Administrative Review Division (ARD)

Rules governing QRTPS are still pending, so guidance available now may be revised in the future. Email pauline.hoekstra@state.co.us with questions about licensing.

Andrew Gabor at andrew.gabor@state.co.us.

The information in this section was developed by the Colorado Department of Human Services and the Colorado Human Services Directors Association for Colorado's Family First Implementation Guide for County Directors.

using the best availablescience, to maximize physical and psychological safety, facilitate the recovery of thechild and family, and support their ability to thrive.”

immediate & ongoing data-driven case planning Moving away from always least restrictive to matching

n the short-term, OBH guidance allows for virtual visits for the next calendar year, whileencouraging face-to-face visits whenever possible

take advanced Family First andtrauma-informed care trainings.

he entire assessment process fromthe time of referral to the completed assessment summary is completed within 14 days. Ideallythe process should be completed before placement, but it must be completed within 10 businessdays of placement if that’s not possible.

Effective residential treatment programs provide:

Residential treatment programs provide intensive help for youth with serious emotional and behavior problems. While receiving residential treatment, children temporarily live outside of their homes and in a facility where they can be supervised and monitored by trained staff.

• Make specific findings to deviate from the assessmentrequired in 19-1-115 (4)(h).• Make findings regarding why an alternative other thanQRTP does not meet the needs of the child/youth.• Lack of available placements cannot be a reason.• Make required findings:• QRTP provides the most effective appropriatelevel of care for the child/youth/juvenile in the leastrestrictive environment.• Consistent with the permanency plan (if set).• Consistent with the child/youth/juvenile’s short- andlong-term goals.• Set QRTP review prior to discharge date or no longerthan 90 days, see 19-1-115(4)(g)

The court shall give great weight to the recommendation in the independent assessment. If the Court deviates from the recommendations in the assessment, the Court shall make specific findings of fact set forth in 19-1-115 (4)(h)

Family First Prevention Services ActQualified Residential Treatment Program Bench Card

Reasonable CandidatesReasonable candidates for foster care, for the purposes of Title IV-E program, are childrendetermined to be at risk of imminent placement out of the home as defined in Section 19-1-103(64), C.R.S. Administrative costs may be claimed for children who are determined to be atimminent risk of removal from the home through a voluntary placement agreement or court-ordered custody with the county department. A determination must be made as to whether thechild is at imminent risk of removal from the home no less frequently than every six (6) months.Reasonable efforts shall be made to prevent the removal of the child from the home until suchtime that pursuing removal of the child from the home becomes necessary.

F. To be eligible for admission to a qualified residential treatment program (QRTP) the child must bedetermined to be appropriate for placement in a qrtp through the independent assesssmentprocess by a qualified individual in accordance with 19-1-115(4)(e)(i), c.r.s

7.424.21 REFERRAL AND ELIGIBILITY

When the child, juvenile, or youth has not been committed to the division of youth services and the court has ongoing jurisdiction,

If the court or administrative review division deviates from the qualified individual’s assessment and recommendation, the court or the administrative review division shall make specific findings of fact regarding the most effective, appropriate, and least restrictive placement for the child or youth and whether the placement is consistent with child- or youth-specific short- and long-term goals for the child or youth and the family. When making such findings of fact, the court or administrative review division shall consider all relevant information, including:(I) Whether the protocol for the qualified residential treatment program assessment was followed;(II) The strengths and specific treatment or service needs of the child or youth and the family;(III) The expected length of stay; and(IV) The placement preference of the child or youth and the family.

Question 1. May we claim Federal financial participation (FFP) for the administrative costs associated with foster care candidates even for children who never enter foster care? Answer Yes. Federal financial participation for administrative costs listed at 45 CFR 1356.60(c) may be claimed regardless of whether the child is actually placed in foster care and becomes a recipient of title IV-E foster care benefits. However, reimbursement is limited to those individuals the title IV-E agency reasonably views as candidates for title IV-E foster care maintenance payments consistent with section 472(i)(2) of the Social Security Act. The three acceptable methods of documentation indicating that a child is a candidate for title IV-E foster care benefits are: (1) A defined case plan which clearly indicates that, absent effective preventive services, foster care is the planned arrangement for the child, (2) an eligibility determination form which has been completed to establish the child's eligibility under title IV-E, or (3) evidence of court proceedings in relation to the removal of the child from the home, in the form of a petition to the court, a court order or a transcript of the court's proceedings. Should the title IV-E agency determine that the child is no longer a candidate for foster care at any point prior to the removal of the child from his home, subsequent activities will not be allowable for reimbursement of costs under title IV-E. Source/Date ACYF-CB-PA-87-05 (10/22/87); 7/7/2006; (12/17/2019) Legal and Related References Social Security Act - sections 471(a)(15), 472(i)(2), and 479B; DHHS Grant Appeals Board Decision No. 844; ACYF-CB-IM-06-02

By definition, a candidate is a child for whom the title IV-E agency is either pursuing or making reasonable efforts to prevent a remova

Question 2. At what point may a child be considered a candidate for foster care? Answer A candidate for foster care is a child who is at serious risk of removal from home as evidenced by the title IV-E agency either pursuing his/her removal from the home or making reasonable efforts to prevent such removal. The basis for determining when a child may be considered a candidate for foster care can be found in statute, Departmental policy, and Departmental Appeals Board (DAB) decisions: STATUTE: Section 471(a)(15)(B)(i) of the Act provides the frame of reference for determining the point at which a child becomes a candidate for foster care by requiring a title IV-E agency to make reasonable efforts to prevent a child's removal from home. A child may not be considered a candidate for foster care solely because the title IV-E agency is involved with the child and his/her family. In order for the child to be considered a candidate for foster care, the title IV-E agency's involvement with the child and family must be for the specific purpose of either removing the child from the home or satisfying the reasonable efforts requirement with regard to preventing removal. DEPARTMENTAL POLICY: Stipulates the three acceptable methods for documenting a child's candidacy for title IV-E foster maintenance payments. The existence of these forms of documentation indicates that a child legitimately may be considered a candidate for foster care: 1) A defined case plan which clearly indicates that, absent effective preventive services, foster care is the planned arrangement for the child. The decision to remove a child from home is a significant legal and practice issue that is not entered into lightly. Therefore, a case plan that sets foster care as the goal for the child absent effective preventive services is an indication that the child is at serious risk of removal from his/her home because the title IV-E agency believes that a plan of action is needed to prevent that removal. 2) An eligibility determination form which has been completed to establish the child's eligibility for title IV-E foster care maintenance payments. Completing the documentation to establish a child's title IV-E eligibility is an indication that the title IV-E agency is anticipating the child's entry into foster care and that s/he is at serious risk of removal from home. Eligibility forms used to document a child's candidacy for foster care should include evidence that the child is at serious risk of removal from home. Evidence of AFDC eligibility in and of itself is insufficient to establish a child's candidacy for foster care. 3) Evidence of court proceedings in relation to the removal of the child from the home, in the form of a petition to the court, a court order or a transcript of the court proceedings. Clearly, if the title IV-E agency has initiated court proceedings to effect the child's removal from home, s/he is at serious risk of removal from the home. DAB DECISIONS: DAB Decision No. 1428 offers the following guidance for identifying the point at which a child may be considered a candidate: "...The methods of documenting candidacy [identified in the Department's policy guidance] involve activities which occur at a point when the state has initiated efforts to actually remove a child from his or her home or at the point the state has made a decision that the child should be placed in foster care unless preventive services are effective..." The DAB also ruled in Decision No. 1428 that a report of child abuse or neglect is insufficient for establishing a child's candidacy for foster care: "...The fact that a child is the subject of [a child abuse/neglect report] falls far short of establishing that the child is at serious risk of placement in foster care and thus of becoming eligible for IV-E assistance..." A candidate, in the opinion of the DAB, is a child who is at serious risk of removal from his/her home because the title IV-E agency is either pursuing that removal or attempting to prevent it. A child cannot be considered a candidate for foster care when the title IV-E agency has no formal involvement with the child or simply because s/he has been described as "at risk" due to circumstances such as social/interpersonal problems or a dysfunctional home environment. Source/Date ACYF-CB-PA-01-02 (7/3/01); (12/17/2019) Legal and Related References Social Security Act - sections 471(a)(15), 472(i), and 479B; Departmental Appeals Board Decision No. 1428

FEDERAL DEFINITION OFCANDIDACYA “child who is a candidate for foster care” is defined asa child who is identified in a title IV-E prevention plan asbeing at imminent risk of entering foster care, but whocan remain safely in the child's home or in a kinshipplacement as long as the title IV-E prevention servicesthat are necessary to prevent the entry of the child intofoster care are provided”This includes a child whose adoption or guardianshiparrangement is at risk of a disruption or dissolution thatwould result in a foster care placement (section 475(13)of the Act).

Family Involvement & After Care•Family members will be involved in treatment

level of care assessment is intended to be collaborative with the family, identified family supports and all who may be providing services and supports to the youth/

assessment process, the caseworker must arrange a "Family and Permanency Team meeting”

placement provides the most effective level of care

COLORADO IMPLEMENTATIONCORE VALUES

FAMILY FIRST 101

QRTP Placement Requirement – Ongoing Review and Permanency Hearing Requirements:As long as a child remains placed in a QRTP, the title IV-E agency shall submit evidence at eachstatus review and each permanency hearing held for the child:• demonstrating that ongoing assessment of the strengths and needs of the child continuesto support the determination that the needs of the child cannot be met through placementin a foster family home, that the placement in a QRTP provides the most effective andappropriate level of care for the child in the least restrictive environment, and that theplacement is consistent with the short- and long-term goals for the child, as specified inthe permanency plan for the child;• documenting the specific treatment or service needs that will be met for the child in theplacement and the length of time the child is expected to need the treatment or services;and• documenting the efforts made by the agency to prepare the child to return home or to beplaced with a fit and willing relative, a legal guardian, or an adoptive parent, or in a fosterfamily home (section 475A(c)(4) of the Act)

Placement in a QRTP must be necessary, temporary and treatment-focused

3. Child and Adolescent Needs and Strengths (CANS)The department elected to use the Child and Adolescent Needs and Strengths functional assessmenttool, adapting as Minnesota’s QRTP Child and Adolescent Needs and Strengths functional assessmenttool.The CANS is a functional assessment tool developed by the Praed Foundation that informs QRTPassessments. QIs will interview children, parents, and consult with the family and permanency team andtribal representative to gather all pertinent information needed to complete the CANS and make arecommendation. The CANS is used at the end of this discovery or assessment process to organizeinformation collected. It will help QI understand and determine a child’s strengths and areas where theyneed support. The CANS reflects consensus from the entire group. It is not a diagnostic tool and doesnot make the final decision for a recommendation.According to the Praed Foundation, since the tool’s primary purpose is communication, the CANS isdesigned based on communication theory, rather than psychometric theories that influenced mostmeasurement development. The CANS is based on transformational collaborative outcomesmanagement theory. The decision-making process is a consensus and belief that parents and childrenknow their story. Administering the CANS is a story-telling process. Assessors bring together all of thestorytellers. The key principles of this tool come from Inuit tribal cultural worldview, also used in thewraparound model; it is the concept of expertise using a circle, talking things through, and reachingconsensus. Administration of the CANS is a discovery process leading to a decision to help. The tool firstensures understanding of cultural context before making decisions regarding what to do. This processdescribes a person, not how they are or are not using services.The CANS tool captures:• Narrative of a child’s story• Child and the family and permanency team’s perspectives• Explanations on how needs can warrant action• Ideas that it may also serve as an intervention unto itself• Use of language reflective of a child’s and families’ strengths.The Minnesota QRTP individualized assessment modules, depending on needs of individuals. Basic coreitems are rated for all children and youth:

(2) Within 60 days of the start of each place-ment in a qualified residential treatment pro-gram, a family or juvenile court or anothercourt (including a tribal court) of competentjurisdiction, or an administrative body ap-pointed or approved by the court, independ-ently, shall—(A) consider the assessment, determina-tion, and documentation made by the quali-fied individual conducting the assessmentunder paragraph (1);(B) determine whether the needs of thechild can be met through placement in a fos-ter family home or, if not, whether place-ment of the child in a qualified residentialtreatment program provides the most effec-tive and appropriate level of care for thechild in the least restrictive environmentand whether that placement is consistentwith the short- and long-term goals for thechild, as specified in the permanency planfor the child; and(C) approve or disapprove the placement

(h) In making a decision as to proper placement in a qualified residential treatment program, the court or the administrative review division shall consider the assessment provided by the qualified individual and the most recent assessment, as described in subsection (4)(e) of this section, and shall give great weight to the recommendation in the assessment when making a qualified residential treatment program placement decision. An assessment prepared by the qualified individual must identify whether a qualified residential treatment program is the most effective, appropriate, and least restrictive placement for the child or youth. The assessment must also identify child- or youth-specific short- and long-term goals for the child or youth and the family. If the court or administrative review division deviates from the qualified individual’s assessment and recommendation, the court or the administrative review division shall make specific findings of fact regarding the most effective, appropriate, and least restrictive placement for the child or youth and whether the placement is consistent with child- or youth-specific short- and long-term goals for the child or youth and the family. When making such findings of fact, the court or administrative review division shall consider all relevant information, including:(I) Whether the protocol for the qualified residential treatment program assessment was followed;(II) The strengths and specific treatment or service needs of the child or youth and the family;(III) The expected length of stay; and(IV) The placement preference of the child or youth and the family.

SEC. 202. ASSESSMENT AND DOCUMENTATION OF TH_ NEED FOR PLACEMENTIN A QUALIFIED RES- —_ IDENTIAL TREATMENT PROGRAM.

The quali-fied individual conducting the assessment, required

The qualified individual conducting the assessment, required under subparagraph (A) shall work in conjunction with the family of, and permanency team for, the child while conducting and making the assessment.

The family and permanency team shall consist of all appropriate biological family members, … as well as, as appropriate, professionals who are a resource to the
family of the child, such as teachers, medical or mental health providers who have treated the child, or clergy.

THE STATE SHALL document in the child’s case plan—
    (I) the reasonable and good faith effort of the State to identify and include all such individuals on the family of, and permanency team for, the child;

    (II) all contact information for member of the family and permanency team, as well as contact information for other family members and fictive kin who are not part of the family and permanency team;

    (III) EVIDENCE THAT MEETINGS of the family and permanency team, including meetings relating to the assessment required under subparagraph (A), are held at a time and place convenient for family

    (IV) if reunification is the goal, EVIDENCE demonstrating that the parent from whom the child was removed provided input on the members of the family and permanency team;

    (V) EVIDENCE that the assessment required under subparagraph (A) is determined in conjunction with the family and permanency team; and

    “(VI) [EVIDENCE^] the placement preferences of the family and permanency team relative to the assessment and, if the placement preferences of the family and permanency team and child are not the placement setting recommended by the qualified individual conducting the assessment under subparagraph (A), the reasons why the preferences of the team and of the child were not recommended.

‘“(C) In the case of a child who the qualified individual conducting the assessment under subparagraph (A) determines should not be placed in a foster family home, the qualified individual shall specify in writing the REASONS WHY THE NEEDS OF THE CHILD CANNOT BE MET BY THE FAMILY OF THE CHILD

determinewhether the needs of the—child can be met with family members

An Assessment Summary will be created at the end of the assessment and given to the referring party

A full psychosocial assessment:•Face to Face with child•Meets with family•Connects with collateral informants: schools, GALs, religious leaders, case workers, current/previous providers, DYS•Reviews documentation: hospital discharges, DYS assessments, school assessments, etc.•Attends Family and Permanency Meeting•Uses the Child and Adolescent Needs and Strengths (CANS) tool to help identify goals, guide decisions making•The Assessor must specify why the needs of the child cannot be met by the family of the child or in a foster family home or any other level of care•The lack of availability of a lower level of care is not a justification for QRTP services

Specialty: Qualified Residential Treatment Program (QRTP)Specialty Code: 689 Enrollment Type: Facility Each service location must complete a separate application. A QRTP cannot be enrolled as a Residential Child Care Facility (RCCF-provider type 52) at the same time. Required Attachments: Department of Human Services, Office of Early Childhood, Division of Early Care and Learning, Time Limited Child Care License indicating Service Type as: Qualified Residential Treatment Program. Accreditation by the Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, or Council on Accreditation of Services for Families and Children. Attestation Form for Facilities Enrolling with Health First Colorado (RCCF & QRTP), which can be found on the Provider Forms web page under the Provider Enrollment & Update Forms drop-down, must be completed and attached for in state only. W9 (signed and dated within the last 6 months). Voided business check (no temporary checks or deposit slips) or bank letter (dated within the last 6 months). Malpractice/Liability insurance information must be entered in the application; however, proof of insurance is not a required attachment.

For Dependency & Neglect Cases: The Court always conducts the initial review following placement. If all parties consent, subsequent reviews can be conducted by the ARD. The ARD’s first review in these cases would be prior to the 90th day of placement.  The ARD review considers the independent assessment, initial and ongoing CANS, clinical documentation, progress in treatment up to the date and all other relevant case information provided by the county to determine if QRTP placement is and continues to be the most appropriate level of

community. Access the analysis of residential providers’ transition plans, which shows the latest information on providers ready for QRTP approval that will be approved in Trails on October 1; providers that have submitted a complete application to become a QRTP and are close to approval; facilities pursuing a PRTF license; and facilities pursuing other options. CDHS Licensing is providing one on one coaching, transition planning and technical assistance to facilities that are applying to become a QRTP and/or need to adapt their business model.  Transition Funding: SB21-278 requires that CDHS assist residential placement providers in transitioning to models that are Title IV-E and medicaid eligible with Colorado Transition Act funding. About $1.1 million of the state’s transition funds were awarded in grants to providers.  Joint CDHS and HCPF Town Halls on Family First Providers cover up-to-date information on the following topics: Child placement rates for provider types; New rates for treatment and therapeutic foster care and age-based rates for standard foster care developed by the Foster Care Workgroup that will take effect July 1st; Identified QRTP needs and updated provider QRTP application process and information about aftercare services; HCPF rule clarification and implications; PRTF placement type and new rates; and Resources - where to find answers and how to get technical assistance. A recording of the June 3rd town hall can be accessed here. Notes for quick reference are also available to Directors on CHSDA’s site.

CDHS has developed a set of key strategies, based on stakeholder input, for rightsizing and refining the placement continuum. If there are no QRTP beds available when needed, county staff will need to find the next most appropriate, least-restrictive placement and treatment option until a QRTP placement becomes available.

The court must then “determine and approve” the QRTP placement within 60 days and find that the placement provides the most effective, least restrictive level of care, and is consistent with the permanency plan. If any party objects to QRTP placement or the independent assessment does not recommend QRTP level of care, the court hearing must be within 30 days of placement instead of 60. Judges, magistrates and other judicial system partners (Dependency and Neglect and Delinquency) have access to training on Colorado’s QRTP Benchcard and the independent assessment process. County directors also have access to QRTP Benchcard training specific to child welfare practice.

The independent assessment process includes a full psychosocial assessment (CANS), direct contact with the child or youth, family or caregivers, interviews with a variety of professionals, and a Family and Permanency meeting. An assessment summary will be created at the end of the assessment and given to the referring party. The summary will include level of care recommendations, clinical recommendations, history of services, time spent in a QRTP to date, if consensus was achieved during the Family and Permanency meeting, findings from the psychological assessment tool, and short- and long-term clinical goals. The Qualified Individual must specify why the needs of the child cannot be met by other levels of care. A lack of lower-level placement options is not a justification for QRTP placement.

ASOs will have access to Qualified Individuals in other regions and they are trying to share resources during this initial phase of implementation. If an ASO does not have available Qualified Individuals, they will need to inform OBH and DCW immediately so they can problem solve to ensure that the assessment is done within the timeframes. I

Contractually, ASOs are required to provide independent assessments in a timely manner.

The CDHS Office of Behavioral Health contracts with the Administrative Service Organization (ASO) in your region, who is then responsible for contracting directly with and hiring the Qualified Individual(s) needed and managing quality assurance. Qualified Individuals must be licensed behavioral health professionals, trained in the Child and Adolescent Needs and Strengths (CANS) tool and take advanced Family First and trauma-informed care trainings. As of October 1, 2021, the independent assessment process for all counties is up and running. ASOs continue to be concerned about Qualified Individual capacity, workforce shortages and waitlists.

Qualified Individual” means a trained professional or licensed clinician, as defined in the federal “Family First Prevention Services Act”. “Qualified Individual” must be approved to serve as a Qualified Individual according to the state plan. “Qualified Individual” must not be an interested party or participant in the juvenile court proceeding and must be free of any personal or business relationship that would cause a conflict of interest in evaluating the child, juvenile, or youth and making recommendations concerning the child’s, juvenile’s, or youth’s placement and therapeutic needs according to the federal Title IV-E state plan or any waiver in accordance with 42 U.S.C. sec. 675a

The entire assessment process from the time of referral to the completed assessment summary is completed within 14 days. Ideally the process should be completed before placement, but it must be completed within 10 business days of placement if that’s not possible. Federal funding for a child/youth/juvenile in QRTP placement is initially allowed for up to 30 days and then only allowed past that timeframe if the independent assessment determines that a QRTP is the appropriate level of care.

At that meeting, everyone will discuss treatment and care goals and determine if QRTP is the level of treatment required. This recommendation as well as the Independent Assessment will be presented to a judicial officer who will make the final determination

Counties will notify family members, children and youth about the process and will schedule a family and permanency meeting within eight days of the referral for an Independent Assessment to bring all concerned parties together. During those eight days, the Independent Assessment will be completed.

The Independent Assessment is used to develop a shared treatment and care plan

The Independent Assessment is completed by a licensed behavioral health professional who completes a full psychosocial assessment, reviews all provided documentation, meets with the child or youth, speaks with a wide variety of individuals, and has completed a robust set of training. The CANS tool is used after the psychosocial assessment to help the behavioral health professional identify key needs and strengths with the family and child or youth. The CANS tool is also used to frame the assessment in a measurable way and to work with all parties involved to gain a consensus of the needs and strengths

Qualified Individuals are licensed behavioral health professionals who have advanced training in trauma, cultural considerations, Family First requirements and the placement continuum, and are contracted directly with the Administrative Service Organizations and overseen by the CDHS Office of Behavioral Health. The Qualified Individuals will be completing the Independent Assessment.

Once a county or the Division of Youth Services (DYS) determines a child or youth may benefit from treatment at a QRTP, the county will make a referral for an Independent Assessment. The Colorado Department of Human Services has contracted with the regional Administrative Services Organizations (ASOs) to implement the Independent Assessor process in Colorado

months and a youth 13 or older is in care for 12 consecutive or 18 non-consecutive months.These ongoing oversight requirements exist to ensure that children are in a QRTP only as long asis necessary to meet their treatment needs. The level of acuity of care that a QRTP offers isdesigned to serve as an intensive and time-limited intervention, not a long-term placement.Evidence demonstrates that children fare best in families,

Is there no limit on QRTP placement length if the placement is continuallyassessed and confirmed by the court and approved by HHS at the appropriateintervals?While Family First does not create a hard deadline for moving children out of a QRTP

Title IV-E eligible children must receive an assessment within 30 days of placement in a QRTP.The Children’s Bureau has indicated that the 30-day timeline begins when a child enters aQRTP

If a child moves from one QRTP program to another, will a new 30-dayassessment/60-day court review be required?Yes. The assessment and court review process apply to each QRTP setting in which ajurisdiction places a child. [§475A(c)(1)(A); P.L. 115-123 §50742]

Family First requires a QRTP to provide discharge planning and family-based aftercare supportfor at least six months post-discharge.

How is the child’s family involved in assessment process?Family First requires that, as part of the assessment to determine whether a QRTP is anappropriate setting for a child, the Title IV-E agency work to convene a family and permanencyteam to provide input on the process of determining the most appropriate and least restrictiveenvironment for the child. The purpose of this team is to ensure that those adults closest to achild and who best know the child’s needs can share their perspectives as part of the process ofdetermining the most appropriate setting for the child. A family and permanency team mustconsist of all of a child’s appropriate birth family members, relatives, and other individuals whohave an emotionally significant relationship with the child but are unrelated by birth or marriage,known as fictive kin. The team must also include, as appropriate, professionals who are aresource to the child’s family, including teachers, medical or mental health providers who havetreated the child, or clergy. The team’s role is to provide input during the assessment process,particularly during the determination of whether a child’s needs can be met with family membersor in a foster family home, or if not, what type of non-family setting is appropriate to meet theirneeds. The team also helps to develop a list of child-specific short- and long-term mental andbehavioral health goals. To ensure the voice and perspective of youth is a part of this process, forchildren 14 and older, the team must include individuals that the young person selects from theirpermanency planning team as required by Sec. 475(5)(C)(iv). This youth engagement practicebuilds upon pre-existing policies in federal law that promote youth engagement (See Youthengagement in case plans - what Federal Law Requires). The qualified individual conducting theassessment will work with the family and permanency team when making the assessment.[§475A(c)(1)(B)(i); P.L. 115-123 §50742

What happens if a jurisdiction places a child in a QRTP, but the assessmentdetermines that is not an appropriate setting for them?Title IV-E FCMPs may continue for no longer than 30 days following a determination that theplacement is no longer recommended or approved for that child.

Are there requirements that the Title IV-E agency document how it engaged thefamily in the assessment process?Family First requires that a child’s case plan include documentation on how to contact the familyand permanency team members, as well as evidence that the meetings are held at times andplaces convenient to the family. If a child’s assessment outcome is different than the wishes of

the family and permanency team, the case plan must also outline why the assessment does notrecommend those preferences. [§475A(c)(1)(B)(iii)(VII); P.L. 115-123 §50742]

As part of the QRTP model, Family First creates a new process for ensuring that a Title IV-Eeligible child needs the level of treatment intervention that a QRTP offers. Within 30 days ofentering a QRTP, a child must receive an assessment from a qualified individual using anappropriate functional assessment tool to determine whether they need care in a QRTP andwhether that particular QRTP can meet their specific treatment needs. The purpose of thisprocess is to acknowledge that QRTPs are a treatment intervention, and that through the processof specialization, not every QRTP will be appropriate for each child’s specific needs

Effective training of assessment professionals in child development, childtrauma, and the types of particular QRTPs and how they meet the needs of individual childrenwill be essential to the effective implementation of this aspect of Family First.

What if our jurisdiction does not have anyone available who meets the qualifiedindividual criteria?There is a process for Title IV-E agencies to obtain from the HHS Secretary a waiver from therequirement that a qualified individual conduct the assessment. Title IV-E agencies must submitdocumentation to the HHS Secretary certifying that trained professionals or licensed cliniciansconducting these assessments shall maintain objectivity in determining the most effective andappropriate placement for a child. This certification process is required to prevent conflicts ofinterest in placing children in QRTPs

What organizations can accredit a QRTP?A QRTP can receive accreditation from the Joint Commission on Accreditation of HealthcareOrganizations, the Commission on Accreditation of Rehabilitation Facilities, or the Council onAccreditation. The HHS Secretary may also choose to approve other independent, not-for-profitaccrediting bodies. [§472(k)(4)(G); P.L. 115-123 §50741]