Family Services, Dept. of

Providers of Substitute Care Services, Certification of

Chapter 10: Residential Treatment Centers (RTC)

Effective Date: 11/08/2017 to 09/03/2021

Rule Type: Superceded Rules & Regulations

Reference Number: 049.0029.10.11082017

CHAPTER 10

RESIDENTIAL TREATMENT CENTERS (RTC)

Section 1. Program Specific Certification Standards.

(a) For the purpose of these rules, the term Residential Treatment Center (RTC) includes facilities that are certified by Medicaid as a Psychiatric Residential Treatment Facilities (PRTF).

(b) All RTCs must comply with all sections of this Chapter and with the following Chapters and Sections of these rules:

1. (i) Chapter 1: All
2. (ii) Chapter 2: All
3. (iii) Chapter 3: Sections 1-28 and 30-32.

Section 2. Program Description.

RTCs provide services for children who require a combination of therapeutic, educational, and treatment services in a group care setting.

(a) RTCs shall provide:

(i) Wyoming Department of Education approved or accredited on-grounds school, a High School Equivalency program, or a program which works with the local school district to meet the educational needs of the child;

(ii) A minimum of twenty-four (24) hours of therapeutic services per child per month, which shall include a combination of behavior modification, individual therapy, group therapy and family therapy. The specific services shall be determined by the treatment team through the creation and implementation of an ITPC that is family based, child guided and culturally responsive; and

(iii) Ongoing discharge and continuing care planning.

(b) Secure RTC is defined as an RTC or portion of an RTC, which uses locked doors or any other physical measures to prevent children from leaving the RTC.

(i) Secure RTCs shall comply with all standards set forth in this Chapter.

(ii) A facility which offers both secure and non-secure care shall have a separate living unit or wing of a living unit provided exclusively for secure care.

(iii) Locking hardware is permitted on children’s sleeping room doors if equipped with an approved electronic locking-release mechanism.

(iv) All secure RTCs must be nationally accredited.

(c) Therapeutic Wilderness Program is defined as a program within a Residential Treatment Center, which provides, in an outdoor living setting, services to children who are enrolled because they have behavioral, emotional, mental health problems or problems with abuse of alcohol or drugs. A Therapeutic Wilderness Program does not include any programs, ranches, or outdoor wilderness adventure experiences for children designed to be recreational.

(i) All Therapeutic Wilderness Programs shall be accredited through the Association for Experiential Education (AEE) Accreditation Program. The accreditation shall be maintained and current.

Section 3. Maximum Capacity.

All levels of RTCs shall provide services for no more than twenty (20) children in each living unit.

Section 4. Program Personnel.

(a) RTCs shall have, at a minimum:

(i) Administrator/Executive Director;

(ii) Licensed mental health professionals on staff or under contract, to direct the ITPCs;

(iii) Certified educational staff;

(iv) Direct care staff; and

(v) Medical personnel on staff or under contract, to include, at a minimum, a licensed practical nurse (LPN).

Section 5. Specialized Training (Chapter 3, Section 11).

All RTC staff must complete a thirty (30) hour orientation program and twenty (20) hours of annual training.

Section 6. Admissions Criteria.

(a) In order to qualify for placement in an RTC program, a child must exhibit one (1) of the following conditions:

1. (i) Child cannot function in his/her community;
2. (ii) Child has treatment issues requiring therapeutic intervention;
3. (iii) The child has received a psychiatric evaluation resulting in a diagnosed behavioral condition;
4. (iv) The child is only minimally accepting of the treatment process;
5. (v) There are documented attempts to treat the child with the maximum intensity of services available at a less intensive level of care that cannot meet or has failed to meet the needs of the child;
6. (vi) Without intervention, there is clear evidence that the child will likely decompensate and present a risk of serious harm to self or others; and
7. (vii) Child cannot attend public school.
8. (viii) In addition to meeting one (1) of the conditions above, children exhibiting the following behaviors may be appropriate for placement in a RTC:
9. (A) Inability to follow directions and conform to structure of school, home or community;
10. (B) Constant, sometimes violent arguments with caretakers, peers, siblings and/or teachers;
11. (C) Moderate level of self-injurious behavior, risk taking, and/or sexual promiscuity;
12. (D) Suicidal actions/history of serious suicidal actions;
13. (E) Almost daily physical altercations in school, home or community;
14. (F) Constant verbally aggressive and provocative language;
15. (G) Frequent and severe property damage;
16. (H) Probable juvenile justice system involvement; and/or
17. (I) Moderate to high risk for sexually victimizing others.
18. (b) The following are required within 14 days of admission to an RTC:

(i) Initial diagnostic assessment;

(ii) Medical, psychiatric and substance use history;

(iii) Family and social assessment;

(iv) Child assets and strengths;

(v) Developmental history and current developmental functioning with respect to physical, psychological and social areas, including age appropriate adaptive functioning and social problem-solving;

(vi) Psycho-educational assessment;

(vii) An assessment of the need for psychological testing, neurological evaluation and speech, hearing and language evaluations; and

(viii) A problem list, related to the reasons why the child was admitted to this level of care.

Section 7. Staffing Ratios.

(a) RTCs shall maintain one (1) full time equivalent licensed mental health professional/child ratio of 1:10 or a ratio of 1:12 when the licensed mental health professional works with an aide for the delivery of therapeutic services.

(b) Direct care staff for RTCs:

(i) Daytime and evening hours. The minimum ratio of direct care staff to child ratio is 1:6. If the teacher is counted in the staff/child ratios, he/she shall complete all training required for direct care staff.

(ii) Nighttime sleeping hours.

(A) There shall be awake direct care staff/child ratio 1:10 during nighttime sleeping hours;

(B) Bedroom checks of children shall be conducted at a minimum of three (3) times per hour, on a random, unscheduled basis and the exact time of the check shall be documented in an overnight log; and

(C) One (1) or more staff members shall be available on-call to provide direct care to any child in crisis or in need of supervision during the nighttime hours.

(iii) Direct supervision of individual youth shall be adjusted to meet his/her specific needs (ie. runaway risk, youth on room restriction, risk to self or others).