18.4  Referral Process

If the decision is made that residential treatment can best meet the child’s clinical needs, referrals to residential treatment shall follow these guidelines:

1. The case manager must assess the child’s need, via completion of the “Residential Treatment Referral” (CS-9), for residential treatment services.  The family, the FST, and other resources shall be utilized to assure the child’s needs are addressed in the CS-9.  Referrals for emergency and non-emergency residential placement must be submitted to the RCST Coordinator:

   NOTE: Referrals to consider traditional foster family, relative home, or kinship home are NOT submitted to the RCST Coordinator.

   1. Determine what needs to occur to facilitate the child’s return to family or to another permanent placement in the community, coordinating and planning with the parent(s), the youth, and using recommendations of the provider and the RCST Coordinator. 
   2. Utilize the needs list to develop the “treatment plan” to be implemented by the case manager and the residential treatment facility. 
   3. If it appears the child will be unable to return to family of origin, develop alternate plans using concurrent planning and meeting the ASFA requirements and mandated time lines.
   4. If other services are needed, involve the Department of Mental Health (DMH): Division of Comprehensive Psychiatric Services (CPS)/Division of Mental Retardation and Developmental Disabilities (MRDD) at this time to maximize interagency expertise and financial participation.
2. The FST shall assess the child’s needs and devise the treatment plan.  The FST shall include the child (if age appropriate), family, juvenile court representative, Guardian Ad Litem, community representatives, the Children’s Service Workers, and other members of the family’s support system:
   1. Because placement should always be in the least restrictive setting, efforts should be made to place a child with a relative home, kinship home, traditional foster home, or a therapeutic foster home prior to referral to residential treatment.
   2. Collateral documentation of behavior or other factors that indicate a need for residential treatment services should be provided, before referral to residential treatment is considered.
   3. The treatment plans must include strategies to allow for the child to remain “connected” to his/her family, kin, community, etc.
   4. Connection to the community must be an integral part of the treatment plan for older youth who have a permanency plan of independent living.
   5. The case manager/worker and the FST must remain an active and viable part of treatment planning.
   6. Maintain the child in care of provider until placement with the new provider is available, if an emergency placement is not needed; or
   7. Seek other resources for placement until the RCST Coordinator reaches a decision that residential treatment services are appropriate and available.
3. Submit the following materials to the RCST Coordinator when the child has met the above criteria.  The family, community members, or others who know the child can help with providing this material:
   1. Completed CS-9 that includes the CSPI;

      NOTE:  Upon completion of the CSPI, staff shall update the SS-61.  The Rehabilitation (REHAB) Service Begin Date will be the date on which the CSPI is completed.

   2. Social history or psychosocial assessment or court assessment completed within last 60 days;
   3. Current case plan (CS-1);
   4. Current school report/grade level and any applicable records.  For children with special education requirements, current Individualized Education Plan (IEP) and educational diagnostic assessment;
   5. Medical history;
   6. Copy of parent’s service agreement;
   7. Immunization record;
   8. Court orders and petitions;
   9. Criminal history;
   10. Psychological/psychiatric evaluation;
   11. Copy of birth certificate or number; and
   12. For any youth age 16 and over, include CS-3 Life Skills Inventory, Daniel Memorial Life Skills Inventory, or CS-1 Attachment.
4. Submit the CS-9 to the RCST Coordinator if it appears residential treatment services will best meet the child’s clinical needs.  The Case manager, supervisor, and RCST Coordinator will share information about the referral, discussion of possible placement resources, the urgency of need for placement, and other relevant information.

   NOTE:  The RCST Coordinator will determine the most appropriate residential childcare agency, treatment period and placement date, authorizing all items on the CS-67A.

   NOTE:  Additionally, the RCST Coordinators will verify a child’s REHAB-RT eligibility prior to entering any SEAS authorization for a residential treatment service.  If the RCST Coordinator determines that an otherwise REHAB eligible youth has not had eligibility established in the ACTS system, they will immediately contact the child’s case manager and/or supervisor.  SEAS authorizations for residential treatment services are not to be entered without verification that the ACTS system indicates the child’s eligibility.

5. Receive notification from the RCST Coordinator regarding appropriateness of referral for placement, and receive copies of the RCST Coordinator’s written request for admission/placements to appropriate providers.
6. Carry out any of the following actions as appropriate to the RCST Coordinator’s decision or recommendations:
   1. Advise court and develop alternative treatment and/or case plan if referral is determined inappropriate or if other options besides residential placements have been suggested.
   2. Coordinate all planning if county of current placement is different from county of jurisdiction.
   3. Receive notification from the RCST Coordinator when a resource becomes available if child has not yet been accepted in an appropriate placement.
   4. Notify the RCST Coordinator in writing if placement is no longer needed.

      NOTE:  Written notification should be made in all instances of placement or withdrawal of placement request.

7. Receive notification from provider of date for pre-placement interview visit.
8. Proceed with placement preparation including the following:
   1. Prepare child and parents for change in placement.  Provide information about the facility, location, special programs, visitation arrangements, etc.
   2. Assess clothing needs and seek approval for expenditure if clothing is needed.
   3. Arrange dental and medical examination within 30 days prior to actual placement, if provider requires more recent medical report.
9. Assure child’s arrival at facility on date arranged for entry.

   NOTE:  At time of placement, all case plan responsibilities revert to the Children’s Service Worker in the county of jurisdiction if child had been placed in another county.

10. Update the SS-61 to denote new placement and CSPI scores.  When updating the SS-61 accordingly, the REHAB Service Begin Date shall be the date the CSPI was completed.  This is the eligibility determination date.  Staff are not to backdate the REHAB Service Begin Date to reflect the date of placement unless the CSPI was completed on that date:

    NOTE:  For children entering emergency residential placement, the CS-9, including the CSPI shall be completed within five (5) working days and submitted to the RCST
    Coordinator.  Additionally, the Residential Care Screening Team (RCST) Coordinators will verify a child’s REHAB-RT eligibility prior to entering any SEAS authorization for a residential treatment service.  If the RCST Coordinator determines that an otherwise REHAB eligible youth has not had eligibility established in the ACTS system, they will immediately contact the child’s case manager and/or supervisor.  SEAS authorizations for residential treatment services are not to be entered without verification that the ACTS system indicates the child’s eligibility.

    1. Complete the CS-65 if any special expenses are needed, have been approved, and are not included in the residential treatment contract.
    2. Update the SS-61 to delete maintenance for any child entering a residential child care agency.
11. Provide any needed placement support services consistent with the Case Plan (CS-1) including services to the parents:
    1. Receive progress reports from provider. The initial evaluation and plan of care should be in compliance with the FST plan, or if different, the reasons for any change must be documented.
    2. Determine what needs to occur to facilitate the child’s return to family or to another permanent placement in the community, coordinating and planning with the parent(s) and using recommendations of provider and the RCST Coordinator.
    3. Submit copy of Case Plan (CS-1), including Family Support Team (FST) recommendations, to the RCST Coordinator at intervals required for each form.

       NOTE:  Representatives of the treatment provider must be invited to attend the FST meeting.  The treatment facility staffing can be combined with FST when appropriate as treatment goals, modality, and progress of child and family should be relevant discussion for members of both groups.  Often the team members are the same for both meetings.

    4. Submit reports to court at required intervals incorporating progress reports, and the case Plan (CS-1) including the FST and the treatment plan as determined by the FST.  This should be the same treatment plan as that determined by the residential treatment facility.
    5. Submit copy of report to assigned Court Appointed Special Advocate (CASA) volunteer, if applicable.
    6. Maintain responsibility for case record and case action including FSTs.
    7. Notify local law enforcement agency or Missouri Highway Patrol immediately if child is reported as a runaway.
    8. Notify RCST Coordinator in writing, immediately, of any child removed from an authorized placement.  Include date of discharge and identification of present placement resource.
12. Inform the RCST Coordinator, in writing, of any additional service needs the child may require.  Include information describing the child’s actual needs requiring a service outside of those provided by the residential child care agency.  Indicate the reasons as stated by the agency that they are unable to provide these services.  The RCST Coordinator will determine if these services are excluded from the contract with the facility.
13. Integrate content of progress reports into services to the parents, FSTs, case plan development, reports to Court, etc.  The family may be included in therapeutic services provided to the child.  The Rehabilitation contract requires the facility to provide rehabilitative services, encourage visitation with the family, and work toward reunification of the family members.
14. Receive written notification from the RCST Coordinator at least 60 days prior to expiration date of treatment authorization.
15. Receive notification from the provider at least 30 days prior to planned discharge of the child.  If the FST has determined that the child and family are to be reunited, this plan shall be put into place.  The residential facility, through therapeutic intervention with the youth and family, as well as working with the assigned case manager, shall identify necessary systems to support the family and youth during reunification.  The case manager and other members of the FST will assure these supports are available to the family and youth as the goal of reunification is put into place. If the FST determines that the youth’s needs cannot be met in the community and that return to the family or to another family setting - such as a therapeutic foster family, is not appropriate, the FST shall recommend that the child remain in a residential setting.  If this is the case, the case manager will:
    1. Submit recommendations to the RCST Coordinator regarding child’s continued need for treatment as soon as possible.
    2. Send copy of notification to service county, if different from the county of jurisdiction.
16. The case-manager shall continue to determine what needs to occur to facilitate the child’s return to family or to another permanent placement in the community, coordinating and planning with the parent(s) and using recommendations of provider and the RCST Coordinator.  The case manager shall continue to utilize this needs list to develop the treatment plan to be implemented by the case manager and the residential treatment facility.  If it appears the child will be unable to return to family of origin, the FST, with the involvement of the child and family shall develop alternate plans for the child using concurrent planning and meeting the Court and ASFA time lines.  The child and his family shall be encouraged to locate relative placements or other permanent placements that will allow the child to remain involved with his/her family of origin, even if it is not realistic for the youth to be reunited with his/her family.
17. Provide aftercare services when the child returns to own family.  If the child is unable to return to his/her family of origin, provide other replacement services, as appropriate to the child’s needs and permanency plan.
18. Record all activities every 30 days, incorporating progress reports, FST meetings, and Case Plan changes as appropriate.

Memoranda History: (prior to 1/31/07)

Memoranda History: