N.H. Admin. Code § He-C 4001.30

Current through Register No. 50, December 12, 2024

Section He-C 4001.30 - Treatment Planning Process for Specialized Care Programs

(a) SCPs shall conduct a psycho-social assessment with recommendations for treatment for the resident.

(b) Based on the assessment and recommendations, the SCP shall conduct a treatment team meeting and develop a treatment plan within 30 calendar days of placement of the child.

(c) The treatment plan shall include:

(1) The summary of the psycho-social assessment;

(2) A transitional section for the child and family that includes:

a. An estimate by the treatment team members of the child's length of stay, based upon referral information and the SCP's assessment; and

b. The child's permanency plan identifying the following alternatives for the child in care, including the identified resource if known at the time of the treatment plan:

1. Reunification with the family;

2. Adoption;

3. Guardianship by a relative or other person;

4. Permanent placement with a fit and willing relative; or

5. Another Planned Permanent Living Arrangement (APPLA) in accordance with RSA 169-C:24-b, II(c); and

(3) Community reintegration and transition tasks that identify the following:

a. Specific needed supports or services that would provide for the child to successfully transition out of the SCP and into the community;

b. The treatment team member who is responsible for completing each task necessary; and

c. The projected time frame for completion of each task.

(d) The treatment plan shall at a minimum, contain the following domains relating to rehabilitative and restorative services provided by the SCP:

(1) Safety and behavior of the child;

(2) Family;

(3) Medical;

(4) Education, if clinically necessary; and

(5) Adult living preparation if determined clinically necessary.

(e) Each domain identified in (d) above shall address:

(1) The goals and measurable objectives to be achieved by the child and family;

(2) The time frames for completion of objectives; and

(3) The individualized interventions that will be used to address the objectives, including:

a. Identification of the staff or individual providing or implementing the stated intervention;

b. The frequency of the intervention; and

c. How that intervention is documented.

(f) The treatment plan shall include the date and signatures of the following team members, indicating that they participated in the process:

(1) The child;

(2) The child's parents or guardian(s);

(3) The prescribing practitioner; and

(4) The clinical coordinator or the SCP's program director. If the prescribing practitioner is also the clinical coordinator, he or she shall indicate dual functions.

(g) When any of the individuals in (f) above do not participate, the SCP shall document its efforts to involve them.

(h) Revisions to the treatment plan outside the scheduled treatment plan reviews shall include the signatures of the prescribing practitioner, clinical coordinators, and other team members identified in (f) above, as available, and shall be explained in writing to any individuals of the team who are unable to participate.

(i) The treatment team and the staff of the SCP shall implement the treatment plan, which shall be reflected in the child's daily routine, logs, progress notes, and discharge summary.

(j) The treatment team shall consist of the individuals identified in (f) above in addition to the following invited participants:

(1) Clinical staff of the SCP;

(2) Attorney or guardian ad litem (GAL) for the child;

(3) A representative of the local educational agency when clinically appropriate;

(4) Other persons significant in the child's life if clinically appropriate, including but not limited to:

a. Teachers;

b. Staff members from the SCP;

c. Counselors;

d. Friends;

e. Relatives; and

f. Educational surrogate.

(k) The treatment plan shall be filed in the child's record and copies provided to the individuals identified in (f) above.

(l) During each treatment team meeting, the treatment team shall review and update the treatment plan as necessary, in accordance with the following:

(1) Three months from the initial treatment plan; and

(2) Every 3 months thereafter until discharge, at no point exceeding 3 months.

(m) Changes and updates to the treatment plan shall be made based on progress identified by the treatment team, areas of continued treatment needs, achievement of goals or objectives, and effectiveness of interventions, in accordance with the requirements of (f) through (l) above.

(n) SCPs shall acquire signatures on the treatment plans of individuals identified in (f) above within 7 calendar days of the treatment team meeting, such that:

(1) Reasonable efforts to obtain the signature of the parent(s)/guardian(s) and DCYF shall be documented as meeting the requirements of (n); and

(2) Any team members participating through electronic means, other than the prescribing practitioner or clinical coordinator, may provide verbal assent in lieu of signature on the treatment plan but this shall not preclude efforts identified in (1) above.

(o) Once the treatment plan is complete, all clinical and direct care staff shall receive supervision and instruction to ensure that they consistently implement each child's treatment plan.

(p) All residential treatment programs shall provide and coordinate services and treatment interventions to meet the goals identified in the treatment plan, as follows:

(1) Treatment interventions shall meet the individual needs of the children and families in therapeutic and group-living experiences;

(2) Treatment programs shall include individual/group problem solving and decision-making;

(3) The clinical coordinator shall ensure therapeutic interventions and other services are implemented and integrated into the treatment programming for the individual child and family;

(4) Services required by the treatment plan including individual, group, and family counseling to children shall be available within the SCP or shall be referred to community agencies depending on the need of the child and family; and

(5) Direct care staff that provides group counseling shall receive supervision from clinical staff.

(q) Services required by the treatment plan, including counseling of children and families, shall be available within the SCP or shall be provided through the local community, as follows:

(1) Treatment plans shall provide and allow for increased community-based integration and involvement, based on progress and individualized needs; and

(2) The clinical coordinator or another staff member who meets the requirements of clinical staff may provide individual or family counseling;

(r) The program shall maintain a multi-disciplinary, self-contained means of service delivery to meet the needs identified within the treatment plan, as follows:

(1) There shall be a clinical staff to child ratio of one clinical staff to 10 children;

(2) There shall be clinical services provided through the residential treatment program's on-site program unless a special circumstance is identified through the treatment plan to support utilizing a community provider;

(3) Clinical staff shall provide treatment interventions to meet the individual needs of the children and families served and shall provide a therapeutic group-living experience;

(4) Unless otherwise specified in the child's treatment plan, any combination of individual, group, or family counseling services shall be provided to each child or the family a minimum of 3 times a week;

(5) There shall be a family-centered services component designed to promote and provide opportunities for families to be involved in all aspects of their child's care, including, but not limited to:

a. Activities designed to promote permanency and support continued family involvement throughout placement;

b. Services that promote family involvement and partnership in a therapeutic process from intake to discharge, which supports the identified permanency plan;

c. Implementation of the reasonable and prudent parent standard by staff including a description of how the program will identify and support normal age and developmental experiences including social, extracurricular, enrichment, and cultural activities in the community;

d. Whenever possible, activities in the family's home at the family's convenience, and other services to support the identified permanency plan;

e. Parental education, as needed to support the child and family's permanency, safety, and well-being;

f. Communication that includes the family in the program's initial orientation process and ongoing activities; and

g. The program's grievance procedures, which shall ensure that children may constructively address their concerns without fear of retaliation; and

(6) The residential treatment program shall organize its clinical staff and family workers in a flexible manner so long as families are seen face-to-face no less than one time per week, unless otherwise specified in the child's treatment plan, as follows:

a. Technology may be used to supplement clinical services as a part of the child's treatment; and

b. The utilization of a video-conferencing technology shall not replace face-to-face contact unless documented in the child's treatment plan with the agreement of the treatment team;

(s) The program shall be staff-secure and be able to serve those children whose needs require a high level of treatment and supervision, as follows:

(1) There shall be a minimum staff to child ratio of one staff to 4 children during hours when children are awake; and

(2) Except for residential treatment programs that have an independent living component housed in a separate area and have the capability of moving children that need more supervision back to the intensive care level, there shall be an awake staff member in each building housing children.

N.H. Admin. Code § He-C 4001.30

Derived from Volume XLI Number 06, Filed February 11, 2021, Proposed by #13151, Effective 12/30/2020, Expires 12/30/2020.