18.6.1  Levels of Care:

• Emergency Shelter:  This is a short-term resource for children requiring an immediate, temporary living arrangement in an open facility where their safety and supervision is ensured through an organized program of appropriate activities.  This service is appropriate for children who need the following:
  • Physical maintenance services - including food, clothing, shelter, medical and dental care, nurturance and supervision;
  • Family centered services - including individual, family and group therapy for the child and/or his/her parents;
  • Educational, religious, recreational, and socialization experiences according to the needs of the individual child; and
  • Joint planning between provider and Division, evaluation, implementation and review of treatment objectives, as determined by the FST.
• Moderate Need Level II:  This is an extended placement resource for children requiring a planned program affording safety, structure, and supervision.  This level is indicated for children who by reason of family situation, relationship problems with family, level of development and/or maladaptive behaviors are unable to accept traditional family ties and/or successfully participate in traditional family settings.  Facilities that have signed a Rehabilitation Options Contract, should provide reunification services, work with the family, community based services, schools, etc. as a part of therapeutic services provided.  Moderate Need Level II service is appropriate for children who need the following:
  • Physical maintenance Services - including food, clothing, shelter, medical and dental care, nurturance, and supervision;
  • Family centered services - including individual, family and group therapy for the child and/or his/her parents;
  • Educational, religious, recreational and socialization experiences according to the needs of the individual child;
  • Diagnostic assessment;
  • Adjunctive services based upon the developmental level of the child and level of need; and
  • Both individual and group counseling to the child and his parents as part of the overall treatment effort, recognizing that reunification of the child and family is the primary goal of the agency if safety of the child in that setting can be assured.
• Severe Need/Level III:  This is an extended placement resource for children requiring active, coordinated, and professional intervention on a residential basis.  This level is indicated for children who cannot be effectively managed in a less restrictive setting.  These children exhibit a mental illness or mental disorder as diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).  These children have continued difficulty adjusting to an open public school setting.  A CSPI shall be completed on the child by the case-manager to evaluate his/her current needs.  See CS-9 instructions.  Facilities that have signed a Rehabilitation Options Contract, should provide reunification services, work with the family, community based services, schools, etc. as a part of therapeutic services provided.  Severe Need service is appropriate for children who need the following:
  • Physical maintenance services - including food, clothing, shelter, medical and dental care, nurturance, and supervision;
  • Family centered services for the child and/or his/her parents - including individual, family and group therapy;
  • Educational, religious, recreational and socialization experiences according to the needs of the individual child;
  • Psychological and/or psychiatric treatment services;
  • Joint planning, evaluation, and implementation of treatment objective as mutually agreed upon with the FST;
  • Intensive individual and group counseling, adjunctive, and supporting activities, dependent upon the child’s needs while the child is in placement;
  • Intensive individual and group counseling with the parents while the child is in placement; and;
  • Treatment planning for aftercare services to maintain the growth achieved in residential care.
  • In addition to the services required for Level III care, the appropriate services must include the following:
  • Psychiatric supervision and review of child’s individual treatment wherein the psychiatrist’s physical contact with the child shall occur no less than once every 30 days;
  • Classroom education as required by law, which shall be provided in a school located at the contractor’s facility;
  • Treatment services encompassing a coordinated plan, utilizing, at a minimum, group and individual therapeutic modalities consistent with the needs of the child.
• Intensive Need/Level IV:  This is an extended placement resource for children requiring active, coordinated, and professional intervention in a highly structured and secure environment.  Such children will have demonstrated an inability to function in any less restrictive setting.  This level is indicated for children who exhibit a severe mental illness and/or persistent mental disorder as diagnosed according to the DSM-IV.  A CSPI shall be completed on the child by the case-manager to determine current needs.  See CS-9 instructions.  Facilities that have signed a Rehabilitation Options Contract, should provide reunification services, work with the family, community based services, schools, etc. as a part of the therapeutic services provided. These children are unable to function consistently in an open, public school setting.  They present a chronic runaway risk.  They also typically present a history of showing rage, including physical aggression.  This service is appropriate for children who:
  • Have previously received care in an acute psychiatric hospital, but are not currently in need of inpatient psychiatric treatment; or
  • Have treatment needs, which cannot be met by any of the residential care facilities contracted with the state agency to provide treatment to children with severe needs.

18.6.2  Progress Reports

Facilities under contract are required to complete a treatment plan and progress report and submit these to the Children’s Service Worker and the RCST Coordinator at the following intervals:

1. A treatment plan must be developed within fifteen (15) days of the child’s initial placement.  Progress reports are due every ninety (90) days thereafter, as long as the child remains in placement;
2. Within thirty (30) days prior to the end of each six (6) months of the child’s placement.  This progress report should include a current CSPI, completed by the facility evaluating the child’s current needs as differentiated from the child’s needs at the time of placement; and
3. Thirty (30) days prior to the expiration date of the child’s treatment authorization or planned discharge.

Progress reports can be submitted more frequently if the individual case plan indicates that doing so would enhance services.  Such reports shall contain the following information:

1. Contractor’s understanding of the long range plan for the child including the tasks and goals related to the efforts at reunification;
2. Contractor’s understanding of the specific goals for placement;
3. Tasks within the total plan for the child and parents as assigned by the FST should be identified specifically;
4. Of the tasks completed (assigned to contractor/child/parent(s):
   1. Are achievements documented?
   2. Have the tasks led to the desired goal?
   3. Are there child or parent strengths apparent now that were not at the time of placement?
5. Of tasks not completed (assigned to contractor/child/parent(s):
   1. Why were tasks not completed?
   2. Are failures to complete the tasks documented?
   3. Are tasks reasonable or appropriate?
6. Planned visiting between parent(s) and children:
   1. Were plans for visiting reasonable and appropriate and were they carried out?
   2. Why did visiting not occur, if applicable?
   3. Are failures to visit documented?
7. Expected length of continued placement, in months, including whether this has changed since the initial placement, and the documented reason for the child to remain in the treatment facility;
8. Identification of needed changes in the long range plan, specific tasks, or visiting schedule; and
9. Information to the payment designee as to when reports are received, so payment to provider is not interrupted.