QRTP_Scope_of_Work_Amendment_1.pdf

Scope of Work

Direct Contract for Qualified Residential Treatment Program (QRTP)

SCOPE OF WORK

Congregate Care Service Qualified Residential Treatment Program

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

Phoenix, AZ 85012

Direct Contract

1.0 Purpose

The purpose of this contract is to secure a safe and reliable source of Qualified Residential Treatment Program (“QRTP”) beds that can provide time limited, trauma informed programming for children in the custody of Arizona Department of Child Safety (“ADCS”) where they can thrive free from abuse and neglect while addressing underlying emotional and behavioral needs prior to transitioning to a family like setting.

2.0 Background

2.1 The ADCS is statutorily responsible to provide services to children and families involved with ADCS.

ADCS Vision and Mission Statements are:

Vision: Children thrive in family environments free from abuse and neglect.

Mission: Successfully engage children and families to ensure safety, strengthen families, and achieve permanency.

2.2 One of the ADCS’s Strategic Goals is to improve capacity to place children in family environments.

2.3 The ADCS recognizes that children who do not required Higher Level of Care but whose needs cannot be met in a family setting require high quality, trauma-informed residential care that allows them to successfully transition back to family care

2.4 ADCS has established a program with the policies and procedures (DCS15-13) which will be used to certify residential placement providers who contract with the Department meet the requirements of a QRTP in compliance with the Family First Prevention Services Act.

2.5 A QRTP is a facility that must comply with the requirements according to H.R. 1892, Sections 50741-50742, A Qualified Residential Treatment Programs (QRTP).

2.6 The program is licensed and nationally accredited by the Commission on Accreditation of Rehabilitation Facilities (“CARF”), the Joint Commission on Accreditation of Healthcare Organizations (“JCAHO”), the Council on Accreditation (COA), or others approved by the Secretary of HHS.

2.7 Placement eligibility is determined by ADCS placement administration. Services are referral driven based upon the needs of the child and the Contractor who can best meet the child(ren)’s needs.

2.7.1 Any child who is placed in a QRTP setting shall participate in an evaluation by a ‘Qualified Individual’ to assess the strength and needs of the child using an age

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

appropriate, evidence based, validated, functional assessment tool approved by the Secretary as defined in Social Security Act 475A (1)(A).

2.7.1 (a) To be eligible for placement in a QRTP a youth must have a Child and Service Intensity Instrument (CASII), or other approved ADCS assessment tool, score of 3 or higher and;

2.7.1(b) The placement questionnaire must identify a specific QRTP program that will meet the needs of the child (See Exhibit I).

2.7.1.(c) The Contractor will not be responsible for administering the CASII assessment.

3.0 General Requirements: Contractors are to be responsive to the needs of DCS and shall provide services that ensure safety and promote permanency of the children in the custody of DCS.

Service provision, includes but is not limited to the following:

3.1 Provide a facility operated by an ADCS licensed Child Welfare Agency or Arizona Department of Health Service (DHS) in good standing where children are in their care and supervised in accordance with Section 471 (a) (10) of the Social Security Act.

3.2 Have meet all requirements as defined in ADCS policy DCS15-13, been confirmed by the

Office of Licensing and Regulation and been accredited a Qualified Residential Program.

3.3 Has a trauma-informed program model that is designed to support the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances.

3.4 Able to implement the interactions identified for the child by the required initial assessment of the appropriateness of the QRTP placement and the clinical interventions the child(ren) I receiving through the Child and Family Team (CFT) Process;

3.5 Provide supervision by staff unrelated to any of the child(ren) placed in the home by the referring agency. Contractor shall make the referring agency aware of any conflicts prior to accepting a placement.

3.6 Provide, or have access to, a registered or licensed nursing staff (and other clinical staff if the program model requires it) who are on-site according to the provider’s program model, and are available 24 hours per day, 7 days per week;

3.7 Facilitates family member participation in the child’s care (to the extent possible, and in accordance with the child’s best interest) including maintaining contact information for any known birth family and fictive kin

3.8 Comply and work in collaboration with ADCS, including Office of Licensing and

Regulation (“OLR”), DHS, law enforcement and other legal authorities.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

3.9 Prohibit the use of alcohol, drugs and/or tobacco/nicotine products (including electronic and vapor) of any kind where services are provided to child(ren) and/or adjacent to the facility.

3.10 Leverage existing community resources to provide regular activities for children who require support, guidance, encouragement and the development of life skills such as coping, solving problems, and developing positive social behaviors.

3.11 Provide twenty (24) hours per day, seven (7) days per week monitoring of children during day and sleeping hours. Staffing should be sufficient to ensure a safe and secure environment based on the cohort group being served. This includes awake staff during sleeping hours.

3.12 Ensure that all services, procedures and forms provided to child(ren) and family are culturally relevant, gender responsive (including Lesbian, Gay, Bi-sexual, Transgender, Questioning (LGBTQ) issues), linguistically appropriate to the population to be served as determined by the Case Manager and comply with any and all non-discrimination policies, rules and laws.

3.13 Ensure cross-cultural communication support with the involvement of culturally competent staff in all levels of service delivery, beginning with the intake process and throughout the course of services.

3.14 Have the ability to serve non-English speaking child(ren) when referred by being able to provide an individual who speaks or obtain interpretation of the language of the child(ren), especially Spanish, American Sign Language, Arabic, Farsi, and Swahili. (See Exhibit II)

3.14.1 Provide translation/interpretation services for any language needed. Contractor is required to cover the cost of the five (5) most common listed languages.

3.14.1(a) The Contractor must provide a certified translator/interpreter over the age of twenty-one (21) as needed.

3.14.2 All other languages that require interpretation and/or translation services for will be reimbursed by ADCS at cost upon submittal of receipts or invoices with the Monthly Invoice.

3.15 Respect the spiritual and religious preference(s) of the child(ren). Under no circumstances may a Contractor compel or otherwise require a child(ren) to participate in any Contractor preferred spiritual or religious activities or programs.

3.16 Seek community events and constructive ways for child(ren) to express and appreciate their own individuality.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

3.17 Address cultural factors in the provision of all program components including, but not limited to, providing culturally appropriate and necessary hair and skin care products

3.18 Assist in obtaining a state identification card within ninety (90) days of placement, as appropriate to their age (e.g. SSN card, ID). Birth certificate and social security card to be retained by ADCS. Contractor can “check out” these documents to assist in obtaining the identification card.

3.19 Support educational achievements by attending recognition events or acknowledging the receipt of an achievement.

4.0 Specific requirements: The contractor shall provide, but not be limited to, the following:

4.1 Placement

4.1.1 Accept all QRTP placements

4.1.1(a) Only the ADCS Placement Administration will arrange for placement, including those ordered by the court, of children assessed as appropriate for a QRTP placement;

• ADCS will not pay for placements made by case managers.

Authorizations for placement will only come through the ADCS Placement Administration.

• The Contractor shall immediately notify ADCS Placement Administration if they are approached by a case manager or supervisor for placement.

4.1.2 Respond to all requests for placement within two (2) hours of receipt of a placement referral (Exhibit III) sent via secure email by ADCS Placement Unit.

4.1.2(a) If the referral is incomplete, contact Placement Administration.

4.1.2(b) If a child(ren) turned 18 in care and has signed a voluntary extended care agreement, this is a valid placement and shall be treated like any other placement from ADCS.

4.1.3 Accept physical placement of children on a twenty-four (24) hour, seven (7) days per week basis.

4.1.4 Accept child(ren) for placement in times of need due to emergency and natural disaster.

4.1.5 Accept placement immediately if there is a vacant bed.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.2 Intake: In accordance with Arizona Administrative Code (A.A.C.), Title 6, Chapter 5, Article 74, process every intake for each child(ren) within 24 hours as follows:.

4.2.1 Within the first twenty-four (24) hours provide a child(ren) admitted into the facility with:

4.2.1(a) Review any personalized service plan and assess the existing services and needs before or at the time of the child(ren)’s admission. Make any necessary changes to group home support and schedule to conform to the identified services and needs.

4.2.1(b) Arrange space and furnishings to enable the Contractor to provide supervision while respecting the child(ren)’s right to privacy.

4.2.1(c) Provide secured space for personal belongings.

4.2.1(d) Inventory all items, ensure the Contractor, youth and guardian/case manager reviews and signs the personal property inventory form and place the form in the child’s case record. Update as required.

4.2.1(e) Establish and maintain a confidential case record for each client to whom services are provided in accordance with Records section 8.0;

4.2.1(f) All prescriptions must be filled at a pharmacy in Mercy Care DCS CHP’s network. If you need pharmacy services after hours, on weekends or holidays, many pharmacies are open 24 hours, 7 days a week. You can find a list of pharmacies in the Mercy Care DCS CHP Provider Directory.

Visit our website at www.MercyCareAZ.org and select “For Members” under Mercy Care DCS CHP. You’ll locate “Find a Pharmacy” in the upper right corner of the screen.

If you have any questions or trouble filling a prescription while you are at the pharmacy, you can call Mercy Care DCS CHP. Mercy Care DCS CHP Member Services can help you with the member’s prescriptions Monday through Friday from 8 a.m. to 5 p.m. If you have questions or problems outside Mercy Care business hours, you can call the Mercy Care 24-hour Nurse Line at 602-212-4983 or 1-833-711-0776 (TTY/TDD 711).

4.2.1(g) Obtain a digital photo of the child(ren) and place in case file.

4.2.3 Clothing: In accordance with A.A.C., Title 6, Chapter 5, Article 74, provide http://www.mercycareaz.org/

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.2.3.(a) Provide or facilitate acquisition of an adequate amount of clean, good condition, age-appropriate, well-fitting/appropriately sized, and culturally appropriate, seasonal clothing that includes attire appropriate for play, school (school uniforms if required), work, faith based, social, recreational and other formal activities. Clothing shall go with the child(ren) upon transition to another placement;

4.2.3.(b) Allow the child(ren) to wear his/her own clothing that is reflective of his/her religious belief;

4.2.3.(c) Request, and receive authorization from the ADCS Placement Administration, for Special clothing allowances for ADCS placed child(ren) in out-of-home placement, if necessary; and

4.2.4 Within the specified number of days provide a child(ren) admitted into the facility with:

4.2.4.(a) Contractor shall be required to transport child(ren) to their home school unless ADCS provides a written determines that it is in the best interest of the child(ren) to change schools after holding a best interest determination meeting.

4.2.4.(b) During the school year, if a change in school is authorized by

ADCS, enroll the child(ren) within five (5) school days of placement. If not placed during the school year, then as soon as possible and applicable.

4.2.4.(c) Within ten (10) days of a child(ren)’s admission, a Contractor shall document all interim planning efforts identifying the child(ren)’s needs and initial plans for service to ensure stability of placement.

4.2.5 Within the first twenty one (21) Days of a child(ren) being admitted into the facility:

4.2.5.(a) Review how the child(ren) is acclimating to the program. Include the following elements in this review and document in the service plan on Exhibit I:

• Progress on the program, moving towards discharge o Is the youth participating in the trauma informed elements of the QRTP program and how is the program supporting the youth’s engagements, the Team’s plan for the youth and support of their overall service plan?

o Include a response to relevant QRTP Placement questions as indicated on Exhibit I.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

o How is the child adjusting to relationships (peers and staff)

▪ Describe how the youth is transitioning into the program including the development of relationships with program staff and other youth residing in the program o Incident reports

▪ Describe any Incident Reports since the youth entered the program.

• Connection to services and progress of their service plan o Confirm if the youth has begun services as defined in their Individualized Service Plan o How is the youth adjusting to the service plan and how is the QRTP supporting the youth in participating in those services as well as applying any relevant skills

• School performance o If the youth actively enrolled in school, how are they performing and what supports have been provided since transition into the program to aid the youth in education outcome success o When a youth is entering a QRTP, any changes in school enrollment will be reviewed per the Department’s standard processes including best interest evaluation?

• Contact with family and visits o Has the DCS Specialist and family (when appropriate) been involved in the QRTP program supports for the youth

▪ What efforts have been made and what barriers need to be overcome ensuring the family and specialist are supporting the youth’s completion of the QRTP Program

▪ If reunification is not the case plan goal, what efforts are being supported to identify a family like setting and what does the plan do to support this.

4.2.5(b) Include in the review the child(ren)’s behaviors/needs. Review should include, but not be limited to any of the following documents related to services provided to the child(ren):

• Child Placement Referral done upon child(ren)’s entry into the care of ADCS;

• Individual Education Plan (if available);

• Rapid Response/CPS Stabilization Assessment; and for

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

• Placement Packet

4.2.5.(c) Personalized Service Plan (Exhibit IV) – In accordance with A.A.C., Title 6, Chapter 5, Article 74, develop, review and/or update per the following:

• Personalized service plan is intended to be a subset of the

Integrated Service Plan (ISP) developed by the CFT. The QRTP shall be an integral part of the youth’s CFT advocating for the needs of the youth.

• Develop the personalized service plan for the child(ren) to describe QRTP provider actions, responsibilities, and implementation steps to support child(ren) needs as defined by relevant crisis, service, other plans and tailored to the child(ren)’s unique background, needs, strengths weaknesses, and challenge; in line with the trauma informed program at the facility.

• Each Service Plan shall have a crisis plan (if appropriate) to direct staff responses to support the child(ren) when crisis and/or urgent needs are present.

• Each of the requirements 4.2.5.(c) shall be discussed and reviewed during the CFT. The QRTP shall identify the elements of the ISP they are responsible for monitoring, supporting and reporting back to the CFT in support of the youth.

4.2.5.(d) The Personalized Service Plan shall include at a minimum the following:

• Options for participating for six (6) month in after-care in a support function only at the request of the CFT or documentation of support recommendations for the six (6) month after care plan;

• Identification of persons responsible for implementing the Personalized Service Plan, with an explanation of each person’s role.

• A description of how family outreach is made for the child(ren) to include contact information; and maintain contact information for any known birth family and fictive kin of the child or outreach to transition to a family like setting placement.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

If no family has been identified, work with ADCS to partner with an FAS provider and locate foster family setting for discharge.

• Develop a written plan to foster family member participation in the program and with the child(ren), including post-discharge and how sibling connection are maintained; and documents family integration as part of the child(s) service plan.

4.2.6 Healthcare Services

4.2.6(a) Within seven (7) days of the child(ren)’s admission arrange for a physician, physician's assistant, or nurse practitioner to give the child(ren) a comprehensive wellness medical examination that meets the Title XIX Early Periodic Screening Diagnosis and Treatment (EPSDT) requirements located at:

https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/Ch ap400.pdf, including immunizations unless the Contractor has been provided documentation from the Department or previous placement of a medical examination occurring within the previous forty-five (45) days.

4.2.6(b) Have a direct care staff member, trained as prescribed in A.A.C R6-5- 7433(B)(4) visually access the child(ren)’s general health as follows:

• Monitor and communicate with the treating provider health care issues such as, but not limited to diabetes, asthma, skin integrity, behavioral, durable medical equipment needs, allergies and/or feeding/dietary issues;

• Accept training & instruction from the treating provider and teach the child and other staff how to use other durable medical equipment such as insulin pumps and injectables as appropriate;

• Reinforce training to the child/youth general disease management under the instruction from the treating provider;

• Provide information for the child’s health care visits that informs the health care provider of issues and coordinate discharge/after visit instructions;

• Have knowledge of required health care visits including EPSDT, preventative dental as well as immunizations and coordinate with health care providers to ensure child receives services http://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/Ch

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.2.6(c) Administer medication (if applicable) as prescribed in A.A.C R6-5-7453 and R6-5-7454 to include:

• Engage and educate the child and other staff in the monitoring and oversight of the child in the administration and knowledge of their medication, dosage, side effects and administration

• Document administration, side effects, errors and disposal to include injectables, topical and other forms of administration as prescribed in R-5-7438.

• Document a written medication schedule for each child(ren) who receives medication with usage instructions in order to manage the child(ren)'s medication (if applicable

Use the medication logs as provided in Exhibit V.

• Keep a list of medication including over the counter provided during care, with a summary of the reasons for prescribing the medication and any outcomes/reactions of the medication.

• Ensure medication including medical foods, if applicable, accompanies the child when the child is admitted or moved to another caregiver including a copy the documentation of administration, side effects, errors or any other care coordination notes.

4.2.6(d) Allow behavioral health service providers into the home as appropriate for necessary assessments, service plan development and delivery of behavioral health services

• Coordinate with the Behavioral Health provider to schedule, attend and participate in services implemented from the plan of treatment;

• Coordinate appointments and activities related to delivery of physical and behavioral health services with the DCS Specialists, treating health care providers and agencies in accordance with the Child and Family Team Model and Arizona Twelve Principles;

• Coordinate health information sharing among all healthcare providers serving the child for optimization of care;

• Obtain training and train staff on the implementation of child specific BH plan of treatment including, but not limited, to:

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

cooperation with ABA providers, use of clinical recommended techniques, crisis plan (aka safety plan), functional behavioral analyses; and

• Train staff on trauma informed care; and implement trauma informed organizational measures including the recognition of vicarious trauma, compassion fatigue etc. as well as appropriate disciplinary procedures in the context of trauma informed care.

4.2.6(e) Ensure child receives a comprehensive medical (EPSDT) and preventative dental exams upon entry into care or in accordance with the EPSDT periodicity schedule as required by A.A.C. R6-5-7452 and an annual comprehensive wellness medical examination with the primary care physician as per A.A.C., Title 6, Chapter 5, Article 74, and ADCS Policy Chapter 3, Section 8.1.

• Urgent care visits, sports physicals are not considered comprehensive medical (EPSDT) visits; and

• Visits to a dentist for oral pain or treatment are not considered preventative dental visits.

4.2.6(f) Contractor may obtain preventative visit verification from DCS Comprehensive Health Plan (DCS CHP) if child transitioned from another caregiver.

4.3 Ongoing Requirements:

4.3.1 Transport the child(ren) to and from appointments, including medical, behavioral health, court hearings, school, work, social, afterschool, required testing and work related activities.

4.3.1(a) Transportation for ADCS placements will be reimbursed at the state rate for trips over 50 miles one way; and

4.3.1(b) Transport and supervise a child(ren) waiting for assessment and admission to the hospital.

4.3.2 Utilize public transportation services, depending upon the age and developmental ability of the child(ren) to access this service on his/her own.

4.3.2(a) Payment for the public transportation service is the responsibility of the

Contractor; and

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.3.2(b) Obtain the prior approval of the Case Manager for the use of public transportation.

4.3.3 Ensure that a physical exam is provided upon admission back into the facility for any child(ren) who leaves the facility as “runaway” upon admission back into the facility in cases where the child(ren)’s location or activity during their absence is unknown. This does not include drug testing unless authorized by the service or crisis plan or the Case Manager.

4.3.3(a) The results of the examinations shall be provided to the Case Manager within five (5) business days from the date of the examination.

4.3.4 Understand, educate and advocate for the child(ren)’s needs in their various settings (educational, social, or within the home) to ensure that all child(ren) receive necessary and assessed behavioral health and substance abuse services.

4.3.4(a) Attend and participate in any school meeting, CFT or other meeting to discuss the educational needs of the placement

4.3.4(b) Participate in the assessment process in person and provide information pertinent to an effective assessment; and

4.3.5 Participate with all involved parties in the coordination of care for children under any plan developed by the child(ren) and any team if assigned after assessment.

4.3.6 Provide continuing observation of physical, social and emotional functioning of the child(ren).

4.4 Coordinate with ADCS staff to arrange support services that are consistent with the child(ren) and family’s needs, including when necessary the coordination of care with other contracted service providers and community agencies (e.g. life skills coaches, counselors, etc.).

4.4.1 Coordinate with the designated CFT to understand service array, implement and facilitate service delivery, and allow access to child(ren) as appropriate.

4.4.2 Allow children to identify and participate in activities that extend beyond their own immediate personal experiences (e.g. girl scouts).

4.5 Meals:

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.5.1 Provide meals in accordance with A.A.C. R6-5-7446 that meet the Dietary

Guidelines and Nutritional Goals for Age-Sex groups aligned with healthy eating patterns. www.Nutrition.Gov.

4.5.2 Ensure potable water is accessible to children for personal use at all times at a consumable temperature.

4.5.3 Do not serve expired food, bruised fruit, or rotten vegetables.

4.5.4 Serve meals in a clean dining area at tables which allow children, staff and guests to eat together.

4.5.5 Allow child(ren) to participate in food preparation as a part of basic age and developmentally appropriate life skills training.

4.6 Educational Support

4.6.1 Unless specifically provided for in writing by ADCS maintain the school of origin.

4.6.2 Have available educational materials, including an adequate number of computers with internet access, software such as, word-processing/spreadsheet/presentation programs and materials for school projects, in ratios/amounts that allow every child(ren) sufficient access to complete schoolwork within a reasonable timeframe, prior to the assigned due date.

4.6.3 Have adequate on-line access to allow for alternative school support (e.g. on-line high school).

4.6.4 Ensure appropriate educational activities (e.g. tutoring) are identified and provide support and access to said identified activities.

4.6.5 Support and Participate in any Individualized Education Program (IEP) as necessary.

4.6.6 Provide age appropriate child(ren) sexual development and learning programs to child(ren) 12 and over to include the following:

4.6.6.(a) If the QRTP is serving SMB population, the sexual development program must be reviewed with the treatment provider to ensure it is supportive of the youth’s treatment plan.

4.6.6.(b) Personal and family values regarding sexuality;

4.6.6.(c) Religious and cultural issues regarding sexuality;

4.6.6.(d) Self-respect and its relationship to sexual behaviors and character development;

4.6.6.(e) Physiological information;

http://www.nutrition.gov/

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.6.6.(f) Personal hygiene related to sexuality;

4.6.6.(g) Long-term and permanent relationships with partners, spouses and friends;

4.6.6.(h) Family planning information including abstinence;

4.6.6.(i) Sexually transmitted diseases (STDs), including HIV/AIDS;

4.6.6.(j) Recognizing, preventing and avoiding sexual abuse and the impact of sexual abuse and other sexual victimization on sexual development;

and

4.6.6.(k) LGBTQ awareness.

4.6.7 Administer age appropriate life skills assessment an ADCS approved evidence-based life skills curriculum for child(ren) over the age of fourteen (14);

4.6.8 Provide adequate support system to assist and reinforce life skills training to include the following:

4.6.8 (a) Money management/consumer awareness;

4.6.8.(b) Credit reporting/identity theft;

4.6.8.(c) Food management;

4.6.8(d) Personal appearance;

4.6.8.(e) Housekeeping;

4.6.8.(f) Emergency and safety skills; and 4.6.8.(g) Leisure activities;

4.6.9 Allow youth access to schools with open enrollment.

4.6.10 Arrange for educational services that address the needs of the individuals.

4.6.11 Follow and abide A.A.C., Title 6, Chapter 5, Article 74, R6-5-7449. Educational and Vocational Services.

4.7 Activities in accordance with A.A.C. R6-5-7450 and the following:

4.7.1 Arrange for the child(ren) to participate in age appropriate extracurricular activities of their choosing, such as volunteering, employment, community sports and school sponsored activities. (ADCS Policy and Procedure Manual, Chapter 4).

4.7.2 For child(ren) with special concerns, locate and offer support to attend supportive activities such as camps for youth with common medical/behavioral conditions, youth peer support groups, educational presentations in support of understanding diagnosis and conditions, etc.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.7.3 Support the continuation of existing activities and arrangements for the child(ren) for appropriate activities as listed in the personalized service plan and approved by the referring agency such as employment, school, post-secondary education, vocational training program, and locating and completing community service hours.

4.7.4 Have age and developmentally appropriate equipment, toys, social and recreational activities at all times for all child(ren).

4.7.5 Provide play materials and sports equipment for both indoor and outdoor activities in appropriate ratios and in a variety of sizes and designs appropriate to the child(ren)’s developmental, social and emotional needs.

4.7.6 Ensure that the items are maintained in a usable condition and disinfected as necessary.

4.7.7 Support efforts of child(ren) to obtain and maintain employment including evening shift hours including transportation to and from the job.

4.8 Communication and Visitation as per A.A.C. R6-5-7448

4.8.1 Ensure the child(ren) is provided opportunities for private and uncensored communication and visits with family members and relatives, significant others or potential and/or former foster parents to preserve and enhance relationships with and attachments to the family of origin unless the contact is detrimental to the child(ren)'s health and safety as determined by ADCS. This includes transitional visits with the next placement.

4.8.2 Allow communication between a child(ren) and the child(ren)'s parent, guardian, or friends except:

4.8.2(a) For reasons as determined with the referring agency staff and/or the child(ren); and

4.8.3 Scheduled Group Home activities shall not replace or interfere with a child(ren)'s communication and visits with family and friends.

4.8.4 Ensure that a child(ren) does not go on visits to the residences of the group home personnel except for specific events approved and authorized by the referring agency Director or his/her designee.

4.8.4.(a) Placements are expected to reside at the physical address of the group home. This includes weekdays, after school, and weekends.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.8.4.(b) Taking placements to group home personnel’s residences, including the owner’s, without authorization will be considered a material breach of the contract and may result in contract cancellation.

4.9 Clothing Allowance:

4.9.1 Monthly Clothing Allowance will be paid to each child(ren) in the care, custody and control of ADCS in accordance with ADCS Policy and Procedures Manual;

4.9.2 Inform or make the child(ren) aware of their clothing fund balance no less than once a month.

4.9.3 Record the distribution of the clothing allowance within 24 hours in Allowance/ Purchase Ledger form. Record purchases on the Basic Wardrobe and Property Inventory in the Child's Placement Packet;

4.9.4 Emergency Clothing Service Authorization: Request approval from the Placement Unit for a one-time payment up to a maximum of $150 per child(ren) at initial placement; and

4.9.5 Child(ren) in the Independent Living Subsidy Program are not eligible for these allowances.

4.10 Personal Allowance:

4.10.1 Monthly Personal Allowance will be paid to each child(ren) in the care/custody and control of ADCS in accordance with ADCS Policy and Procedures Manual;

4.10.2 Distribute the personal allowance to the child(ren) not less than once per month;

4.10.3 The personal allowance is to be paid directly to the child(ren) or deposited directly into the child(ren)’s personal account;

4.10.4 The personal allowance cannot be used as "payment" to the child(ren) for chores, nor as a means of reward or punishment; and

4.10.5 Record the distribution of the personal allowance within 24 hours in Allowance/Purchase Ledger form FC-126 in the Child's Placement Packet.

4.11 Sleeping arrangements in accordance with A.A.C. Title 6, Chapter 5, Article 74 provide the following:

4.11.1 Appropriate sleeping arrangements for child(ren). Cohort groups may require the child(ren) to have their own bedrooms.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.11.2 If applicable, sleeping arrangements must be compliant with recommendations made by the CFT

4.12 Disruptions

4.12.1 Maintain placement by ensuring child(ren) at risk for disruption due to behavioral, medical or other reasons are provided with culturally appropriate (including ethnic and gender sensitive) preventative services and interventions.

4.12.2 Reasons for disruption: Contact the ADCS for the following issue(s):

4.12.2(a) The child(ren) is under the influence of drugs or alcohol and is in the need of detoxification as determined by a qualified behavioral health professional and the detoxification requires the child(ren) to be absent from the facility for more than seven days or the detoxification discharge plan indicates a need to change placement;

4.12.2(b) The child(ren) is in need of emergency medical attention requiring in-patient hospitalization as determined by a licensed physician and the hospitalization requires the child(ren) to be absent from the facility for more than seven days or the hospitalization discharge plan indicates a need to change placement;

4.12.2(c) The child(ren) is placed in detention and will not be released for more than seven days; and

4.12.2(d) The child(ren) is determined to be a runaway and has not returned by 11:59 pm of the next day, or sooner if approved by referring agency.

4.12.3 Turning eighteen (18) years of age is NOT a reason for disruption. If the child(ren) turn eighteen (18) while in State care:

4.12.3.(a) ADCS child(ren) can remain in placement until the age of twenty-one(21) if all of the following are met:

• Pursuing a high school diploma, or enrolled in a vocational training program, or post-secondary educational program; and

• Signed a Voluntary Foster Care Agreement.

4.12.3.(b) ADCS youth not signing a Voluntary Foster Care Agreement, a transition plan for child(ren) turning eighteen(18) will need to be developed six (6) months prior to and effective on the child(ren)’s eighteenth birthday.

4.13 Procedures for addressing disruption incidents:

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.13.1 Contact the Case Manager and the Placement Unit.

4.13.2 Contact the appropriate authorities (as applicable).

4.13.3 Request a Team Decision Making (TDM) or Child & Family Team (CFT) meeting to determine additional services needed to meet the needs of the child(ren) and stabilize the placement.

4.13.3(a) If ADCS fails to respond to a request for TDM or CFT within 48 hours, Contractor shall email, using a secure email, the Case Manager and copy the Supervisor; and

4.13.3(b) If TDM or CFT is still not scheduled, contact the Program Manager.

4.13.4 Request 1 on 1 supervision until a TDM or CFT occurs.

4.13.5 Participate in TDM or CFT providing general information including (but not limited

to) personal information, relationships, custody, education history, evaluations, diagnosis, and any other supporting documentation that may be helpful.

4.13.6 Adhere to the crisis plan developed by the CFT or TDM.

4.13.1.6(a) If, the child(ren) is considered a danger to themselves or others and there are no services or supports available contact ADCS or other source that will ensure the child(ren)’s safety in placement; and

4.13.6(b) If the crisis plan does not manage the safety issues, only then can a 30 day disruption notice be submitted and a call placed to the Placement Unit.

4.14 Emergency Disruption

4.14.1 If reason for disruption re-occurs within 2 weeks of the TDM or CFT, Contractor shall contact the placement unit, listing the date and details of the CFT/TDM, and document the reason for disruption. The standard reasons for disruption still apply.

4.15 One-on-One Supervision (Exhibit VI)

4.15.1 Provide one-on-one supervision as outlined in the One-on-One Supervision Guidelines.

4.15.2 One-on-One Supervision is only for the specific child(ren) as designated on the written authorization from ADCS.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.15.3 The written authorization from will state the details of the service authorized.

4.15.4 The Daily Log must include the signatures of the staff who provided the One-on- One supervision.

4.16 Re-admission and Bed Hold:

4.16.1 ADCS Bed Hold procedure

4.16.1.(a) Hold the bed for placement (Exhibit VII) for a maximum 7 days if authorized in writing, by the ADCS Placement Unit;

• Email bed hold request to: Bedhold@azdcs.gov

4.16.1.(b) Bed holds longer than 7 days require the authorization, in writing, of the ADCS Placement Unit Program Administrator; and

4.16.1(c) Re-admit the child(ren) if the reason(s) for discharge has been remediated and the level of care remains appropriate to the needs of the child(ren).

• Runaway: If the child(ren)’s whereabouts are unknown, but the and the child(ren) has not returned to the facility by 11:59 p.m., an automatic 1 day bed hold will go into effect. This shall be noted via an email to the Placement Administration. If the child returns to the home and the QRTP has occupancy, the youth must be permitted re-admittance to the program.

• Medical: If the need for medical attention requiring in-patient hospitalization has been remediated and the Case Manager has determined the child(ren) is safe at the QRTP;

• Behavioral: If the child(ren) is placed in a twenty-three (23) hour observation, is not admitted to the hospital, and the ADCS CHP has deemed the child(ren) is safe to be placed in a QRTP; and

• If the child(ren) is placed in detention for less than forty-eight (48) hours upon the child(ren)’s discharge

4.16.2 Refusal to accept re-admission of a placement is considered a material breach of the contract. Refusal to readmit will void a bed hold and payment will not be made.

mailto:Bedhold@azdcs.gov

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.17 Review of Personalized Plan

4.17.1 Review the Personalized Service Plan every forty five (45) to sixty (60) days, conduct a re-occurring review and document progress updates as requested below and on each element identified in the original review and case plan.

• How has the youth progressed and made improvements on the behaviors that warranted the initial QRTP placement. What areas of strength and areas of opportunity has the youth demonstrated?

• Discharge caregiver identified and transition visits in progress

• Provide a summary of the youth’s progress towards discharge from the current QRTP setting to a family like setting. The family like setting may include transition home through reunification, transition into a kinship or family foster home.

• Specify targeted efforts to transition the youth to Therapeutic Foster Care or Transitional Living arrangement if authorized by DCS.

If targeted efforts to Transitional Living what additional efforts are occurring to support transitional process, progress towards secondary, post-secondary and/or vocational education

• Note that transition from QRTP to traditional Group Home should not be sought as an option. The nature of the QRTP program is to transition youth to a family like setting. Any deviation must be approved thru the Placement Administration Program Administrator.

• Change in behaviors that warranted QRTP placement

4.17.2 Submit to the Case Manager and file a copy with the Case Record.

4.18 Transition: The following are transition activities and not considered a disruption from the QRTP

4.18.1 Not the appropriate QRTP

• Document reason in the initial review report within 2-3 days of arrival with supporting information

• Staff with the QRTP coordinator

• Upon agreement of this determination, contract will work with QRTP coordinator and CFT to work with the newly identified placement for a successful transition as defined in 4.19.

4.18.2 Transition to a higher level of care (HLOC)

• Document issues in the individualized service plan

• Engage the CFT, and if transitioning to an inpatient facility include the treating physician

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

• If the child(ren) are not recommended for a HLOC after an evaluation, the QRTP shall take the placement back unless the CFT determines that it is not in the child(ren)s best interest.

• Bed holds will apply in this scenario and be managed by Placement Administration

4.18.3 Discharge to a family like setting

• This is part of the discharge plan to be developed beginning at acceptance at the facility

• This may include a non-medically necessary TFC

• This does not include transitioning to a group home.

• Document and engage other support agencies, both community and state, kin, family and other youth support services

4.18.4. Voluntary termination by a child(ren) reaching the age of 18,

4.18.5 Emergency termination by the ADCS.

4.19 Transition Support

4.19.1 Assist the ADCS in making determinations of readiness for transition and continuity of care based on Personalized Service Plan progress, child(ren)’s behavior, ability to maintain behaviors, and case plan goals.

4.19.2 Group Home placement is not considered an acceptable transition plan or placement.

4.19.3 Provider is required to support transition to the next placement as determined by ADCS by:

4.19.3(a) Participate in pre-release meetings with identified child(ren) in order to ensure a smooth transition to the next placement.

4.19.3(b) Ensure that child(ren) are properly prepared for transition to a less restrictive service.

• Explain the discharge plan to the child(ren);

• Help the child(ren) understand the plan; and

• Arrange and accompany the child(ren) on pre-move visitations as mutually agreed upon between the placements.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.19.4 Provide the name of a staff member who is familiar with the child(ren) and will be responsible for answering the questions from the next caregiver about the child(ren) during the transition and up to sixty (60) calendar days after the child(ren) is transitioned to the new placement; and

4.19.5 Ensure all medications and documentation, as well as the contents of the child(ren)’s case plan is current.

4.19.6 Update the placement packet. If transporting to next placement ensure placement packet is delivered upon transition. If someone else is transporting the child to the next placement, ensure that the individual transporting has the updated packet to transition with the child.

4.20 Emergency Termination by the ADCS

4.20.1 The ADCS may remove a child(ren) from placement with the Contractor immediately when any of the following apply:

4.20.1(a) An allegation of child(ren) abuse, neglect or other conditions causing the referring agency to determine that the child(ren) is at unreasonable risk of harm;

4.20.1(b) Action taken pursuant to a court order;

4.20.1(c) Termination of an interstate compact agreement for placement of the child(ren);

4.20.1(d) Loss (or suspension) of provider license; and

4.20.1(e) Any other issue deemed appropriate for removal.

4.20.2 If ADCS removes a child(ren) for any of the above mentioned reasons, no new placements will be processed until the issue has been remediated.

4.21 Release of Child(ren).

4.21.1 At no time release a child(ren) to anyone other than the ADCS, or designee, or to a person designated by documented authorization from the ADCS.

4.21.2 Ensure that there is a procedure to verify telephone authorizations initiated by the

ADCS.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

4.21.3 Ensure that child(ren) are not moved from one facility to another facility within the

Contractor’s agency, without prior approval from ADCS Case Manager.

Movement without documented approval is a material breach of the contract.

4.21.4 Prepare an updated placement packet and ensure all of the child(ren)'s clothing, personal belongings, medications, medical/dental/behavioral health records (A.A.C. R6-5-7455) and documentation accompany the child(ren)’s to the next placement. A copy of the child(ren)'s case record, to the Case Manager.

4.21.5 Provide an appropriate suitcase or duffel bag for the child(ren) to transport belongings and clothes.

4.21.6 Replace and/or reimburse personal property of the child(ren) if determined it was lost/stolen inside the group home.

4.22 Discharge

4.22.1 Complete a written Discharge Summary (Exhibit VIII), in accordance with the Arizona A.A.C. R6-5-7442, and upload into the case manage system:

4.23 After-Care Plan

4.23.1 THE QRTP shall support the youth’s CFT as requested ensuring a smooth and stable transition from the program to a family like setting. QRTP shall, if requested to, participate as a member of the CFT for the purposes of supporting the youth

5.0. CONTRACTOR’S RESPONSIBILITY

5.1 Contractor’s General Requirements:

5.1.1 Comply with the statutory obligation to report child(ren) maltreatment, as prescribed in A.R.S. § 13-3620. In addition, the Contractor shall report incidents of sexual conduct or physical injury between children in care.

5.1.2 Ensure that Contractor personnel at no time endanger the health or safety of the child(ren) under their care.

5.1.2.(a) The Contractor or Contractor’s staff shall not be the perpetrator of a substantiated report of abuse or neglect towards any child(ren);

5.1.2.(b) Employees under investigation shall have no direct care responsibilities and shall not have any contact or access to the child making the claim; and

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

5.1.2.(c) Substantiated claims of the owner or of an employee of the Child Welfare Agency is a material breach of the contract and may result in termination.

5.1.3 Ensure that child(ren) do not have unsupervised contact (including social media) with any person not currently authorized by the Contractor according to Reasonable and Prudent Parenting Standards (“RPPS”), court or the referring agency.

5.1.4 Maintain compliance at all times with all applicable and current federal and state laws (as may be amended) and:

5.1.4(a) The ADCS Policy and Procedure Manual (https://dcs.az.gov/about/policy );

5.1.4(b) Any statute, rule or policy of the licensing agency; and

5.1.4(c) The ADCS Qualified Residential Treatment Program Policy and Procedures.

5.1.5 Comply with the ADCS Discipline Policy (ADCS Policy Manual, Chapter 4) as may be amended.

5.1.5(a) Ensure that a child(ren) is not allowed to punish another child(ren);

and

5.1.5(b) Use only appropriate restraint holding techniques. Physical holds shall only be utilized after de-escalation techniques have failed.

5.1.6 Collaborate and participate in meetings with other community agencies, such as:

5.1.6(a) Team Decision Making (TDM);

5.1.6(b) Child & Family Team (CFT);

5.1.6(c) ADCS Case Plan staff meetings;

5.1.6(d) Adult Treatment meetings;

5.1.6(e) Substance Exposed Newborn Safe Environment Program (SENSE) staff meetings;

5.1.6(f) Pre-release meetings; and 5.1.6.(g) Other meetings as may be determined.

5.1.6.(h) If the Contractor is concerned regarding the provision of services to a child(ren) the Contractor shall contact the case manager.

• If the case manager does not respond within 5 business days, the

Contractor may contact the Program Manager.

(QRTP)

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

• If the Program Manager does not respond within 5 business days the Contractor may contact the Program Administrator.

5.1.6.(i) If the Contractor is concerned with any contract terms, the Contractor shall contact the designated procurement officer.

5.1.7 Utilize…