Wyo. Code R. 049-0029-10
Providers of Substitute Care Services, Certification of
Chapter 10: Residential Treatment Centers
Effective Date: 05/15/2013 to 11/08/2017
Rule Type: Superceded Rules & Regulations
Reference Number: 049.0029.10.05152013
SUBSTITUTE CARE SERVICES FOR CHILDREN
RESIDENTIAL TREATMENT CENTERS (RTC)
(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). PRTF’s certified by Medicaid must also comply with all applicable Medicaid rules
(b) All RTCs must comply with all sections of this Chapter and with the following Chapters and Sections of these rules:
(iii) Chapter 3: Sections 1-31 and 33-36.
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) Long-term, out-of-home residential care in a structured, therapeutic environment;
(ii) Wyoming Department of Education approved or accredited on-grounds school which offers a comparable public school program which provides credits and/or coursework that are transferable to a public school or a GED program or a program which works with the local school district to meet the educational needs of the child;
(iii) Regularly scheduled supervised recreational/leisure activities;
(iv) 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 (v) 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 section.
(ii) A facility which offers both secure and non-secure care shall have a separate cottage or wing of a dormitory 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.
(a) All levels of RTCs shall provide services for no more than twenty (20) children in each living unit.
(a) RTCs shall have, at a minimum:
(i) Administrator/Executive Director;
(ii) Sufficient professional staff to provide for all components of the ITPC, including:
(A) Licensed or certified therapist(s) to direct the ITPCs;
(B) Certified educational staff.
(iii) Direct care staff; and
(iv) Medical personnel on staff or under contract, to include, at a minimum, a licensed practical nurse (LPN).
(a) All RTC staff must complete a thirty (30) hour orientation program, as described in Chapter 3, Section 11.
(b) All RTC staff must complete twenty (20) hours of annual training, as described in Chapter 3, Section 11.
(a) In order to qualify for placement in an RTC program, a child must exhibit one (1) of the following conditions:
(i) Child cannot function in his/her community;
(ii) Child has treatment issues requiring therapeutic intervention;
(iii) The child has received a psychiatric evaluation resulting in a diagnosed behavioral condition;
(iv) The child is only minimally accepting of the treatment process;
(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;
(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
(vii) Child cannot attend public school.
(viii) In addition to meeting one (1) of the conditions above, children exhibiting the following behaviors may be appropriate for placement in a RTC:
(A) Inability to follow directions and conform to structure of school, home or community;
(B) Constant, sometimes violent arguments with caretakers, peers, siblings and/or teachers;
(C) Moderate level of self-injurious behavior, risk taking, and/or sexual promiscuity;
(D) Suicidal actions/history of serious suicidal actions;
(E) Almost daily physical altercations in school, home or community;
(F) Constant verbally aggressive and provocative language;
(G) Frequent and severe property damage;
(H) Probable juvenile justice system involvement;
(I) Frequent school suspensions; and/or
(J) Moderate to high risk for sexually victimizing others.
(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;
(viii) A problem list, related to the reasons why the child was admitted to this level of care;
(ix) Identification of interventions for the immediate management of the problems identified in 8; and/or
(x) The treatment objectives (desired child responses) expected to be met by the time of the first continued stay review.
(a) Case loads for therapists:
(i) RTCs shall maintain a case ratio of one (1) full-time equivalent licensed or certified therapist for every ten (10) children or a ratio of one (1) full-time equivalent licensed or certified therapist for every twelve (12) children when the therapist works with an aide for the delivery of therapeutic services.
(b) Direct care staff for RTCs:
(i) Daytime and evening hours – Non-classroom time.
(A) The minimum ratio of direct care staff to children is 1:6.
(ii) Daytime and evening ratios to be maintained in school classroom:
(A) The same ratios apply as stated above; and
(B) If the teacher is counted in the staff/child ratios, he/she shall complete all training required for direct care staff.
(iii) Nighttime sleeping hours.
(A) There shall be awake direct care staff/child ratio of one (1) staff for every ten (10) children during nighttime sleeping hours;
(B) 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.
(a) In RTCs, each child shall be provided with room and board and is to be assigned a bedroom, unless there are safety issues that would contraindicate assigning the child to a bedroom. Each bedroom shall include, at a minimum, a bed, mattress, mattress pad, pillow, supply of bed linen and space for the storage of personal items.
(b) The organization shall develop, adopt, follow and maintain on file written policies and procedures ensuring that:
(i) Children shall receive guidance and instruction in personal care and hygiene appropriate to their age, gender, race and culture; and
(ii) Children shall follow personal care and good hygiene practices.
(a) A preliminary ITPC, which is individually tailored for each child, shall be developed within fourteen (14) calendar days of admission in accordance with the standards set forth in Chapter 3, Section 34 of these rules; and (b) The ITPC shall be developed by the child's treatment team, which may include but not be limited to the child, parent(s) or legal guardian(s), licensed or certified therapist, educational staff, direct care staff, consultants and DFS caseworker if in DFS custody. Participants shall sign and date the ITPC. Phone and video participation should also be noted and signed for by someone physically present at the meeting.