The DFPS State Office Placement Division has been working on several projects and initiatives to increase and improve placement options for children and youth in the child welfare continuum of care. One of these initiatives is a Qualified Residential Treatment Program (QRTP) Pilot for children and youth with complex emotional, mental, and behavioral health needs in a residential treatment setting.

Background

The Family First Prevention Services Act (FFPSA) was enacted under the Bipartisan Budget Act of 2018. FFPSA changed the way DFPS is paid for children or youth placed in congregate care (or residential care, referred to in Texas as General Residential Operations, GROs). FFPSA allows DFPS to continue to use contracted GROs for placement, but as of September 29, 2021, Title IV-E maintenance payments are no longer allowed for any child or youth in a GRO after the first 14 days, unless the placement meets specific criteria.  One of the criteria is if a provider meets the requirements of being designated as a QRTP. DFPS released a DFPS FFPSA Strategic Plan in September 2020, which includes a plan to pilot a Qualified Residential Treatment Program.

On April 1, 2022, DFPS published an Open Enrollment opportunity for licensed GROs to apply to become contracted QRTP providers. For more information, see the QRTP Open Enrollment.

DFPS is currently on track to be ready to serve the first child or youth in a QRTP by July 1, 2022.

What is a QRTP?

QRTPs are providers who are accredited and licensed as General Residential Operations (GROs) and provide time-limited clinical intervention and treatment services to children and youth in DFPS conservatorship with the most complex emotional, mental, and behavioral health needs.

The goal is to provide the child or youth with the appropriate level of treatment services for their individual needs so they are able to transition out of foster care and back to their family of origin - or achieve positive permanency in a less restrictive environment while receiving aftercare supports for a minimum of six months.

Single Source Continuum Contractors (SSCC) & Community-Based Care (CBC)

In order to be efficient and consistent, during the initial QRTP pilot phase, DFPS will centrally manage QRTP contracts, referrals, assessments, eligibility, protocols, and evaluation processes.

Children and youth under the purview of an SSCC who may require QRTP services will be incorporated in a similar manner as children served through the legacy system.

Length of Treatment

Under FFPSA, there are specific timeframes that a child or youth can remain in a QRTP placement for which Title IV-E maintenance funds can be claimed:

  • For a child or youth who is between the ages of 13 and 17, the length of treatment cannot exceed 12 consecutive or 18 non-consecutive months.
  • For any child under the age of 13, the time frame cannot exceed 6 months, whether consecutive or non-consecutive.

Child and Youth Characteristics and Eligibility

Some of the characteristics which may qualify for a QRTP placement are children or youth who:

  • Have had unsuccessful placements in less restrictive environments, such as foster homes and relative/fictive kinship placements
  • Have had multiple instances of being defined as a child without placement, which is directly associated to their emotional and mental health needs and behavioral issues
  • Have been placed in and are being discharged from acute or sub-acute psychiatric hospital settings
  • Have history of juvenile justice involvement
  • Have been diagnosed with an emotional disorder, including, but not limited to, bipolar affective disorder, depression, post-traumatic stress disorder, reactive attachment disorder, disruptive mood dysregulation disorder, or have a serious intellectual or emotional disability
  • Exhibit child sexual aggression or sexual behavior problems or have been diagnosed with a sexual behavior disorder
  • Exhibit aggression/violence with serious behavioral disorders
  • Exhibit self-injurious behaviors
  • Have or exhibit any combination of the above

QRTP Referrals

DFPS Caseworkers and SSCC Permanency Workers are responsible for submitting a complete placement referral packet for all QRTP placement requests.

The following documents must be attached to the request:

  • QRTP Referral, Assessment, and Recommendation form (form instructions)
  • Application for placement  
  • Psychological evaluation of the child completed within the preceding 14 months or psychiatric evaluation within the preceding 6 months
  • All clinical notes and information within preceding 12 months, if applicable
  • Discharge documents from any placements within the preceding 12 months, if applicable
  • Additional supporting documents, such as discharge summaries, educational information (FIE, ARD, IEP), incident reports, behavior notes, or therapy notes, as applicable

QRTP Assessment

The Assessment is a very important part of completing a QRTP placement and is a requirement under FFPSA. An assessment of the child or youth must be completed within 30 days of initial placement and must recommend placement into a QRTP.

The assessment process in the Texas DFPS Model includes 3 steps that must be completed thoroughly and timely:

  • QRTP Permanency Team Meeting (QRTP PTM)
  • Child and Adolescent Needs and Strengths (CANS)
  • Third party review - clinical assessment, review, and recommendations by a qualified individual for placement into a QRTP

Note: Any child or youth under the purview of a Single Source Continuum Contractor (SSCC) must have a CANS and QRTP PTM completed within 16 calendar days of submitting a QRTP placement referral to DFPSQRTP@dfps.texas.gov.

What is a QRTP Permanency Team?

FFPSA clearly defines that the permanency team shall consist of all appropriate biological family members, relative, and fictive kin of the child, as well as, as appropriate, professionals who are a resource to the family of the child, such as teachers, medical or mental health providers who have treated the child, or clergy. In the case of a child who is 14 years or older, the family and permanency team shall include the members of the permanency planning team for the child that are selected by the child.

QRTP Court Requirements

FFPSA requires courts to review the recommendations of the initial QRTP assessment with all supporting documentation within 60 calendar days of the start of the placement when children or youth are placed into a QRTP. The court must either approve or disapprove the initial QRTP placement.

The court must also review and approve or disapprove of continued placement at each status review hearing and each permanency hearing held, so long as the child or youth remains in QRTP.

For more information, see the Court Process for the Texas QRTP Pilot.

Discharge and Transition

Discharge planning must begin at the time of placement and should include the QRTP provider, child’s family or subsequent caregiver support, and other members of the Permanency Team.

All unplanned discharges are subject to review and approval by the Associate Director, Director of Placement Services, or their designee.

Transition requires post-discharge aftercare services and support by the QRTP provider for a minimum of 6 months. 

See the DFPS Residential Child Care Discharge form.

Extension Requests

Placement into a QRTP is dependent upon the child or youth’s age. However, there may be times when an extension is therapeutically recommended. An extension must be initiated 90 days prior to the original discharge date. A DFPS caseworker may request an extension by completing a QRTP Extension (Waiver) Request form and including all required documentation, including a statement from the Treatment or Clinical Director at the operation.

Note: FFPSA requires all extension requests to be reviewed and approved or denied by the DFPS Commissioner. 

Provider Requirements: Overview

Under FFPSA requirements, QRTP providers must:

  • Be accredited
  • Have 24/7 licensed nursing and clinical staff according to their treatment model
  • Have a trauma-informed treatment model
  • Provide family outreach, engagement and inclusion
  • Provider aftercare support for six months

Under the DFPS QRTP model a QRTP provider must also:

  • Be accredited by one of the three DFPS approved Accrediting entities:  JCHOA, CARF or COA
  • Have a trauma-informed treatment model that is evidence-based, promising practice or research supported, and that is submitted and approved
  • Facilitate family finding activities
  • Provide aftercare support for six months that includes crisis intervention and monthly contact with the family or next caregiver and the child/youth
  • Provide 1:4 supervision during awake hours and 1:5 during sleep hours
  • Accept any youth referred when they meet the operations admission criteria (see FAQs).
  • Not conduct an unplanned discharge of the youth without the approval of the Associate Director, Director of Placement, or their designee (see FAQs)
  • Conduct twice monthly multidisciplinary team meetings for individualized treatment planning, which include the child and permanency team
  • Provide a minimum of 3 therapeutic sessions weekly for the child or youth, with at least one being individual therapy

Frequently Asked Questions

Can SSCC/CBC providers establish their own contracts for QRTPs?

During the initial pilot phase, SSCC/CBC providers will not be able to enter into QRTP contracts apart from the DFPS QRTP contract.

What are JCHOA, CARF, and COA?
Is extra funding being provided to QRTP providers for the 1:4 and 1:5 ratios?

Yes, the supervision ratio is taken into account for the reimbursement rate for a QRTP placement.

Will the child or youth be part of the meetings each month with the Permanency and/or Multidisciplinary teams? What meetings will the child attend?

Children and youth will be able to and should be encouraged to attend all meetings regarding their treatment and progress during a QRTP placement. 

Is the plan to be ready to place children in a QRTP starting in July 2022 a realistic timeline?

DFPS is on track for readiness to serve the first child or youth by July 1, 2022. As of May 20, 2022, DFPS did not yet have an approved QRTP provider in Texas.

Can you explain, in lay terms, how QRTPs are different than Residential Treatment Centers (RTCs) of the past?

QRTPs are required to be accredited, provide 24/7 nursing and clinical staff, and provide a minimum of 6 months aftercare support. These are the biggest differences.

In addition, QRTPs will have increased supervision ratios and must have treatment models which are trauma-informed, submitted to DFPS, and approved to provide treatment to the intended population of children and youth.

Will any past or current RTCs become QRTPs, or will these be new establishments?

The application to become a QRTP is open to any provider who meets the requirements under the Texas model.

Where can I find a list of QRTPs?

The DFPS website will include information about QRTPs and a list of QRTP providers as they become contracted.

Will children or youth leaving QRTPs be placed with therapeutic foster parents or other foster parents who have specialized training?

The goal is to place a child or youth with family first. When looking at other foster care settings and family caregivers both, QRTP providers need to integrate that next caregiver into the treatment, discharge, and transition processes, and ensure they are provided the aftercare support for the minimum 6 months. The process of QRTPs should involve any next caregiver throughout the QRTP placement to help them know how to work with the child/youth upon discharge.

Will team meetings have a virtual option to allow greater access for everyone and address time constraints?

Yes, virtual hearings and meetings are approved to be used.

Shouldn't the child's Attorney ad Litem/Guardian ad Litem (AAL/GAL) approve placement before the child is placed, instead of objecting after?

Ideally, the AAL/GAL will always be involved in the QRTP Permanency Team Meetings and provide input based on that initial meeting, the information obtained, and treatment goals established for the child/youth prior to a placement into a QRTP.

What if a child doesn’t have an attorney? What is the remedy for a child who disagrees with placement and/or a judge’s determination for continued placement if contrary to the GAL's?

Under Texas Family Code Chapter 107.106, the court is required to continue the appointment of the AAL, or the GAL, or an attorney serving in the dual role as long as child is in DFPS conservatorship. As a best practice, courts should continue the appointment of both the child’s AAL and GAL as long as the child is in the managing conservatorship of DFPS.

Will Motion for Hearing in hotdocs be available elsewhere for those not using hotdocs?

The Children’s Commission will work with DFPS to make this information publicly available.

Has the Office of Court Administration (OCA) set up a tickler for the CPC Courts to provide ongoing hearings for these kids?

The Children’s Commission will work with the Office of Court Administration to develop this case management capability.

Are there QRTPs outside the state of Texas? If so, is it possible that a Texas child would be placed in one of those?

There are QRTPs outside of Texas, however, as of May 2022 there have been no established contracts with the Texas model. They must still meet Texas DFPS QRTP requirements. If there are contracts established in QRTPs outside of Texas that meet the child or youth’s needs, then it could be an option for placement.

Are there things that would make a child ineligible for a QRTP, such as IQ or intellectual capacity?

Each operation (or QRTP provider) can establish their own admission criteria such as age, IQ, gender, and child characteristics. While these things do not make a child or youth “ineligible”, there may not be QRTPs available that admit specific populations. 

Is the referral like a Common Application, but more intensive?

The referral process includes the Application for Placement (formerly known as the “Common Application”), but also utilizes a new referral form (DFPS Form K902-2355) that is a comprehensive form where a lot of the required assessment information is documented. Other historical documentation is still required, such as the psychological/psychiatric evaluation, school records, clinical/therapy notes, etc. 

When are the QRTP Permanency Teams going to do work for our children without placement (CWOP)? I have heard no evidence about this from the Department. Why is that?

As of May 20, 2022, there were no QRTP placement options for youth. As providers become available, Permanency Team Meetings will be held with the youth and their supports.

What is the expectation for children or youth visits with family? Either in person or virtually?

During a QRTP placement, the expectation is that all children or youth will be encouraged and permitted to have visitation with family as frequently as possible.  Visitation is a large part of the collaboration and inclusion of family under the QRTP model.  This can be done in person or via video conferencing, as appropriate.

Historically, a child is discharged before new placement is located. How is this being addressed in the discharge/transition plan?

QRTP providers will be working with the child, family, supports, and Permanency Team throughout the placement to provide a realistic discharge and transition for the child or youth. Youth who have no identified next placement will be closely monitored and the regional placement teams will be alerted and provide assistance prior to the final discharge date for the child or youth. 

What triggers the assessment for a QRTP? And how can we get that expedited?

Caseworkers will make a referral for a QRTP placement, and a State Office Program Specialist will screen the referral.  If the screening process determines the child or youth is a good candidate for a QRTP, caseworkers will be advised to move forward with the assessment steps, which must be completed within 20 days of the referral date.  The referral can be expedited by ensuring all information is available and all potential QRTP Permanency Team members are ready to conduct a timely Permanency Team Meeting.  Additionally, all interested persons can inquire about a referral to a QRTP for youth with whom they work.

Can AAL/GAL make referrals to caseworkers now?

It would be beneficial to begin having discussions as early as possible with caseworkers about youth who may need a QRTP setting. However, DFPS cannot begin taking referrals because there are not yet any contracted QRTP placement providers.

Will children in CWOP have priority for a QRTP?

Children and youth should be referred to QRTP according to their individual treatment needs. Youth with the most complex needs, regardless of placement setting or lack thereof, will be screened and assessed accordingly. 

Do the caseworkers even know about the QRTP referral process?

DFPS Conservatorship and Family Group Decision Making caseworkers and supervisors are being trained on QRTP requirements and the referral process throughout May and June 2022.  DFPS is also working with the SSCCs to prepare their staff for the initial pilot phase implementation.

Can QRTP placements be educated alongside, or otherwise mingle with, other populations served?

Children or youth who are in QRTPs must have programs set apart from other populations served.

May a contract applicant propose to serve clients from a specific geographical area, or must they be open to serve clients from any area of the state?

A QRTP must be agreeable to serve children or youth from anywhere statewide. 

What are the requirements and expectations regarding 24-hour nursing and clinical staff?

The requirements and expectations regarding 24-hour nursing and clinical staff  is  dependent upon the treatment model that is being utilized by the operation. The  published open enrollment, which is consistent with FFPSA, states:

“Must have registered or licensed nursing staff and other licensed clinical staff onsite consistent with the Applicant’s treatment model and who are available 24-hours a day, seven days a week.”

If the operation is using a treatment model that requires on-site nursing staff and other licensed clinical staff during business hours, or even on-site nursing and other licensed clinical staff 24/7, then that is the expectation.  If the treatment model allows for on-call nursing and other licensed clinical staff 24/7, then that would be the expectation.  Either way, nursing and other licensed clinical staff must be available 24/7. 

What are the admission and discharge requirements?

Admission: General Residential Operations who contract with DFPS to be a QRTP will establish clear admission criteria for the types of child characteristics they will be willing and able to serve in their operation.  If there is a child that would be accepted by admission criteria alone, but there are other reasons the child should not be admitted that are in the child’s best interest, DFPS would discuss with the provider and come to a mutual agreement.

(Unplanned) Discharges: Prior to submitting an (unplanned) discharge notice, providers will need to make and clearly document all efforts to alleviate any issues that have arisen leading to a discharge request. This should include using the multidisciplinary meetings, permanency team, therapist and any other resources available.  This information will be assessed by the DFPS State Office Director, Associate Director of Placement Services, or designee, and will be discussed with the provider prior to final decision to approve or deny the discharge request.

The intentions of these QRTP contract requirements is to help facilitate clear communication and collaboration of all parties in the best interest of the child or youth.

State Office Placement Division QRTP Team

If you would like more information regarding the DFPS Qualified Residential Treatment Program model or pilot implementation, please contact the state office QRTP program specialists at DFPSQRTP@dfps.texas.gov.