Library: Policy

340:75-11-364. Contracted Level E qualified residential treatment programs (QRTP)

Issued 2-1-22

(a) Contracted Level E services include:

(1) structured group therapy, a minimum of two hours per week for each child;

(2) individual therapy, a minimum of one hour per week for each child;

(3) family time;

(4) family therapy;

(5) substance use, abuse, or chemical dependency therapy within a group or individual counseling or therapy session for each child, as needed;

(6) psychological or psychiatric intervention for each child through direct contact with a psychologist or psychiatric consultant or the contractor's designated therapy counseling staff;

(7) behavior redirection 24-hours a day, seven days a week to ensure safety, meet the treatment plan's goals and objectives, and respond to any behavioral crisis of the child.  The contractor ensures that staff is available to respond in a crisis to stabilize the child's behavior and prevent placement disruption;

(8) active teaching and redevelopment of the child's basic living and social skills, both on-site and in the community.  At minimum, the focus is on the restoration of skills for:

(A) personal health and hygiene;

(B) maintenance of the living environment, including food preparation;

(C) money management;

(D) job skills readiness, acquisition, and retention;

(E) community awareness and mobility, including the use of community resources; and

(F) socialization skills and techniques, including communication;

(9) developing and implementing policy and procedures to successfully deliver adulthood skills training to youth, using an approved curriculum for teaching successful adulthood skills;

(10) assisting in the provision of federally mandated successful adulthood services that include coordinating with the assigned child welfare (CW) specialist to ensure:

(A) the life skills assessment is completed with each youth 14 years of age and older and implementing the successful adulthood plan produced by this assessment; and   • 1

(B) each youth 14 years of age and older attends one community contractor successful adulthood seminar each year;   • 1

(11) providing 24-hour awake supervision of each child;

(12) providing 24-hour on-call and on-site crisis intervention and behavior management services to each child, as needed.  Emergency or crisis intervention services include face-to-face encounters with the child to resolve acute emotional dysfunction by providing intervention resolution and stabilizing functions through triage screening, planning, and documentation;

(13) providing recreation services with a recreation coordinator for each child;

(14) providing schooling according to the school district where the child is located and as agreed upon by the child’s educational team.  The child's educational team is comprised of the local education agency, contractor, CW specialist and education surrogate;

(15) operating with a trauma-informed treatment model;

(16) providing transition services throughout the child’s placement episode; and

(17) providing post discharge support to each child and their family.

(b) Contracted Level E QRTP are accredited by a federally-approved, independent, not-for-profit accrediting organization and are provided in a setting licensed as a residential child care facility that is not located in a hospital, either medical or psychiatric, or psychiatric residential treatment center.

(c) The contractor:

(1) complies with Part 105 of Oklahoma Administrative Code (OAC) 317:30-5 for residential behavior management services in group settings;

(2) provides clothing, after the child's initial placement.  Emergency funds for clothing may be accessed, per OAC 340:75-13-45;

(3) completes a written incident report describing any extreme behavioral incident or major rule violation, including the contractor's response.  The contractor submits the original incident report to the Child Welfare Services (CWS) Specialized Placements and Partnerships Unit (SPPU), submits a copy to the assigned CW specialist and CW facility liaison, and files a copy in the child's case record;

(4) meets the staffing guidelines defined in the Oklahoma Human Services (OKDHS) contract;

(5) complies with a child's rights, per OAC 340:75-11-237;

(6) complies with all general requirements, per OAC 340:75-11-240;

(7) maintains documentation of each child's unapproved absence from the facility and leave days defined in the contract and reports leave days on Form 04CB002E, CWS Claim for Purchase of Residential Care;

(8) establishes a procedure to address and document a response to concerns in Level E QRTP that do not warrant a referral for an abuse or neglect assessment or investigation.  When documented efforts to address these issues do not remove the concerns, OKDHS has the right to impose adverse contract actions or decline use of the facility.  Examples of this type of concern include, but are not limited to:

(A) an employee's judgment or supervision;

(B) disciplinary practices;

(C) non-compliance with policy or contract;

(D) unacceptable housing standards;

(E) inadequate clothing provisions for the child; or

(F) a lack of involvement in the child's education or independent living skills;

(9) is paid by OKDHS at a fixed daily rate for the total number of beds specified in the OKDHS contract.  The fixed daily rate is a blend of Title IV-E and Title XIX federal funds, per eligibility of each child served, and state funds; and

(10) submits Form 04CB002E for payment to CWS Contracting and Acquisitioning Unit.

(d) Children served in Level E QRTP.

(1) The primary goal of Level E services is the remediation of emotional or behavioral disorders or behavioral problems through clinical interventions.

(2) Children served in Level E QRTP exhibit a wide range of severe emotional and behavioral disorders as described in OAC 317:30-5-240.1.

(3) Children served typically have a history of trauma that results in some of, but not limited to, the following characteristics:

(A) high risk of leaving placements without approval;

(B) difficulty attending public school settings;

(C) acts of violence and aggression toward peers, property, and authority figures;

(D) sexual behaviors, including sexual aggression and sexually predatory behavior;

(E) substance us or related needs;

(F) severe delays in development;

(G) verbal aggression;

(H) difficulty with peer or adult relationships;

(I) history of disruptions in attachment;

(J) difficulties in emotional functioning and regulation;

(K) multiple placement changes;

(L) dual adjudication with the Office of Juvenile Affairs or a history of criminal activities;

(M) inability to experience joy, happiness, and meaningful play or recreate; and

(N) damage to trust, impaired relationships, and difficulty forming relationships and attachments to people.

(4) Level E placements are the most restrictive treatment intensive placements available for children outside of a psychiatric facility.

(5) In general, children served in Level E QRTP are 13 to 18 years of age.  Each contractor serves a specifically defined target population of children.  • 1

(6) The contractor receives referrals for the placement of children from CWS SPPU through the CW facility liaison.  • 1 through • 2

(e) Children served in Level E QRTP designated for victims of sexual exploitation.

(1) The primary goal of a Level E QRTP designated for victims of sexual exploitation is to address the unique needs of survivors, assist victims in gaining an understanding of the victimization process, empower survivors, and prepare children for reintegration into a family or a successful adulthood living environment.

(2) Services provided in designated Level E QRTP for victims of sexual exploitation include a protected environment, specified cognitive behavioral therapy, individualized therapeutic services, and positive behavioral supports.

(3) Per Section 1-9-123 of Title 10A of the Oklahoma Statutes (10A O.S. § 1-9-123), OKDHS immediately reports to law enforcement no later than 24 hours after receiving information on a child or youth who was identified as a sex trafficking victim, per 10A O.S. § 1-1-105.

(f) Level E QRTP with enhanced support, known as Level E Enhanced, serve the individualized treatment and supervision needs of children who meet Level E criteria and who can benefit from an enhanced supervision ratio and special programing.  Level E Enhanced services include all services listed in subsection (a) of this Section, with the addition of a higher level of staffing ratio than the traditional Level E, to meet the unique needs of the children served.

(g) Level E QRTP with increased psychiatric supports, known as Level E plus (+), serve the individualized needs of children who meet traditional level E criteria and who can benefit from additional psychiatric services.

(1) Level E+ has five major goals for children:

(A) reducing inpatient psychiatric hospitalizations;

(B) stabilizing children who are experiencing significant mental health issues;

(C) teaching children new skills to meet their needs;

(D) preparing and planning for the child to live in a less restrictive environment, such as a family-like setting; and

(E) providing child safety through 24-hour awake intensive supervision.

(2) Level E+ services include all services listed in subsection (a) of this Section with the addition of:

(A) weekly psychiatric treatment;

(B) completion of a psychological evaluation within five-business days of a child’s placement; and

(C) treatment plan updates every 30-calendar days.

Issued 2-1-22

1.  Successful adulthood services.  The assigned child welfare specialist:

(1) ensures that the youth's basic life skills assessment is completed; and

(2) arranges for the youth to attend seminars, per Oklahoma Administrative Code 340:75-6-110.

2.  Level E contractors are listed in KIDS Resource Directory, category - Residential - State Office Authorized and type - Level E.