65C-28.021. Qualified Residential Treatment Programs

This rule applies to qualified residential treatment programs (QRTP). A QRTP is a licensed child-caring agency that provides care for youth who have serious emotional or behavioral disorders or disturbances.  

(1) Placement of a child in a qualified residential treatment program (QRTP) is for the specific purpose of addressing the child’s emotional and behavioral health needs through observation, diagnosis, and treatment in a treatment setting. QRTPs must not be used for emergency placements or to provide secure shelter for the child. If the child is in acute psychiatric crisis, the child must be referred to a crisis stabilization unit for emergency screening and stabilization in accordance with Sections 394.463 and 394.467, F.S.

(2) The community-based care (CBC) lead agency must maintain documentation of a child's placement in a QRTP and is responsible for ensuring that each child receives as assessment prior to placement in the QRTP.

(3) For placement in a behavioral qualified residential treatment program (BQRTP) licensed pursuant to Rule 65C-46.0211, F.A.C. the assessment must be completed by the Qualified Individual (QI). A Qualified Individual is the child’s treating licensed clinical professional, a Qualified Evaluator outlined in s. 39.407(6), F.S., or a Comprehensive Behavioral Health Assessor who meets the qualifications as required in the Agency for Health Care Administration, “Specialized Therapeutic Services Coverage and Limitations Handbook,” March 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16546.  

(a) A child may be placed in a BQRTP based on the preliminary assessment recommendation from a QI. However, the final assessment by QI must be completed within 30 calendar days to continue placement in the setting.

(b) A preliminary assessment must include the following components:

1. A face-to-face attempt with the child,

2. Review of the Comprehensive Placement Assessment completed during the placement multidisciplinary team staffing pursuant to Rule 65C-30.023, F.A.C., and

3. The reasons that support the preliminary recommendation for placement.

(c) The final assessment must include the components set forth in paragraph (5).

(4) For placements in a QRTP credentialed pursuant to Rule 65C-46.021, F.A.C., the assessment must be completed by a Qualified Evaluator (QE) pursuant to s. 39.407(6), F.S. The assessment must include the components set forth in paragraph (5).

(5) Each placement assessment must include the following components:

(a) Short term and long term mental and behavioral health goals:

(b) The use of the Child and Adolescent Needs and Strengths (CANS) Trauma Comprehension assessment tool, March 2013, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13092. 

(c) A review of prior treatment records and consultation with relevant parties in the child’s life, including, but not limited to, the guardian ad litem, case manager, current caregiver, the child’s family, Department of Juvenile Justice staff, treating clinical professional, and the child’s attorney;

(d) The recommendation of the child’s treating clinical professional; and

(e) An interview with the child.

1. While face to face contact is the preferred method for contact with the child, telehealth may be utilized.

2. If the child refuses to participate in the interview, the assessment must include good faith efforts to engage the child. Good faith efforts are defined as documented efforts that demonstrate the assessor took all steps in light of the child’s age, intelligence, emotional development and stability, and demeanor to enable the child to participate in a conversation to determine whether the child needs QRTP placement.

(6) For a child placed in a BQRTP, if the QI’s final assessment does not recommend continued placement, the child welfare professional must request a reconsideration in the event the child has experienced a decompensation in mental, emotional, or behavioral health functioning.

(7) If the reconsideration by the QI does not result in a recommendation to continue placement in a BQRTP, the child welfare professional must:

(a) Make arrangements to have the child moved from the program within 30 calendar days of the recommendation.

(b) Request a multidisciplinary team staffing pursuant to s. 39.4022. F.S., to determine placement.

(8) If the QE assessor does not recommend initial QRTP placement, the child welfare professional must request a reconsideration in the event the child has experienced a decompensation in mental, emotional, or behavioral health functioning.

(9) When the assessor recommends placement in a QRTP, within 60 calendar days after initial placement, the Department must request the court to approve or disapprove the placement based on the assessment, determination, and documentation made by the assessor. If placement in the QRTP is approved by the court the child welfare professional must request the following if the child remains placed in a QRTP:

(a) A court review every 90 days after the initial 60 day-review, and

(b) An independent assessment which must be completed prior to each 90-day review by the court.

(10) If the assessor does not recommend initial or continued placement in a QRTP, but the court orders the child to be placed in a QRTP, the child welfare professional must request a reconsideration.

(11) If at any time the court denies the motion to place the child into a QRTP or orders the placement of the child into a less restrictive setting during a review hearing, the child welfare professional will follow local protocol to coordinate the referral and placement of the child into the least restrictive setting that is best suited to meet the child’s needs. If the child is already in a QRTP, the child welfare professional must make arrangements to have the child moved from the QRTP within 30 calendar days of the determination.

(12) Upon immediate placement of a child in a QRTP, a copy of the assessment must be provided to all parties pursuant to s. 39.407(6)(d) F.S.

(13) A child may not be placed in a QRTP for more than 12 consecutive months or 18 nonconsecutive months, or in the case of a child who has not attained age 13, for more than six consecutive or non-consecutive months, without approval of the Department. Requests for approval must be made using the Qualified Residential Treatment Program (QRTP) Extended Placement Request Form, CF-FSP 5450, Apr 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13075. The Department must consider the recommendations of the multidisciplinary team staffing conducted within the last 90 calendar days and the most recent assessment recommendation in deciding whether to approve the continued placement. A copy of the signed approval must be attached to the child’s case plan. The Department must provide a determination within seven business days from receipt of the request from the CBC.

(14) Discharge and Aftercare Support.

(a) The child welfare professional must participate in discharge planning and aftercare support to meet the needs of the child with intent for the child to reside in the most appropriate, least restrictive setting. Planning must include input from the child, child’s parent or guardian, caregiver, child’s attorney, and guardian ad litem.

(b) Aftercare support must be provided for a minimum of six months post discharge. Aftercare support is not required for youth who discharge to another QRTP setting or higher level of care such as a residential treatment program, also known as Statewide In-Patient Psychiatric Program (SIPP), or therapeutic group home which are defined in s. 39.407(6), F.S.

1. The BQRTP must provide after care support to all children discharged if placed within a 50-mile radius of the BQRTP. The child-welfare professional is responsible for aftercare support when a youth is discharged to a placement setting outside a 50-mile radius of the BQRTP.

2. All youth discharged from a QRTP credentialed pursuant to Rule 65C-46.021, F.A.C., will receive after care support from the QRTP credentialed provider.

(c) The child welfare professional must ensure written aftercare progress reports provided by the QRTP are uploaded into the state’s official system of record and the child welfare professional must notify the court of the child’s progress during a judicial review.

(15) A child who elopes or is admitted to a higher level of care for crisis services, such as a Baker Act, from a QRTP may be readmitted into the same or newly identified QRTP without an additional assessment as long as the child was not discharged from the QRTP.

(16) If a child transfers from one QRTP to another without a lapse in placement, a new assessment is not required. The CBC must coordinate a multidisciplinary staffing with both QRTP providers to complete a transition plan pursuant to s. 39.4023, F.S.

Rulemaking Authority 39.0121, 409.175(5), FS. Law Implemented 39.407, 409.175, FS. History‒New 5-23-21, Amended 4-15-24.