4533. Behavior Rehabilitation Services

Original Date: September 27, 1995

Revised Date: October 1, 2019

Sunset Review: October 31, 2023

Approved by:  Ross Hunter, Secretary


Purpose

Behavior Rehabilitation Services (BRS) is a temporary intensive wraparound support and treatment program for children and youth with high-level complex service needs.

BRS is intended to stabilize children and youth (in-home or out-of-home) and:

  • Assist them in achieving their permanent plan more timely.
  • Keep them in their own homes with supports to the family.
  • Meet the needs of children and youth in family-based care setting to prevent the need for a more restrictive setting.
  • Reduce their length of services by transitioning them to a permanent home or less intensive service.

Scope

This policy applies to DCYF child welfare employees.

Laws

RCW 13.34.130 Order of disposition for a dependent child, alternatives - Placement with relatives, foster family home, group care facility, or other suitable persons

RCW 74.13.031 Duties of Department - Child Welfare Services - advisory committee.

RCW 74.13.080 Group Care Placement - Prerequisites for payments

 

Policy

  1. Prior to considering or referring a child or youth to BRS, they must be referred for and receive a Wraparound Intensive Services (WISe) screen. 
    1. If the WISe screen shows the child or youth is eligible and recommended for services, WISe must be given priority over BRS.
    2. Consider BRS services if: 
      1. WISe alone cannot safely serve the child or youth’s needs. BRS and WISe can be opened concurrently.
      2. The WISe agency is unable to meet the child or youth’s needs and intensive services is required to meet their needs.
  2. Children and youth with high-level complex service needs are eligible for BRS when they have:
    1. Received a WISe screen from a provider on the WISe Referral Contact List.
    2. Been assessed to need BRS level of care based on all of the following:
      1. Completed WISe screen.
      2. BRS Referral DCYF 10-166A and supporting documentation packet.
      3. The Children’s Functional Assessment Rating Scale (CFARS).
      4. Recommendations from the shared planning meeting (SPM) or Family Team Decision Making (FTDM) meeting.
    3. The required approvals on the BRS Referral DCYF 10-166A form.
  3. BRS can only be provided by contracted BRS service providers. BRS ongoing contracts can be issued to out-of-state agencies only if they are located within 50 miles of Washington State.
  4. Caseworkers will continue to pay BRS In-Home/Support Services if they are being provided at the contract rate. This rate is not intended to be all inclusive. Services and other funds DCYF would normally pay for should continue, e.g., rent, child care, concrete goods, etc.
  5. Follow the Placement - Intensive Resources policy when a child or youth’s individual service needs are beyond what can be provided through the BRS contract and other more intensive services are needed.
  6. Caseworkers assigned to children or youth in BRS must:
    1. Participate in the BRS Child and Family Team (CFT) case review meetings.
    2. Facilitate the discussion to identify a targeted discharge date and transition placement.
  7. Children and youth placed in a BRS Qualified Residential Treatment Program (QRTP) must have DCYF and court approval for the placement and:
    1. A court review hearing within 60 calendar days of the QRTP placement.
    2. A court review at least every six months.
    3. DCYF deputy secretary approval if placed in a QRTP longer than six months.
    4. Regional administrator or designee if placed in a QRTP longer than twelve months and every twelve months thereafter.

Procedures

  1. Eligibility and Referral
    1. Before a BRS referral is made, caseworkers must:
      1. Refer the child or youth for a WISe screen from a provider on the WISe Referral Contact List if a screen has not already been completed within the last 60 calendar days.
      2. Consult with the regional BRS Program Manager (PM) to determine if BRS is appropriate.
      3. Conduct a SPM or FTDM meeting to identify needed supports and services for the child or youth and family, and determine if BRS is an appropriate and needed resource for the child or youth.
    2. If the SPM or FTDM meeting determines BRS is needed, caseworkers must:
      1. Complete a BRS Referral DCYF 10-166A form and provide the documentation listed on the form. The BRS referral must include:
        1. Information about the child or youth’s current needs.
        2. The SPM or FTDM meeting recommendations.
        3. The most current supporting documentation in the BRS packet.
      2. Review the WISe results and:
        1. Include a copy of the completed WISe screen results in the BRS packet, when available.
        2. Document on the BRS Referral DCYF 10-166A form:
          1. Reasons why the youth is not eligible for WISe or is screened eligible, but WISe services are not being used.
          2. The results of the WISe screen if a copy of the completed WISe screen is not available.
          3. If the WISe screen was not completed:
            1. The reason it was not completed and date of the request.
            2. The plan to complete the WISe screen.
        3. Document in a FamLink case note:
          1. When a WISe referral is made.
          2. WISe screening completion date.
          3. Results of the WISe screening.
      3. Obtain supervisor and area administrator (AA) approval and send the completed BRS referral packet to the regional BRS PM for final approval.
      4. Determine if the child or youth will need an out-of-state BRS contract placement. If so:
        1. Complete the Interstate Compact on the Placement of Children (ICPC).
        2. Obtain court approval, when required.
    3. When receiving the BRS referral packet, regional BRS PMs must:
      1. Verify the BRS referral packet is complete and includes the WISe screen results and reasons why BRS is needed for a child or youth who is eligible for WISe. If a WISe screen was not completed, verify the BRS Referral DCYF 10-166A form includes:
        1. The date of the WISe screen request and reasons why it was not completed.
        2. The plan to complete the WISe screen.
      2. Review the BRS referral packet:
        1. For current supporting documentation and recommendations from the SPM or FTDM meeting.
        2. To determine the child or youth's eligibility for BRS based on information provided. This includes the results of the WISe screen, documentation listed in the BRS Referral DCYF 10-166A form, and the SPM or FTDM meeting recommendations.
      3. Complete a QRTP Assessment DCYF 10-167 on BRS eligible children or youth to determine their needed level of care.
      4. Make a referral to BRS contractors based on the assessment of the child or youth’s needs, the contractor’s ability to adequately provide services for those unique needs, quality of services provided, and performance on outcome data.
      5. Only refer children or youth to a QRTP who are assessed to need that level of care.
      6. Provide the completed QRTP Assessment DCYF 10-167 to the assigned caseworker if a child or youth is placed in a QRTP.
      7. Review the child or youth's discharge or permanency plan.
      8. Only send complete and current referral packets to contractors.
      9. Notify the caseworker once the referral has been accepted by a contractor, with contractor information, service level, and contracted rate.
      10. Determine if the child or youth's supervision needs exceed the BRS level of care.
      11. Negotiate one-to-one supervision as needed to address the child or youth’s specific behaviors with in-state agencies.
      12. Follow Placement - Intensive Resources policy for Intensive Residential Child Specific contract if one-to-one supervision through the BRS provider does not meet the specific needs of the child or youth.
      13. Complete the extra supervision rate proposal using Child Specific Contract Rate Proposal DCYF 10-490 form and submit for approval and signatures listed on the document.
      14. If the Contract Rate Proposal DCYF 10-490 is approved, provide the completed Child Specific Contract Rate Proposal DCYF 10-490 form to a fiduciary for the additional payment.
      15. If the child or youth requires an in-state or out-of-state child specific contract, follow the Placement - Intensive Resources policy
  2. Placement and Ongoing Services
    1. Regional BRS PMs must provide the service agreement that includes: type, placement, if needed, and payment level to the regional fiscal analyst (RFA) or designee.
    2. RFAs or designees must:
      1. Enter the placement and payment information into FamLink.
      2. Upload the service agreement.
    3. CFT Meetings
      Caseworkers must:
      1. Participate in CFT case review meetings and actively involve the child or youth, their family, and other identified supports in case planning.
      2. Focus on measurable outcomes related to the child or youth’s safety, stability, permanency, and discharge planning including transitioning to less intensive services or a permanent home.
      3. During the CFT meetings with the BRS provider:
        1. Review the child or youth’s progress and transition planning, WISe screen results, and CFARS. BRS providers are required to refer children or youth for a WISe screen from the WISe Referral Contact List at least every six months and prior to discharge. If a child or youth is participating in BRS and WISe at the same time, WISe screens will be completed by the WISe provider every 90 days.
        2. Document the results of case reviews in FamLink case notes.
      4. Follow the Health and Safety Visits with Children and Monthly Visits with Out-of-home Caregivers and Parents policy, and:
        1. Discuss with the child or youth their safety, stability, permanency, and discharge planning. If necessary, conduct a SPM to address these areas.
        2. Share information with the dependent child or youth about the court processes and their right to request legal representation.
      5. Assist youth age 15 years and older and placed in out-of-home care for more than 30 calendar days in completing the Casey Life Skills Assessment (CLSA) and Learning Plan (LP) per the Transitioning Youth for a Successful Adulthood policy.
      6. Follow Transitioning Youth for a Successful Adulthood and The Transition Plan policies to effectively engage, support, and prepare youth for adulthood.
    4. Youth Placed in a QRTP
      1. Court Hearings
        Caseworkers must:
        1. Immediately notify the assistant attorney general (AAG) to request a court hearing to:
          1. Inform them that court approval is needed for the placement.
          2. Occur within 60 calendar days of the QRTP placement if one is not already scheduled, e.g. shelter care hearing, dependency hearing, permanency review hearing, etc.
        2. Initial and Ongoing Court Hearings
          1. Provide the court with the completed QRTP Assessment DCYF 10-167 and justification for the QRTP.
          2. Obtain court approval for the QRTP placement.
          3. Upload the completed court order and other court documentation, as applicable, into FamLink.
          4. Provide copies of court approved documents to the regional BRS program manager.
          5. For ongoing dependency or permanency planning hearings:
            1. Request a copy of the current QRTP Assessment DCYF 10-167 from the regional BRS managers at least 10 business days prior to the hearing.
            2. Provide the court with the updated QRTP Assessment DCYF 10-167 and court report including justification for the continued need for QRTP.
      2. Administrative Approvals
        1. After the first six months of placement:
          1. Caseworkers must complete the Administrative Approval Request DCYF 05-210 form and submit to the RA or their designee for approval.
          2. The RA or designee if approved, must submit Administrative Approval Request DCYF 05-210 to the Deputy Secretary for approval.
          3. The deputy secretary after completing the review and approval will send copy to the assigned caseworker.
          4. If approved, the caseworker must:
            1. Provide a copy of the completed and signed Administrative Approval Request DCYF 05-210 form to the regional BRS PM.
            2. Upload the document in FamLink.
        2. After the first 12 months and every 12 months thereafter:
          1. Caseworkers must complete the Administrative Approval Request DCYF 05-210 form and submit to the RA or their designee for review.
          2. The RA must review the request for approval.
          3. If approved, the caseworker must:
            1. Provide a copy of the completed and signed Administrative Approval Request DCYF 05-210 form to the regional BRS PM.
            2. Upload the document in FamLink.
      3. Follow the EFC policy for a youth to remain in BRS past their 18th birthday. 
    5. Regional BRS PMs must:
      1. Provide oversight, guidance, and consultation regarding BRS provider's compliance. Including quality of service, outcomes, and performance.
      2. Monitor and track regional BRS data, including, but not limited to:
        1. Date of entry
        2. Exit
        3. Length of stay
        4. Placement type
        5. Service and rate
        6. Dates of the six-month case review hearings (children or youth in QRTP only)
        7. Contractor outcomes and performance measures on the BRS Monthly Census Report.
      3. Review the child or youth's service needs, level of care, expected exit date, and transition plan every six months in collaboration with the caseworker and contracted service provider.
      4. Participate in CFT meetings, when possible.
      5. If a child or youth is placed in a QRTP:
        1. Provide the caseworker with a current QRTP Assessment DCYF 10-167 at least 10 business days prior to all dependency or permanency planning review hearings.
        2. Provide a copy of the assessment to the caseworker.
  3. Aftercare services are provided to children or youth transitioning out of BRS to a less restrictive environment. When this occurs:
    1. Caseworkers must:
      1. Participate in CFT meetings, at least quarterly, to discuss aftercare wraparound planning that supports the child or youth and family to achieve stability, permanency, or placement transition.
      2. Verify discharge planning and family-based aftercare support is provided for all children and youth transitioning from a QRTP for at least six months as determined by the transition plan, if applicable.
      3. Arrange aftercare support with another contractor closer to the child or youth’s discharge placement, if needed. WISe must be used as the discharge support service, when applicable.
    2. Regional BRS PMs must:
      1. Consult with caseworkers to develop an aftercare service plan.
      2. Negotiate with the contracted provider on an aftercare service plan.

Forms