Residential Treatment Facilities Overview

1. Residential Treatment FacilitiesOverview June 28, 2006

2. At-a-Glance—RTF Funding and Children Served Fee-for-Service • In FY 2000-01, $56.4 million was spent on RTF services • A total of 1,588 children received RTF services HealthChoices • In calendar year 2000, $55.9 million in HC was spent on RTF services • $28.3 million in HC spent for CISC for RTF services • A total of 1,701 children received RTF services, of which 824 were CISC

3. RTF Funding continued • In HealthChoices in CY 2004 Total $115,184,693 spent on RTF care In Fee for Service in CY 2003 Total $58,986,182

4. Historical Background • Scott Lawsuit • Lawrence K. Settlement • Medicaid (Medical Assistance) • Accreditation / Non-Accreditation distinction • Cross system Licensing and approval process

5. Current Picture • In-State—138 MA enrolled RTFs (96 Accredited and 42 Non-Accredited) • Bed capacity of 4,751

6. RTFs Vary in Scope and Size • Locally based providers • Larger statewide providers • Some RTFs admit out of state residents

7. Current RTF Provider Requirements • RTF must be licensed by OCYF (Chapter 3800 regulations) • RTF must be enrolled as a MA provider (MA Bulletins 01-93-04 and 1157-95-01) • RTF must meet the DPWs Interim Guidelines for RTFs (Attachment 4 to above Bulletins) • Adhere to CASSP Principles for Children’s Services (Attachment 5) • RTF must submit rate setting information to OMAP for the establishment of a payment rate

8. OMHSAS RTF Approval Procedures • Initial Contact coordinated with OCYF Regional Office • Service description (outlined in Interim Guideline 1) demonstrating the provider’s ability to meet needs of children with severe/persistent psychiatric disability must be submitted to OMHSAS regional Field Office • Population to be served/number, characteristics • Goals, objectives and outcomes of the program

9. OMHSAS RTF Approval Procedures (continued) • Specific ways (mechanisms) needs are addressed • Specific disciplines/procedures to meet the needs of the population related to the overall goals and services of the program • Types and amounts of services the program will provide (staffing levels/clinical services) • Provider is held accountable to implementing the approved service description

10. OMHSAS RTF Approval Procedures (continued) • Each Field Office has children’s MH Program Reps designated to review RTF • OMHSAS lead team conducts on-site visit using Interim Guidelines as measure • Team may include representatives from Regional OCYF, OMAP, a family member, and CASSP Coordinator and OMHSAS regional psychiatric consultant • Treatment Record Requirements (Interim Guideline 2) • Staff Credentials (Interim Guideline 3)

11. OMHSAS RTF Approval Procedures (continued) • Entitlements (Interim Guideline 4) • Medical director (Interim Guideline 5) • Information to family re: Advocacy Groups (Interim Guideline 6) • Individualized Treatment Plans/ Educational Services (Interim Guidelines 7)

12. OMHSAS RTF Approval Procedures (continued) • Treatment Plan Reviews (Interim Guideline 8) • Educational Placement (Interim Guideline 9) • Additional Services (Interim Guideline 10) • Physical Plant (Interim Guideline 11) • Visitation cannot be limited for disciplinary reasons (Interim Guideline 12) • Restrictive Procedures (Interim Guideline 13) • Transfer to Higher Level of Care (Interim Guideline 14)

13. OMHSAS RTF Approval Procedures (continued) • Survey Report sent to the provider outlining areas of the Guidelines not met • Provider responds in writing with their plan for correction or improvement • OMHSAS FO sends a letter to the provider outlining that the facility has been certified under the MA Bulletin • Annual Recertification Process

14. Timeframes • Timeframes for approval—Approximately 3-6 months • Issues that impact timeframe • Zoning/Labor and Industry Approval • Agreement for Educational Services • Provider ability to comply with Interim Guidelines • New providers to PA unfamiliar with system

15. Residential Treatment Facilities Survey Report Form • Service Description • Philosophy of the program • Population served • Goals, objectives, and expected outcomes of the program. • Mechanisms by which the needs of persons with multiple disorders or disabilities are addressed. • Specific disciplines and procedures to support interdisciplinary team interaction. • Types and amounts of services the program will provide to the children.

16. Residential Treatment Facilities Survey Report Form- Continued • Treatment Record • Strengths of the individual • Presenting problems • History of previous mental health service • Medical history and status • Diagnosis • Mental status • Emotional and behavioral functioning • Social history • Drug-use profile, if applicable • Role of the family within the development process

17. Residential Treatment Facilities Survey Report Form- Continued • Staff Credentials • Entitlements • Medical Director • Coordinates and advises on medical matters • Trained/experience in dealing with the needs of children and adolescents with MH service needs • Provides direction/consultation • Information on Advocacy Groups • Treatment Plans and Educational Services

18. Residential Treatment Facilities Survey Report Form- Continued • Treatment Plan Reviews • Educational Placement • Services (case management, partial hospitalization, outpatient therapy services etc…) • Physical Plant • Visitation • Transfer to a higher level of care • Restrictive Procedure/Seclusion (OMHSAS Bulletin 02-01/ACT) • Policies meet the federal and state requirements and are consistent with the Special Transmittal.

19. Alternatives to Coercive Techniques (ACT) • Special Transmittal • Core Strategies • Leadership toward Organizational Change • Use of Data to Inform Change • Workforce Development • Use of Seclusion/Restraint Reduction Tools • Child and Family Roles • Debriefing Techniques