What does this Mean?

When a child needs a higher level of support, a non-family like setting may be needed (group home or a psychiatric residential treatment facility). Family First encourages non family-based placements to be temporary, focusing on individual children’s needs, and preparing them for return to family and community life.

Family First creates a specific non family-based placement type and a structure around placing children in these types of placements. The new placement type is called a Qualified Residential Treatment Program (QRTP).

Why does this Matter?

Federal funding for foster youth with specific treatment needs will only be available for non family-based placements that qualify as a QRTP.

What is a Qualified Residential Treatment Program(QRTP)?

A Qualified Residential Treatment Program is a new designation of non-family based placements by the Administration for Children and Families (ACF). QRTPs serve children with specific treatment needs who need short term placement out of their home. Upon implementation of Family First in Virginia, Title IV-E funds can only be used for non-family based placements which are designated as QRTPs.

Family First requires that QRTPs meet the following requirements:

  • Accredited by at least one of the following:
    • The Commission on Accreditation of Rehabilitation Facilities
    • Joint Commission on Accreditation of Healthcare Organizations
    • Council on Accreditation
  • Utilize a trauma-informed treatment model
  • Must be staffed by a registered or accredited nursing and clinical staff in accordance with the treatment model who:
    • Provide care within the scope of their practice as defined by state law
    • Are on-site according to the treatment model
    • Are available 24 hours a day and seven days a week
  • Be inclusive of family members in the treatment process and documents the extent of their involvement
  • Offer at least six months of support after discharge

What is the QRTP Placement Process?

  • Within 30 days of a youth being placed in a qualified residential treatment program, an assessment must be performed by a “qualified individual” to determine if a qualified residential treatment program is the best fit for them. In Virginia, a “qualified individual” means a licensed mental health professional. (As defined in 12VAC35-105-20.)
  • Within 60 days of a foster youth's placement in a QRTP, a court review must take place to approve or disapprove the placement. The Court will consider the 30 day assessment and determine whether the needs of the youth can be met through placement in a foster family home or whether or not the QRTP provides the most effective and appropriate level of care for the youth, as specified in the permanency plan for the youth.
  • A QRTP placement must be reviewed by the VDSS Commissioner and the United States Department Health and Human Services Secretary if a foster youth 14 years of age or older has been placed in a QRTP for 12 consecutive months or 18 non-consecutive months.
    • A QRTP placement must be reviewed by the VDSS Commissioner and the United States Department Health and Human Services Secretary if a foster youth 13 years of age or younger has been placed in a QRTP for 6 consecutive months.

QRTP Frequently Asked Questions

A QRTP is a non-family based placement which provides treatment to children using a trauma-informed treatment model. QRTP’s must be accredited by a non-profit accrediting agency (JACHO, CARF, and COA), facilitate outreach to the family, have registered or licensed nursing staff and clinical staff, and provide after care support for at least 6 months. Within 30 days of placement in a QRTP, children must complete a clinical assessment to determine the appropriateness of the placement (aligning with Virginia’s current DMAS Clinical Assessment). Within 60 days the court must approve the child’s placement in a QRTP.

The Secretary of Health and Human Resources has not given official approval to delay from the proposed October 1, 2019 implementation date. A more realistic implementation date is likely to be July 1, 2020 which is also in alignment with the first phase of the DMAS and DBHDS Behavioral Health Redesign, as well as the new state fiscal year. Unexpected information, decisions, or delays in Federal guidance or State alignment may cause this date to be adjusted.

Yes. The AFDC standards to determine IV-E eligibility when entering foster care have not changed. Children will be assessed for IV-E eligibility through the normal process. IV-E eligible children do not lose their eligibility; however the placement may not be IV-E reimbursable. Children already in a congregate care placement when Family First is implemented will be “grandfathered” as far as IV-E is considered. Only new placements will be subject to the Family First guidelines.

Family First will not do away with group homes. However, when Family First is implemented, IV-E maintenance payments will be limited to the following six placement categories:

  • Family foster homes (including relatives) with six or fewer children in the home
  • Placements for pregnant or parenting youth
  • Supervised independent living for youth 18+
    Qualified Residential Treatment Programs (QRTP) for youth with treatment needs
  • Specialized placements for victims of sex trafficking
  • Family-based residential treatment facility for substance use disorders

Group homes will be reimbursed if they meet one of the six placement categories. Payment for other placements is restricted by this legislation. After the implementation of Family First, IV-E funding is restricted (see the exception of children already in placement mentioned in Question 3. above). During a yet to be defined transition period, CSA funds may be utilized to cover the cost of IV-E ineligible placements; however, this is expected to be a short-term support through the implementation period.

Youth who are in placement upon implementation of Family First are “grandfathered” into their placement and funding sources. Only new youth who enter care or youth who move from placement to placement after implementation are subject to Family First requirements.  There is no expectation that Family First will eliminate the need for all non-family based care placements.

A shortage of foster family homes is not an acceptable reason for placement in a non-family based placement. The intent of the legislation is to reduce the use of group homes and non-family based care whenever possible.

There is a statewide campaign to raise awareness and recruit additional foster parents. It is important that LDSS also work towards recruiting more foster families and ensuring that relatives are assessed for placement in every case.

Non-family based placements should be the exception, not the rule. During JLARC’s review they found that youth were being placed in non-family based placements because there was nowhere else for them to go, not because of clinical need. VDSS is working on a Diligent Recruitment Plan that will be maximizing family based placements so youth do not have to leave their community. VDSS is partnering with the Virginia Fosters Initiative (VA Kids Belong and the Governor’s Office) to connect foster families, faith based communities, and community partners to support parents and youth involved in the foster care system.

VDSS also received $851,000 to begin building and expanding evidence based services in communities to provide services for children and their families. VDSS is partnering with DJJ in providing evidence based services of Multisystemic Therapy and Functional Family Therapy across the Commonwealth. 

Local agencies and providers should ensure that concurrent planning begins at the beginning of placement in foster care, for every placement, and is occurring throughout the life of the case. Concurrent planning is following “Plan A”, while creating and following “Plan B” simultaneously. VDSS is also exploring the development of evidence based foster care models (Treatment Foster Care Oregon and Professional Foster Parents) which could be reimbursable by IV-E which would provide a higher level of care for youth.

VDSS will continue to work in collaboration with OCS, DMAS and DBHDS to ensure the best level of care is available for the youth.

The funding source should not drive the services available and provided to youth. Programs should begin preparing to become QRTP certified program now. If a program chooses not to take a certain funding source, the program may not be able to receive full payment from another funding source if there are other available funding sources which they did not chose to utilize by becoming a QRTP.

Virginia has identified that the “qualified individual” will align with the current DMAS Clinical Assessment requirements and it must be a licensed mental health professional. Licensed Mental Health Professional meaning a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, or licensed behavior analyst as defined: DMAS refers to DBHDS’ definition and DBHDS refers to DHPs definitions. DHP has the authority of who meets the criteria of a LMHP. It is the court’s responsibility to make sure a “qualified individual” completed the assessment.

Family First specifies three accrediting bodies: the Joint Commission on Accreditation of Healthcare Organizations (JACHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA).

Accreditation does not convey automatic status as a QRTP in Virginia. Virginia will designate QRTP’s through collaboration with VDSS Division of Family Services, VDSS Licensing, DBHDS Licensing, DMAS and OCS. 

The federal QRTP requirements are slightly different than Virginia’s current licensing requirements. The determination has not fully been decided on how QRTP’s will be designated in Virginia at this time. VDSS is partnering with DBHDS Licensing, VDSS Licensing, DMAS, and OCS to work through this process and determine how to best implement the federal law in Virginia.

Current, licensing regulations indicate that each site is required to be licensed. There will be discussion about this question moving forward and clarity will be provided in the near future.

Family First does not say anything specific about this. The Three Branch and inter-agency teams will work to offer solutions to this question.

Family First believes that reunification is important and should be valued as long as it is safe to do so. Steps should be taken to show effort to get safe involvement of the siblings. The safety and well-being of the child is of utmost importance.

Yes; but the QRTP program is responsible for making sure that aftercare support happens. Virginia does not allow a program to assign liability/responsibility to a subcontractor. The contract staff would still be subject to the safety requirements.

Services for children who are discharged from a QRTP may be funded through the local CSA program or through Medicaid (for Medicaid covered services) as is the current situation. DMAS is also exploring additional options for payment for aftercare services.

A standardized format has not been discussed at this time.

Family First requires that the QRTP provides aftercare support. A determination has not been made that every youth who is placed in a non-family based placement requires CSB case management. It is also true that not all CSBs have case management for children available. The commitment is to prevent duplication and redundancy for youth, families and programs.

Family First states that a program could contract for nursing staff and does not necessarily mean a direct staff-employer relationship. Given the intent of the legislation, it is not anticipated that utilizing Urgent Care or Emergency Rooms would satisfy the requirement of the law. It should be noted that all contracted staff will need to have an “employee file” onsite with all the required trainings and background checks conducted by the provider and be maintained by the provider.

The 12-month review requirement includes an expectation that plans for discharge should not wait until the 11th month, services should be time limited, and that placements will be found and exceptions will be more rare than common. There will be emphasis on moving the process along. The Three Branch and inter-agency teams will work to offer additional clarity around this issue.

The intent is that a child will always have a safe place to go. The Three Branch and inter-agency teams will work to offer clarity around this issue.

Family First does not speak to that directly. A definitive decision has not been made, but it will likely be a partnership through the program and the local agency.

In any foster care court hearing, youth should be present.

There is nothing in the law that states that programs must send a staff person to a court hearing. It may be helpful for program staff to talk with the local agency worker, the child’s Guardian ad Litem, and CASA worker to determine appropriate representation at court hearings. If the court is reviewing a placement decision, it would likely be beneficial for a staff person to be available to testify to the provision of services, the child’s needs, and why the child needs to continue to receive services in order for the court to make an informed decision. Written reports are generally not admissible in court. Arrangements for transporting the child to the hearing should also be determined collaboratively.

The Court Improvement Program of the Supreme Court of Virginia is required to provide training to judges on the new QRTP requirements. The Court Improvement Program has already begun training judges.

A judge makes their decision based on information presented and the relevant statutes. The reports and information given to the court should provide what is needed for the judge to make a fully informed decision. If a different placement is deemed necessary by the court, there is a grace period for a change in placement most fitting to the child’s needs.

Foster care hearings are conducted in the locality in which the child’s family resides (the funding locality) and where the LDSS holds custody.

These will need to be addressed on an individual basis. The FAPT, Judge/Commissioner should be collaborating to provide the best plan for the child. However, statute provides the judge with final authority for determining a child’s placement and local CSA programs must comply with the court’s orders.

Discharge planning is a part of the treatment in the QRTP. An ongoing plan for the next steps for the child should be under review by all working with the child at the placement.

Decisions or recommendations have not been made at this time regarding funding levels. The General Assembly required DMAS to conduct a rate analysis which resulted in DMAS asking the residential facilities to submit the cost reports. Results of DMAS's rate study will determine whether there will be an adjustment to rates.

This matter is being discussed internally, and the high administration burden is to be addressed.

The expectation is it does not matter how the youth enters a program (parental placement vs. foster care) the level of service is the same. Work is being done to align all funding sources in Virginia to ensure the same level of care.

The expectation is that all children placed in a facility will receive the same high level of treatment. It is not the intention to have different levels of care.

This is under review as part of the DMAS/DBHDS Behavioral Health Redesign effort. There is no specific information to report at this time.

DMAS is considering expanding coverage. The specifics have not been released at this time.