/20/2022

  • Addition of #4 and #5 under If QRTP placement is recommended in the QRTP assessment, the SSW:​

  • Addition of Discharge Planning for Youth Placed in Congregate Care.

  • Addition of #1 under Contingencies and Clarifications.  

  • Deletion of  If the SSW has not initiated the QRTP assessment prior to a youth’s placement in a QRTP, TWIST will automatically initiate a QRTP assessment with CRP at the time of placement. in footnote # 1

  • Addition of footnotes #4, #10, #11 , and # 17

1/18/2023 
  • Effective 1/20/23 if a youth is being considered or referred for residential treatment, or if the youth is placed in a residential program, the SSW will submit the referral (and all accompanying documents) for the 30-calendar day QRTP assessment in TWIST.  The request will no longer be emailed to the Children’s Review Program (CRP).  ​​​