The purpose of the proposed amendments is to remove language made obsolete by the promulgation of Chapter 65E-9, F.A.C., Licensure of Residential Treatment Centers and to update guidelines for residential placement of uninsured children and youth by ...

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Mental Health Program

RULE NO.: RULE TITLE:
65E-10.013: Applicability
65E-10.014: Definitions
65E-10.016: Licensing Requirements
65E-10.018: Client Eligibility for Placement in Residential Treatment Programs
65E-10.019: Cost Sharing
65E-10.021: Standards for Residential Treatment Programs Serving Emotionally Disturbed Children and Adolescents
PURPOSE AND EFFECT: The purpose of the proposed amendments is to remove language made obsolete by the promulgation of Chapter 65E-9, F.A.C., Licensure of Residential Treatment Centers and to update guidelines for residential placement of uninsured children and youth by the Department of Children and Families with general revenue funds.
SUMMARY: This chapter establishes standards for providing treatment services to children with emotional disturbance in residential programs that are solely funded by the Department of Children and Families.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein:
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
RULEMAKING AUTHORITY: 394.4781(3) FS.
LAW IMPLEMENTED: 394.4781(3) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Kimberley E. Brown, Department of Children and Families, Mental Health Program, 1317 Winewood Blvd., Building 6, Room 296, Tallahassee, Florida 32399

THE FULL TEXT OF THE PROPOSED RULE IS:

65E-10.013 Applicability.

(1) These rules shall apply to the placement of children in residential treatment programs funded by Department of Children and Families to provide treatment services to children who have an emotional disturbance.

(2) No change.

Rulemaking Specific Authority 394.4781(3) FS. Law Implemented 394.4781(3), (4) FS. History–New 3-1-84, Formerly 10E-10.13, Amended 4-8-96, 8-12-96, Formerly 10E-10.013, Amended________.

 

65E-10.014 Definitions.

When used in Rules 65E-10.013 through 65E-10.018, F.A.C., 65E-10.021, F.A.C., unless otherwise clearly written in the text:

(1) “Child and family specific team” means a defined group of people that includes the child and his/her family, a behavioral health representative from the Department of Children and Families or their designee, and any individuals important in the child’s life who are identified and invited to participate by the child and family. “Clinical director” means a person with a master’s degree and two years of “specialty” experience in a clinical capacity with severely emotionally disturbed children.

(2) “Continuum of care” means alcohol, drug abuse and mental health services ranging from the least restrictive prevention services to the most restrictive residential programs. The continuum is prevention-oriented in that it promotes early problem identification and intervention to reduce the need for more restrictive, intrusive, longer term treatment programs. The following services comprise the continuum of care.

(a) Prevention services;

(b) Diagnostic and evaluation services;

(c) Outpatient services;

(d) Day treatment services;

(e) Crisis counseling services;

(f) Residential programs; and,

(g) Treatment or receiving facilities.

(3) “Hazardous procedure” means aversive conditioning, any activity that places the client at physical risk or pain, or any experimental treatment methodology.

(2)(4) “Child” means any person under the age of 18.

(3)(8) Psychiatrist” means a medical practitioner licensed under Chapter 458, F.S. as defined in Section 394.455(2)(b), F.S. This person shall have experience in treating emotionally disturbed children and adolescents.

(4) “Psychologist” means a mental health service provider as defined in Section 490.003(7), F.S., licensed to practice in Florida with experience in working with children and adolescents.

(5) “Nurse” means a person licensed as a registered nurse or practical nurse and two years’ experience, of which one must be general nursing experience and the other in a specialty area working with children and adolescents.

(6) “Nursing assessment” means a general assessment conducted by a registered nurse in accordance with provisions of Section 464.003(3)(a)1. of the Nurse Practice Act. It does not serve as the physical examination required by Section 394.459(2)(c), F.S.

(5)(9) “Residential treatment program” means any program providing 24 hour live-in care and therapeutic services and includes the following:

(a) “Wilderness therapeutic service” means programs that use wilderness environments to provide therapeutic treatment experiences for emotionally disturbed youths.

(a)(b) “Therapeutic foster home” means a residential program in a community-based setting where one or two minors live in a licensed foster home with adults who receive specialized mental health training and support. Such support is also provided to natural parents and others as determined in the treatment plan.

(b)(c) “Therapeutic group home” means a 24 hour residential treatment program licensed under Chapter 65E-9, F.A.C., providing community-based mental health services in a home-like group setting for up to twelve children who meet the criteria in Section 394.492(5) or (6), F.S. eight emotionally disturbed minors with extensive mental health support services and training provided to the group home parents or staff and the natural parents.

(c)(d) “Residential treatment center for children and adolescents” means any 24 hour residential program as defined in Section 394.67(21), F.S. providing mental health services to emotionally disturbed or psychotic minors. These, typically privately operated, programs offer a variety of treatment modalities in a more restrictive setting.

(6) “System of Care” means a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life. The following services comprise the system of care.

(a) Prevention services;

(b) Diagnostic and evaluation services;

(c) Outpatient services;

(d) Day treatment services;

(e) Crisis counseling services;

(f) Residential programs; and,

(g) Treatment or receiving facilities;

(h) Other services and supports designed to build resilience and support recovery.

(7) “Physician” means a medical practitioner as licensed pursuant to Chapter 458 or 459, F.S.

(8) “Psychiatrist” means a medical practitioner as defined in Section 394.455(2)(b), F.S. This person shall have experience in treating emotionally disturbed children and adolescents.

(9) “Residential program” means programs providing 24 hour live-in care and therapeutic services and includes the following:

(a) “Wilderness therapeutic service” means programs that use wilderness environments to provide therapeutic treatment experiences for emotionally disturbed youths.

(b) “Therapeutic foster home” means a residential program in a community-based setting where one or two minors live in a licensed foster home with adults who receive specialized mental health training and support. Such support is also provided to natural parents and others as determined in the treatment plan.

(c) “Therapeutic group home” means a 24 hour residential program providing community-based mental health services in a group setting for up to eight emotionally disturbed minors with extensive mental health support services and training provided to the group home parents or staff and the natural parents.

(d) “Residential treatment center” means a 24 hour residential program.providing mental health services to emotionally disturbed or psychotic minors. These, typically privately operated, programs offer a variety of treatment modalities in a more restrictive setting.

(10) “Restraint” means restraining the child’s limbs, head or body by the use of mechanical or physical devices; for example, straps, cuffs, harnesses, mittens, camisoles, for the purpose of preventing a person from inflicting injury upon themselves or others.

(11) “Seclusion” means to isolate and contain in a room those children who pose an imminent threat of physical harm to themselves or others. The room shall incorporate features which substantially reduce the possibility of children doing harm to themselves or leaving the room without authorization.

Rulemaking Specific Authority 394.4781(3), (4) FS. Law Implemented 394.4781(3) FS. History–New 3-1-84, Formerly 10E-10.14, Amended 4-8-96, Formerly 10E-10.014, Amended 9-14-98,_________.

 

65E-10.016 Licensing Requirements.

(1) Children shall be placed in residential treatment programs which meet the applicable licensing standards of Chapters 65E-9 and 65C-14, F.A.C., or Chapter 395, F.S., or in the case of foster homes, are certified as therapeutic foster homes. All participating residential treatment programs homes must meet the applicable licensing requirements as indicated in Chapters 65C-13, 65C-14, 65C-15, F.A.C.

(2) It shall be the responsibility of the provider to secure the required licensure or certification and to make verification of such licensure or certification available to the Department upon request.

Rulemaking Specific Authority 409.165(1), 409.175(1), (2) FS. Law Implemented 394.4781(4), 409.145, 409.165, 409.175 FS. History– New 3-1-84, Formerly 10E-10.16, Amended 4-8-96, Formerly 10E-10.016, Amended_________.

 

65E-10.018 Client Eligibility for Placement in Residential Treatment Programs.

(1) through (1)(a) No change.

(b) Be assessed within 90 days prior to placement as emotionally disturbed by a clinical psychologist or by a psychiatrist licensed to practice in the State of Florida, with experience or training in children’s disorders; who attests, in writing, that: be impaired to the extent that residential services are required; and

1. The child has an emotional disturbance as defined in Section 394.492(5), F.S., or a serious emotional disturbance as defined in Section 394.492(6), F.A.C.;

2. The emotional disturbance or serious emotional disturbance requires treatment in a residential treatment setting;

3. A less restrictive than residential treatment setting is not available or clinically recommended;

4. The treatment provided in the residential treatment setting is reasonably likely to resolve the child’s presenting problems as identified by the psychiatrist or psychologist;

5. The nature, purpose, and expected length of treatment have been explained to the child and the child’s parent or guardian.

(c) Have been staffed at a assessed by minimum by the child and family specific appropriate district multidisciplinary team and been presented with all available options for treatment determined eligible for service.

(2) General revenue funds designated as children’s mental health funding State Children’s Mental Health funding, purchase of services, shall not be used to maintain children over the age of 18 in programs encompassed by these rules or to place a child for whom no appropriate services are available in Florida in an out of state residential treatment program which is not an approved Medicaid provider in the state where the child is being placed.

(3) Placement of children and youth in therapeutic out of home settings with general revenue funds is dependent on the availability of funds.

Rulemaking Specific Authority 394.4781(3) FS. Law Implemented 394.4781(3), (4) FS. History–New 3-1-84, Formerly 10E-10.18, Amended 4-8-96, Formerly 10E-10.018, Amended_________.

 

65E-10.019 Cost Sharing.

Rulemaking Specific Authority 394.4781(3)(c) FS. Law Implemented 394.4781(3)(c), (4), 409.2561 FS. History–New 3-1-84, Formerly 10E-10.19, 10E-10.019, Repealed_________.

 

65E-10.021 Standards for Residential Treatment Programs Serving Emotionally Disturbed Children and Adolescents.

Rulemaking Specific Authority 394.4781(3), (4) FS. Law Implemented 394.4781(3) FS. History–New 3-1-84, Formerly 10E-10.21, Amended 4-8-96, Formerly 10E-10.021, Amended 9-14-98, Repealed_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Kimberley E. Brown, Department of Children and Families, Mental Health Program, 1317 Winewood Blvd., Building 6, Room 296, Tallahassee, Florida 32399
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: David Wilkins, Secretary Department of Children and Families
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 13, 2011
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: December 17, 2010