Qualified Residential Treatment Programs

 

DEPARTMENT OF CHILDREN AND FAMILIES

Family Safety and Preservation Program

RULE NO.:RULE TITLE:

65C-28.021Qualified Residential Treatment Programs

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 46 No. 249, December 24, 2020 issue of the Florida Administrative Register.

65C-28.021 Qualified Residential Treatment Programs

(1)  No change.

(2) The community-based care lead agency shall maintain documentation of a child's placement in a QRTP and is responsible for ensuring that each child receives a “suitability qualifying assessment” prior to no later than 30 calendar days after placement in the QRTP. The community-based care may request an assessment prior to the child being placed in the QRTP. 

(3) A “suitability qualifying assessment” includes the development of short term and long term mental and behavioral health goals and 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-XXX, by a qualified evaluator (QE) individual (QI) to make a determination of placement in a QRTP setting concerning a child who has a serious emotional or behavioral disorder or disturbance. 

(4) The suitability qualifying assessment must be conducted by a QE QI who meets the following requirements:

(a) Is a psychiatrist or psychologist pursuant to s. 39.407(6), F.S. licensed clinician or a master’s level practitioner under supervision of a licensed clinician;

(b) Has at least 2 3 years' experience working with children or adolescents involved in the child welfare system of care;

(c) through (d) No change.

(5)  The QE QI must conduct a review of prior treatment records and speak 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 worker, treating clinical professional, child’s attorney, and the permanency team.

(a) No change.

(b) The QE QI shall consider the recommendation of the child’s treating clinical professional when conducting the assessment.

(6)  The QE QI must conduct an interview with the child.

(a) While face to face contact is the preferred method for contact with the child, the QE may utilize telehealth while abiding by the Agency for Health Care Administration (AHCA) telehealth guidelines when using a Medicaid service. Interviews may be completed via video conferencing if the child is outside a 50-mile radius from the location of the QI or in the event of a declared emergency.

(b) When a child refuses to participate in the interview, the QE QI shall make good faith efforts to engage the child. Good faith efforts are defined as documented efforts that demonstrate the QE QI 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 with the QE QI that could aide or assist in obtaining information to determine whether the child meets the criteria for needing placement in a qualified residential treatment program center, even if those efforts were not fully successful.  Marginal or token efforts to communicate with the child are not sufficient to constitute good faith efforts.

(7) The QE QI shall recommend one of the following placement options:

(a) through (b) No change.

(c) Placement in a statewide inpatient psychiatric program Referral for an assessment. 

(8) The QI may only recommend placement in a residential treatment center if he or she meets the qualifications of a pursuant to Section 39.407, F.S.

(8)(9) If the QE QI was not provided with all components of the clinical record prior to the assessment or the child has experienced a decompensation in mental or behavioral health functioning since the assessment, the assigned child welfare professional may request a reconsideration.

(9)(10) If the QE QI determines the child does not meet criteria for placement in a QRTP, the child’s multidisciplinary team shall offer to assist in developing a plan for necessary treatment and support services for the child in the community.

(10)(11) When the suitability qualifying assessment does not recommend placement in a QRTP, the child welfare professional must make arrangements to have the child moved from the program within 30 calendar days of the recommendation.

(11)(12) Within 60 calendar days after initial placement in a QRTP, the Department shall request the court to approve or disapprove the placement and to consider the suitability qualified residential treatment assessment, determination, and documentation made by the qualified evaluator individual. If the court orders the child to be placed in a QRTP after the QE QI does not recommend placement, the assigned child welfare professional shall request the QE consider doing a new assessment.

(12)(13) If placement in the QRTP is approved by the initial 60-day court review, the QE QI must conduct an independent suitability qualifying assessment review at least every 90 days after the child’s initial placement so long as the child remains placed in a qualified residential treatment program. It is the child welfare professional’s responsibility to request a 90-day review from the QE QI.

(13)(14) No change.

(14)(15) A copy of the suitability qualifying assessment must be provided to the Department, community-based care agency or case management agency, the guardian ad litem, parents, child’s attorney, and the court having jurisdiction over the child, all of whom must be provided with the opportunity to discuss the findings with the evaluator.  

(a) The initial suitability qualifying assessment shall include, at minimum, the outcome of the face to face interview with the child, review of prior treatment records, contact with relevant parties, whether or not the QE recommends recommendation for placement in a QRTP, and attachment of the Department-approved evidenced-based functional assessment tool.

(b) The 90-day independent qualifying assessment review may be an addendum to the initial assessment and shall include, at minimum, the outcome of a new face to face interview with the child, review of new treatment records, attachment of the Department-approved evidenced-based functional assessment tool, documentation of any psychosocial changes, and whether or not the QE recommends recommendation for continued placement in a QRTP. 

(15)(16) 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 6 consecutive or non-consecutive months, without approval of the Department’s Regional Managing Director (RMD) or DCF designee. Requests for approval shall be made using the Qualified Residential Treatment Program (QRTP) Extended Placement Request Form, CF-FSP 5450, date, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXX.  The RMD or DCF designee shall consider the recommendations of the multidisciplinary team staffing conducted within the last 90 60 calendar days and the most recent suitability qualifying assessment recommendation recommending in making a decision whether to approve the continued placement. The RMD or DCF designee shall consult with a Department of Substance Abuse and Mental Health (SAMH) clinical professional regarding their decision to approve.  A copy of the signed approval shall be attached to the child’s case plan. The RMD or Department designee shall provide a determination within seven (7) business days from receipt of the request from the CBC.   

(16)(17) Discharge and Aftercare Support

(a) Discharge planning and aftercare support shall be developed to meet the needs of the child with intent for the child to reside in the most appropriate, least restrictive setting. Planning shall include input from the child, child’s parent or guardian, caregiver, the child’s case management team, child’s attorney, and guardian ad litem.

(b) Aftercare support must be offered to all children who were placed and have a suitability qualifying assessment and court order recommending placement in a QRTP setting. Aftercare support is not required for youth who discharge to another QRTP setting or higher level of care such as a to include Statewide In-Patient Psychiatric Program (SIPP) or Specialized Therapeutic Group Home (STGH).  

(c) No change.

(d) When a child is discharged to a placement setting outside a 50-mile radius of the provider, the lead community-based care agency shall resume responsibilities of the aftercare support services offered to the child once coordinated by the child-caring agency.

(d)(e) Written aftercare progress reports provided to the child welfare professional by the QRTP child-caring agency shall be uploaded into the state’s official system of record and the child welfare professional shall notify the court of the child’s progress during a judicial review. 

(17)(18) A child who elopes or is admitted to a higher level of care for crisis services, such as a Baker Act, Acted from a QRTP may be readmitted into the same or newly identified QRTP without an additional assessment so long as the child was not discharged from the QRTP returns within seven (7) calendar days from the date of the occurrence.

(18)(19) No change.