Residential treatment shall only be considered if it best meets the child’s clinical needs.

The following placement settings are considered residential treatment settings.  These settings require review by the Residential Care Screening Team (RCST) Coordinator and an Independent Assessor as described further below:

• Residential treatment (levels II, III, and IV) (as licensed in 13 CSR 35-71)
• Qualified Residential Treatment Programs (QRTP) (residential treatment agencies at levels II, III, and IV who have a QRTP Designation issued by Children’s Division).
• Psychiatric Residential Treatment Facilities (PRTF)

The following placement settings are not considered residential treatment.  These settings require review by the Residential Care Screening Team (RCST) but do not require review by the Independent Assessor*:

• Emergency shelters (temporary placements not to exceed 30 calendar days**, as licensed in 13 CSR 35-71)
• Maternity homes for pregnant or parenting youth (as licensed in 13 CSR 35-71)
• Transitional living placements (transitional living group home (TLG), scattered site apartments)
• Department of Mental Health (DHM) Division of Developmental Disability (DDD) licensed or certified placements

*If a child’s behaviors or presenting conditions may necessitate residential treatment, even though a youth may require an emergency placement immediately, the process for an Independent Assessor shall be followed.

**Emergency shelters are temporary placements, and shall not be used for placement after 30 calendar days, unless authorized as explained here.  In the event that another placement is not available after 30 calendar days, approval for any additional days, not to exceed an additional 30 calendar days, shall be made by the RCST Coordinator in writing, if determined necessary by the RCST Coordinator and Residential Service Manager.  The Case Manager shall be responsible for submitting written requests for approval for an extended emergency placement past 30 calendar days. Extension requests shall document all efforts made by the Division to locate appropriate placement for the child. The Case Manager shall continue to actively seek alternative placements regardless of a request for, or approval of, an extended emergency placement.

A referral to the RCST Coordinator for possible residential treatment may be triggered by the following events:

1. The child has recently entered or re-entered CD custody and is currently placed in residential treatment;
2. A court has ordered residential treatment or an independent assessment for residential treatment;
3. A Youth with Elevated Needs Staffing (YWEN) Team has recommended residential treatment (information regarding YWEN can be found in Section 4, Chapter 4, Subsection 5);
4. A Team Decision Making (TDM) meeting or Placement Stability Family Support Team meeting has recommended residential treatment;
5. An emergency exists where the case manager and supervisor have staffed the child’s case, and the child was placed in emergency placement, either a shelter or residential facility; or
6. A qualified clinician such as a primary care physician or psychologist has recommended residential treatment, or the child is being discharged from a hospital setting with a qualified clinician’s recommendation for residential treatment.

Note: In the event that the court orders residential treatment of a child prior to the completion of the Independent Assessment process, outlined below, a copy of the court order shall be sent to the RCST Coordinator immediately upon receipt of such an order for possible Division of Legal Services (DLS) action.  The RCST Coordinator shall refer the matter to DLS in the event that the independent assessment review process outlined in this policy was not followed.  In the event that the court orders residential treatment using a name of a specific facility, the same process of notification to the RCST Coordinator and DLS shall be followed.

Starting the Residential Referral Process

If one of the six triggering events occurs, the case manager and supervisor shall complete the following steps within three (3) calendar days of the decision to refer the child to a residential setting or within three (3) calendar days upon receipt of legal custody of a child already placed in a residential setting:

1. The case manager for the child shall complete the Residential and Specialized Placement Referral (CS-9) Section A.
2. In the event of a need for emergency residential placement, the CS-9 Section A, shall be completed and submitted to the RCST within three (3) calendar days of placement.  
3. The CS-9, including all attachments shall be submitted for supervisory review.
4. The supervisor shall review and if complete, shall approve the referral.
5. The supervisor shall submit the CS-9 and the applicable attachments to the RCST Coordinator for the region. The Case Manager shall also be included on the communication.
6. Upon submission of the CS-9 to the RCST, the Case Manager shall utilize the Residential Referral Tracking Sheet (CD-303) to monitor the referral.

Note: Failure to include all documents for the CS-9 may cause a delay in the screening process.  Case Managers shall include any specialized information as my required on the form, including Maternity and Parenting care (Section B) and Infant and Toddler Care (Section C).

The Childhood Severity of Psychiatric Illness scale (CSPI) is a required component of the CS-9.  The CSPI is an assessment tool developed to assist in the planning of appropriate services and is required to accompany the CS-9 for children age six (6) years and older.

The CSPI also serves as the eligibility determination process for child enrolled in the Medicaid Rehabilitation Option.  This program allows Children’s Division to access federal funding to purchase rehabilitative services to meet identified mental health service needs of children.

Note: Emergency residential shelter placement is a short-term resource for children requiring an immediate, temporary living arrangement in an open facility where their safety and supervision is ensured through an organized program of appropriate activities. For children entering an emergency residential placement, the CS-9 Section A shall be completed and submitted to the RCST within three (3) calendar days of placement.  

Reviewing the Referral

Upon submission of the Residential and Specialized Placement Referral (CS-9) to the RCST Coordinator, the RCST Coordinator shall:

1. Screen the CS-9 and the attachments for appropriateness for residential treatment.
2. Contact the case manager requesting additional information or clarification, as necessary.
3. If the placement setting requires review by an Independent Assessor:

Forward the approved referral to the assigned Independent Assessor within three (3) calendar days of receipt of the completed CS-9.

4. If the placement setting does not require review by an Independent Assessor, the RCST Coordinator shall determine and secure the most appropriate placement setting.

• The child’s special needs shall take priority over placement to the parent(s) or guardian(s).
• The case manager shall be available to answer questions from the potential facilities.
• The RCST Coordinator will confirm the child’s admission with the case manager once placement has been identified and secured.

Note: If Above Level IV services and/or programming are recommended, the residential treatment facility shall send a request and certification for Above Level IV services and programming to the RCST Coordinator. The request shall include supporting documentation of the specific behaviors exhibited by the child and/or the specific treatment needs that require the Above Level IV services and/or programming; to include an explanation of the extra supervision and services that are requested based on the specific needs of the child. If the RCST Coordinator approves the request, the RCST Coordinator will forward the request to the Central Office for final approval. In the event there is a disagreement in the services requested by the placement and the Division’s determination, the determination of the Children’s Division shall govern.

Independent Assessor’s Review

Upon receipt of the CS-9 and supporting documentation from the RCST Coordinator, the Independent Assessor shall:

1. Send the RCST a written response acknowledging receipt of the referral within three (3) calendar says of receipt of the referral.
2. Work in conjunction with the family of, and FST for, the child while conducting and making the assessment.
3. Complete the assessment within thirty (30) calendar days of the referral.

Send the completed assessment to the RCST Coordinator, Circuit Manager, Supervisor, and Case Manager using a secure mode of transmittal.

The purpose of the Independent Assessment will be to assess the strengths and needs of the child using an age-appropriate, evidence-based, validated, functional assessment tool.  The assessment will be in writing, and will determine whether the needs of the child can be met with family members or through placement in a foster family home or, if not, which setting would provide the most effective and appropriate level of care for the child in the least restrictive environment and be consistent with the short- and long-term goals for the child, as specified in the permanency plan for the child.

If the Independent Assessor determines the child should not be placed in a foster family home, he/she must specify in writing:

1. The reasons why the child’s needs can’t be met by the family or in a foster family home (a shortage of foster family homes is not an acceptable reason for determining the child’s needs cannot be met in a foster family home); and
2. Why the recommended placement in a residential treatment setting is the setting that will provide the child with the most effective and appropriate level of care in the least restrictive environment; and
3. How the setting is consistent with the short- and long-term goals for the child, as specified in the permanency plan for the child.

Note: The assessment shall be in person or by telehealth using video communication. Transportation to the assessment is the responsibility of the foster parent, case manager, or residential provider.

For a full listing of Independent Assessor responsibilities see Section 4, Chapter 2, Subsection 10, Independent Assessor Responsibilities.

Review and Dissemination of the Independent Assessor Report

Immediate upon receipt of the report, the Case Manager shall:

1. Distribute the Independent Assessor’s report to the parties to the juvenile proceeding, the members of the family support team and the court. Redactions may be necessary to protect information that is confidential as a matter of law, or may be harmful to the best interests, safety, and welfare of the child.
2. Ask the court to assess the appropriateness for the child to be placed or remain in a residential treatment setting as described below. The Case Manager may need the assistance of DLS (such as preparing a motion) in order to trigger action by the court.
3. In the event that after 15 calendar days after being sent the report, the court has not made a written finding to approve or disapprove the recommendations of the Independent Assessor’s report, the Case Manager shall complete a referral to DLS, attaching the Independent Assessor’s report.

When conducting an assessment of appropriateness for the child to be placed or remain in a residential treatment setting, the Division shall ask the court to make specific written findings of fact and:

1. Consider the assessment, determination, and documentation made by the qualified individual conducting the assessment;
2. Determine whether the needs of the child can be met through placement in a foster home or, if not, whether placement of the child in a residential treatment setting provides the most effective and appropriate level of care for the child, in the least restrictive environment;
3. Determine whether that placement is consistent with the short-term and long term goals for the child, as specified in the permanency plan for the child; and
4. Approve or disapprove the placement setting recommended by the Independent Assessor’s report. Such approval or disapproval must be documented in the case plan, and uploaded to OnBase.

In the event the court disapproves the placement, the Division shall seek placement in another setting, consistent with the findings of the Independent Assessor’s report.

Note: This written finding shall be made within 60 days of the child’s placement in the residential treatment setting.  It is important to immediately start this process so that the timeline is met.  A failure to follow this requirement may result in the Division’s inability to claim certain funds in accordance with the Family First Prevention Services Act (FFPSA) (Public Law 115-123).

Continued Review of the Placement

As long as a child remains placed in a residential treatment setting, the Children’s Division or contracted agency shall submit evidence at each review and each permanency hearing held for the child.  Evidence shall include:

1. Demonstrating that ongoing assessment of the strengths and needs of the child continues to support the determination that the needs of the child cannot be met through placement in a foster family home, that the placement in a residential setting provides the most effective and appropriate level of care for the child in the least restrictive environment and that the placement is consistent with the short- and long-term goals for the child, as specified in the Social Service Plan;
2. Documenting the specific treatment or service needs that will be met for the child in the placement and length of time the child is expected to need the treatment or services; and
3. Documenting the efforts made by the agency to prepare the child to return home or to be placed with a fit and willing relative, a legal guardian, or an adoptive parent, or in a foster family home.

The Division shall ask the court at each review and each permanency hearing held to:

1. Consider the assessment, determination, and documentation made by the qualified individual conducting the assessment;
2. Determine whether placement of the child in a residential treatment setting continues to provide the most effective and appropriate level of care for the child, in the least restrictive environment;
3. Determine whether that placement is consistent with the short-term and long term goals for the child, as specified in the permanency plan for the child; and
4. Approve or disapprove the placement setting recommended by the Independent Assessor’s report. Such approval or disapproval must be documented in the case plan and uploaded to OnBase.

In the event the court disapproves the placement, the Division shall seek placement in another setting, consistent with the findings of the Independent Assessor’s report.

Note: DLS may provide support to the Division to accomplish these requirements.

New Placement Actions for All Residential Settings

As part of the residential placement process, the case manager shall proceed with placement by:

1. Completing the residential admission packet and returning the information prior to admission;
2. Arrange for adequate transportation of the child;
3. Prepare the child and parent(s)/guardian(s) for placement, providing information about the facility, location, special programs, and visitation/contact arrangements, etc.;
4. Inviting the parent(s)/guardian(s) to participate in the child’s admission process, if appropriate as determined by the case manager;
5. Arriving at the placement with the child and participating in the intake process.
6. Entering the child’s new placement information into FACES within 24 hours of placement.
7. Entering a “Rehabilitation Service Begin Date” or an updated date on the Rehabilitation Services Tracking screen in FACES.  The Rehabilitation Service Begin Date must be the date the CSPI was completed or the date of placement, but may not be backdated to the date of placement unless the CSPI was completed on or before the placement date.

Move and Discharge Requirements for All Residential Settings

The residential facility shall begin planning the child’s discharge immediately upon entry into the residential facility.

The residential facility shall make every effort to reduce or eliminate the number of unplanned discharges, emergency discharges, and moves to more restrictive settings for children placed in residential settings.

If a child is being discharged on an unplanned/emergency basis or as the result of a 30-day notice for removal to another residential facility, the case manager shall follow the CS-9 referral process listed above.

New Placement to Another Residential Treatment Setting

If the child moves from a residential treatment placement to another residential treatment placement, the following steps shall be taken:

1. The case manager shall begin the Starting the Residential Referral Process again, as outlined in this policy.
2. A subsequent Independent Assessment shall be completed as outlined in the Independent Assessor’s Review section in the policy.
3. All timeframes listed previously in this policy shall be followed.
4. The case manager shall utilize the Residential Referral Tracking Sheet (CD-303).
5. A transfer conference shall be held between the current provider and the next provider when a child moves from one residential treatment placement to another. The purpose of this conference is to share information about the child to aid in his/her transition to the next placement. This conference shall be arranged by the case manager and/or supervisor, with the current and subsequent placement provider, as well as the child (if developmentally appropriate). The RCST Coordinator may also attend the transfer conference, as necessary. The conference can be completed face-to-face or via conference call within the timeframes specified below:
   • For a planned discharge, a transfer conference shall be held prior to a child’s move, but not to exceed the first five (5) calendar days of a child’s placement move. 
   • For an emergency discharge, a transfer conference shall occur during the Placement Stability Family Support Team Meeting (FSTM) within 72 hour hours of placement, or separately from the FSTM within the first five (5) calendar days of the placement change.
6. Transfer meeting notes shall be documented in the contact communication log in FACES.

Support from the Division of Legal Services

DLS can assist with any motions or hearings as may be required by the court in order for a ruling by the court regarding the approval or disapproval of the Independent Assessor’s report within the timeframes of this policy.