Appropriate Placement Under FFPSA
Beginning October 1, 2019, states must take steps to safely reduce the inappropriate use of congregate/group care for children. States have the option delay the effective date for up to two years; however any state that does so must also postpone seeking Title IV-E prevention investments for the same period of time.
Beginning with the third week of a child entering foster care, states will only be eligible for Title IV-E foster care payments on behalf of a child in the following settings:
A foster family home of an individual or family that is licensed or approved by the state, and is capable of adhering to the reasonable and prudent parent standard, provides 24 hour care for children placed away from their family, and provides care to six or fewer children in foster care (exceptions to this limit can be made to accommodate parenting youth in foster care to remain with their child, keep siblings together, keep children with meaningful relationships with the family, and care for children with severe disabilities).
A child-care institution, defined as a licensed private or public child-caring institution with no more than 25 children, that is one of the following settings:
A Qualified Residential Treatment Program (QRTP)
A setting specializing in providing prenatal, post-partum, or parenting supports for youth.
A supervised setting for youth ages 18 and older who are living independently.
A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims.
Children who are placed with a parent in a licensed residential family-based substance abuse treatment facility for up to 12 months.
QRTP: Detailed REquirements
Qualified Residential Treatment Programs (QRTP) (Sec. 50741):
A Qualified Residential Treatment Programs (QRTP), is defined as a program that:
Has a trauma-informed treatment model designed to address the needs, and clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances, and can implement the necessary treatment identified in the child’s assessment. (See the section below for more information on the assessment.)
Has registered or licensed nursing staff and other licensed clinical staff who can provide care, who are on-site consistent with the treatment model, and available 24 hours and 7 days a week. The QRTP does not need to have a direct employee/employer relationship with required nursing and behavioral staff. o Facilitates family participation in child’s treatment program (if in child’s best interest)
Facilitates family outreach, documents how this outreach is made, and maintains contact information for any known biological family and fictive kin of the child.
Documents how the child’s family is integrated into the child’s treatment, including postdischarge, and how sibling connections are maintained. o Provides discharge planning and family-based aftercare supports for at least 6 months postdischarge.
The program is licensed and nationally accredited by an accrediting body approved by the Secretary the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation (COA), or others approved by the Secretary.
Assessment to Determine Appropriateness of Placement in a QRTP (Sec. 50742):
Within 30 days of a child being placed in a QRTP setting, a qualified individual must assess the child’s strengths and needs using an age-appropriate, evidence-based, validated, functional assessment tool to determine if the child’s needs can be met with family members or in a foster family home, or in one of the other approved settings (i.e. facilities for pregnant or parenting youth or independent living facilities) consistent with the short- and long-term goals of the child and their permanency plan. HHS will release guidance on valid assessment tools. The qualified individual will also need to develop a list of child-specific short- and long-term mental and behavioral health goals.
The assessment must be done by a “qualified individual”, who is a trained professional or licensed clinician who is not a state employee or affiliated with any placement setting in the state. However, this requirement may be waived by the Secretary upon request of a state certifying that trained professional or licensed clinician can maintain objectivity in the assessment process.
If the assessment is not completed in the first 30 days of the child’s placement in a QRTP the state can no longer receive federal reimbursement for foster care maintenance payments for that child while they are in that placement.
The qualified individual must conduct the assessment in conjunction with the child’s family and permanency team, which may include parents, relatives, fictive kin, appropriate professionals (teachers, medical and mental health providers, clergy or others familiar with the child). If the youth is age 14 or older she can also select and bring with her two members of the permanency planning team, as established in the Preventing Sex Trafficking and Strengthening Families Act of 2014.
The state will need to document in the child’s case plan their efforts to identify and include a family and permanency team for the child, contact information for the team (including other family and fictive kin who aren’t in the team), evidence that meetings were held at a time convenient for the family and permanency team, evidence that the child’s parent provided input if reunification is the permanency goal, evidence that the assessment was made in conjunction with the team, the placement preference of the team that acknowledges the importance of keeping siblings together, and if the team’s placement preference is different than that of the qualified individual the reason why the recommendations are different.
Steps Taken After a Determination is Made that a Child Should Not be Placed in a QRTP (Sec. 50741):
If it is determined by an assessment of court order that a QRTP placement is not appropriate for a child, then the state has an additional 30 days from the time that determination is made to transition the child down to another placement or step the child up to a facility that can better address the child’s needs. States will be reimbursed at the FFP during this 30 day period, but states will have to pay the full cost for the child beyond those 30 days if the child remains in a setting that is not appropriate for addressing the child’s needs. These funds appear to be able to assist with the transition.