Florida Regulations 65C-28.021: Qualified Residential Treatment Programs
Current as of: 2024 | Check for updates
|
Other versions
(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 shall not be used for emergency placements or to provide secure shelter for the child. If the child is in acute psychiatric crisis, the child shall 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 lead agency shall maintain documentation of a child’s placement in a QRTP and is responsible for ensuring that each child receives a suitability assessment prior to placement in the QRTP.
(3) A suitability 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-13092, by a qualified evaluator (QE) 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 assessment must be conducted by a QE who meets the following requirements:
(a) Is a psychiatrist or psychologist pursuant to Florida Statutes § 39.407(6);
(b) Has at least 2 years’ experience working with children or adolescents involved in the child welfare system of care;
(c) Has no actual or perceived conflict of interest with placement in a QRTP; and
(d) Has completed training pertaining to the population of children in the child welfare system. Training topics shall include, but are not limited to, trauma-informed care and human trafficking.
(5) The QE 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) The treating clinical profession shall be a member of the permanency team.
(b) The QE shall consider the recommendation of the child’s treating clinical professional when conducting the assessment.
(6) The QE 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.
(b) When a child refuses to participate in the interview, the QE shall make good faith efforts to engage the child. Good faith efforts are defined as documented efforts that demonstrate the QE 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 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, 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 shall recommend one of the following placement options:
(a) Placement in a QRTP;
(b) Placement in a less restrictive setting with wraparound services; or
(c) Placement in a statewide inpatient psychiatric program.
(8) If the QE 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) If the QE 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) When the suitability 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) 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 assessment, determination, and documentation made by the qualified evaluator. If the court orders the child to be placed in a QRTP after the QE does not recommend placement, the assigned child welfare professional shall request the QE consider doing a new assessment.
(12) If placement in the QRTP is approved by the initial 60-day court review, the QE must conduct an independent suitability 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.
(13) 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. The child welfare professional must make arrangements to have the child moved from the program within 30 calendar days of the determination.
(14) A copy of the suitability 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 assessment shall include, at minimum, the outcome of the interview with the child, review of prior treatment records, contact with relevant parties, whether or not the QE recommends placement in a QRTP, and attachment of the Department-approved evidenced-based functional assessment tool.
(b) The 90-day independent assessment review may be an addendum to the initial assessment and shall include, at minimum, the outcome of a new 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 continued placement in a QRTP.
(15) 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, Apr 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13075. The RMD or DCF designee shall consider the recommendations of the multidisciplinary team staffing conducted within the last 90 calendar days and the most recent suitability assessment recommendation 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) 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 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 Statewide In-Patient Psychiatric Program (SIPP).
(c) Aftercare support must be provided for a minimum of 6 months post discharge.
(d) Written aftercare progress reports provided to the child welfare professional by the QRTP 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) 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 so long as the child was not discharged from the QRTP.
(18) If a child transfers from one QRTP to another without a lapse in placement, a new assessment is not required. The community-based care shall coordinate a multidisciplinary staffing with both QRTP providers to discuss the child’s identified needs and sharing of records to allow for adequate continuation of services and treatment.
Rulemaking Authority 409.175(5), FS. Law Implemented 409.175, FS. History—New 5-23-21.
Terms Used In Florida Regulations 65C-28.021
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
(3) A suitability 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-13092, by a qualified evaluator (QE) 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 assessment must be conducted by a QE who meets the following requirements:
(a) Is a psychiatrist or psychologist pursuant to Florida Statutes § 39.407(6);
(b) Has at least 2 years’ experience working with children or adolescents involved in the child welfare system of care;
(c) Has no actual or perceived conflict of interest with placement in a QRTP; and
(d) Has completed training pertaining to the population of children in the child welfare system. Training topics shall include, but are not limited to, trauma-informed care and human trafficking.
(5) The QE 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) The treating clinical profession shall be a member of the permanency team.
(b) The QE shall consider the recommendation of the child’s treating clinical professional when conducting the assessment.
(6) The QE 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.
(b) When a child refuses to participate in the interview, the QE shall make good faith efforts to engage the child. Good faith efforts are defined as documented efforts that demonstrate the QE 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 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, 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 shall recommend one of the following placement options:
(a) Placement in a QRTP;
(b) Placement in a less restrictive setting with wraparound services; or
(c) Placement in a statewide inpatient psychiatric program.
(8) If the QE 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) If the QE 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) When the suitability 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) 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 assessment, determination, and documentation made by the qualified evaluator. If the court orders the child to be placed in a QRTP after the QE does not recommend placement, the assigned child welfare professional shall request the QE consider doing a new assessment.
(12) If placement in the QRTP is approved by the initial 60-day court review, the QE must conduct an independent suitability 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.
(13) 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. The child welfare professional must make arrangements to have the child moved from the program within 30 calendar days of the determination.
(14) A copy of the suitability 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 assessment shall include, at minimum, the outcome of the interview with the child, review of prior treatment records, contact with relevant parties, whether or not the QE recommends placement in a QRTP, and attachment of the Department-approved evidenced-based functional assessment tool.
(b) The 90-day independent assessment review may be an addendum to the initial assessment and shall include, at minimum, the outcome of a new 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 continued placement in a QRTP.
(15) 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, Apr 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13075. The RMD or DCF designee shall consider the recommendations of the multidisciplinary team staffing conducted within the last 90 calendar days and the most recent suitability assessment recommendation 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) 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 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 Statewide In-Patient Psychiatric Program (SIPP).
(c) Aftercare support must be provided for a minimum of 6 months post discharge.
(d) Written aftercare progress reports provided to the child welfare professional by the QRTP 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) 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 so long as the child was not discharged from the QRTP.
(18) If a child transfers from one QRTP to another without a lapse in placement, a new assessment is not required. The community-based care shall coordinate a multidisciplinary staffing with both QRTP providers to discuss the child’s identified needs and sharing of records to allow for adequate continuation of services and treatment.
Rulemaking Authority 409.175(5), FS. Law Implemented 409.175, FS. History—New 5-23-21.