Subchapter C. CHILDREN SERVICES


GENERAL PROVISIONS

Sec.


5310.91.    Special requirements for community residential rehabilitation services (CRRS) serving children.
5310.92.    Applicability.

ORGANIZATION AND ADMINISTRATION


5310.101.    Governing body.
5310.102.    Personnel management.

CLIENT CHARACTERISTICS


5310.111.    Client Characteristics.

SERVICES MANAGEMENT


5310.121.    Program description.
5310.122.    Intake.
5310.123.    Residential service plan.
5310.124.    Service agreement.
5310.125.    Health care services.
5310.126.    Termination from program.
5310.127.    Program closure.
5310.128.    Service linkages.

STAFFING AND TRAINING


5310.131.    Staffing.

CLIENT RECORDS


5310.141.    Case record.
5310.142.    Confidentiality.

CLIENT RIGHTS


5310.151.    Client rights.

PHYSICAL STANDARDS


5310.161.    [Reserved].
5310.162.    Host homes.

DIET AND MEDICATION


5310.171.    Medication
5310.172.    Nutrition.

Cross References

   This subchapter cited in 55 Pa. Code §  5310.21 (relating to client characteristics).

GENERAL PROVISIONS


§ 5310.91. Special requirements for community residential rehabilitation service (CRRS) serving children.

 This subchapter contains the requirements for community residential rehabilitation services (CRRS) for children and is supplemental to, or if in conflict with, supersede § §  5310.12—5310.14, 5310.21, 5310.31—5310.39, 5310.51—5310.52, 5310.71—5310.72 and 5310.81—5310.82.

§ 5310.92. Applicability.

 (a)  This subchapter applies to all CRRS that provide full-care for children in host home settings. Persons under 18 years of age, with the exception of emancipated minors, may not be cared for in a partial-care CRRS nor in a CRRS site in which adults are served.

 (b)  When a CRRS accepts a child who is in the legal custody of the county children and youth agency or a public or private social service agency for placement in CRRS group home or host home, the requirements of Chapter 3800 (relating to child residential and day treatment facilities) apply. These requirements are additional to the requirements in this chapter.

Authority

   The provisions of this §  5310.92 amended under Articles IX and X of the Public Welfare Code (62 P.S. § §  901—922 and 1001—1080).

Source

   The provisions of this §  5310.92 amended June 25, 1999, effective October 26, 1999, 29 Pa.B. 3295. Immediately preceding text appears at serial page (211945).

ORGANIZATION AND ADMINISTRATION


§ 5310.101. Governing body.

 (a)  Insurance coverage must be in effect to the extent deemed necessary by the governing body to protect the governing body, staff, surrogate parents, clients, and property of the community residential rehabilitation service (CRRS) and to meet the requirements of State and Federal statutes.

 (b)  This section supersedes §  5310.11(d)(3) (relating to governing body).

§ 5310.102. Personnel management.

 (a)  The community residential rehabilitation service (CRRS) must establish and implement written personnel policies and procedures which cover:

   (1)  Recruitment, selection, and promotion of staff and surrogate parents.

   (2)  Agency method of staff and surrogate parent development through in-service and out-service training and professional consultation.

 (b)  Personnel policies shall be compiled, updated, and made available to all staff and surrogate parents.

 (c)  Each staff member and surrogate parent must be provided with a copy of his job description at the time of hiring and whenever the job description is changed.

 (d)  This section supersedes §  5310.14(a)(1), (10), (b) and (d) (relating to personnel management).

CLIENT CHARACTERISTICS


§ 5310.111. Client characteristics.

 A child placed in a community residential rehabilitation service (CRRS) must:

   (1)  Be under the age of 18 years and not an emancipated minor.

   (2)  Have demonstrated, over a period of time, maladaptive interpersonal behavior which significantly impairs the child’s functioning within the family and among the child’s peers.

   (3)  This section supersedes §  5310.21(a)(1) and (3) (relating to client characteristics).

SERVICES MANAGEMENT


§ 5310.121. Program description.

 (a)  Psycho-social rehabilitation services to develop interpersonal, and when appropriate, community living skills must be provided. This subsection supersedes §  5310.31(2)(iii) (relating to program description).

 (b)  Services required in addition to those specified in §  5310.31(2), are:

   (1)  Assistance with schoolwork assignments and school related activities as needed.

   (2)  Age appropriate recreational activities.

   (3)  Family support and training services which, for example, assist the parents of the child to identify social-emotional needs of the child, use appropriate strategies in meeting the child’s needs, and develop family interpersonal relationships which will allow the child to return to the child’s family if this has been identified as a goal of the rehabilitative program.

§ 5310.122. Intake.

 (a)  During intake, the community residential rehabilitation service (CRRS) staff shall review the criteria for program enrollment and program termination, the services offered by the CRRS and the programmatic, legal and financial responsibilities of the child, his parent, the agency having legal custody of the child and the CRRS with parent and, if applicable, with the agency having legal custody of the child. A child under 14 years of age should be included, whenver possible, in the review. A child who is 14 years of age or older must be included in the intake process. This subsection supersedes §  5310.32(b) (relating to intake).

 (b)  In addition to the intake information required in §  5310.32(c), intake for children shall include:

   (1)  Requests are made to the education agency for any school evaluation and records, as well as teacher observations, which might assist in understanding the child’s behavior and in identifying socio-personal needs.

   (2)  Family social history.

 (c)  Children who are 14 years of age or older must voluntarily consent to enrollment into the CRRS or enrollment into the CRRS must be denied.

 (d)  This subsection (a) supersedes §  5310.32(b) (relating to intake).

§ 5310.123. Residential service plan.

 (a)  Upon the child’s enrollment, an individualized written client residential service plan shall be developed by the community residential rehabilitation service (CRRS) staff with the child’s parent, the agency having custody of the child, if applicable, and the child when the child is 14 years of age or older. When the child is under 14 years of age the child may be included in the development of the individual residential service plan, as appropriate.

 (b)  The service plan shall be based on an evaluation of the child’s social and emotional development relative to age appropriate expectations for functioning in interpersonal relationships within the family, peer groups and the community. The service plan includes as needed:

   (1)   Self care skills.

   (2)   Health care, including medication management.

   (3)   Housekeeping skills.

   (4)   Ability to meet nutritional needs.

   (5)   Mobility.

   (6)   Money management skills.

   (7)   Interpersonal skills.

   (8)   Educational/vocational pursuits.

   (9)   Use of leisure time.

   (10)  Time structuring.

   (11)  Community participation.

 (c)  The service plan must specify short and long-term goals for service formulated by staff and parent of the child, the agency having legal custody of the child, if applicable, and the child when the child is 14 years of age or older. When the child is under 14 years of age, the child may be included in specifying goals whenever possible.

 (d)  The child’s parent, the agency having custody of the child, if applicable, and the child shall participate in the goal-setting, service planning, decision-making and progress assessment associated with the service plan.

 (e)  At the time of enrollment into CRRS and through the service period, each client must be assigned a primary staff person who is responsible for assuring that the residential service plan is coordinated with the service plans of other agencies having responsibility for specific facets of the child’s life, for example, education agencies, children and youth agencies, base service units, juvenile justice system, and mental health service agencies.

 (f)  Subsections (a)-(d) supersedes §  5310.33(a), (b), (c)(1), and (f) (relating to residential service plan). Subsection (e) supersedes §  5310.33(h). The requirement of §  5310.33(e) does not apply to CRRS programs serving children.

§ 5310.124. Service agreement.

 (a)  There must be a written service agreement negotiated at intake and signed by the community residential rehabilitation service (CRRS) and the child’s parent, the agency having custody of the child, if applicable, and when possible and appropriate, the child except that in cases wherein the client is 14 years of age or older, the child must be included.

 (b)  This agreement shall specify the services to be provided and the rights and responsibilities of parent, the agency having custody of the child, if applicable, and the child.

 (c)  The agreement must include a copy of the CRRS house rules, client rights, client grievance procedures, and termination policy.

 (d)  The agreement must specify the arrangements and charges for housing and food and any liability for the cost of services other than room and board.

 (e)  The agreement must be updated and signed again whenver any of the terms change.

 (f)  This subsection supersedes §  5310.34 (relating to service agreement).

§ 5310.125. Health care services.

 (a)  The community residential rehabilitation service (CRRS) must develop health care policies and procedures to insure the availability of age-appropriate health services for children. Prior to or upon the child’s enrollment to the CRRS, a health appraisal signed by a licensed physician shall be obtained for each child. The health appraisal shall include the following information recommended by the American Academy of Pediatrics.

   (1)  A review of previous health history.

   (2)  A complete physical examination unless a record is available of a physical examination which was completed within 6 months prior to placement.

   (3)  Growth assessments.

   (4)  A review and update of the child’s immunization status to conform with the United States Public Health Service requirements.

   (5)  Provision of age-appropriate screening tests according to the standards of the American Academy of Pediatrics.

   (6)  Recommendations pertaining to medication required or limitations of the child’s activities and diet, and further medical tests or examinations that may be required.

   (7)  Medical information pertinent to diagnosis and treatment in case of emergency.

   (8)  A statement of recommendation for follow-up treatment or special care, if required.

 (b)  The CRRS must encourage participation by parent or, if applicable, the agency having legal custody in the health care services being provided for the child, and if appropriate, transporting the child to and from medical appointments.

§ 5310.126. Termination from program.

 (a)  The community residential rehabilitation service (CRRS) must establish written criteria and procedures to cover the following two types of terminations:

   (1)  Planned termination of services. The parent, the agency having legal custody of the child, if applicable, the child, CRRS staff and others responsible for the child’s welfare agree that the child should leave the program and have planned and prepared for the move.

   (2)  Unplanned termination of services. The child runs away, requires hospital care, or demonstrates behavior that requires immediate removal. In all cases of unplanned termination, the CRRS must immediately notify the child’s parent and the agency having custody of the child, if applicable.

 (b)  If the planned termination is a result of a failure on the part of the child’s parent or the agency having legal custody of the child, if applicable, or the child to abide by the terms of the service agreement, the CRRS must notify all parties in writing of the termination decision, including a termination date which shall be no sooner than three weeks from the date of notification. The notification must explain the reason for termination and indicate any recourse available under the client grievance procedure.

 (c)  When surrogate parents request the removal of a CRRS child from their home, at least 10 working days notice must be given for the CRRS to establish an alternate placement for the child. The CRRS must notify the child’s parent or the agency having custody of the child, if applicable, and the child if the child is 14 years of age or older within two days after such a request is made. Emergency removal must be arranged in situations where serious harm could come to the child or surrogate family.

 (d)  Within two weeks of the termination date, the CRRS must prepare a termination summary for each client terminated which must be included in the child’s record and provided to the placement and case management agency, if any.

 (e)  This section supersedes §  5310.35 (relating to termination from program).

§ 5310.127. Program closure.

 (a)  If the community residential rehabilitation service (CRRS) intends to cease operation, the governing body shall provide at least 30 days written notice of the intent to cease operation and the projected closing date to the child’s parent, the agency having custody of the child if applicable, the child, all treatment/case management agencies, the County Mental Health/Mental Retardation (MH/MR) Office and to the Department.

 (b)  This section supersedes §  5310.37 (relating to program closure).

§ 5310.128. Service linkages.

 (a)  When the community residential rehabilitation service (CRRS) provides care for a child who is in the legal custody of the county children and youth agency or a public or private social service agency, the CRRS must have a written letter of agreement with the responsible agency which specifies:

   (1)  The respective roles of each agency in the development and implementation of the placement plan and the procedures for follow-up.

   (2)  The respective roles of each agency in the recruitment and study evaluation process for surrogate parents.

   (3)  An agreement on the role of each agency in communicating with the parent and in providing family services.

   (4)  The respective role of each agency in arranging for health care services.

 (b)  When the CRRS provides care for a child of school age, the CRRS must develop arrangements with the appropriate education agencies having responsibility for the child’s education which specify:

   (1)  The role of the school in the planning and implementation of the service plan.

   (2)  The role of the CRRS in the planning and implementation of the child’s education plan.

   (3)  The scheduling of treatment services and how such services are to be coordinated with the education program partricularly during those hours in which the child would normally be expected to participate in the education program.

   (4)  The procedures developed for the exchange of verbal and written information between the CRRS and the school.

 (c)  This section supplements §  5310.39 (relating to service linkages).

STAFFING AND TRAINING


§ 5310.131. Staffing.

 (a)  An adult must be on the site whenever a child is present. In group homes, the adult must be a staff member. In host homes, the adult must be a surrogate parent having responsibility for the daily care of the child, except where the CRRS makes arrangements for or approves the use of other adults to provide relief time for surrogate parents for a reasonable number of hours per week.

 (b)  The requirements of §  5310.41 (relating to staff and training) apply to all CRRS group homes serving children.

 (c)  The following requirements apply to all CRRS host homes serving children:

   (1)  All couples or individuals interested in being surrogate parent shall file a written application with the CRRS provider or the agency designated by the CRRS provider to screen surrogate parent applicants. The CRRS Provider shall maintain responsibility to make the final determination regarding the applicant’s approval as a surrogate parent.

   (2)  The study-evaluation process must be used to determine the suitability of the applicant for surrogate parent and the type of children the prospective surrogate parent can best serve. The study-evaluation process shall assure that sufficient information is provided to the applicant to allow them to make an initial decision as to their suitabiltiy as surrogate parent.

   (3)  The study-evaluation process must include interviews with the applicant surrogate parent and their children. The process also must include one visit to the applicant’s home. All family members who will live in the same residence as the child shall be present during at least one home based interview.

   (4)  The study-evaluation process must include references. References stating the applicant’s ability to care for children must be provided by three persons not related to the applicant.

   (5)  The content of the study-evaluation of the applicant for surrogate parent shall include:

     (i)   Age, as it affects functioning.

     (ii)   Health,including a written statement from a physician, assuring the applicant freedom from contagious disease and ability to handle increased stress.

     (iii)   Income, sufficient to meet regular family expenses.

     (iv)   A dwelling that presents no hazards to the safety of a child and is in keeping with the community in which it is located.

     (v)   Family composition as it affects the number and type of children for whom care can be given.

   (6)  Surrogate parent capabilities must be assessed by giving consideration to the following factors.

     (i)   Existing family relationships, attitudes, and expectations regarding their own children and parent-child relationships especially where they might affect a CRRS child.

     (ii)   The family ideas and practice in regards to child discipline.

     (iii)   Attitudes of significant members of the extended family regarding placement of a CRRS child.

     (iv)   Ability to accept and respect a child as the child is.

     (v)   Capacity to absorb a child into family life without undue disruption.

     (vi)   Capacity to meet the needs of both a CRRS child and their own child or children.

     (vii)   The attitudes of the surrogate parent’s child or children to accepting a CRRS child.

     (viii)   Realistic appraisal of positive and negative aspects of surrogate parenthood.

     (ix)   Ability to provide continuity of care throughout a child’s placement.

     (x)   Ability to meet changing needs over the course of a child’s placement.

     (xi)   Ability to accept a CRRS child’s relationship with the child’s own parent.

     (xii)   Ability to care for children with special needs.

     (xiii)   Areas in which ongoing supportive services may be needed.

     (xiv)   Number and characteristics of CRRS children best suited to the surrogate parent family.

     (xv)   Ability to work in partnership with the CRRS and other agencies as required.

   (7)  The decision to approve or disapprove an application to be a surrogate parent must be communicated in a conference between the CRRS or its designated agency and the applicant and confirmed in writing. Reasons for approval or disapproval must be clearly stated.

   (8)  The CRRS must provide in writing the following information to surrogate parents:

     (i)   Policies setting forth the respective responsibilities of the CRRS and surrogate parent in identifying and meeting a child’s basic needs which include the physical environment, nutrition, privacy, involvement with schools or other community resources.

     (ii)   Policies regarding disciplinary methods for CRRS children which must exclude any form of abusive, degrading, or vindictive punishment.

     (viii)   A description of consultation and training which the CRRS will furnish to assist surrogate parent in further improving their parenting skills.

     (iv)   A procedure for reporting to the CRRS any emergency, serious injury or illness, or death or impending death of a child placed with a surrogate parent.

     (v)   A statement regarding the reimbursement rate which will be paid to surrogate parent.

     (vi)   A telephone number by which the CRRS may be contacted on a 24-hour basis.

     (vii)   A statement as to the role of the surrogate parent in the development and implementation of the service plan.

   (9)  The CRRS must also furnish the surrogate parent the following information to assist them in making a decision regarding the acceptance of a specific child.

     (i)   The child’s medical history.

     (ii)   The child’s general behavior.

     (iii)   The child’s likes and dislikes, including special interests.

     (iv)   The child’s religious affiliation, if any.

     (v)   The child’s school adjustment and academic performance.

     (vi)   The circumstances which led to CRRS placement.

     (vii)   Important life experience which may effect the child’s adjustment, including information about prior placements.

     (viii)   The child’s relationship with the child’s parent.

   (10)  Surrogate parent shall be informed that information provided on CRRS children and their families must be kept confidential and shall sign an agreement to this effect.

   (11)  All surrogate parents shall be under the direct supervision of a mental health professional.

CLIENT RECORDS


§ 5310.141. Case record.

 (a)  The requirement in §  5310.51(b)(2)(iii) (relating to case record) is not required for community residential rehabilitation service (CRRS) children.

 (b)  Each case record must include a copy of written agreement between the CRRS, the child’s parent, the agency having custody of the child, if applicable, and the child if the child is 14 years of age or older.

 (c)  Subsection (b) supersedes §  5310.51(b)(4)(viii).

§ 5310.142. Confidentiality.

 (a)  All client records and information are confidential and may not be disclosed directly or indirectly without the written consent of the child’s parent or the agency having custody of the child, if applicable, and the child if the child is 14 years of age or older.

 (b)  Exceptions stated in §  5310.52(a)(1)—(6) apply to client records and information in community residential rehabilitation service (CRRS) for children.

 (c)  Written consent is required by the child’s parent or the agency having custody of the child, if applicable, and the child if the child is 14 years of age or older to disclose information from the child’s record and must include:

   (1)  Date and nature of request for information.

   (2)  Name of the person, agency or organization to whom disclosure is made.

   (3)  Type of information disclosed.

   (4)  Dated signature of the child’s parent, or the agency having legal custody of the child and the child if the child is 14 years of age or older.

   (5)  Dated signature of a witness.

   (6)  Expiration date of consent form.

   (7)  Statement of the rights of the parent or agency having custody of the child and the child to revoke the consent each has given.

 (d)  A copy of each disclosure consent form must be given to the parent or agency having legal custody and the child if the child is 14 years of age or older. A copy must also be placed in the child’s case record.

 (e)  Subsections (a) and (b) supersede §  5310.51(a) (relating to confidentiality); subsection (c) supersedes §  5310.52(e); and subsection (d) supersedes §  5310.52(f).

CLIENT RIGHTS


§ 5310.151. Client rights.

 (a)  The community residential rehabilitation service (CRRS) must have written policy and procedures to assure that the child’s parent, the agency having custody of the child, or the child, if the child is 14 years of age or older, have the right to inspect the child’s records provided that access can be denied to portions of the record under the following conditions.

   (1)  The Director determines that:

     (i)   Disclosure of specific information would be a substantial detriment to the child or to the involvement of the child’s family in family therapy.

     (ii)   Disclosure of specific information would identify and breach any confidentiality of other persons.

   (2)  The denial of access must be recorded, with justification, in the child’s record, dated and signed by the Director.

   (3)  This subsection supersedes §  5310.64 (relating to client right to inspect client record).

 (b)  In addition to the requirements of § §  5310.61—5310.65 (relating to client rights), CRRS must report all cases of alleged child abuse suspected in the child’s home, the group home or the host home under Chapter 3490 (relating to protective services).

PHYSICAL FACILITY STANDARDS


§ 5310.161. [Reserved].


Source

   The provisions of this §  5310.161 reserved June 25, 1999, effective October 26, 1999, 29 Pa.B. 3295. Immediately preceding text appears at serial page (211955).

§ 5310.162. Host homes.

 The following requirements apply to host homes:

   (1)  Host homes are not subject to the site control requirement specified in §  5310.71 (relating to site control).

   (2)  The dwelling of surrogate parent must be evaluated to insure that it presents no hazard to the safety of a community residential rehabilitation service (CRRS) child and is in keeping with the community in which it is located.

   (3)  The age of the child is considered in determining the safety of the home of a surrogate parent. In the case of very young children, special consideration must be given to the following requirements:

     (i)   Safe, easily accessible, outdoor play areas.

     (ii)   Fencing or natural barriers for unsafe areas such as drainage ditches, wells, or swimming pools in or around the outdoor play areas.

     (iii)   Decks or balconies above the ground level of a home.

     (iv)   Adequate lighting and handrails in staircases.

     (v)   Protective guards or insulation for hot water pipes and other sources of heat which are accessible to children and which exceed 110°F.

     (vi)   Use of space heaters, fireplaces and wood-burning stoves.

     (vii)   Condition and anchoring of outdoor play equipment like climbing apparatus, slides, and swings.

     (viii)   Storage of all medicines, cleaning materials, detergents, aerosal cans, and other poisonous and toxic materials.

   (4)  All electrical equipment must be in good repair. Equipment such as washers and garbage disposals must have protective safety devices which prevent use when open. All electrical power tools must be locked in a cabinet, closet or storage room when not in use and must be used only by staff. Electrical kitchen equipment may be operated by children only when under direct supervision of staff.

   (5)  Each host home must have a telephone. Those homes which have an unlisted number must make this number available to the child’s parent, the CRRS and the agency having custody of the child, if applicable.

   (6)  The CRRS must provide fire extinguishers and smoke detectors for use in host homes and ensure that the surrogate parent receives instruction in the proper use of this equipment.

DIET AND MEDICATION


§ 5310.171. Medication.

 (a)  The community residential rehabilitation service (CRRS) programs must establish and implement written policies and procedures regarding medications which meet legal restrictions regarding administration of medications and which shall cover the following requirements:

   (1)  Staff and surrogate parents may administer medication to a child only with the written consent of the child’s parent and the agency having custody of the child, if applicable, and under the written instructions of the physician who prescribes the medication.

   (2)  The attending physician shall provide the staff or surrogate parent with written instructions which must contain the following information:

     (i)   Name of child.

     (ii)   Name of medication—brand name and/or generic name.

     (iii)   Type of medication, for example, liquid or tablets.

     (iv)   Dosage to be given per administration.

     (v)   Number and time of administrations per day.

     (vi)   Ending date of medication administration, if applicable.

     (vii)   Possible side effects of the medication.

     (viii)   Instructions in the event of serious reactions.

     (ix)   Emergency phone numbers.

     (x)   Special instructions, for example, take with meal, take on an empty stomach, do not take with citrus juice.

     (xi)   Signature of the physician.

   (3)  The written consent of the parent and the agency having custody of the child, if applicable, must specify all information contained in the physician’s written instruction form and may consist of signing the same form.

   (4)  All medications must be kept in their original prescription containers.

   (5)  All medication must be stored in a locked container or a container in a locked room. When medication must be refrigerated, it must be kept in a locked box in the refrigerator.

   (6)  A permanent log must be maintained for each child indicating:

     (i)   Name of medication given.

     (ii)   Dosage level given.

     (iii)   Time given.

     (iv)   Date given.

     (v)   Person administering the medication.

     (vi)   Number of tablets with dosage of each specified.

   (7)  When a child is receiving psychotropic drugs, the prescribing physician shall review the drug plan once a month.

 (b)  This section supersedes §  5310.81 (relating to medication).

§ 5310.172. Nutrition.

 (a)  Section 5310.82(a) and (b) (relating to nutrition) do not apply to community residential rehabilitation services (CRRS) serving children.

 (b)  The requirements of §  5310.82(c)(2)—(4) and (6)—(8) do apply to all CRRS’s serving children.



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