922 KAR 1:390. Standards for residential child-caring facilities.

CABINET FOR FAMILIES AND CHILDREN

Department for Community Based Services

Division of Policy Development

922 KAR 1:390. Standards for residential child-caring facilities.

RELATES TO: KRS 199.011, 199.640, 199.645 to 199.670, 214.034(4), Chapter 424, 600.020, 610.110 (6), 615.010, 615.030, 615.040

STATUTORY AUTHORITY: KRS 194B.050(1), 199.640 (5), 199.645, 615.050

NECESSITY, FUNCTION, AND CONFORMITY: KRS 199.640(5) requires the Cabinet for Families and Children to promulgate administrative regulations relating to standards of care and service for child-caring facilities. This administrative regulation establishes standards of care and service for residential child-caring facilities.

Section 1. Definitions.

(1) "Cabinet" means the Cabinet for Families and Children.

(2) "Child" is defined at KRS 199.011 (4), 600.020(8), and 610.110(6).

(3) "Child-caring facility" is defined at KRS 199.011 (6).

(4) "Child-caring program" means the method of delivering a child-caring service.

(5) "Community resources" means a service or activity available in the community that supplements those provided by the child-caring facility in the care and treatment of a child

(6) "Crisis intervention unit" means a unit operated to serve a child in need of short term intensive treatment and to avoid risk of placement to a higher level of care.

(7) "De-escalation plan" means a treatment method used to decrease the intensity of emotional conflict or aggressive behavior.

(8) "Executive director" means the person employed by the board of directors to be responsible for the administration and management of a child-caring facility.

(9) "Family residential treatment program" means intensive professional assessment and treatment-oriented services provided by a residential treatment facility to a family unit in order to prevent out-of-home placement, or to facilitate family reunification.

(10) "Group home" is defined at KRS 199.011 (10).

(11) "Individual treatment plan" or "ITP" means a plan of action developed and implemented to address the needs of a child.

(12) "Latching device" means an instrument used to secure a seclusion room door that does not require the use of a key or combination.

(13) "Living unit" means a building or part of a building in which a child resides, containing sixteen (16) or fewer beds.

(14) "Residential child-caring facility" means an institution or group home providing twenty-four (24) hour care.

(15) "Residential treatment program " means an intensive professional treatment-oriented service provided by a residential facility.

(16) "Seclusion" means the temporary placement of a child in a room in a residential treatment facility to prevent harm to the child or others.

(17) "Treatment" means individualized management and care of a child, utilizing professionally credentialed and certified staff and a component of the treatment environment to assist the child in resolving his emotional conflict or behavioral disorder.

(18) "Treatment director" means an individual who oversees the day-to-day operation of the treatment program.

(19) "Treatment team" means a representative group of people who provide services to the child and the child's family.

Section 2. Administration and Operation.

(1) Licensing procedures. Licensing procedures for a residential child-caring facility shall be in compliance with 922 KAR 1:305 for a child-caring facility.

(2) A residential child-caring facility shall meet the requirements of 922 KAR 1:300, Sections 3 through 7.

Section 3. Residential Child-caring Facility Services.

(1) The child-caring program services for a residential child-caring facility shall be in compliance with 922 KAR 1:300, Section 7.

(2) Unless a child is a member of a family group placed in a facility, a child under six (6) shall not be placed in the residential child-caring facility unless that facility is also licensed to provide emergency shelter service as established in 922 KAR 1:380.

Section 4. Residential Treatment Program.

The following additional requirements shall apply to a residential child-caring facility providing intensive treatment services.’

(1) Professional treatment services.

(a) The facility shall secure needed services for a child who has an assessed need for a psychological, psychiatric, or other professional treatment service not provided by the residential child-caring facility.

(b) The admission decision shall be the responsibility of a treatment team comprised of clinical, social service, and other disciplines designated by the residential child-caring facility’s treatment director.

(c) After assessment and development of the ITP in accordance with 922 KAR 1:300, Section 7, the treatment team shall identify services to meet the needs of the child and his family. The services shall be provided by the residential child-caring facility or arranged through contract with another qualified residential child-caring facility or child-placing agency, as established in 922 KAR 1:310, or a treatment professional and shall include, as developmentally appropriate, a minimum of weekly:

1. Individual counseling from a social worker or other treatment professional; and

2. Group counseling conducted by a trained social worker or other treatment professional as determined appropriate by the treatment team and under the supervision of the treatment director.

(d) Other services identified after the assessment and development of the ITP by the treatment team may include:

1. Psychiatric counseling;

2. Specialized therapy recognized by mental health credentialing authority; or

3. Family counseling.

(e) A residential child-caring facility shall become accredited by a nationally recognized accreditation organization before October 2004 or within two (2) years of initial issuance of a license for treatment.

(2) Staffing requirement.

(a) The child-caring facility shall maintain a staff-to-child ratio of at least one (1) child care staff member to six (6) children during the child’s waking hours, and one (1) child care staff member for every twelve (12) children in a living unit during nonwaking hours. At least one (1) staff member in each living unit shall remain awake during children's sleeping hours.

(b) The treatment director shall:

1. Hold at least a master’s degree in a human service discipline; and

2. Have at least five (5) years experience in mental health treatment of children with emotional or behavioral disabilities and their families and be responsible for the:

a. Supervision;

b. Evaluation; and

c. Monitoring of the:

(i) Treatment program;

(ii) Social work; and

(iii) Other treatment staff.

(c) A residential child-caring facility providing a treatment service for more than thirty (30) children shall employ a separate treatment director other than the executive director.

(d) A residential child-caring facility providing a treatment service for thirty (30) or fewer children may utilize the executive director in a dual role as treatment director, if at least fifty (50) percent of his duties are spent supervising the treatment program. If an employee serves as both executive director and treatment director, the higher staff qualification shall apply.

(3)(a) When seclusion is used, a residential child-caring facility shall:

1. Before a child is placed in seclusion, develop and maintain clearly-written policy and procedures governing the placement of a child in seclusion, including a requirement for a de-escalation plan in the child’s ITP;

2. Provide a copy of the policy and procedures to staff members responsible for placement of a child into seclusion; and

3. Require a staff member who uses seclusion as part of the forty (40) hour annual training program established in 922 KAR 1:300, Section 3, to complete at least sixteen (16) hours of training in approved methods of de-escalation and the use of seclusion, from a nationally-recognized accreditation organization approved by the cabinet, to include:

a. Assessing physical and mental status, including signs of physical distress;

b. Assessing nutritional and hydration needs;

c. Assessing readiness to discontinue use of the intervention; and

d. Recognizing when medical or other emergency personnel are needed.

(b) Seclusion shall be used only in an emergency or crisis situation when:

1. A child is in danger of harming himself or another; and

2. The effort made to de-escalate the child's behavior prior to placement was ineffective.

1. Punishment;

2. Discipline; or

3. Convenience of staff.

(d) Approval from the treatment director or treatment staff designee as established in 922 KAR 1:300, Section 3, shall be obtained prior to or within fifteen (15) minutes of the placement of a child in seclusion.

(e) More than one (1) child shall not be placed into the same seclusion room at a time.

(f) An object that may be used for self harm shall be removed from the child before he is placed in seclusion.

(g) Except for a belt and shoes, a child's clothing shall not be removed while he is placed in seclusion.

(h) Within a twenty-four (24) hour period of time, the maximum amount of time that a child remains in latched seclusion shall not exceed the following:

1. Age nine (9) and younger, fifteen (15) minutes; and

2. Age ten (10) and older, one (1) hour.

(i) If a child's behavior is stabilized, the child shall be released from seclusion prior to the time period specified in this section.

(j) If a child requires repeated placement in seclusion, a treatment team meeting shall be conducted by the treatment director to reassess the child's ITP, including referring the child to a higher level of care.

(k) A staff member shall observe visually a child who is in seclusion every five (5) minutes.

(l) Seclusion shall be discontinued if a child displays adverse side effects including:

1. Illness;

2. Severe emotional or physical stress; or

3. Physical damage.

(m) A child in seclusion shall be provided with food, water, and access to a lavatory.

(n) Staff shall document, in the child's record, the following information regarding seclusion of a child:

1. An intervention to de-escalate the child's behavior prior to placement;

2. Date and time of placement;

3. Date and time of removal;

4. Reason for placement;

5. Name of each staff member involved;

6. Treatment director's or designee's approval;

7. Five (5) minute visual observation by staff of the child's placement; and

8. Intervention provided by treatment staff when the child leaves seclusion.

(o) A room used for seclusion shall be:

1. Lighted, ventilated, and maintained at a temperature consistent with the rest of the child-care facility;

2. Internally observable if the door is closed;

3. At least fifty-six (56) square feet in size; and

4. Free from an object that allows the child to do self-harm.

(p) Immediately upon the child's exit from seclusion, treatment staff shall provide therapeutic intervention.

(q) Exclusive of weekends and holidays, within forty-eight (48) hours of placement in seclusion an incident report shall be:

1. Completed by designated treatment staff;

2. Reviewed no later than one (1) working day after its use; and

3. Signed by the treatment director or designee and the program director or designee.

(r) Staff shall have visual contact with a child in latched seclusion at all times.

Section 5. Crisis Intervention Unit.

(1) An emergency service provided in a crisis intervention unit shall include the following:

(a) A mental status evaluation and physical health questionnaire of the child upon admission;

(b) A treat ment planning process;

(d) Discharge and aftercare planning processes.

(2) A program shall have a written policy concerning the operation of a crisis intervention unit.

(a) Staffing.

1. At least one (1) direct-care staff member shall be assigned direct-care responsibility for:

a. Four (4) children during normal waking hours; and

b. Six (6) children during normal sleeping hours.

2. Administrative oversight of the program shall be provided by a staff member who shall be a:

a. Treatment director; or

b. Person qualified to be executive director.

(b) A licensed psychiatrist shall be available to evaluate, provide treatment, and to participate in the treatment planning.

a. Upon admission, the crisis intervention program shall provide the child and his parent, guardian, or other legal representative with a clearly written and legible statement of rights and responsibilities; or

b. If unable to read the statement of rights and responsibilities, the statement shall be read to the child and his parent, guardian, or other legal representative.

2. Written policy and procedure developed in consultation with professional and direct-care staff shall provide:

a. For behavior management of a child, including the use of time-out; and

b. An explanation of behavior management techniques to a child and his parent, guardian, or other legal representative.

(3) The crisis stabilization unit shall prohibit the use of:

(a) Seclusion; or

(b) Mechanical restraint.

Section 6. Family Residential Treatment Program.

The following additional requirements shall apply to one (1) pilot family residential treatment program in Fayette County for providing intensive family in-residence treatment services.

(1) The child-caring facility may provide services for a family when deemed appropriate following the completion of a comprehensive family and risk assessment to include consideration of:

(a) The child’s permanency plan;

(b) History of abuse or neglect;

(d) History of domestic violence;

(e) History of substance abuse;

(f) History of mental health problems;

(g) Developmental history of child;

(h) History of family needs;

(i) Whether parenting skills are adequate;

(j) Quality of caregiver to child relationship;

(k) Medical history of each family member; and

(l) Legal history of each family member.

(2) Staff qualifications and training. An intensive family residential treatment program shall employ or have on contract a therapist with the appropriate licensure or certification and evidence of training in the following areas:

(a) Family dynamics and family therapy;

(b) Substance abuse;

(d) Attachment issues.

(3) Staff that have direct contact and supervision of a family shall have orientation and training in the following:

(a) Attachment and nurturing issues;

(b) Parenting skills;

(d) Identification of signs of domestic violence, substance abuse, child abuse and neglect; and

(e) Adult intervention strategies and conflict resolution.

(4) The training requirements listed in subsection (3) of this section may be included as part of the forty (40) hours of annual training established in 922 KAR 1:300, Section 3(6)(o).

(5) Except for adults, staffing requirements established in Section 4(2)(a) of this administrative regulation shall be maintained on the family living unit.

(6) Unless there is imminent danger to staff, child, or an adult member of a family, physical restraint shall not be used.

(7) The living unit shall be a distinct and separate part of the facility or housed in a separate building and shall be monitored by staff or electronic surveillance on a twenty-four (24) hour basis.

(8) A family treatment plan shall be developed for each family with the needs of each family member addressed and a description of how those needs will be met.

(9) A family member with a history of aggressive behavior or sexual acting-out shall be assessed by the treatment team prior to admission.

(10) The treatment team shall develop a safety plan with each family to ensure the safety of all residents at the facility.

(11) Sleeping arrangements shall be specified in the family's treatment plan.

(12) Facility policy shall ensure the safety of staff, family members, and residents.

Section 7. Group Home.

The following additional requirements shall apply to a group home program.

(1) Documentation of evidence of publication of a "notice of intent" in an area newspaper, in accordance with KRS Chapter 424, advertising that:

(a) A public hearing shall be held if requested by citizens in the community or an appropriate local governmental entity; and

(b) Information obtained at the hearing shall be made available to the public and the cabinet.

(2) A staff-to-child ratio of one (1) child-caring staff member for each four (4) children. An on-duty staff member who is away from the group home with a child shall be included for the computation of this ratio.

(3) Documentation of the use of community resources and efforts to encourage a child to participate in community activities.

Viola Miller, Secretary

Dietra Paris, Commissioner

Adopted: June 14, 2002