Community Treatment Facility (CTF) Placements through the Interagency Placement Screening Committee

0600-515.11 | Revision Date: 07/28/21

Overview

This policy guide provides instructions to DCFS staff on how to meet a child/youth/Nonminor Dependent’s (NMDs) mental health needs when a child/youth/NMD requires placement in a Community Treatment Facility (CTF).

TABLE OF CONTENTS

Policy

Child and Family Team Meetings (CFTMs)

Intensive Mental Health Treatment

Community Treatment Facility (CTF) Criteria

Exclusionary Criteria

Interagency Placement Committee (IPC) Screening Criteria for Placement in a CTF

Procedure

Preparing for an IPC) Screening for Placement in a CTF

Continuing Services (CS) CSW Responsibilities

CS Supervising CSW (SCSW) Responsibilities

Assistant Regional Administrator (ARA) or Designee Responsibilities

Regional Administrator (RA) or Designee Responsibilities

Residential Care Liaison (RCL)/CTF IPC Liaison Responsibilities

Presenting and Placing a Child/Youth/NMD in a CTF through the IPC Screening Process

CS CSW or SCSW Responsibilities

RCL/CTF IPC Liaison Responsibilities

Approvals

Helpful Links

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version, to align with the Continuum of Care Reform (CCR) mandates, such as uses of CFTMs, and to reflect current program processes for placement in a CTF.

POLICY

Child and Family Team Meetings (CFTMs)

The Child and Family Team (CFT) process is aligned with the values of the Core Practice Model (CPM).  The CFT process is an integral part of family engagement and service planning and is designed to empower the family. Placement decisions are a key part of this process, thus CFTMs are to be utilized to keep the CFT members fully informed and involved in decision-making, including decisions related to the placement of a child/youth/NMD.

Intensive Mental Health Treatment

DCFS is required, by law, to ensure that children/youth/NMDs in out-of-home care with mental health needs:

• Promptly receive necessary, individualized mental health services in their own home or in the most home-like setting appropriate to their needs.

• Receive care and services to prevent removal from their families or, when removal cannot be avoided, to facilitate reunification.

• Receive care and services that are consistent with the law and with best child welfare and mental health practice.

• Be afforded stability in their placements whenever possible.

A child/youth/NMD may require intensive mental health treatment, particularly when they have been identified as severely emotionally disturbed (SED) and has not benefited from other treatment and services.

In California, the levels of mental health treatment for children/youth/NMD include, from least to most restrictive, the following:

• Intensive Services Foster Care (ISFC)
  

• Short-Term Residential Therapeutic Program (STRTP)

• CTF

• Psychiatric mental health facilities/hospitals

STRTPs and CTFs are not meant for children/youth/NMDs that are intellectually impaired. Children/youth/NMDs in these facilities should have an IQ of 70 or above. Those with an IQ between 60 and 70 will be considered on a case-by-case basis.

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Community Treatment Facility (CTF) Criteria

CTFs are residential facilities that provide mental health treatment services to children/youth/NMDs in group setting. They also provide secure containment to reduce the likelihood of someone getting hurt.

When considering referring the child/youth/NMD's case for an IPC screening to determine the appropriateness of treatment and placement in a CTF, the child/youth/NMD must be determined by a mental health care professional to be described as stated below:

The child/youth/NMD must meet one (1) or more of 1 a, or b, or c and items 2, 3, and 4 below.

1. The child/youth/NMD must have met the Seriously Emotionally Disturbed (SED) criteria as defined below.

1. Impairment in at least two (2) of the following areas
   
   
   • Self-Care
     
     
   • School Functioning
     
     
   • Family Relationships
     
     
   • Functioning in the community
     
     And either,
     
     
   • Risk of removal from home or has already been removed, or
     
     
   • The mental health disorder and impairments have been present for more than six (6) months, or are likely to continue for more than one (1) year without treatment.
     
     
   
   
2. The child/youth/NMD displays one (1) of the following
   
   
• Psychotic features
  
  
• Risk of suicide
  
  
• Risk of violence to other due to mental health disorder

c.The child/youth/NMD is a special education student that is determined to have an emotional disturbance.  This means a condition exhibiting one (1) or more of the following characteristics over a long period of time and to a degree that adversely affects a child's educational performance:




• An inability to learn that cannot be explained by intellectual, sensory, or health factors
  
  
• An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
  
  
• Inappropriate types of behaviors or feelings under normal circumstances
  
  
• A general pervasive mood of unhappiness or depression
  
  
• A tendency to develop physical symptoms or fears associated with personal or school problems.

2. The child/youith/NMD may require a period of containment to participate in, and benefit from, mental health treatment, and the CTF program must be reasonably expected to improve the child/youth/NMD's mental health disorder.
   
   
3. Other, less restrictive interventions must have been attempted and proved insufficient; or, the child/youth/NMD is in an inpatient psychiatric hospital. This applies to children/youth/NMDs placed in and out of state.

• This includes denial of admission into an STRTP through an IPC screening where it is determined the child/youth/NMD would benefit from a higher level of care.
  
  
• This may include outpatient therapy, family counseling, case management, family preservation efforts, special education classes, or nonpublic schooling.

4. There must be consent for treatment/placement or the child/youth/NMD must have a conservator appointed through Department 103 of the Superior Court.
   

• A child/youth may not consent to psychiatric hospitalization without prior authorization from the Court, via a WIC 6552 hearing/court order if they have been found within the jurisdiction of the Juvenile Court and they do not have a conservator. A hearing must be conducted for such a child/youth and they must be offered the advice of counsel. This restriction applies to all dependents, regardless of their parents’ willingness to consent on the child/youth's behalf.
  
  WIC 6552 does not apply to NMDs since it is specific to minor children only.  NMDs are adults and, as such, would provide their own consent.  Court authorization is not needed.
  
  
• Refer to CS CSW Responsibilities item #4 under "Presenting and Placing a Child/Youth/NMD in a CTF through the IPC Screening Process" when the child/youth/NMD does not consent.
  
  

Exclusionary Criteria

A child/youth/NMD may not qualify to be placed in a CTF if one(1) or more of the following exists:

• A history of acts, or attempted acts, that would indicate an extreme risk to the safety of other facility residents, staff, and/or the community
• A persistent pattern of violent acts or sexual offenses of a predatory nature
• A sustained Juvenile Court petition alleging that the child/youth/NMD committed a violent act
• Knowledge that a child/youth/NMD has committed or attempted extremely violent act(s), including murder or rape.
  
  

Interagency PlacementOne agency has custody of the child and another agency approved the applicant assessment. Committee (IPC) Screening Criteria for Placement in a CTF

A child/youth/MND may not be admitted to a CTF or psychiatric hospital without a hospital recommendation/authorization from the IPC, unless one (1) of the following exists:

1. The NMD is eighteen (18) or older and was involuntarily admitted to a psychiatric hospital under WIC 5150.
   
   

The IPC meets at least one (1) time per week to review cases. It consists of representatives from the following agencies:

• All the CTFs
• DCFS
• DMH, including at least one (1) psychiatrist
• Probation Department
  
  

The Bureau of Clinical Resources and Services (BCRS) IPC Liaison schedules the presentation of cases.

The case of a DCFS-supervised child/youth/NMD may be presented by:

• Children’s Social Worker (CSW)

• Supervising Children’s Social Worker (SCSW)

The IPC discusses a case, asks questions of the presenter, and determines whether or not the child/youth/NMD meets criteria for placement in a CTF. If the case meets criteria, the IPC makes placement recommendations, which it records and files using the DMH case number, the presenter’s name, and the date on which the case was presented. The presenter is provided with a written copy of the recommendation/authorization.

• The child/youth/NMD's Counsel and County Counsel should be immediately informed of the recommendation.
  
  

A child/youth may not consent to placement in a CTF without prior authorization from the Court, via a WIC 6552 hearing/court order if he/she has been found within the jurisdiction of the Juvenile Court and does not have a conservator. A hearing must be conducted for such a child and he/she must be offered the advice of counsel. This restriction applies to all dependent children, regardless of their parents’ willingness to consent on the child’s behalf.

• WIC 6552 does not apply to NMDs since it is specific to minor children only. NMDs are adults and, as such, would provide their own consent. Court authorization is not needed.

  
  

  • The NMDs Counsel should be given notice and the NMD should be given an opportunity to consult with their attorney before consenting to placement.

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PROCEDURE

Preparing for an IPC Screening for Placement in a CTF

Continuing Services (CS) CSW Responsibilities

1. Case-planning and placement decisions are required to be informed by CFTs, who identify the core services and supports for the child/youth/NMD and their caregiver. Thus, prior to referring a child/youth/NMD for an IPC screening, a CFTM should be held to discuss the child/youth/NMD's needs, services, and supports.
   
   

• The discussion should include efforts to preserve the placement.
• The results of the CFTM shall be documented in CWS/CMS in accordance with the CFT policy.

2. Upon the conclusion of the CFTM, if a decision is made not to refer the child/youhth/NMD for an IPC screening for consideration in a CTF, implement placement preservation efforts identified during the CFTM or, if it was determined the placement could not be preserved, locate an alternative placement.

3. If a decision is made to refer the child/youth/NMD for an IPC screening for consideration in a CTF, complete the following:
   
   

1. Obtain the opinion of the child/youth/NMD's mental health provider regarding th
   child/youth/NMD's treatment needs via a written statement that could be utilized for the IPC CTF screening and/or request the mental health provider to participate in presenting the child/youth/NMD's case at the IPC CTF screening.
   
   
   • The written statement should include the following:
   • The child/youth/NMD meets the SED criteria
   • The child/youth/NMD requires a period of secure containment to participate in, and benefit from, mental health treatment
   • The proposed treatment program is reasonably expected to improve the child/youth/NMD's mental health
   • The child/youth/NMD has either participated in other, less-restrictive mental health interventions, or is currently placed in a psychiatric hospital or an out-of-state mental health treatment facility.
     
     
2. Inform the child/youth/NMD in person of the mental health provider's recommendations.

    

   • If the recommendation is for placement in a secured (i.e., locked) facility, ask the child/youth/NMD if they will consent to such treatment.
     
     
3. Complete an IPC CTF referral packet.

 

4. Upon receipt of the mental health provider’s written statement or agreement to participate in the IPC CTF screening refer the child/youth/NMD for an IPC screening by completing the IPC screening referral packet and email the packet to the RCL via the DCFS IPC central inbox at DCFSIPC_referrals@dcfs.lacounty.gov
   
   
5. The following documentation should be uploaded as part of the referral packet:
   
   

1. DCFS IPC Referral Form
   
   
2. Mental health assessment and diagnosis completed by a licensed mental health professional within the past year
   
   
3. Clinical documents from recent psychiatric hospitalization(s), if applicable and available
   
   
4. Psychotropic MedicationMedications used as tools for producing certain chemical and physiological effects in the central nervous system. They are usually classified according to the types of disorders they are primarily used to treat. Authorization from (JV-220), if applicable
   
   

6. The following documentation is not required for submission of the referral packet; however, the CSW should be able to address historical and current information during the IPC related to the following:
   
   

1. Health and Education Passport, including but not limited to, current physical examination results, immunization and school records, and, if applicable, the child/youth/NMD’s Individualized Education Plan (IEP)
   
   
2. Developmental records, including Regional Center assessments/evaluation, if applicable
   
   
3. Recent Status Review Court Report and Detention Report or Jurisdiction Report
   
   
4. The most recent minute order that contains language that a mental health assessment and/or services have been ordered
   
   

CS Supervising CSW (SCSW) Responsibilities

1. Discuss the reasons for the IPC referral for consideration of a CTF placement with the CSW.
   
   

1. If approval is not given for placement in a CTF, discuss alternative placement options. Placement in a CTF should not occur.
   
   
2. If approval is given, submit the IPC CTF referral packet directly to the ARA for approval or return the IPC referral packet to the CSW for submission to the ARA.
   
   

2. Consult with the ARA and RA or their designees regarding the IPC CTF referral or ensure the CSW consults with the ARA and RA or their designees prior to the CSW referring the child/youth/NMD for an IPC CTF screening and ensure the consultations are documented in the CWS/CMS Case Notes (i.e., Title XX’s).
   
   

• For children twelve (12) years of age and under, ensure approval is obtained from the Deputy Director or their designee prior to making the referral.
  
  

Assistant Regional Administrator (ARA) or Designee Responsibilities

1. Discuss the reasons for the IPC referral for consideration of a CTF placement with the CSW and/or SCSW.
   
   

1. If approval is not given for placement in CTF, discuss alternative placement options. Placement in a CTF should not occur.
   
   
2. If approval is given, submit the IPC CTF referral packet to the RA for approval.
   

Regional Administrator (RA) or Designee Responsibilities

1. Discuss the reasons for the IPC referral for consideration of a CTF placement with the CSW and/or SCSW.
   
   

1. If approval is not given for placement in a CTF, discuss alternative placement options. Placement in a CTF should not occur.
   
   
2. If approval is given, return the IPC referral packet to the CSW for submission for an IPC CTF screening.
   
   

• For children twelve (12) years of age and under, if approval is given, ensure approval is obtained from the DD or their designee prior to making the referral.
  
  
• Staff should utilize the procedures set forth by their regional office management and Service Bureau staff on obtaining DD approval.

Residential Care Liaison (RCL)/CTF IPC Liaison Responsibilities

1. Review the IPC Referral Form and contact the CSW to discuss the appropriateness of a CTF placement.

2. Assist the CSW in gathering the required documents for completion of the IPC CTF screening referral packet, as needed.

• For children twelve (12) and under, email the CSW upon receipt of the referral and documents to confirm ARA and RA approval.
  
  
• Upon confirmation from the CSW that ARA and RA approval has been obtained, notify the respective Service Bureau for DD approval.

3. Submit the completed IPC CTF referral packet to DMH via email at IPC@dmh.lacounty.gov in order to schedule an IPC CTF screening.
   
   

• CTF screenings are held once per week; however, an expedited screening can be scheduled to accommodate urgent requests on a case-by-case basis.

4. Coordinate the teleconference date, time, location, and call-in information for the IPC CTF screening from DMH.

Presenting and Placing a Child/Youth/NMD through the IPC Screening Process

A set of guidelines has been established for presenting cases to the IPC for placement of all children/youth/NMDs in CTFs. To assist the CSW in preparing for the IPC screening, DMH has developed a presentation guide that the CSW may find useful towards preparing for the IPC screening presentation.

• Use of the presentation guide is strongly encouraged to ensure best practice as well as to ensure that the CSW captures all of the relevant information necessary for the team to make an informed decision about the most appropriate placement and services for the child/youth/NMD.

CS CSW or SCSW Responsibilities

1. Present the child/youth/NMD’s case on the appointed day/time via teleconference.
   
   

1. If the IPC recommends a placement in a CTF, the CSW will be provided with the IPC Authorization and prospective CTF placements from DMH at the close of the meeting.

2. If the IPC authorizes placement in a CTF, proceed as follows:
   
   

1. For children/youth who are current dependents and do not have a conservator, obtain authorization from the Court via a 6552 hearing/court order to proceed with placement in the CTF.
   
   

• Complete the DCFS 280, Technical Assistance Action Request form to acquire a placement packet and proceed with placement.
  
  

2. If the child is conserved, the conservator will make placement decisions and can involuntarily place the child/youth. (Youth are conserved because they cannot make their own decisions; therefore, neither their consent nor a hearing in dependency court is required.
   
   
   

3. When there is no conservator, if the IPC recommends a CTF placement and the child/youth/NMD consents to treatment, a WIC 6552 hearing is still needed:
   
   

1. File an Ex Parte Application with the designated court to request a WIC 6552 hearing to verify the child/youth consent to the placement.
   

• WIC 6552 does not apply to NMDs since it is specific to minor children only. NMDs are adults and, as such, would provide their own consent. Court authorization is not needed.
• The NMD's counsel should be given notice and the NMD should be given an opportunity to consult with their attorney before consenting to placement.
• A child/youth may not consent to psychiatric hospitalization placement in a CTF without prior authorization from the Court, via a WIC 6552 hearing/court order if he/she has been found within the jurisdiction of the Juvenile Court and does not have a conservator. A hearing must be conducted for such a child and he/she must be offered the advice of counsel. This restriction applies to all dependent children, regardless of their parents’ willingness to consent on the child’s behalf.
  

b. Notify the child/youth’s attorney of the date and time of the hearing.

c. Ensure that the child/youth attends the hearing.

d. If the Court authorizes the child/youth to consent, obtain a copy of the authorizing minute order and place it in the court folder for the facility to obtain a copy and approve the placement.

e. Proceed with placing the child/youth in the facility.

4. If the IPC recommends a locked mental health facility placement and the child/youth/NMD does not consent:

1. Advocate to have the child/youth/NMD’s current attending psychiatrist initiates the referral process to request that a conservator be appointed by the Mental Health Court.

2. Notify the child/youth/NMD’s attorney immediately of this request.

5. Update the Case Plan

1. Document how the specific needs of the child/youth/NMD cannot be met in a less-restrictive placement.

2. Describe the treatment that will be provided to the child/youth/NMD.

6. Document all contacts in the CWS/CMS Contact Notebook.
   
   
   

Back to Procedure  

RCL/CTF IPC Liaison Responsibilities

1. Assist the CSW in gathering any additional documentation, if necessary, in preparing for the IPC screening presentation.

2. Participate in the IPC screening.

3. Upload the IPC Authorization in the CWS/CMS Case Management section and document the outcome of the IPC screening in the CWS/CMS Contact Notebook.

4. Enter the IPC screening date on the “Special Projects” page of the CWS/CMS.
   
   
5. Maintain a log of all children/youth/NMDs who received an IPC screening.
   
   
6. If the placement authorization could not be met within the IPC Authorization form’s indicated timeframe, assist the CSW in re-initiating the IPC screening process.
   
   

• The IPC placement authorization is valid for a limited timeframe as indicated on the IPC Authorization Form.

APPROVALS

SCSW Approval

• CTF placements

ARA or Designee Approval

• CTF placements
  
  
  

RA or Designee Approval

• CTF placements for children twelve (12) years of age and under
  
  
  

Deputy Director or Designee

• CTF Placements for children twelve (12) years of age and under

HELPFUL LINKS

Forms

DMH Presentation Guide

LA Kids

Automated DCFS 280, Technical Assistance Action Request

Referenced Policy Guides

0070-548.01, Child and Family Teams

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0100-510.55, Screening and Placement of Children, Youth, and Nonminor Dependents (NMDs) in a Short-Term Residential Therapeutic Program (STRTP)

0100-510.60, Placement Considerations for Children

0300-503.94, Set-On/Walk-On Procedures 

0600-501.05, Psychological Testing of DCFS Supervised Children

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

0600-514.10, Psychotropic Medication Authorization, Review, and Monitoring for DCFS-Supervised Children

0700-504.20, Referring Children for Special Education or Early Intervention Services

0900-522.10, Specialized Care Increment (SCI)A rate paid in addition to the basic care rate for the care of children/youth with special needs. – D-Rate

Statutes

All County Letter (ACL) 16-84 - Provides information and guidance regarding the use and formation of child and family teams to deliver child welfare services, as required by AB 403.

ACL 17-122, States, in part, the case plan documentation requirements for initial placements and maintaining placements in an STRTP, including but not limited to the placement purpose and plan for transitioning to a less restrictive environment. Age-based placement timeframes in an STRTP and second level review requirements for continued placement are also indicated.

Health and Safety Code (HSC) Section 1502 – Defines, in part, a community care facility as well as a residential facility and a community treatment facility.

Katie A., et.al vs. the State of California – Obligates the Los Angeles County DCFS, in part, to improve and better ensure services to children with mental health needs.

Welfare and Institution Code (WIC) Section 4096(b) – States, in part, that each interagency placement screening committee shall establish procedures for assessing and ensuring that each dependent child to be placed, or placed, in a RCL 13 or 14 group home program is also seriously emotionally disturbed.

WIC Section 5150 – States, in part, that a person, as a result of a mental health disorder, may be involuntarily taken into custody for up to seventy-two (72) hours for assessment, evaluation, and/or crisis intervention if the individual is a danger to others or him/herself, or if he/she is deemed gravely disabled.

WIC Section 5585.50 – States in part, that if a minor demonstrates a mental disorder and proves to be a danger to him/herself or others, or if he/she is gravely disabled and is unable to authorize treatment voluntarily, a peace officer, member of an attending county-designated evaluation facility, or other county designated profession may take, or cause to be taken, a minor into custody and may place him/her in a facility for minors for seventy-two (72) hours for treatment and evaluation.

WIC Section 6552 – States, in part, that a child who has been found to be within the jurisdiction of the Juvenile Court and who does not have a conservator may not consent to psychiatric hospitalization without prior authorization from the Court.

WIC Section 11462.01 – Provides, in part, for a group home program at the RCL 13 or RCL 14 level and states the requirements that must be met for them to operate.

WIC Section 11462.01(b)(2) – States that a child may be placed in an STRTP upon an assessment determining as such. Further, the assessment shall ensure that the child has needs in common with other children or youth in the residential care facility.

WIC Section 11462.01(b) – States the conditions required for placement of a child in an STRTP.

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