4535. Placement - Intensive Resources

Approval:  Connie Lambert-Eckel, Assistant Secretary 

Original Date:  September 27, 1995 

Revised Date:  July 1, 2018 

Policy Review: July 1, 2021


Purpose 

Intensive resources are used to stabilize children and youth in placement. These services can be emergent, crisis or longer term depending on the need of the child or youth.  This policy provides direction on: 

  • When to request intensive resources.
  • How to refer children or youth to intensive resources.
  • When to request an in-state or out-of-state child specific contract.
  • How to access Emergent Placement Services (EPS).
  • What conditions must change for a child or youth to return home, and making active and reasonable efforts for timely reunification.
  • How to access specialized Child Placing Agency (CPA) - Group Receiving Care Services.

Scope 

This policy applies to CA staff.

Laws 

RCW 13.34.020  Legislative declaration of family unit as resource to be nurtured—Rights of child.

RCW 13.34.030  Definitions

RCW 13.34.050  Court Order to take a child into custody, when – Hearing

RCW 13.38  Washington State Indian Child Welfare Act

RCW 26.44   Abuse of Children

RCW 74.13.283  Client Information

RCW 74.14A.020   Services for emotionally disturbed and mentally ill children, potentially dependent children, and families-in-conflict. 

RCW 74.15.020   Definitions

RCW 74.15.090   Licenses required for agencies.

Policy

  1. Intensive Resources
    1. If a child or youth has intensive service needs above the  Foster Care Rate Assessment levels of care, including any exceptional cost plans or Behavioral Rehabilitation Services (BRS), the caseworker must consult with the regional gatekeeper or program manager.
    2. Prior to referring for In-State or Out-of-State Intensive Residential Child Specific Contracts, follow BRS or Medically Fragile Children policies and verify all less intensive services are unavailable or unable to meet the child or youth’s needs.   
    3. Prior to referring for In-State or Out-of-State Intensive Residential Child Specific Contracts, the child or youth must be referred for a WISe screen and the results documented according to the WISe and BRS policies.  If WISe is unable to meet child or youth’s needs, document the reasons why in the WISe section of the BRS referral form DSHS 10-166A.
    4. If BRS or medically fragile contracts cannot safely meet the child or youth’s needs or services are unavailable, the regional BRS program manager will attempt to negotiate a Child Specific Contract with a Washington State service provider.
  2. In-State Intensive Residential Child Specific Contracts (ISIRCSC  
    1. Regional BRS program managers must only pursue an ISIRCSC contract for a child or youth when all other less intensive contracted services are unavailable or cannot meet the needs of the child or youth.
    2. When the regional BRS program manager determines an ISIRCSC is needed, they must complete all of the following:  
      1. Inform the caseworker of the need to enter into an ISIRCSC.
      2. Negotiate with prospective in-state agencies regarding an ISIRCSC and obtain regional administrator (RA) or designee approval.
      3. Consult with the CA headquarter (HQ) intensive resource manager about the need to pursue an ISCSC and to explore any other alternatives.  
      4. Document the reason for the ISIRCSC on the contract approval request form DSHS 15-470, and attached a completed Child Specific Contract Rate form DSHS 10-490.  Send the completed forms to the individuals listed on DSHS 15-470 for signature approval.   
      5. Once approved, inform the caseworker of the rate and placement information so that the caseworker can document this in FamLink.
      6. Verify the WISe screen was completed and the results are documented according to the WISe policy. 
      7. Review the child or youth's service needs, level of care, target exit date, and transition plan in collaboration with the caseworker and contracted service provider as indicated by the child and youth’s needs, and at least every three months.
  3. Out-of-State Intensive Residential Child Specific Contracts (OSIRCSC)
    1. CA must only pursue an out-of-state placement for a child or youth when in-state resources are unavailable or cannot meet the needs of the child or youth.
    2. Before looking for an OSIRCSC resource that can meet the specific service needs of the child or youth, the regional BRS program manager must first exhaust all available in-state resources, document these efforts and in-state provider denials, and complete all of the following:
      1. Verify the caseworker has updated the BRS Referral form 10-166A and the BRS packet as needed.
      2. Consult with CA HQ intensive resource manager about the need to pursue an OSIRCSC to explore any other resources.
      3. Inform the caseworker of the need to search out-of-state.
      4. Search for out-of-state resources.
      5. Negotiate with prospective out-of-state agencies regarding an OSCSC and obtain approval from the RA or their designee.
      6. Document the reason for the OSIRCSC  on the contract approval request form DSHS 15-470, and attached a completed Child Specific Contract Rate form DSHS 10-490. Send the completed forms to the individuals listed on DSHS 15-470 for signature approval.  
      7. Verify the WISe screen was completed and results are documented according to the BRS policy.
      8. Review the child or youth's service needs, level of care, target exit date, and transition plan in collaboration with the caseworker and contracted service provider as indicated by the child or youth’s needs, and at least every three months.
      9. If there is a placement disruption of an out-of-state placement, diligent efforts must be made and documented to locate an in-state resource prior to searching for another out-of-state placement.
  4. Approved Out-of-State Placement
    ​Caseworkers must:
    1. Follow ICPC policy.
    2. Coordinate with the court and the child or youth’s guardian ad litem (GAL), Court Appointed Special Advocate (CASA) or attorney and obtain court approval to place out of state.
    3. Complete a safety assessment at key points in the case according to the Safety Assessment policy.
    4. Complete the Child Information and Placement Referral (CHIPR) DSHS 15-300.
    5. Verify the completion of the Comprehensive Family Evaluation (CFE).
    6. Follow Health and Safety Visits with Children and Monthly Visits with Caregivers and Parents policy. The assigned caseworker will make arrangements for Health and Safety visits. This may include contracting with an out-of-state provider to perform and document the visits (consult with the regional contracts manager). Review the documentation of these visits to ensure the child’s needs are met.
    7. Coordinate visits between parents and siblings according to the Parent, Child, and Sibling Visits policy.
    8. Follow Outside Communication for Children in Out-of-Home Care policy.
    9. Make and document reasonable efforts to reunify the family and achieve timely permanency. If there is reason to believe the child is a member, or the biological child of a member and eligible for membership, in a federally recognized tribe, and document the active efforts made to reunify the family, including a description of the services that were offered or provided, pursuant to Chapter 7 Indian Child Welfare Policies and Procedures.
    10. Identify conditions for return home at the time of placement and when updating a CFE. Conditions to return home provide the parent or legal guardian with specific information on what changes need to occur in order to create a safe physical, psychological and emotional environment for the child. Conditions are not based solely on the completion of services in a case plan.
    11. Follow Monthly Supervisor Case Reviews policy and discuss the child or youth’s progress and readiness for transition to less intensive services in Washington.
    12. Once plans begin to return a child or youth back to Washington, the caseworker must refer the child to a provider for a WISe Screen to determine eligibility. Use the results to determine service needs.
      1. If the child or youth is eligible follow the service recommendations.
      2. If the child is not eligible or the WISe provider is not able to meet their needs, document the reasons why in a case note or WISe section of the BRS referral form DSHS 10-166A.
  5. Emergent Placement Services (EPS) are contracted short-term (15 calendar days) crisis intensive resources that are used when there is an emergent need for a placement and no other placement options are available.
    1. Referrals
      1. If there is no placement available for a child or youth, the caseworker must contact the regional EPS gatekeeper to see if there is an EPS placement available. Regional EPS gatekeepers are identified by the RA or designee.
      2. The caseworker must verify the CHIPR DSHS 15-300 is updated.
      3. Once a request is received, the regional EPS gatekeeper must contact the EPS provider for placement availability. If there is availability, the EPS gatekeeper will:
        1. Send the CHIPR form to the provider for consideration, and;
        2. Inform the caseworker of the provider’s decision.
      4. If the child or youth is accepted for an EPS placement, the caseworker will arrange the child or youth’s transportation to the provider’s address.
      5. If there is no placement available in the region, the EPS regional gatekeeper may contact the EPS gatekeeper in another region to request an EPS placement. Approval from the receiving regional EPS gatekeeper must be obtained before a child or youth is moved to that placement. 
    2. Length of Service
      1. When the EPS placement begins, the caseworker must immediately begin discharge and transition planning for the child or youth, and communicate the discharge date and transition plan to the provider. 
      2. If EPS placement is needed beyond 15 calendar days, the caseworker must obtain approval from the regional EPS gatekeeper where resource is located.
      3. If the EPS gatekeeper approves the extension, they must notify the EPS provider. EPS placements cannot be extended longer than 30 calendar days.
      4. When the child or youth transitions out of EPS the contractor is required to provide the caseworker an EPS Transition Summary.
    3. EPS Contract Management
      1. The RA or their designee must identify one EPS regional lead to oversee the EPS program and compliance monitoring. 
      2. The EPS regional lead must:
        1. Track a daily census of the contracted programs within their region.
        2. Track the provider’s monthly reports for:
          1. Percentage of referrals accepted.
          2. Utilization of contracted bed days per month.
          3. Reasons for denied referrals.
        3. Identify if a provider is in compliance with the referral acceptance rate percentage identified in the contract on a quarterly basis. If the provider fails to meet the required acceptance percentage, notify the regional contracts manager within two weeks and request a compliance plan from the provider. 
        4. For providers who are not compliant with the required acceptance rate percentage in the EPS contract for the annual reporting period, the regional lead will:
          1. Inform the provider they will no longer receive the monthly per bed base rate and will move to a fee for service daily rate as stated in the EPS contract.
          2. Inform the contracts and fiduciary staff of the payment structure change to a fee for service daily rate for the next contract cycle. This will continue until the next annual review and the provider achieves the required acceptance outcome.
  6. CPA Specialized Group Receiving Care are contracted short-term placement (14 calendar days) for children and youth who are in need of emergency housing. The rates cover all costs associated with placement and service delivery for the children and youth. There are two tiers available within these services. Both tier one and two provide children and youth a residence, food, clothing, and other essentials. Services must include a caregiver or staff providing supervision for the children and youth. Tier two is a higher level of service and includes 30 hours of therapeutic case aide services per 30-day stay. The caseworker will also receive a Tier 2 Transition Summary within 24 hours of discharge to assist with service planning for the youth.  
    1. Referrals
      ​The caseworker, placement desk worker or after-hours worker must:
      1. If Specialized Group Receiving Care is needed, send a written referral request to a contracted provider.
      2. Authorize the tier one or tier two service when entering the placement. The contracted rate for all tiers is all inclusive and no other payment authorization must be made for placement.
      3. Verify the CHIPR form DSHS 15-300 is updated and send to the provider as soon as possible, but no later than three business days of the child’s placement.
    2. Length of Service
      ​The caseworker, placement desk worker or after-hours worker must:
      1. Immediately begin discharge and transition planning for the child or youth when the placement is approved, and communicate the discharge date and transition plan to the provider. 
      2. Meet weekly to coordinate timely discharge plans.
      3. Only authorize services as needed for no longer than 30 calendar days.
      4. Obtain signed authorization by the area administrator if the placement is beyond the initial 30 days. Authorizations must be approved every seven days for a maximum of 60 days. Send a copy of each signed authorization to the provider for their client file.
  7. Documentation
    ​Caseworkers must:
    1. Verify a child or youth’s placement was documented within three business days in FamLink.
    2. Describe the following information in FamLink.
      1. Use of shared planning to identify and develop a plan to meet the family and child or youth’s needs.
      2. Behavioral and permanency goals to be achieved through this placement.
      3. Determination of anticipated length of stay.
      4. Development of a preliminary discharge plan which includes a description of how supports will be developed so that the child can be returned to the community quickly and which relates to barriers previously identified.

Resources

Child Specific Contract Rate form DSHS 10-490

Contract Approval Request form DSHS 15-470

Contracted Health and Safety Visit Referral DSHS 10-566

Contracted Health and Safety Visit Report DSHS 10-567

EPS Transition Summary

Child Information and Placement Referral (CHIPR) DSHS 15-300

Specialized CPA - Group receiving care services Tier 2 Transition Summary