This policy guide was updated from the 07/01/14 version, to add DCFS Medical Director pre-approval protocol for in-patient treatment facilities; Los Angeles County Auditor Controller's (LACAC) requirements re: group home special placement criteria; length of placement time frames, transitioning children to a suitable DCFS-contracted placement timely; requirement to obtain group home authorized representatives signature on the new DCFS 6082, Group Home Foster Care Services Special Placement Agreement and; for CSWs to notify children of their right to access the LACAC Group Home Ombudsman. Added requirement regarding use of the DCFS 5540, Special Payment Authorization Request; updates to Attachments and; other minor clarifying information. Changed the title to: "Special Placements".

POLICY

Special Placements

Special placement policy and procedures do not apply to out-of-state placements.

A special placement is a Group Home (GH), Regional Center vendorized Home (RC Home), adult facility, or Foster Family Agency (FFA)A non-profit organization licensed by the State of California to recruit, certify, train, and provide professional support to foster parents. or Specialized Treatment/Residential/In-Patient facility that does not have a contract with Los Angeles County DCFS but has been identified as a program that will meet the special and unique needs of a particular child and is licensed to provide residential care. If the identified special facility is willing to accept the placement it must enter into a Placement Agreement with DCFS. The Placement Agreement documents that the facility is required to provide specific services to improve the child's safety, permanency and well-being and; that incidents are reported through the DCFS web-based Incident Tracking System (iTrack).

An authorized group home representative must sign the DCFS 6082, Group Home Foster Care Services Special Placement Agreement prior to the child being placed in the facility.

All out-of-home facilities that DCFS contracts with are listed on the Child Welfare Services Case Management System (CWS/CMS). Lists of contracted GHs and FFAs approved for the placement of Los Angeles County DCFS children are available on LAKids in the "Quick References" section under GH/FFA Alpha List.

Non-DCFS contracted FFA placements are flagged with a "Hold" status in CWS/CMS. When a placement is on a "Hold" status, placements cannot be generated in CWS/CMS. The "Hold" may be removed by the Out-of-Home Care Management Division (OHCMD) or the Bureau of Clinical Resources and Services (BCRS) once the DCFS 4213, Special Placement - OR - 1-on-1 Services Request form has been processed and approved.

A child can only be placed in the following Special Placements: GH, RC Home, licensed adult facility, FFA or specialized treatment/residential/in-patient facility once the DCFS 4213, has all the required signatures.

A Fost-Adopt/Pre-Adoptive placement only requires the initial approval of the DCFS 4213A, Special Placements for Fost-Adopt/Pre-Adoptive Placement. Approved Special Placements for Fost-Adopt/Pre-Adoptive Placement do not need to be reevaluated or renewed.

A placement in a licensed adult facility only requires the DCFS 4213 approval. Out-of-Home Care Management Division (OHCMD) clearance and approval is not required.

A placement in an in-patient facility [such as UCLA Neuropsychiatric Institute (NPI), Developmental DisabilityA disability that originates before an individual attains age 18 years, continues or can be expected to continue, indefinitely, and constitutes a substantial disability for that individual. The term includes mental retardation, cerebral palsy, epilepsy, and autism. It also includes disabling conditions found to be either closely related to mental retardation or to require treatment similar to that required for individuals with mental retardation, but shall not include other handicapping conditions that are solely physical in nature. Mental Illness (DDMI), Center for Discovery or California Psychiatric Treatment (CPT)], must be "pre-approved" by the Bureau of Clinical Resources and Services (CRS) DCFS Medical Director.

For children/youth entering UCLA NPI court approval is needed after the Medical Director's review and approval. Therefore, court approval should not be requested prior to the Medical Director's review of the case.

Timeframes

Most special placements will be approved for six (6) months at a time and will not exceed twelve (12) months (with the exception of Fost-Adopt/Pre-Adoptive Placements, Regional Center placements or highly specialized placements).

Special placements for Regional Center Homes (vendorized) require a rate letter and may be approved for up to one (1) year.

A GH Special Placement should be temporary and limited in duration until a more suitable or contracted placement is available.

GH Special Placements must be reviewed every six (6) months to determine whether there is a suitable contracted placement available and to ensure that children are transitioned to contracted placements timely.

If a child requires the special placement to continue beyond the period of approval, a Child and Family Team (CFT) meeting is highly recommended and a new DCFS 4213 must be submitted for approval.

Criteria for Special Placement

CSWs should place a child in non-contracted placement only after existing contracted resources have been explored and exhausted. A request to use a non-contracted placement must additionally be based on one or more of the following criteria:

The CSW has conducted and documented an extensive search for a suitable placement without success, including contacting the Accelerated Placement Team (APT)The team is made up of former RUM (Resource Utilization Management) staff who have experience in finding placement for high risk/needs children. APT Specialist CSWs can assist Regional CSWs expedite the process in finding placement/replacement after hours and/or when all other efforts have been unsuccessful., and the proposed special placement is the only appropriate placement that exists to meet the child’s specific needs.

The child has extraordinary and unusual behavioral or medical needs that make the child difficult to place. These needs include but are not limited to being:

Being medically fragile

Being a brittle diabetic

Having severe head injuries

Having a dual diagnosis of mental illness and substance abuse

Having a dual diagnosis of developmental delay and mental illness

No other DCFS-contracted private non-profit facility or public licensed residential care home exists in the State of California that can meet the child’s special needs and is willing to accept placement of the child.

The facility is recommended by the Regional Center for a developmentally disabled child or a child with special health care needs.

A child cannot be placed at an agency that is eligible to receive the dual agency rate, if the child:

Has developmental disability

Is eligible for federal AFDC-FC payments, and

Is eligible for Regional Center services.

The Juvenile Court has ordered the child to be placed in a specific placement facility. An official recommendation may never be made to the Juvenile Court for a child to be placed in a non-contracted facility.

An official recommendation may never be made to the Juvenile Court for a child to be placed in a specialized Treatment/Residential/In-Patient facility unless necessary for the planned placement and pre-approved by the DCFS Medical Director.

The identified prospective adoptive family for a child is certified through a non-contracted Foster Family Agency (FFA).

Types of Special Placements (For-Profit, Non-Profit, Fost-Adopt/Pre-Adoptive and Specialized Treatment/Residential/In-PatientFacility)

For-Profit placement requires that the identified group home or FFA be licensed with the California Department of Social Services (CDSS).

The provisions of WIC 11402.6 must be met for a Special Placement to be eligible for AFDC-FC funding.

Non-Profit placement requires that the identified GH or FFA be licensed with CDSS and have an established rate funded by AFDC-FC.

Fost-Adopt/Pre-Adoptive placement requires the initial approval of the DCFS 4213A.

Specialized Treatment/Residential/In-Patient Facility (such as UCLA NPI, DDMI, Center for Discovery or CPT) must be "pre-approved" by the DCFS Medical Director.

Back to Policy

PROCEDURE

Selecting and Utilizing a Special Placement

Case-Carrying CSW Responsibilities

CSWs are responsible for monitoring the quality, standard of care, and supervision of special placements and for adhering to visitation requirements.

Work with the Accelerated Placement Team (APT) to explore an appropriate contracted placement.

If a contracted program is not available and a special placement (non-contracted) is identified:

For non-contracted GH placements, complete the DCFS 6082 , Group Home Foster Care Services Special Placement Agreement form and obtain the signature of the group home authorized representative.

Conduct a site visit or facility assessment prior to, or at the time of placement to ensure the child’s safety, quality of care, and compatibility with the placement.

Verify the facility license and ensure that all facility occupants over the age of eighteen (18) and staff members are criminally cleared.

Obtain a program description of the population served and services offered by the special placement.

If the identified special placement is in a For-Profit facility:

Ensure and clearly document in the case file, that the child meets all of the following eligibility criteria:

The child has extraordinary or unusual behavioral or medical needs that make the child difficult to place. This includes, but is not limited to: being medically fragile, being a brittle diabetic, having severe head injuries, having a dual diagnosis of mental illness and substance abuse, having a dual diagnosis of developmental delay and mental illness.

The child has a developmental disability and is eligible for both federal ADFC-FC payments and for Regional Center services.

Fully document the following in the case file:

No other comparable private non-profit facility or public licensed residential care home exists in the state that can meet the child’s extraordinary special needs and that is willing to both accept placement of the child.

Clear demonstration that no other alternate placement option exists for the child.

That the CSW reported to the Juvenile Court at every six (6) month interval with a case plan that states whether or not the placement remains appropriate and necessary and what plan there is for replacing the child to a less restrictive placement.

For children meeting the eligibility criteria in Step a. above, clearly document in the case file how the following requirements have been met:

DCFS has entered into a performance-based placement agreement with the For-Profit facility, which ensures that the facility is providing services to improve the child’s safety, permanency, and well-being.

DCFS has monitored and reviewed the facility's outcome performance indicators every six (6) months.

That the CSW has ensured that the placement is in the child’s community to the best degree possible, in order to enhance on-going connections with the child's family and to promote lifelong connections with committed adults.

DCFS has ensured that a maximum limit of twelve (12) cumulative months per child in one or more AFDC-FC-funded For-Profit facilities.

Discuss and consult regarding the need for a Special Placement with the SCSW, ARA and RA. If it is determined that a Special Placement is necessary, complete the DCFS 4213.

Clearly justify how the placement meets the special needs of the child and provide all the information requested, as applicable, when completing the form.

Attach all pertinent supporting documents, including available psychological evaluations, medical assessments, and Regional Center case plans.

When using a Regional Center home (vendorized) obtain and attach all of the following to the DCFS 4213:

A letter from the child’s Regional Center case manager that recommends a specific level of care.

A letter approving the placement’s use from the Regional Center.

For children aged 16.5 years old or older, include the documented status of the youth’s SSI application.

When recommending a Specialized Placement/Residential/In-Patient Treatment Facility:

Hold a Child and Family Team (CFT) meeting and upon its conclusion, review and discuss the case with the SCSW and ARA to ensure all other resources for the child/youth have been explored such as Regional Center involvement or an RCL 14 screening (if applicable).

The ARA on the case will send an email to the DCFS Medical Director with a cc to the applicable Service Bureau requesting a review of the case by the DCFS Medical Director.

If the DCFS Medical Director grants the "pre-approval" for an in-patient treatment facility, staff from the BCRS will coordinate the child/youth's admission to the facility and complete a Letter of Agreement (LOA) on behalf of the Medical Director.

Upon notification that the DCFS Medical Director has "pre-approved" placement in an in-patient treatment facility, complete a DCFS 4213 and obtain remaining Management approvals/signatures listed in the DCFS 4213 Approval Process Flow Chart.

If the pre-approval is for UCLA NPI, obtain court approval by submitting a Walk-On Request.

Court approval should not be requested prior to the Medical Director's review of the case.

Submit the DCFS 4213, the program description, and all pertinent supporting documentation to the SCSW for SCSW, ARA and RA approval.

Upon receipt of SCSW, ARA and RA approval, scan and email the completed DCFS 4213 and all submitted documentation to the Service Bureau Deputy Directors Office for approval.

Service Bureau 1

Service Bureau 2

The Service Bureau Liaison will email the completed DCFS 4213 and all supporting documentation to OHCMD for clearance.

Upon clearance by OHCMD, the DCFS 4213 will be emailed to the CSW, SCSW and the Service Bureau Liaison. The Service Bureau Liaison will obtain the remaining management approvals/signatures as listed in the DCFS 4213 Approval Process Flow Chart.

Ensure the DCFS 4213 is forwarded to the Bureau of the Medical Director (BMD) within 24-hours of receipt of email from OHCMD with clearance/approval if applicable.

Complete the top portion only (identifying and contact information, case number and placement date - no signatures required) of the DCFS 5540, Special Payment Authorization Request and attach it to the DCFS 4213 before submitting to BCRS.

Request a placement packet from the Technical Assistant (TA) via the Automated 280 (Foster Care Search System) and attach the scanned BCRS approved DCFS 4213 and the DCFS 709, Foster Child Needs and Case Plan Summary .

Contact OHCMD when the TA is ready to process the placement in CWS/CMS.

Request that the “Hold” be temporarily lifted so placement can be made.

After processing is completed, notify OHCMD to reinstate the “Hold”.

Arrange placement and, when appropriate, notify relevant parties of the pending placement date.

If a GH placement, inform the child/youth of his/her right to access the Auditor Controller's Group Home Ombudsman and provide the following contact information:

Michelle Day, Department of the Auditor Controller, Children's Group Home Ombudsman, 213-893-0551.

General Group Home Ombudsman Information: website, email, Phone: 888-445-1234.

Notify the court and other appropriate parties of the change in placement per existing policy.

Review the DCFS Special Placement every six (6) months to determine whether there is a suitable DCFS contracted placement available. When available, ensure the child is transitioned to the DCFS contracted placement timely.

If the child needs to remain in the Special Placement beyond the DCFS 4213 approved time period, initiate a Child and Family Team (CFT) meeting (or RA approved alternative family team meeting) and complete a new DCFS 4213.

Obtain approval for the continued Special Placement before the current approval expires.

Document when the CFT meeting (or RA approved alternative family team meeting) was completed on the DCFS 4213.

SCSW, ARA, RA, Service Bureau Deputy Director (DD) Responsibilities

When a Specialized Placement/Residential/In-Patient Treatment Facility is the recommendation:

Following the required CFT meeting, the ARA will review and discuss the case with the SCSW and CSW to ensure all other resouces for the child/youth have been explored such as Regional Center involvement or and RCL 14 screening (if applicable).

The ARA will request a review by the DCFS Medical Director by:

Sending an email to the DCFS Medical Director and cc-ing the applicable Service Bureau requesting a review of the case. The email must include/address the following information:

Child's name

What is approval being requested for?

SSISupplemental Security Income. This program pays monthly benefits to blind or disabled children/youth who have limited income and resources. It is administered by Social Security.

Regional Center involvement (if applicable)

RCL 14 screening (if applicable)

Diagnosis

Current placement

Past evaluations

Specific reasons why an inpatient setting is recommended

Requested testing (UCLA NPI only)

Behavioral problems

Medication history (current and past)

Hospitalizations

School

Additional relevant information

In all other cases, review the DCFS 4213 and all supporting documents.

SCSWs must ensure that all management signatures are obtained within 24- hours of receipt of the OHCMD emailed approval.

Consult the DCFS 4213 Approval Process Flow Chart for specific responsibilities once DCFS 4213 is approved.

Discuss the placement decision with the individual who forwarded the DCFS 4213.

If approved, sign the DCFS 4213 and submit it to the next individual on the Approval Process Flow Chart.

If not approved, return the DCFS 4213 to the individual from whom it was received it for corrective action.

Out-of-Home Care Management Division (OHCMD) Staff Responsibilities

Review the completed DCFS 4213 and Regional Center letter if the DCFS 4213 is for a RC placement.

If not approved, return the DCFS 4213 to the CSW and SCSW for corrective action.

Verify that the facility’s license is in good standing through Community Care Licensing (CCL).

Check the status of an FFA certified home with CCL.

Conduct a CWS/CMS search for a certified foster parents’ prior Child Welfare (CW) history or any current CW referrals.

Obtain the OHCMD Division Chief or designee’s approval and signature on the DCFS 4213.

Scan and email the signed DCFS 4213 to the CSW and the SCSW and Service Bureau Liaison.

Bureau of Clinical Resources and Services (BCRS) Staff Responsibilities

If the DCFS Medical Director "pre-approves" a request for a Specialized Placement/Residential/In-Patient treatment facility, coordinate the child/youth's admission to the facility and complete a Letter or Agreement (LOA) on behalf of the DCFS Medical Director.

In all other cases, review the proposed placement for its ability to meet the child’s developmental, medical, and mental health needs.

If not approved, return the DCFS 4213 to the OHCMD Division for corrective action.

If approved and net county costs will be incurred by the placement, fax the DCFS 4213 to the Bureau of Finance and Administration for further approval.

If needed, negotiate a Letter of Agreement (LOA) with the Special Placement by the facility.

Temporarily lift the “Hold” status when notified by the CSW or the Technical Assistant (TA) that the placement seeking an approved DCFS 4213 is ready to be generated in CWS/CMS.

Reinstate the “Hold” upon notification that the processing of the placement has been completed.

Upon receipt of the approved DCFS 4213 from the Bureau of Finance and Administration, forward it to the all of the following:

The CSW at the Regional OfficeThe DCFS office that is responsible for providing services to the child, youth, dependent, or nonminor dependent. Usually, the office where the child's CSW is located.

The OHCMD

The Service Bureau Deputy Director

Monitor the approved Special Placement on a quarterly basis and one (1) month prior to the expiration of the approval.

Bureau of Finance and Administration Responsibilities

Review the DCFS 4213.

Children who require same day placement should be prioritized.

Confirm that the facility has an approved foster care rate level assigned by the California Department of Social Services (CDSS) Foster Care Rates Bureau.

Authorize the use of Net County Cost (NCC) for the requested non-DCFS contracted placement either for a For-Profit organization, a Specialized Placement/Residential/In-Patient treatment facility or when AFDC-FC eligibility may not be met.

If not approved, return the DCFS 4213 to the CSW and the SCSW.

If approved, fax the approved form to the Office of the Medical Director.

Back to Procedure

Considering a Special Placement for a Pre-Adoptive/Fost-Adopt Placement

APRD CSW Responsibilities

Ensure that the adults residing in the home have been cleared through CWS/CMS and that any related CWS/CMS history is sufficiently addressed in the applicant assessment or addendum.

After the applicant presentation during the matching and pre-placement process, complete a DCFS 4213A, Special Placements for Fost-Adopt/Pre-Adoptive Placement.

Provide the FFA license number in the proposed placement section.

Do not provide the Adoption’s Agency’s license number.

Submit the DCFS 4213A and all supporting documents to the SCSW for review and approval by the SCSW and the ARA.

Once approval has been obtained, forward the DCFS 4213A to the APRD Division Chief for approval.

After being notified both that the placement can be made and the date the placement is determined, contact OHCMD to request the “Hold” status be lifted on the day the placement episode is generated.

Once the DCFS 4213A is signed and returned by OHCMD, inform the necessary parties that the placement can be made and placement papers must be generated.

APRD SCSW Responsibilities

Review the DCFS 4213A and all supporting documentation.

Discuss the placement decisions with the APRD CSW.

If approved, sign the DCFS 4213A and submit it to the ARA or equivalent for approval.

If not approved, return the DCFS 4213A to the CSW for corrective action.

ARA Responsibilities

Review the DCFS 4213A and all supporting documentation.

Discuss the placement decisions with the SCSW.

If approved, sign the DCFS 4213A and submit it to the RA for approval.

If not approved, return the DCFS 4213A to the SCSW for corrective action.

APRD Division Chief Responsibilities

Review the DCFS 4213A and all supporting documentation.

Discuss the placement decisions with ARA or equivalent.

If approved, sign the DCFS 4213A and have it forward to the OHCMD.

If not approved, return the DCFS 4213A to the ARA for corrective action.

Out-of-Home Care Management Division (OHCMD) Staff Responsibilities

Verify that the FFA facility’s license is in good standing with Community Care Licensing (CCL) and confirm the rate information.

If the facility is in good standing, sign or initial the DCFS 4213A and return the form to the CSW and the SCSW.

If the facility is not in good standing, notify the CSW, SCSW, ARA or equivalent, and the APRD Division Chief.

Lift the “Hold” status when notified by the APRD CSW or the Technical Assistant (TA) that the placement for an approved DCFS 4213A is ready to be generated.

Reinstate the “Hold” status upon notification that the processing of the placement has been completed.

Back to Procedure

APPROVALS

SCSW, OHCMD Division Chief, ARA, RA, Service Bureau Deputy Director (DD), Bureau of the Medical Director, Bureau of Finance and Administrative Deputy Director

DCFS 4213. See DCFS 4213 Approval Process Flow Chart.

Bureau of Finance Administrative Deputy Director

DCFS 4213 (net county costs only)

SCSW, ARA, Division Chief APRD, OHCMD Division Chief

DCFS 4213A

Back to Approvals

HELPFUL LINKS

Attachments

DCFS 4213 Approval Process Flow Chart

Forms

CWS/CMS

DCFS 709, Foster Child Needs and Case Plan Summary

LA Kids

Automated 280 - Foster Care Search System

DCFS 709, Foster Child Needs and Case Plan Summary

DCFS 4213, Special Placements and 1:1 Requests

DCFS 4213A, Special Placements for Fost-Adopt/Pre-Adoptive Placement

DCFS 5540, Special Payment Authorization Request

DCFS 6082, Group Home Foster Care Services Special Placement Agreement

SOC 154, Agency Group Home Agreement

SOC 154B, Agency Group Home Agreement Nonminor Dependent Placed by Agency in Group Home

Instructions for Completion of the DCFS 4213 form

Referenced Policy Guides

0070-516.10, Assessing a Child's Development & Referring to a Regional Center

0070-548.01, Child and Family Teams

0070-559.10, Clearances

0600-505.10, Placing Children with Special Health Care NeedsAssembly Bill 2268, defines children with special health care needs as those children who are either temporarily or permanently dependent upon medical equipment or in need of other specific kinds of specialized in-home health care, as determined by the child’s physician. See "medically fragile."

0900-523.10, Social Security(SS)/Supplemental Security Income (SSI) Benefits for Children in Care

Statutes

Welfare and Institutions Code (WIC) Section 11402.6 – States, in part, the provisions under which a child residing at a for-profit institution may continue to remain eligible for federal financial participation in ADFC-FC funding.

WIC Section 10601.2 – States, in part, that California counties are required to monitor the performance and outcomes of their child welfare systems.

Back to Helpful Links