DRAFT-Special Population CoC Network SOO 10.17.pdf

ATTACHMENT 1 - STATEMENT OF OBJECTIVES

U.S. Department of Health and Human Services (HHS) Administration for Children and Families (ACF)

Office of Refugee Resettlement (ORR) Unaccompanied Children (UC)

Special Population Continuum of Care (CoC) Network

October 16, 2024

DRAFT

Document Revision History

Mod.

No.

Description of Changes Requested

By Approved

By Date

00 Base

[Note: The document revision history is most useful for tracking changes in a major acquisition.

It may not be needed for less complex acquisitions. Pre-award, it can be used internally by the agency to track the origin of and/or changes to specific requirements (not included in the solicitation when released). Post-award, it can be used to provide a centralized list of changes incorporated by modification.]

Table of Contents

1.0 Purpose

2.0 Background

3.0 Scope

4.0 Performance objectives (required results)

5.0 Type of Contract Contemplated

6.0 Period of Performance

7.0 Place of Performance

8.0 U.S. Holidays and Other Government Closures……...……………………………………...21

9.0 Government information……………………………………………………………………..22

10.0 Government property/equipment

11.0 Required nongovernment information/documents

12.0 Other addenda

13.0 Contractor-Provided Draft Quality Control Plan (if applicable)

14.0 Meetings

15.0 Glossary of Abbreviations and Acronyms (if not provided elsewhere)

Statement of Objectives (SOO) for the

Office of Refugee Resettlement (ORR) Unaccompanied Children (UC)

Special Population Continuum of Care (CoC) Network

1.0 Purpose

The purpose of this contract is to develop region-wide local network Continuums of Care (COC) for unaccompanied children who meet special population criteria, by connecting licensed and accredited care providers experienced with serving special population youth. The COC for special population unaccompanied children includes care for those unaccompanied children who meet criteria for Secure Care, Diagnostic Center (DC) Care, Psychiatric Residential Treatment Facility (PRTF) Care, Partial Hospitalization Program, Residential Treatment Center (RTC) Care, Therapeutic Group Home (TGH) Care, and Heightened Supervision Facility (HSF) Care, Care. When referencing region-wide local network, the ORR expectation is for the contractor to identify a strong community of care providers, inclusive of a sufficient number of providers for each level of special population care, to be located within a cohesive geographic area or region.

In-network care provider facility locations shall be conducive to serving as access to the full continuum of necessary immediate needs or transfers between levels of care for unaccompanied children placed in the contractor’s physical care. The continuum of care design may be located on a same campus and operated by one or more care provider organizations; or the continuum of care may be located within a prescribed geographic area conducive to connecting a network of care provider organizations to make up the continuum of care. The contractor shall describe and explain the proposed design and strategy to deliver a continuum of special population care and how the design and strategy for their described network of licensed and accredited care and services will ensure industry best practices; and timely admissions, diagnostics, transfers between levels of care as may be clinically necessary, discharges and family unifications. The cohesive geographical area or region designed should take into consideration locations of the different in-network levels of care facilities, if not located on one campus. It should take into consideration and describe the strategy for admissions and convenience of distances when there is a clinical need for unaccompanied children to be transferred within the network of care.

Given the arrival of unaccompanied children to the US is not pre-determined and the quantity of beds per levels of care are unpredictable, the contractor shall leverage known network management strategies to maintain a program structure and approach for a proposed number of beds which represent and provide a full scope of special population placements as described in this SOO. In addition, the contractor shall utilize recognized network management strategies to develop and maintain an ability to ramp up additional placements per levels of care in the event of surges, and upon the government’s need for additional special population placements along the COC.

The number of proposed beds for each level of care are expected to be available for admission of the minimum number of unaccompanied children within 30 days of award. In cases where new facilities are being secured and prepared to meet this requirement and require ramp up time for construction, major renovations or upfitting, program approaches shall include facility and location justifications and corresponding budgets and reasonable timelines with milestones for consideration to be negotiated.

2.0 Background

On March 1, 2003, Section 462 of the Homeland Security Act of 2002, transferred responsibilities for the care and placement of unaccompanied alien children from the Commissioner of the Immigration and Naturalization Service to the Director of the ORR. Since then, ORR has cared for more than 560,000 children, incorporating child welfare values as well as the principles and provisions established by the Flores Settlement Agreement in 1997, the Trafficking Victims Protection Act of 2000 and its reauthorization acts, the William Wilberforce Trafficking Victims Protection Reauthorization Act (TVPRA) of 2005 and 2008.

Unaccompanied children apprehended by the Department of Homeland Security (DHS) immigration officials are transferred to the care and custody of ORR. ORR promptly places unaccompanied children in the least restrictive setting that is in the best interest of the child, taking into consideration danger to self, danger to the community, and risk of flight. ORR takes into consideration the unique nature of each child’s situation and incorporates child welfare principles when making placement, clinical, case management, and release decisions that are in the best interest of the child. Following apprehension by a federal agency (usually the DHS), unaccompanied children are transferred to the care and custody of ORR while awaiting immigration proceedings.

The mission of ORR is to develop up-to-three region-wide local network Continuums of Care (COC) for unaccompanied children who meet special population criteria, by connecting licensed, high quality care providers experienced with serving special population youth. Given the arrival of unaccompanied children to the United States (US) is not pre-determined and the quantity and type of bed requirements for unaccompanied children in ORR custody is unpredictable, the contractor shall maintain a program structure and approach for having a full scope of special population placements available for unaccompanied children upon contract award and maintain a mainstay-capacity with ability to ramp up additional placements in the event of surges, and upon the government’s need for additional special population placements along the COC.

Further, innovative proposals shall include research-based best practices and employ clinical strategies to deliver high quality care for special population levels of care. Design strategies employ industry best practices for delivery of high-quality care and services; the Contractor’s proposal shall be designed with management strategies to comply with a no reject and no eject policy. This means, the Contractor cannot refuse to accept a child referred by ORR for a level of special population placement and care and accommodate 100% timely admissions, diagnostics, transfers to higher or lower levels of care pending needs of children, and discharges and family unifications.

CONSTRAINTS

Base Year Bed Capacity Constraints:

For consideration of funding, Offerors shall propose a minimum number of special population levels of care within their continuum of care network; and shall not exceed the maximum number of special population levels of care as provided in table 1.

Table 1 – Base Year Bed Capacity Constraints

Level of Care Minimum

Bed Capacities

Maximum Bed

Capacities

Secure Care Number of Beds Average length of stay 72 days 5 30

Diagnostic Center Number of Beds, Average Stay 30 days MAX 10 50

Psychiatric Residential Treatment Facility Number of Beds, Average length of stay 72 days

10 30

Residential Treatment Center Number of Beds, Average length of stay 72 days

10 70

Staff Secure Care Number of Beds, Average length of stay 72 days

35 140

Therapeutic Group Home Number of Beds, *Not considered restrictive but required therapeutic part of CoC Average length of stay 72 days

8 30

Partial Hospitalization Program (Number of Applications), *Therapeutic resource assistance to support remaining in least restrictive care Average Application 21 days

15 50

If not all planned special population levels of care and corresponding numbers of beds will be available within 30 days from contract award; Offerors shall have the minimum number of proposed special population beds (See Table 1) available within 30 days from contract award and provide an explanation and timeline for any remaining number of special population level of care beds planned as part of their in-network continuum of care. The Offeror’s plan for bed availability and any phase-in plan shall be included in their proposal.

Offerors shall submit in an addendum (not as part of page limits) legal address of all care provider facilities intended to be part of the in-network continuum of care, along with copies of current licenses and accreditations, commitment letters for care providers and/or notice of pending license or accreditation if proposing brand new or additional facilities as part of the proposed in-network continuum of care. Offerors shall also provide any other evidence of capacity to start accepting admissions within 30 days of contract award. Note: This does not disqualify Offerors who may have a number of new care provider facilities newly started that are awaiting a new license and accreditation; but Offerors must provide evidence and timeline for any new facilities being set up or recruited as part of their proposed in-network continuum of care.

ORR reserves the right to schedule on-site visits to Offeror care provider facilities to validate preparedness and continuums of care described in their proposal. Further, ORR reserves the right to conduct post-award on-site visits prior to placing unaccompanied children with the contractor's CoC network care providers.

Minimum Comprehensive Services The minimum comprehensive services provided in Appendix 35 Comprehensive Services shall be included in the daily occupancy rates.

General Facility Requirements The contractor shall comply with the General Facility requirements identified in the Appendix 36.

Settlement Agreements:

Flores Settlement Agreement (FSA) (Appendix 1) outlines protections for immigrant children while in U.S. custody and it is applicable to all ORR approved in-network care providers with physical custody who will be providing care for ORR unaccompanied children; this includes the contractor and any direct care provider sub-contractors and partner agencies who will be providing physical care and services to unaccompanied children. FSA imposes substantive requirements for Government custody of unaccompanied children, including requiring that children be placed in the “least restrictive setting appropriate to the minor’s age and special needs. FSA remains in effect during the lifetime of this contract. (Appendix 1)

Consolidated Appropriations Act, 2024 Pub. L. 118 – 47 (sections 230-234) (Appendix 2)

UC Program Foundational Rule (effective June 30, 2024) 45 C.F.R. 410 Standards to Prevent, Detect, and Respond to Sexual Abuse and Sexual Harassment Involving Unaccompanied Children Interim Final Rule (2014), 45 C.F.R. 411 (Appendix 3)

Lucas R. Settlement Agreements provides new resources and protections by expanding the rights of three classes of unaccompanied children in immigration custody: youth with disabilities

(Appendix 5); youth prescribed psychotropic medication (Appendix 6); and youth who seek assistance of legal counsel (Appendix 7). Full compliance with Lucas R. Settlement agreement remains in effect during the lifetime of this contract.

The Prison Rape Elimination Act (PREA) provides protections via Department of Justice (DOJ) National Standards to Prevent, Detect, and Respond to Prison Rape. This Task Order must have a well-thought out and developed plan with protocols and mechanisms for monitoring to ensure the health and safety of unaccompanied children in care and compliance with all in-network care facilities fully comply with PREA. (Appendix 8)

William Wilberforce Trafficking Victims Protection Reauthorization Act (TVPRA) (2008), as amended, 8 U.S.C. 1232 expanded and redefined HHS’s statutory responsibilities. Congress directed that each child must “be promptly placed in the least restrictive setting that is in the best interest of the child,” subject to considerations of whether the child is a danger to self or others.

See 8 U.S.C. § 1232(c)(2); it further enforces policies and standards of care to ensure unaccompanied children in the United States are protected from traffickers and other persons seeking to victimize or otherwise engage such children in criminal, harmful, or exploitative activity. The TVPRA describes requirements with respect to safe and secure placements for unaccompanied children, safety, and suitability assessments of potential sponsors for unaccompanied children, legal orientation presentations, access to counsel, and child advocates, among other requirements. (Appendix 9)

Homeland Security Act (2002), 6 U.S.C. 279 Under the Homeland Security Act of 2002, Congress transferred the care and custody of unaccompanied children to ORR from the former Immigration and Naturalization Service (INS) to move away from the adult detention model.

(Appendix 10).

Americans with Disabilities Act (ADA) and section 504 of the Rehabilitation Act of 1973, as amended (Appendix 12). Section 504, Rehabilitation Act of 1973 (Appendix 11)

IDEA is the Individuals with Disabilities Education Act is the federal law that supports Special Education in every state and requires public education programs to provide services to students with disabilities to meet their unique and individual educational needs; and services to support their learning needs. IDEA law requires that students with disabilities be taught with their non-disabled peers when appropriate and possible. The closest they can get to being in a typical classroom is called the “least restrictive environment,” or LRE. The most restrictive environment is a specialized school or hospital-based setting. (Appendix 13).

Government Expectation of Region-wide local CoC network. The Government’s expectation is for the contractor to identify a strong community of licensed and accredited care providers, inclusive of a sufficient number of providers for each level of special population care, to be located within in a cohesive geographic area or region. In-network care provider facility locations shall be conducive to local access to the full continuum of care to accommodate same day transfers between levels of care for unaccompanied children placed in the contractor’s physical custody and care.

It is anticipated interested care provider and network management organizations are licensed and accredited and currently operate programs serving domestic youth. There is no government expectation of a requirement for offerors to have facilities utilized only for the care of unaccompanied children under this requirement, or that facilities and services be separate and apart from their currently operating special population levels of care. With this, the continuum of care design may be located on one campus and operated by one or more care provider organizations on the one campus. Or a continuum of care may be located within a prescribed geographic area conducive to a network of multiple and different care provider organizations who will form a CoC community of practice, and leverage resources. The contractor shall fully describe the proposed design and strategy to deliver a continuum of care and how their in-network care providers will ensure industry best practices and collectively provide for the availability of the total number of proposed beds for each special population level of care; in addition, operate in licensed and accredited facilities and in full compliance with ORR governing legislation, including UC policies. This includes, but isn’t limited to, 100% timely admissions, diagnostics, case management, transfers (when clinically determined) within the continuum and throughout the ORR network, and safe and timely family unifications and other types of discharges. The cohesive geographic area or region designed should take into consideration locations of the different in-network levels of care facilities, if not located on one campus.

Additionally, it should describe the strategy for admissions and convenience of distances when there is a clinical need for an unaccompanied child to be transferred within the network of care.

A contractor’s continuum of care is required to accept referrals and conduct admission of new unaccompanied children and transfers of unaccompanied children to new levels of care seven (7) days a week, 365 days a year (including weekends and all Federal Holidays). The full scope of comprehensive services shall be provided 365 days a year, and new placements and transfers must be admitted within 72 hours upon notification from ORR Federal Field Specialists. With this, contractors shall ensure facilities are administered and operated by qualified licensed medical professionals, certified mental and behavioral health care specialists, and dedicated trained direct care staff, 24 hours a day, 7 days a week, 365 days a year (including weekends and all Federal Holidays).

Contractor CoC Network Management:

Each contractor shall be responsible to ensure residential care facilities are licensed in their respective states for each level of care provided, have received a full inspection by their state licensing, have been approved to accept unaccompanied children, and have the appropriate infrastructure, (Generators, emergency systems etc.) to keep unaccompanied children safe.

All in-network care providers must comply with all applicable State child welfare laws and regulations (such as mandatory reporting of abuse) and all State and local building, fire, health, and safety codes.

All facilities must be accredited by the Joint Commission or equivalent agency (i.e., Council on Accreditation, etc.) and in compliance with all licensing and professional accreditation requirements; and with all applicable federal, state, and local residential facility requirements for respective levels of care.

All in-network care providers must deliver services in a manner that is sensitive to the age, culture, native language, and needs of each child. Care providers must develop an individual service plan for the care of each child. All in-network care providers are also required to maintain records of case files and make regular reports to ORR. Care providers must have accountability systems in place which preserve the confidentiality of client information and protect the records from unauthorized use or disclosure (See Section 5.9.1 Requirement to Inform Children of Limits to Confidentiality, (Appendix 15-5 ORR UC Bureau Policy Guide_ Section 5).

ORR’s zero tolerance regulation and policy against all forms of sexual abuse, sexual harassment, and inappropriate sexual behavior; and measures ORR care provider compliance with the Standards to Prevent, Detect, and Respond to Sexual Abuse and Sexual Harassment involving HHS’ Interim Final Rule and ORR’s relevant policies and procedures. The Office of Refugee Resettlement published an interim final rule (IFR) that set forth standards to prevent, detect, and respond to sexual abuse and sexual harassment involving UC at ORR care providers (45 CFR Part 411) (Appendix 14). The IFR requires care providers to undergo an audit by an external auditor once every three years to determine compliance with the IFR standards and ORR’s prevention of sexual abuse policies and procedures.

In-network care provider facility locations shall be conducive to serving as access to the full continuum of necessary immediate needs or transfers between levels of care for unaccompanied children placed in the contractor’s physical care; and shall employ No Reject & Eject Policy.

The contract shall prohibit contractors from denying a referral and admission of an unaccompanied youth in ORR custody who requires placement in the ORR funded continuum of care for special population care. Further, the contract shall prohibit contractors from terminating a placement of an unaccompanied youth placed in their care so long as the unaccompanied youth’s assessed treatment needs are in alignment with the residential type of placement

3.0 Scope

The contractor shall propose an innovative approach incorporating evidence-based network management strategies for complex care coordination of unaccompanied children in ORR custody who meet criteria for special population levels of care. The contractor’s solution shall include an approach to licensed and accredited residential care and services for at least the minimum number of beds for each of the specialized levels of care as provided in the Table 1 – Base Year Bed Capacity Constraints (Constraints). Network management strategies shall be leveraged to ensure on-going availability of the Offeror’s proposed number of beds and include a fiscally efficient strategy to accommodate for the unpredictable and often fluctuating numbers of unaccompanied children who meet the criteria for a special population level of care; as well as in the event of a surge in the number of unaccompanied children who require a special population level of care.

Unaccompanied children arrive from diverse backgrounds, and of all ages with unique and individual needs. It is not uncommon for unaccompanied children to have experienced trauma in their country of origin or while traveling to enter the United States. Some unaccompanied children meet certain criteria that requires placement in care that can address their unique and individual challenges, including a criminal history and mental or behavioral health needs. ORR takes into consideration the unique nature of each child’s situation and incorporates child welfare principles when making placement, clinical, case management, and release decisions. While determining least restrictive care settings, ORR takes into consideration other factors including whether a child is a danger to themselves or other unaccompanied children, danger to others or danger to the community, and whether there is a risk the minor child may try to flee or runaway from ORR custody. The continuum of care for special populations includes Secure Facility care (Secure); Diagnostic Center care (DC); Psychiatric Residential Treatment Facility (PRTF) care;

Residential Treatment Center (RTC) care; Therapeutic Group Home (TGH) care; and Heightened Supervision Facility (HSF) care; and Partial Hospitalization Program. All levels of special population care shall be provided in licensed and accredited facilities and humane, therapeutic, and culturally competent environments; and provide comprehensive services that cater to the needs of each individual child as described in section 12. Other Addenda. Decisions for placement in restrictive levels of care is based on a specific criterion for each restrictive level of care based on ORR’s Notice of Placement criteria.

A Continuum of Care (COC) provides a multitude of benefits in serving children with a variety of psychiatric and behavioral health needs. Children placed in one of the levels of care within the continuum have timely access to medical and clinical evaluations to ensure they are placed in the least restrictive setting. During their placement within the COC, the network will be able to leverage services to develop appropriate individualized service plans to provide the required services in order to achieve the child’s case plan goal. A well-defined continuum of care ensures ORR has the capacity to meet the demands of the number of child referrals requiring a specialized placement regardless of their psychiatric or behavioral health issues.

This contract shall maintain an experienced network of licensed and accredited care providers who are experienced with serving children with varying psychiatric and behavioral health needs and who are committed to incorporating ORR policy and procedures, that intend to provide best outcomes for unaccompanied children. Although the length of time children remain in ORR custody must not be longer than necessary to facilitate a safe and timely release, individual cases may experience a protracted length of stay. This contract will incorporate COC designs that afford ORR’s special populations opportunities to stabilize children’s mental health, develop pro-social and interpersonal skills and achieve key case plan goals and milestones leading to placement in the least restrictive setting, and eventual successful community living. While youth in secure levels of care do not go out for community outings, unaccompanied children in less restrictive levels of care are afforded opportunities for community outings to develop social and interpersonal skills. This contract will ensure appropriate activities are designed for the development of social and interpersonal skills and exercises are offered in-house for secure care placements to contribute to skill development and ability to live independently when they are discharged from ORR custody.

4.0 Performance Objectives (required results)

4.1 Design, Develop, implement, and manage a region wide local CoC Network. The estimated costs for this performance objective are all the direct labor category mix, equipment, materials, and administrative costs, and to include all costs necessary to establish and manage the proposed number of network beds to support the planned continuum of care placements. The CoC special populations levels of care include (in order of most restrictive to least restrictive):

Secure Care: A secure or locked level of care for unaccompanied children who have been charged with or convicted of a criminal offense, or are chargeable with such an offense, or whose alleged conduct poses a threat to self or others. While the secure facility is locked, it is not a juvenile detention facility. It is a secure, locked group home with non-juvenile hardware security measures. For example, no climb fencing as opposed to concertina wire, and offers internal mechanisms and controls to manage violent behaviors. The determination of which unaccompanied children meet secure placement criteria is made by ORR, and assignment of physical custody to a care provider is made as immediately as possible by ORR. Secure levels of care are licensed and accredited in their respective state to operate as a secure facility that houses juveniles with issues surrounding violence and criminal behavior.

Criteria for Secure Care Placement:

Charged, chargeable, or convicted of a crime; subject of delinquency proceedings, adjudicated delinquent, or are chargeable with a delinquent act.

Committed or have made credible threats to commit a violent or malicious act while in ORR custody

Engaged in conduct proven unacceptably disruptive of normal functioning of a staff secure facility with transfer necessary to ensure welfare of the UC and others.

Self-disclosed violent criminal history prior to placement in ORR custody requiring assessment.

Committed sexual abuse by overt or implied threats of violence and posing an immediate danger.

Secure Care Purpose:

Provide humane and secure environment to Unaccompanied Children (UC) between ages of 13–17 who meet above criteria with comprehensive services, including assessment, diagnosis, treatment, and discharge planning.

When appropriate, make transfer recommendations to less restrictive settings.

When appropriate, make safe release recommendations to a vetted sponsor

Diagnostic Center: Provides humane and secure environments for unaccompanied children who have conflicting mental health diagnosis or limited information regarding violent criminal behavior that delivers comprehensive evaluations by licensed medical practitioners to determine least restrictive placement options as alternative to secure placement in juvenile detention.

Diagnostic centers provide temporary and safe custody of unaccompanied children for diagnostic purposes not to be utilized for more than 30 days or otherwise periods of time prescribed by a licensed medical provider. The purpose of Diagnostic Center care is to accept and accurately assess unaccompanied children with undiagnosed or misdiagnosed mental health issues. Secure acute unit for Unaccompanied Children ages 12 to 17; not utilized for more than 30 days.

Criteria for Diagnostic Center Placement:

Charged, chargeable, or convicted of a crime, or subject of delinquency proceedings, adjudicated delinquent, or chargeable with a delinquent act.

Committed or have made credible threats to commit a violent or malicious act while in ORR custody.

Engaged in conduct unacceptably disruptive of normal functioning in a staff secure facility that transfer may be necessary to ensure welfare of UC or others.

Self-disclosed violent criminal history prior to placement in ORR custody requiring further assessment.

Committed sexual abuse, where there is coercion by overt or implied threats of violence.

Diagnostic Center Purpose:

Deliver comprehensive evaluations to determine least restrictive placement options.

Alternative secure placement to juvenile detention.

Provide humane and secure environments for Unaccompanied Children (UC) who have conflicting mental health diagnosis or limited information regarding violent criminal behavior.

When appropriate, makes safe release recommendations to a vetted sponsor.

Psychiatric Residential Treatment Facility (PRTF): A secure unit to provide a humane and therapeutic environment for unaccompanied children between the ages of 12 – 17 with serious psychiatric or psychological issues that result in aggressive behaviors towards others and themselves, and behaviors that cannot be managed in Residential Treatment Center placement.

Unaccompanied children who meet criteria for Psychiatric Residential Treatment Facility Care receive care and custody, assessment and diagnosis, and treatment and discharge plans.

Criteria for PRTF Placement:

Shown no reasonable progress in alleviation of mental health symptoms after significant period in outpatient treatment; and demonstrate behavior that is a result of underlying mental health symptoms and/or diagnosis and cannot be managed in an outpatient setting.

Require therapeutic-based intensive supervision as result of mental health symptoms and/or diagnosis the prevent independent participation in daily schedule of activities.

Present continued real risk of harm to self, others, or community despite short-term clinical interventions.

PRTF Purpose:

Provide humane and therapeutic environment for Unaccompanied Children (UC) between the ages of 12–17 with serious psychiatric or psychological issues that result in aggressive behaviors towards others and themselves, and behaviors cannot be managed in Residential Treatment Center placement.

When appropriate, make safe release recommendations to least restrictive care or to vetted sponsor.

Provide care and custody; assessment and diagnosis; and develop treatment and discharge plans.

Residential Treatment Center (RTC): Care that provides a humane and therapeutic environment for unaccompanied children with serious mental health issues, while delivering comprehensive services. Residential treatment care provides temporary and safe custody of unaccompanied children between the ages of 12 - 17 with serious psychiatric or psychological issues or underlying mental health symptoms or diagnosis that cannot be addressed in an outpatient setting.

Criteria for RTC Placement:

Ages 12 – 17 who demonstrate underlying mental health symptoms or diagnosis that cannot be managed in outpatient setting; or have not shown reasonable progress in alleviation of mental health symptoms after significant outpatient treatment.

Require therapeutic-based intensive supervision due to mental health symptoms and/or diagnosis that prevents independent participation in daily schedule of activities.

Behavior presents continued and real risk of harm to self, others, or the community despite implementation of short-term clinical interventions.

RTC Purpose:

Provide humane and therapeutic environment for Unaccompanied Children (UC); while delivering comprehensive services to UC with serious mental health issues.

For UC who have serious psychiatric or psychological issues that cannot be addressed in an outpatient setting and are danger to self or others.

When appropriate, make safe release recommendations to a vetted sponsor.

When appropriate, make safe transfer recommendation to less restrictive setting.

Therapeutic Group Home (TGH): Not considered a restrictive level of care but is a required therapeutic part of the Continuum of Care for continuity and efficiency of care.

Criteria for TGH Placement:

Ages 12 to 17 who are not a danger to self or others.

Would benefit from enhanced behavioral health services.

Require a smaller care setting.

Do not require Residential Treatment Center level of care.

TGH Purpose:

Provide humane and therapeutic environment for UC; while delivering comprehensive mental health services; and when appropriate, transfer to least restrictive settings.

Make safe release recommendations to a vetted sponsor.

Heightened Supervision Facility (HSF): Supervised care and living quarters that provide a humane and therapeutic environment for unaccompanied children ages 12 – 17 who have behavioral and/or criminal issues that require close supervision, but do not require placement in a secure setting, while delivering comprehensive services. Staff secure care provides temporary and safe custody of unaccompanied children with behavioral and/or criminal issues that require close supervision.

Criteria for HSF Placement:

UC who are disruptive to normal functioning of shelter care facilities such that transfer is necessary to ensure safety and welfare of others; or have displayed pattern of severity of behavior that requires an increase in supervision by trained staff.

UC who are an escape risk.

Have non-violent criminal or delinquent history not warranting placement with secure care provider.

HSF Purpose:

Provide humane, therapeutic environment for UC ages 12 – 17.

Deliver comprehensive services to UC who have behavioral and/or criminal issues that require close supervision, but do not require placement in a secure provider placement.

When necessary, transfer to least restrictive settings.

When appropriate, make safe release recommendations to a vetted sponsor.

Partial Hospitalization Program (PHP): Well-established mental health program that typically meets 5 days per week for several hours a day. Patients are seen in group and individual treatments and engage in structured activities. The program is used to step down from acute hospitalization or to prevent acute admission and is designed to prevent unnecessary hospitalization and to shorten acute stays. Patients attend the program during the day and remain in shelter or least restrictive levels of care at night. Patients typically attend for 3-4 weeks.

Criteria for PHP Program Enrollment:

Unaccompanied children ages 12 – 17 who are not a danger to self or others and who would benefit and be responsive to comprehensive short-term therapeutic interventions.

Unaccompanied children preparing to step down from acute hospitalization back to a non-restrictive level of care.

PHP Purpose:

Therapeutic intervention options for youth ages 12 to 17 who are not a danger to self or others.

Supports least restrictive placements and decreases need for RTC admission and program transfers to restrictive levels of care.

4.3 Design a plan for evidence-based therapeutic environment for in-network residential care facilities and outdoor space. The estimated costs for this performance objective are all the direct labor category mix, equipment, materials and, administrative costs for the contractor to accomplish this effort.

4.4 Develop a Behavior Health Care Model and comprehensive therapeutic program designed with policies and strategies that meet child welfare best practice standards and catered to clinically appropriate practices for each of the special population levels of care described within this SOO.

Behavior management strategies used by the care provider must meet child welfare best practice standards. ORR approves care provider written policies and procedures for behavior management, including rules for the program to provide clear guidance to care providers for the management of behavior of children in care. Care providers must not use behavior management practices that are punitive in nature, involve punishment, involve negative reinforcement, or involve consequences or measures that are not constructive and are not logically and proportionally related to the behavior being regulated. Most importantly, ORR expects care providers to utilize trauma-informed, linguistically responsive, and evidence-based child-behavior management practices that take into consideration the range of ages and maturity of children placed in the program, and that are culturally sensitive to the needs of each child. This includes, but is not limited to, creating a structured environment with routines and schedules, and fostering a supportive environment that encourages cooperation, communication, problem-solving, use of de-escalation strategies, and positive behavioral management skills. See more details at ORR Unaccompanied Children Bureau Policy Guide: Section 3.3.13 Behavioral Management, to include prohibited Behavioral Management Practices, (Appendix 15-3 ORR UC Bureau Policy Guide_ Section 3).

Restraints must only be used in limited situations in which an unaccompanied child is in an emergency safety situation, and as consistent with the use of restraints according to state laws or licensing standards.

Seclusion is only allowed at a secure care provider that is not a residential treatment center (RTC). Restraints or seclusion must be used only as a last resort in emergency safety situations and must be terminated as soon as the physical safety of the child and others can be ensured. Care providers must debrief the use of restraints or seclusion with the child and staff member after its use and follow ORR’s reporting requirements as is specified in Section 5.8.2 Significant Incidents, (Appendix 15-5 ORR UC Bureau Policy Guide_ Section 5).

4.5 Design a network strategy that incorporates evidence-based approach to a well-connected Community of Practice (CoP). Behavioral health care providers for youth serve populations who face significant barriers to wellbeing, building Communities of Practice (CoP) can leverage expertise and resources by strengthening working relationships and partnership among necessary medical, clinical, health and daily care providers to build robust programs and services that will improve opportunities for youth to achieve mental and behavioral health goals. CoPs promote mental health and wellbeing through community-level prevention solutions, such as fostering social connections, improving care provider environments, and increasing access to economic opportunity by enhancing and strengthening protective factors and resilience through relationship and partnership activities.

4.6 Design an approach to ensure for safe and timely family unifications for unaccompanied children and their ORR approved sponsors; this includes releasing unaccompanied children to qualified sponsors who are determined to be capable of providing for the child's physical and mental well-being.

ORR has policies and procedures in place to ensure the care and safety of unaccompanied children (UC) who are apprehended in the United States without immigration status or a parent or legal guardian. These policies require the timely release of children and youth to qualified parents, guardians, relatives or other adults, referred to as “sponsors.”

Case managers are a crucial part of the placement process. They determine whether an individual is an appropriate sponsor, including verifying a potential sponsor’s identity and relationship to a child before releasing a child to a sponsor. They also require case managers to complete an assessment of the child’s past and present family relationships, and relationships to non-related potential sponsors.

Case managers are also required to:

Interview prospective sponsors

Require prospective sponsors to complete an “Authorization for release of Information”

Conduct background checks on all prospective sponsors

Coordinate fingerprint checks of the FBI database for non-parental sponsors, or for parental sponsors where there is a documented risk to the safety of the child, the child is especially vulnerable, or the case is being referred for a mandatory home study

Coordinate a check of the Department of Homeland Security (DHS) Central Index System in some cases.

More details at ORR Unaccompanied Children Bureau Policy Guide: Section 2 (Safe Timely Release Process); Section 2, 2.3.2 (Case Managers); 2.3.3 (Case Coordinators), (Appendix 15-2 ORR UC Bureau Policy Guide_ Section 2).

4.7 Establish and maintain a Contractor Quality Assurance Program (QCP) to ensure a high standard of care for each of the special population levels of care; to include how compliance with all state and federal governing laws and guidance to include ORR UC Program policies.

4.8 Establish a comprehensive plan and internal policies to ensure all in-network care providers in the CoC offer quality education and recreation program for each of the special population levels of care; and how it will ensure compliance with all federal, state, and local governing laws and statutes, and compliance with UC Program policies and requirements.

While in HHS custody and being cared for in HHS funded care provider facilities, unaccompanied children are not enrolled in the local school systems. Care providers must conduct an educational assessment within 72-hours of an unaccompanied child’s admission into the facility in order to determine the academic level of the child and any particular needs they may have. Care providers must provide educational services based on the individual academic development, literacy level, and linguistic ability of each unaccompanied child.

Each unaccompanied child must receive a minimum of six (6) hours of structured education, Monday through Friday, throughout the entire year in basic academic areas (Science, Social Studies, Math, Reading, Writing, Physical Education, and English as a Second Language (ESL), if applicable). Care providers adapt or modify local educational standards to develop curricula and assessments, based on the average length of stay for unaccompanied children at the care provider facility, and provide remedial education and after school tutoring as needed. Learning materials must reflect cultural diversity and sensitivity. Care provider facilities must provide educational instruction and relevant materials in a format and language accessible to all unaccompanied children, regardless of the child’s native or preferred language, including, but not limited to, providing services from an in-person, qualified interpreter, written translations of materials, and qualified remote interpretation when in-person interpretation options have been exhausted. See more details at ORR Unaccompanied Children Bureau Policy Guide:

Section 3, 3.3.5 and 3.3.6 (for vocational education), (Appendix 15-3 ORR UC Bureau Policy Guide_ Section 3).

Care providers must develop recreation and leisure plans that include daily outdoor activities, weather permitting, for unaccompanied children in their care. The plan includes at least one (1) hour per day of large muscle activity and one (1) hour per day of structured leisure time activities other than television (three (3) hours per day on when school is not in session). Recreation and leisure time activities are separate from the required physical educational requirement.

Care providers must screen television, movies, and video games for appropriateness before being provided to unaccompanied children and these may not be substituted for recreational or leisure activities. (Television viewing limitations and other related policies vary from facility to facility.)

Children must have access to appropriate reading materials in languages other than English for use during the unaccompanied child’s leisure time. See more details at ORR Unaccompanied Children Bureau Policy Guide: Section 3, 3.3.8 (Recreation and Leisure Time Services), (Appendix 15-3 ORR UC Bureau Policy Guide_ Section 3).

4.9 Establish guidance and protocols to ensure all in-network care providers in the CoC ensure services respect and support the cultural identity of unaccompanied children placed in their care.

The comprehensive plan shall demonstrate how each required service component will incorporate and respect culture, language, and religious observations.

Unaccompanied children entering ORR custody come from a wide array of cultures, practices, languages, and beliefs. Care providers must have the cultural awareness and systems in place to support the cultural identity and needs of each unaccompanied child. Care providers must provide care in a manner that is sensitive to the age, culture, native or preferred language, and the complex needs of each unaccompanied child.

ORR requires care providers to respect and support the cultural identity of unaccompanied children by:

Allowing unaccompanied children regular contact with safe family members or other support systems through telephone calls, letters, and visits.

Addressing the unaccompanied child by their given name.

Inclusion of cultural awareness in daily activities, such as food menus, choice of clothing, and hygiene routines.

Celebration of culture-specific events and holidays.

Academic education that covers various cultures within a classroom setting.

Care providers must make reasonable efforts to provide comprehensive services and literature in the native or preferred language of each unaccompanied child; provide qualified interpreter or qualified translator as needed; and allow unaccompanied children to communicate in their preferred language when they choose. All required documents provided to unaccompanied children must be translated in the unaccompanied child’s preferred language, either written or verbally. However, care provider facilities must not create their own translations of ORR-issued form templates or handouts.

Care providers must provide opportunities for unaccompanied children to observe and practice their spiritual or religious beliefs, including but not limited to, the celebration of religious holidays, displaying religious art, wearing religious articles of jewelry, following certain food preparation and/or dietary restrictions and attending services and activities (as long as it is safe for the unaccompanied child and staff). Care providers are encouraged to work with clergy or other members of the religious community to provide spiritual/religious services to unaccompanied children in ORR’s custody. Care providers must provide access to recognized members and leaders of religious communities to ORR care provider facilities in accordance with safety policies and procedures. Upon request from an unaccompanied child, assuming that the request is reasonable, and the safety of the unaccompanied child and staff is not adversely impacted, care providers must transport unaccompanied children to places of worship.

If an unaccompanied child requests religious and/or cultural information or items, such as books or clothing, the care provider must provide the applicable materials in the unaccompanied child’s native or preferred language, depending on the child’s preference, and as long as the request is reasonable. Care provider services shall help unaccompanied children obtain skills necessary to acculturate to the United States and to live independently and responsibly. Acculturation services include:

Providing English language classes Access to community services Academic education, including, for example, geography Celebration of relevant holidays Discussion of US. laws Food and entertainment Field trips to local historical, scientific, or cultural points of interest

See more details at ORR Unaccompanied Children Bureau Policy Guide: Section 3, 3.3.7 (Services related to culture, language, and religious observations), (Appendix 15-3 ORR UC Bureau Policy Guide_ Section 3).

Care providers must provide nutritional services in accordance with U.S. Department of Agriculture and U.S. Department of Health and Human Services nutritional guidelines and State licensing requirements. They also must establish procedures to accommodate dietary restrictions, food allergies, health issues, and religious or spiritual requirements. See more details at ORR Unaccompanied Children Bureau Policy Guide: Section 3.3.3.9 (Nutrition Services), (Appendix 15-3 ORR UC Bureau Policy Guide_ Section 3).

Care providers also ensure that unaccompanied children have the appropriate time, space, and items for personal grooming and hygiene. Shaving facial hair may not be required if it violates the unaccompanied child’s cultural norms, religious beliefs, or personal preferences, and head scarves may be worn for religious…