If a contracted provider initiates a placement change, the provider must complete Form 2109 Residential Child Care Discharge [sic, broken link] Within this form, the provider must give all of the following information:

• The provider’s reason for requesting the discharge.
• The provider’s efforts to prevent placement disruption.
• The provider’s recommendations for the future placement of the child or youth, which may include information about his or her triggers, type of placement required, level of supervision, or special services.

Contractually, the provider must submit this form before the placement change except in an emergency situation. If the placement change is an emergency, the provider must submit the form within 48 hours after the notice of emergency discharge.

The contractor must send the form to the child’s or youth’s caseworker, the CPS supervisor, and the Regional Placement Team for the child’s or youth’s legal region.

The caseworker must then forward a copy of the form to the child’s or youth’s CASA, attorney ad litem, guardian ad litem, and local permanency specialist.

See 4111 Identify the Need for Initial or Subsequent Placement.

While the Residential Child Care Discharge Form is not required for non-contracted providers, the caseworker must still discuss the topics in the form with the current caregiver. The caseworker must document this discussion in IMPACT.