Statutory Authority.
Pursuant to
33 VSA, §
306(b)(1)-(7) and
3501,
the Vermont Department for Children and Families is the agency of government
authorized and responsible for the regulation of Residential Treatment Programs
for children/youth and the promulgation of standards governing these
programs.
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SCOPE AND APPLICABILITY OF
REGULATIONS
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These licensing regulations provide for the protection and
well being of children/youth in Residential Treatment Programs. They are
intended to ensure a basic quality of care and ensure the human rights of
residents.
A Residential Child Care Facility is a place, however named,
which provides a planned program aimed at behavioral change, administered by
qualified staff, for children in a twenty-four hour residential setting. This
definition does not include family foster homes, summer camping programs,
facilities approved by other departments of the Agency of Human Services, or
other facilities exempted under the provisions of
33 V.S.A. §
3501.
Vermont laws regulating licensing of Residential Treatment
Programs are set forth in Title 33 of the Vermont Statutes Annotated and read
as follows:
§ 306. Administrative provisions:
(b) "This subsection shall apply to all
licenses, registrations and applications for licenses and registrations which
the commissioner or the department may issue or grant, unless otherwise
specifically provided.
(1) The commissioner
shall issue regulations governing application for, and issuance, revocation,
term and renewal of licenses and registration. In the regulations [the
commissioner] may prescribe standards and conditions to be met, records to be
kept and reports to be filed. Licenses and registration shall be for a term of
one year from issuance unless otherwise prescribed by regulation.
(2) Premises covered by a license or
registration may be visited and inspected by the department at reasonable
hours. A person who accepts a license or registration shall permit visits and
inspections and examinations of the record [the licensee or registrant] is
required to keep.
(3) A license or
registration may be revoked for cause after hearing and may be suspended in
situations which immediately imperil the health, safety or well-being of
persons in the care of the licensee or registrant.
(4) Before a license is granted, the
department shall visit and inspect the premises for which the license is
requested, and make further inquiry and investigation as the commissioner may
direct."
(5) Whenever the attorney
general has reason to believe that a facility required by the commissioner to
be licensed or registered is being operated without such license or
registration, the attorney general may bring an action for equitable relief in
the name of the state against the operator of such facility to restrain such
operation. The action may be brought in the superior court of the county in
which the facility is located. Said courts are authorized to grant equitable
relief to restrain and prevent such operation.
(6) Any person who violates the terms of an
injunction or restraining order issued under section 306(b)(5) shall forfeit
and pay to the state a civil penalty of not more than $ 100.00 for each
violation. In such cases the attorney general acting in the name of the state
may petition for recover of such civil penalty.
(7) Whenever the department determines that a
licensed child care facility or registered family child care home has violated
a health or safety rule, the facility or home shall post the department's
notice of violation in a conspicuous place in the facility or home. In the case
of a serious violation, as defined by the department by rule, the facility or
home shall also notify a person responsible for the welfare of each child
attending that facility or home, by mail. A serious violation shall include
violation of group size and staffing requirements and any violation involving a
situation which immediately imperils the health, safety or well-being of person
in the care of the licensee or registrant.
§
3501.
Foster care and placement licensing:
(a) "A person, other than an employee of the
department with the agency of human services, shall not place any child in
foster care for more than fifteen consecutive days unless the person has a
license from the department to do so or is an employee of a child placing
agency licensed by such department.
(b) A person shall not receive board or keep
any child in foster care for more than fifteen consecutive days unless he has a
license from the department to do so. This subsection shall not apply to foster
homes approved by a department within the agency of human services or by a
licensed child placing agency nor shall it apply to those facilities where
educational or vocational training is the primary service and foster care is a
supportive service only.
(c) This
section shall not restrict the right of a court, parent(s), custodian, or
relative to place a child, or the right of a person not in the business of
providing foster care or child care to receive, board and keep a child when a
valuable consideration is not demanded or received for the child's care and
maintenance."
PENALTY
Unlicensed operation may result in criminal penalties and
denial of license application.
APPEALS
A program that has been refused a license or whose license
has been revoked or suspended will be granted a fair hearing before the Human
Services Board upon request. Rules governing the conduct of fair hearings are
available from the Human Services Board. All requests for fair hearings shall
be addressed to the Human Services Board, State Office Building, Montpelier,
Vermont 05620-4301.
The telephone number is 1 (802) 828-2536.
TECHNICAL ASSISTANCE
The Department for Children and Families, Family Services
Division, Residential Licensing Unit, upon the written request of an applicant,
licensee, or any interested person, will provide assistance interpreting these
regulations.
Section 100
Regulatory Oversight
101 A
Residential Treatment Program shall not be operated without the formal prior
approval of the Department for Children and Families, Residential Licensing
Unit (hereafter "Licensing Authority").
102 A program, which was already operational
before the need for a license was determined, may be considered to be in
compliance if the program has applied for and is making satisfactory progress
toward licensure.
103 A Residential
Treatment Program shall allow the Licensing Authority to inspect all aspects of
a program's operation which may impact children/youth.
104 A Residential Treatment Program shall
allow the Licensing Authority to interview any employee of the program and any
child/youth in the care of the Residential Treatment Program.
105 These regulations are not meant to
supersede State or Federal mandates.
106
An applicant shall apply for a license on a form provided by the Licensing
Authority and provide requested information.
Applications for a Residential Treatment Program license may
be obtained by contacting the Department for Children and Families, Family
Services Division, Residential Licensing Unit. The office is located in the
Osgood Building, 2 [nd ] floor, of the state office complex at Waterbury,
Vermont. The mailing address is:
Department for Children and Families
Family Services Division
Residential Licensing Unit
103 South Main Street
Waterbury, Vermont 05671-2401
The telephone number is (802) 241-2159.
107 When a Residential Treatment Program has
made timely and sufficient application for licensing renewal, the existing
license does not expire until the application for renewal has been acted upon
by the department.
108 A license
may be issued with conditions when regulations have not been met, provided that
the non-compliance does not constitute an unsafe situation or a major
programmatic weakness and the program acts immediately to address the
identified non-compliance.
112
A Residential Treatment Program shall comply with all applicable regulations
unless a variance for a specific regulation(s) has been granted through a prior
written agreement with the Licensing Authority.
113 A variance for specific regulation(s)
shall be granted only when the Residential Treatment Program has documented
that the intent of these regulation(s) will be satisfactorily achieved in a
manner other than that prescribed by the regulation(s).
114 When a Residential Treatment Program
fails to comply with the variance agreement, the agreement shall be subject to
immediate cancellation.
115
Application for renewal of a Residential Treatment Program license shall be
made in accordance with the policies and procedures of the licensing authority.
116
A Residential Treatment Program shall notify the Licensing Authority at least
60 days before any of the following:
-- A substantial change in services provided or population
served;
-- A planned change in staffing pattern;
-- A planned change in the Administration;
-- A planned change of ownership and/or governance;
-- A planned change of location;
-- A planned change in the name of the Residential Treatment
Program.
117 A Residential
Treatment Program shall notify the licensing authority as soon as the change is
known, if any of the above mentioned changes occur without prior planning.
118
A Residential Treatment Program shall report any suspected or alleged incident
of child abuse or neglect within 24 hours, to the Department for Children and
Families, Centralized Intake Unit. (33 V.S.A., Chapter 49, § 4913
)
119 A Residential Treatment
Program will supervise and separate the accused individual(s) and the victim(s)
whose behavior caused report to the Department for Children and Families unless
or until otherwise instructed by the Special Investigation Unit and/or
Residential Licensing Unit.
120 A
Residential Treatment Program shall report incidents of sexual activity between
residents, as defined in these regulations, within 24 hours to the Department
for Children and Families, Centralized Intake Unit; (800) 649-5285.
121
A Residential Treatment Program shall cooperate fully in investigations of any
complaint or allegation associated with the program. This may include, but is
not limited to the Department for Children and Families Special Investigations
Unit, and the Licensing Authority.
122
A Residential Treatment Program shall immediately, or as soon as reasonable,
report to the Licensing Authority incidents that could potentially affect the
safety, physical or emotional welfare of children/youth within the program.
Written report shall follow verbal report within 24 hours.
123 Incidents of restraint which result in
injury to a child/youth or staff member, requiring medical attention shall be
reported in writing to the Licensing Authority as soon as possible, and not
later than within 24 hours. (see regulation 657)
124 Incidents of seclusion which result in
injury to a child/youth or staff member, requiring medical attention shall be
reported in writing to the Licensing Authority as soon as possible, and not
later than within 24 hours. (see regulation 666).
125 Residential Treatment Program shall
report, verbally and in writing, within 24 hours to the Licensing Authority
incidents where the program knowingly or negligently violates licensing
regulations.
Section 200
General Provisions
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THE RIGHTS OF CHILDREN/YOUTH AND
FAMILIES:
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(Substantially from Child Welfare League of America ; Best
Practice Guidelines 2002)
201 A
Residential Treatment Program shall ensure children/youth the following rights:
-- to be served under humane conditions with respect for
their dignity and privacy;
-- to receive services that promotes their growth and
development;
-- to receive gender specific, culturally competent and
linguistically appropriate service;
-- to receive services in the least restrictive and most
appropriate environment;
-- to access written information about the providers policies
and procedures that pertain to the care and supervision of children, including
a description of behavior management practices;
-- to be served with respect for confidentiality;
-- to be involved, as appropriate to age, development and
ability, in assessment and service planning;
-- to be free from harm by caregivers or others, and from
unnecessary or excessive use of restraint and seclusion/isolation;
-- to file complaints and grievances without fear of
retaliation.
202 A
Residential Treatment Program shall ensure families and custodians the
following rights:
-- to access written information about the providers policies
and procedures that pertain to the care and supervision of children, including
a description of behavior management practices;
-- to receive services with respect for
confidentiality;
-- to be involved in assessment and service planning;
-- to give and to withhold informed consent;
-- to be notified immediately or as soon as reasonable of any
runaway, attempted suicide, suicide, or medical emergency requiring the
services of an Emergency Room or hospitalization, death or any other seminal
event in the life of their child/youth;
-- to be notified within 24 hours following the restraint or
seclusion of their child/youth;
-- to file complaints and grievances without fear of
retaliation.
203 A
Residential Treatment Program shall document prohibitions and limitations
regarding parental involvement in the child/youth's Plan of Care and review
such prohibitions and limitations at least every 90 days.
Section 300 The Governing Authority
301 A Residential Treatment Program shall be
incorporated. If incorporated outside the State of Vermont, it shall secure
authorization from the Secretary of State to do business in Vermont.
302 The Governing Authority is ultimately
responsible for all aspects of the Residential Treatment Program.
303 The Governing Authority shall make
available to the Licensing Authority, upon written request, a list of directors
and officers of the board.
304 The
Governing Authority shall:
-- Review major operational decisions;
-- Have provisions which preclude both the fact and
appearance of conflict of interest;
-- Specify the terms of appointment or election of members,
officers, and chairperson(s) of committees;
-- Specify the frequency of meetings and attendance
requirements;
-- Prohibit board members from being paid members of the
staff.
305 The Governing
Authority of a Residential Treatment Program shall appoint a qualified
administrator.
306 The Governing
Authority is responsible for ensuring the writing of an annual evaluation of
the Program Administrator, based on the job description which delineates the
responsibilities and authority of the Program Administrator.
307 The Governing Authority is responsible
for assuring the Residential Treatment Program's continual compliance and
conformity with the following:
-- The program's stated goals and objectives;
-- Relevant laws and/or regulations, whether federal, state,
local or municipal, governing the operation of the Residential Treatment
Program. This may include, but is not limited to Zoning; Department of Public
Safety, Fire Prevention; Department of Health; Interstate and International
Placement of Children; The Prison Rape Elimination Act of 2003.
308 The Governing Authority shall
ensure:
-- Development and on-going review of program policies and
procedures;
-- Development and review of annual budgets to carry out the
objectives of the Residential Treatment Program;
-- Any fund raising, community activity, publicity or
research involving children/youth is conducted in a manner which respects the
dignity and rights of children, youth and their families and complies with all
relevant state and federal laws regarding confidentiality.
309 The Governing Authority shall require and
review an annual report, written by the administrator of the program which
evaluates the program in relation to the program description, with the goal of
continuous quality improvement.
310
The annual assessment shall identify indicators that measure the program's
ability to deliver the services described in the program description. These
indicators may consider (but are not restricted to) the following:
-- The number and circumstances of planned discharges;
-- The number and circumstances of unplanned
discharges;
-- Consumer feedback;
-- Provision of adequate supervision as evidenced by all
reports of child abuse, sexual contact between children/youth;
-- Grievances heard, resolved and unresolved;
-- Personnel actions taken;
-- Staff turnover; and
-- Employee satisfaction surveys.
Section 400 Personnel
401 A
Residential Treatment Program shall not hire, or continue to employ, any person
whose health, behavior, actions or judgment might endanger the physical or
emotional well-being of the children/youth served.
402 A Residential Treatment Program shall not
hire, or continue to employ, any person substantiated for child abuse or
neglect.
403 There shall be a
sufficient number of personnel qualified by education, training and experience
with sufficient authority to adequately perform the following functions:
-- Administrative;
-- Financial;
-- Supervisory;
-- Clinical;
-- Case Management;
-- Direct child care;
-- Housekeeping;
-- Maintenance;
-- Food service;
-- Maintenance of records.
404 A Residential Treatment Program shall
have written job descriptions for all positions within the program, including
lines of authority, which are accessible to all employees.
405 A Residential Treatment Program shall
ensure that direct child care employees have regularly scheduled hours of
work.
406 A Residential Treatment
Program shall establish policies governing employee conduct. These policies
shall be designed to promote:
-- Good role modeling;
-- Adequate supervision of children/youth;
-- The development of healthy relationships between adults,
children/youth.
407
The credentials of the program administrator, directly responsible for the
therapeutic milieu within the residential treatment program, regardless of job
title will include at minimum:
-- Master's degree in a relevant field and,
-- Four years direct care, including supervisory experience
in a residential treatment program or therapeutic setting for children and/or
youth.
or,
-- Bachelor's degree in a relevant field and,
-- Five years direct care, including two years supervisory
experience in a residential treatment program or therapeutic setting for
children and youth.
408 The
credentials of those providing supervision of direct care staff, regardless of
job title will include at minimum:
-- Master's degree in a relevant field and,
-- One year experience providing direct care in residential
treatment programs for children/youth.
or,
-- Bachelor's degree and,
-- Two years experience providing direct care in residential
treatment programs for children/youth.
or,
-- High School Diploma or GED and,
-- Four years experience working with children/youth in
residential treatment programs.
409 The credentials of those providing direct
care for children/youth, regardless of job title will include at minimum:
-- Bachelor's degree and,
-- 21 years of age and,
-- Experience working with children/youth.
or,
-- High School Diploma or GED and,
-- 21 years of age and,
-- Two years experience interacting with children/youth. This
may include, but is not restricted to camp counselor, coach,
babysitting.
410
Individuals providing clinical services for children/youth and families shall
have experience working with children/youth and families shall meet current
Vermont licensing and certification requirements and professional standards.
A Residential Treatment Program shall have written personnel
policies and procedures for the hiring, orientation, training, supervision,
evaluation, recognition, discipline and termination of employees.
Residential Treatment Program shall conduct background
checks, upon hire and every three years thereafter, on all employees, board
member/trustees, volunteers, student interns, and others who may have
unsupervised contact with children/youth in the program. Minimally, the
background checks shall include the Vermont Criminal Information Center,
Vermont Child Protection Registry and the Adult Abuse Registry.
The results of background checks must be received and
evaluated by the program administrator prior to the individual being hired and
prior to having any unsupervised contact with children/youth. Documentation of
completed background checks and administrative review must be maintained and
available to licensing upon request.
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EMPLOYEE ORIENTATION AND
TRAINING
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414
A Residential Treatment Program shall have written policies and procedures for
the orientation of new staff to the program. This orientation must occur within
the first 30 days of employment and include, but is not limited to:
-- Program description and population served;
-- A tour of the facility;
-- Overall program treatment philosophy and approach;
-- Program philosophy of behavior management;
-- Child/youth grievance process;
-- Basic information about behavior children/youth may
exhibit;
-- Identification of early warning signs that indicate
child/youth may become disruptive or aggressive and how these observations are
to be reported;
-- Professionalism in dealing with children/youth, families,
and others;
-- Confidentiality;
-- Program policies and procedure relating to interventions
employed by staff to prevent, deescalate, safely manage child/youth acting out
behaviors;
-- Roles and expectation of various personnel in preventing
and responding to crisis situations;
-- Documentation requirements;
-- Working as part of a team;
-- Policies regarding zero-tolerance for sexual abuse;
-- Procedures for reporting suspected incidents of child
abuse and neglect;
-- Policies and procedures regarding runaway
children/youth
-- Policies and procedures regarding the acquisition,
storage, administration, documentation and disposal of medication;
-- Emergency response procedures;
-- Emergency evacuation procedures;
-- Residential Treatment Program regulations.
415 During orientation, each
employee should be made aware of the plan for his or her particular on-going
training and professional development. Plans should be developed between the
employee and supervisor, and should be based on their roles and
responsibilities in the program.
416 Staff who may work with children/youth
shall receive training in the prevention and use of restraint prior to
participating in the use of restraint. Staff will be competent in (but not
limited to) the following:
-- Relationship building, group processes, restraint
prevention, de-escalation methods, avoidance of power struggles, and threshold
for use of restraint;
-- The physiological effect of restraint, monitoring physical
distress signs and obtaining medical assistance, and positional
asphyxia;
-- Legal issues and idiosyncratic conditions that may affect
the way children/youth and staff may respond to restraint (e.g., cultural
sensitivity, age, gender, developmental delays, history of trauma, symptoms
related to substance abuse, health risks, etc.), and;
-- Escape and evasion techniques, time limits, the process
for obtaining approval for continued restraints, the procedure to address
problematic restraints, documentation, debriefing with children/youth,
follow-up with staff, and investigations of injuries and complaints.
417 A Residential Treatment
Program shall ensure supervisors and those who provide direct care receive
on-going training and develop competencies relevant to the population served
including (but not limited to):
-- Relationship Building ;
-- Listening and communication;
-- Family Engagement;
-- Understanding and analyzing problem behaviors;
-- Trauma informed practices;
-- Positive behavior support;
-- Designing and implementing routines;
-- Setting clear limits;
-- Praising and reinforcing behavior;
-- Early detections of conflict situations;
-- Interventions to minimize potential conflicts;
-- Designing and implementing activity programs;
-- Teaching social and anger management skills;
-- Managing transitions;
-- Managing personal boundaries;
-- Harassment;
-- Conflict resolution;
-- First Aid and emergency medical procedures;
-- Administration of medication and the documentation
thereof.
418 A Residential
Treatment Program shall ensure annual training for every employee responsible
for direct child care effective de-escalation techniques, appropriate use of
restraint, seclusion and expectations regarding the documentation of the use of
restraint and seclusion.
419
A Residential Treatment Program shall conduct, at minimum, an annual
performance evaluation based on performance expectations in the context of each
employee's' job description and plan for on-going profession
development.
420 The evaluation
will identify areas of competence and document targets for growth and
development to be reviewed at established intervals.
421 The evaluation will be signed by the
employee and his/her immediate supervisor. There must be an opportunity for the
employee to express his/her agreement or disagreement with the evaluation in
writing. The employee shall be given a copy of his/her evaluation.
422
A Residential Treatment Program shall maintain a personnel file for each
employee containing:
-- The application for employment and/or resume;
-- Documentation of reference checks;
-- Employee's starting and termination dates;
-- Applicable professional credentials/certifications;
-- A signed job description, acknowledging receipt;
-- Employee's plan for on-going training and professional
development;
-- Documentation of training;
-- All annual performance evaluations;
-- Commendations and disciplinary actions relating to the
individual's job performance.
423
A Residential Treatment Program shall establish procedures to assure adequate
communication and support among staff to provide safety, continuity and
integration of services to the children/youth. This may include logs, shift
notes, minutes of meetings, etc.
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VOLUNTEER SERVICES AND STUDENT
INTERNS:
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424
A Residential Treatment Program may utilize volunteers and student interns to
work directly with a particular child/youth or group of children/youth under
the supervision of an employee of the program.
425 Volunteers will not provide essential
services which would otherwise be unavailable.
426 A Residential Treatment Program shall
ensure that the needs and learning experiences of volunteers and student
interns do not interfere with the care of children/youth.
427 Volunteers and interns are subject to the
same background, character and reference checks as employees.
428 Volunteers shall receive training
relevant to the work they will be doing and issues of
confidentiality.
429 Student
Interns shall receive training relevant to the work they will be doing,
including (but not limited to) the training provided employees within the first
30 days of hire. See regulation 415.
Section 500 Treatment and Case Management
Services
501 A
Residential Treatment Program shall have a written program description,
accessible to prospective residents, parents, custodians, placing agencies and
the general public upon request.
502 The program description shall include:
-- Description of the population served;
-- Criteria for admission;
-- Exclusionary criteria;
-- Description of the milieu;
-- Description of the treatment modalities;
-- Description of the clinical services provided;
-- Description of the educational services provided.
503
A Residential Treatment Program shall have written policies and procedures for
protection of the confidentiality of all children/youth's records.
504 A Residential Treatment Program shall
maintain record(s) for each child/youth. The content and format of these
records shall be uniform within the program and minimally include:
-- The name of the child/youth;
-- Gender;
-- Date of birth;
-- Date of Admission;
-- Legal custody and custodianship status;
-- Informed consent signed by the parent(s) and custodian to
provide emergency medical treatment and for the administration of
medication;
-- Contact information for the parent(s), caretakers;
-- Documented acknowledgement from the child/youth, parent(s)
and custodian that they have been informed of the program's policies and
procedures regarding the use of restraint and seclusion;
-- Informed consent signed by parent(s) and custodian
regarding the policies and procedures guiding the use of restraint and
seclusion that may occur while the child/youth is in the program;
-- De-escalation intervention plan;
-- Referral and Intake information;
-- Treatment/clinical records;
-- Education records;
-- Cumulative medical records including date and results of
last physical and dental examinations;
-- Plan of Care, amendments and reviews;
-- Incident Reports;
-- Discharge Plan;
-- Date of Discharge; and
-- Contact information of the person or program to which the
child/youth was discharged.
505 When information is in the possession of
another person or agency and unavailable to the program, the program shall
document attempts to acquire that information.
506 A Residential Treatment Program shall
establish policies and procedures regarding the retention, storage and disposal
of records.
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REFERRAL/ADMISSION PROCESS
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507
A Residential Treatment Program shall accept a child/youth into care only when
a current intake evaluation has been completed. The evaluation shall include
information and assessments regarding the family, the child/youth's
developmental, social, behavioral, psychological, and medical histories,
allergies and any special needs.
508 A Residential Treatment Program shall
accept and serve only those children/youth whose needs can be met by the
services provided by the program.
509 A Residential Treatment Program shall
have written referral and admission policies and procedures.
510 A Residential Treatment Program shall
ensure that the child/youth, his/her parent(s) and custodian are provided
reasonable opportunity to participate in the admission process and decisions,
and that due consideration is given to any questions/concerns.
511 A Residential Treatment Program shall
provide children, youth, families and custodians upon placement a clear and
simple written statement that includes:
-- The procedure used to report complaints or grievances,
including timelines and accessible reporting formats;
-- Assurance that the complaint may be submitted to someone
other than the individual named in the complaint;
-- Assurance that retaliation will not be tolerated;
-- An opportunity for the child, youth, family member,
custodian or staff member to present his or her version of events and to
present witnesses;
-- A process for informing the complainant of the
results;
-- A process for appeal;
-- Contact information for the licensing authority;
and
-- Contact information for the State-designated protection
and advocacy system.
512 A
Residential Treatment Program shall ensure that upon placement, each
child/youth is asked if he/she has any physical complaints and is checked for
obvious signs of illness, fever, rashes, bruises and injury. The results of
this interview shall be documented and kept in the child/youth's
record.
513 Depending on the age,
gender and needs of the child/youth an inventory and/or search of a
child/youth's belongings as part of the admission process activity will be
conducted by a same gender staff person as the child/youth being admitted and
in the child/youth's presence.
514
A Residential Treatment Program shall obtain the written informed consent of a
child or youth, their parent(s) and custodian before the child or youth is
photographed and/or recorded for research and/or program publicity
purposes.
515 A Residential
Treatment Program shall assign a staff member to orient the child/youth and
his/her parent(s) and custodian, to life at the program; including a verbal
review of emergency evacuation procedures, the child/youth's rights and program
expectations.
516 A Residential
Treatment Program shall make available to each child/youth, parent(s), and
custodian, a simply written list of rules and expectations governing
children/youth's behavior.
517 The
program will inform the child/youth, parent(s) and custodian of the policies
and procedures regarding the use of restraint and seclusion. While this
orientation will include the following content, the mode of delivery is
dependent on the population served.
-- Explanation of de-escalation techniques staff members may
employ to defuse the situation in an attempt to avoid the use of restraint or
seclusion;
-- Description of situations and criteria for the use of
restraint or seclusion;
-- Who is authorized to approve and initiate the use of
restraint or seclusion;
-- A description of the restraint techniques authorized for
use;
-- A viewing of rooms used for seclusion;
-- The protocol for the monitoring of the child/youth's
health and well-being during the restraint, including time frames;
-- The protocol for supervision and monitoring of the
child/youth's health and well-being while secluded, including time
frames;
-- The decision-making process used by staff for the
discontinuation of the use of restraint or seclusion;
-- The internal grievance procedure to report inappropriate
use restraint or seclusion; and
-- Contact information for the Licensing Authority.
518 A Residential Treatment
Program will obtain written acknowledgement from the child/youth, parent(s) and
custodian that they have been informed of the program's policies and procedures
regarding the use of restraint and seclusion.
519 A Residential Treatment Program that uses
restraint or seclusion shall offer the child/youth, parent(s) and custodian the
opportunity to provide information about the child/youth that may help prevent
the use of restraint and seclusion.
520 A Residential Treatment Program shall
gather and assess the following information to develop an individualized
de-escalation plan for each child/youth to avoid the use of restraint and
seclusion.
-- The child/youth's history of violence;
-- The child/youth's history of suicidal ideation or
attempts;
-- Events that may trigger aggressive or suicidal
behavior;
-- Techniques to regain control, self regulate, self-sooth
that have been successful in the past;
-- Preexisting medical conditions or physical disabilities
that place the child/youth at increased risk of harm, and
-- History of trauma that places the child/youth at increased
risk of psychological harm if he/she is restrained or secluded.
521
A Residential Treatment Program shall develop a Plan of Care based on the
review of the referral information and input from the referral source, the
child/youth, parent(s) and custodian within seven days.
522 The Plan of Care shall include:
-- Reason for Admission,
-- Preliminary Goals and Objectives;
-- Services/Interventions to be provided, by whom, and
frequency;
-- How progress will be measured;
-- Family contact and level of involvement;
-- Mental Health status;
-- Physical Health status;
-- Social Skills;
-- Family relationships;
-- Recreation/Activities/Interests;
-- Education;
-- Activities of daily living/Independent living
skills;
-- De-escalation Intervention Plan;
-- Plan for discharge;
-- Aftercare planning.
523 Plans of Care shall be signed by the
administrator of the program (or designee).
524 A Residential Treatment Program shall
demonstrate child/youth, parental and custodial participate in the development
of the Plan of Care.
525 A
Residential Treatment Program shall review and revise the Plan of Care at least
once every 90 days and shall evaluate the degree to which the goals have been
achieved, identify successful interventions, progress toward discharge planning
and recommendations.
526 A
Residential Treatment Program shall ensure that the Plan of Care and subsequent
revisions are explained to the child/youth, his/her parent(s) and custodian in
language understandable to everyone.
527 The current Plan of Care shall be
available upon request at the time of discharge.
Section 600 Residential Life
601 A
Residential Treatment Program shall provide adequate supervision appropriate to
the treatment and developmental needs of children/youth.
602 A Residential Treatment Program shall
ensure that each child/youth has ready access to a responsible staff member
throughout the night.
603 A
Residential Treatment Program shall provide adequate overnight supervision
consistent with the needs of the children/youth.
604
A Residential Treatment Program shall make every possible effort to facilitate
opportunities for children/youth to communicate with parent(s), siblings, and
custodian to foster permanent relationships with family, in accordance with the
Plan of Care.
605 Alternative
visiting hours shall be provided for families who are unable to visit at the
prescribed times, consistent with the Plan of Care.
606 A Residential Treatment Program shall not
use family contact as an incentive to elicit desired behavior; likewise family
contact shall not be withheld as a consequence for misbehavior.
607 A Residential Treatment Program shall
have written procedures for overnight visits outside the program which
includes;
-- The child/youth's location;
-- Length of stay;
-- Plan for transportation;
-- Plan for conveying medication;
-- Discussion of medication regime;
-- Recommendations for supervision;
-- Name, address and contact information for person
responsible for the child/youth while they are away from the program;
-- Relationship to the person responsible for the
child/youth;
-- Plan for the unforeseen return of the child/youth,
and
-- Documentation of above activities.
608 A Residential Treatment Program shall not
place a child/youth in a foster home unless the Residential Treatment Program
is also a licensed Child Placing Agency.
609
A Residential Treatment Program shall ensure that every child/youth is provided
an appropriate educational program in accordance with state law and approved by
the Vermont Department of Education.
610
A Residential Treatment Program shall follow a written daily routine, including
weekends and vacations.
611 Daily
routines shall not conflict with the implementation of a child/youth's Plan of
Care.
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COMMUNICATION AND PRIVACY
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612
A Residential Treatment Program shall permit children/youth to send and receive
mail, make telephone calls and e-mail, consistent with the Plan of
Care.
613 Program staff shall read
a child/youth's mail and e-mail or listen in on telephone conversations only
with the child/youth's full knowledge and understanding of the reasons for this
action, consistent with the Plan of Care.
614 A Residential Treatment Program shall not
bar contact between a child/youth and their parent(s), custodian, attorney,
guardian ad litem, clergy and State-designated protection and advocacy
system.
615 When the right of a
child/youth to communicate in any manner with any person outside the program
must be curtailed, or monitored a residential program shall:
-- Document the decision, including who was involved in the
decision making process, reasons for limitations of his/her right to
communicate with the specified individual(s);
-- Inform the child/youth of the decision making
process;
-- Review this decision minimally at each review of the Plan
of Care.
616
A Residential Treatment Program shall permit children/youth to access his/her
own money consistent with his/her Plan of Care.
617 Fines shall not be levied except in
accordance with a written Program Description which includes a description of
how revenues from fines are used for the benefit of the children/youth residing
in the program.
618
The Residential Treatment Program may assign chores that provide for the
development of life skills and not used as punishment.
619 Children/youth participation in chores
shall not be a substitute for housekeeping and maintenance staff.
620
A Residential Treatment Program with religious affiliation(s) or expectations
for participation shall include such information in the program
description.
621 A Residential
Treatment Program shall make every effort to accommodate a child/youth's desire
to attend and/or participate in religious activities and services in accordance
with his/her own faith.
622
A Residential Treatment Program shall ensure that children/youth have his/her
own adequate, clean, and appropriate clothing.
623 A Residential Treatment Program shall
allow children/youth to bring his/her personal belongings to the program e.g.
comfort items, memorabilia.
624
Limitations on the quantity of personal items shall be discussed during the
referral/admission process.
625
Provisions shall be made for the protection of children/youth's personal
property.
626 Any search of a
child/youth's personal belongings for contraband deemed necessary for the
safety of the child/youth or others within the program will be conducted in the
presence of the child/youth, by same gender staff as the child/youth unless
contraindicated and documented.
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PERSONAL CARE AND HYGIENE
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627
A Residential Treatment Program shall ensure children/youth receive guidance in
healthy personal care and hygiene habits.
628
A Residential Treatment Program shall ensure that a child/youth are provided at
least three nutritional meals, available daily at regular times.
629 There shall be no more than 14 hours
between the evening meal and breakfast, unless nutritional snacks are offered
during the evening.
630 No
child/youth in a Residential Treatment Program shall be denied a meal for any
reason, except by a documented doctor's order.
631 No child/youth shall be required to eat
anything they do not want to eat, nor will there be consequences for food
preferences.
632 Special dietary
needs shall be discussed during the referral/intake process and the Residential
Treatment Program shall make healthy accommodations for children/youth with
special dietary needs.
633
A Residential Treatment Program shall ensure a routine physical examination by
a medical practitioner for each child/youth within 30 days of admission unless
the child/youth received such an examination within 12 months prior to
admission.
634 A Residential
Treatment Program shall have written procedures for staff members to follow in
case of medical emergencies, including the administration of first
aid.
635 A Residential Treatment
Program must ensure that children/youth receive timely, competent routine and
emergency medical care when they are ill or injured and that they continue to
receive necessary follow-up medical care with parent(s) and custodians'
consent.
636 A Residential
Treatment Program shall maintain a cumulative record of medical care. This
record shall include:
-- The name of the resident;
-- The reason for the visit;
-- Name and contact information for the provider;
-- Results of examination, tests and recommendations;
-- Medication(s) prescribed;
-- The time and date the medication is administered.
637
A Residential Treatment Program shall make reasonable effort to ensure each
child/youth has had a dental examination by a dentist within 30 days of the
child/youth's admission unless the child/youth has been examined within 6
months prior to admission and the program.
638 Residential Treatment Program shall make
reasonable effort to ensure children/youth receive timely, competent routine
and emergency dental care and that they continue to receive necessary follow-up
dental care.
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ADMINISTRATION OF MEDICATION
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639
A Residential Treatment Program shall have written policies and procedures
governing the use and administration of medication to children/youth.
640 Policies and procedures governing the use
and administration of medication shall be disseminated to all staff responsible
for prescribing and administering medication.
641 These policies shall specify who can
administer medication, under what circumstances and procedures for documenting
the administration of medication.
642 A Residential Treatment Program shall
ascertain all medication a child/youth is taking when coming into care and
obtain parental and custodial consent for the administration of medication and
any changes in medication(s).
643
Medication will be administered as prescribed by a licensed
practitioner.
644 Medication errors
shall be documented on an incident report.
645
A Residential Treatment Program shall have written policies and procedures
address the presence and supervision of pets in the program.
646 A Residential Treatment Program will
ensure that the presence of any pet does not have an adverse effect on any
child/youth residing in the program, for example allergies or fear.
647 A Residential Treatment Program will
maintain a separate record on each pet that includes:
-- Identifying information;
-- Owner(s) contact information;
-- Record of vaccinations;
-- Record of registration;
-- Statement of good health from a Veterinarian;
-- Veterinarian's contact information and;
-- Incidents involving the pet, for example if the pet is
abused by a child/youth, or if the pet bites a child/youth or staff
member.
648
A Residential Treatment Program shall prohibit all cruel, severe, unusual or
unnecessary practices including, but not limited to:
-- Strip searches;
-- Body cavity searches;
-- Restraints that impede a child/youth's ability to breathe
or communicate;
-- Chemical restraint;
-- Mechanical restraint;
-- Pain inducement to obtain compliance;
-- Hyperextension of joints;
-- Peer restraints;
-- Locked buildings, rooms, closets, boxes, recreation areas
or other structures from which a child/youth can not readily exit;
-- Discipline or punishment which is intended to frighten or
humiliate a child/youth;
-- Requiring or forcing a child/youth to take an
uncomfortable position, such as squatting or bending, or requiring or forcing
the child/youth to repeat physical movements;
-- Spanking, hitting, shaking, or otherwise engaging in
aggressive physical contact (horseplay) with a child/youth;
-- Physical exercises such as running laps or performing
push-ups;
-- Excessive denial of on-grounds program services or denial
of any essential program services;
-- Depriving a child/youth of meals, water, rest, or
opportunity for toileting;
-- Denial of shelter, clothing, or bedding;
-- Withholding of personal interaction, emotional response or
stimulation;
-- Exclusion of the child/youth from entry to the
residence;
-- Any act defined as abuse or neglect by 33 V.S.A., Chapter
28, § 4912.
649 A
Residential Treatment Program shall ensure that behavior management is not
delegated to persons who are not known to the child/youth.
650
A Residential Treatment Program shall not use any form of restraint without
prior approval of the Licensing Authority.
651 Restraint shall be used only to ensure
that immediate safety of the child/youth or others when no less restrictive
intervention has been, or is likely to be, effective in averting danger.
Restraint shall be used only as a last resort.
652 Any restraint lasting more than 10
minutes requires supervisory consultation, approval and oversight.
653 Any restraint lasting more that 30
minutes requires clinical/administrative consultation, approval and
oversight.
654 Restraint shall
never be used for coercion, retaliation, humiliation, as a threat of punishment
or a form of discipline, in lieu of adequate staffing, for staff convenience,
or for property damage not involving imminent danger.
655 A Residential Treatment Program shall
develop and implement written policies and procedure that govern the
circumstances in which restraint is used. These policies and procedures shall
contain and address the following:
-- The threshold for initiating restraint;
-- Forms of restraint that are permitted;
-- Staff members authorized and qualified to order or apply
restraint;
-- Procedures for monitoring the child/youth placed in
restraint for signs of discomfort and medical issues;
-- Time limitations on the use of restraint;
-- The immediate and continuous review of the decision to
restrain;
-- Documentation of the use of restraint;
-- Record keeping of incidents of restraint;
-- Debriefing with the child/youth;
-- Debriefing with all witnesses;
-- Debriefing staff;
-- Notification of parent(s) and custodian; and
-- Administrative review of all restraints.
656 Incidents of restraint shall be reported
to the parent(s) and the person legally responsible for the child/youth as soon
as possible, and not later than 24 hours.
657 Incidents of restraint which result in
injury to a child/youth or staff member, requiring medical attention shall be
reported in writing to the Licensing Authority as soon as possible, and not
later than 24 hours.
658
A Residential Treatment Program shall not use any form of seclusion without
prior approval of the Licensing Authority.
659 Seclusion shall be used only to ensure
that immediate safety of the child/youth or others when no less restrictive
intervention has been, or is likely to be, effective in averting
danger.
660 Children/youth in
seclusion will be provided constant, uninterrupted supervision by qualified
staff, employed by the program and familiar to the child/youth.
661 Seclusion lasting more than 10 minutes
requires supervisory approval and oversight.
662 Seclusion lasting more that 30 minutes
requires clinical/administrative consultation, approval and
oversight.
663 Seclusion shall
never be use for coercion, retaliation, humiliation, as a threat of punishment
or a form of discipline, in lieu of adequate staffing, or for staff
convenience.
664 A Residential
Treatment Program shall develop and implement a written policies and procedures
that govern the circumstances in which seclusion is used. These policies and
procedures shall contain and address the following:
-- Circumstances under which seclusion may be used;
-- Staff members authorized to approve the use of
seclusion;
-- Procedures for monitoring children/youth in
seclusion;
-- Time limitations on the use of seclusion;
-- The immediate and continuous review of the decision to use
seclusion;
-- Documentation of the use of seclusion;
-- Record keeping of incidents of seclusion;
-- Debriefing with the child/youth;
-- Debriefing with all witnesses;
-- Debriefing staff;
-- Notification of parent(s) and custodian; and
-- Administrative review of all restraints and follow up
actions taken.
665
Incidents of seclusion shall be reported to the parent(s) and person legally
responsible for the child/youth as soon as possible, and not later than within
24 hours.
666 Incidents of
seclusion which result in injury to a child/youth or staff member, requiring
medical attention shall be reported in writing to the Licensing Authority as
soon as possible, and not later than within 24 hours.
667
Each incident of restraint and seclusion shall be documented separately by
staff members directly involved in the intervention as soon as possible, not
later than 24 hours.
668 This
incident report written by the staff members shall include:
-- Name, age, height, weight, gender and race of the
child/youth;
-- Date, beginning and ending time of occurrence;
-- A description of what happened; including what activity
the child/youth was engaged in prior to the escalation, the precipitating
events;
-- Description of de-escalation and less intrusive methods of
intervention used and reasons for their use;
-- Supervisory, clinical and/or administrative notification
and approval;
-- Staff involved, including full names, titles, relationship
to the child/youth and if a restraint, date of most recent formal de-escalation
and restraint training;
-- Witnesses to the precipitating incident and subsequent
restraint or seclusion;
-- Preventative actions that may be taken in the
future;
-- Name of person making the report;
-- Detailed description of any injury to the
child/youth;
-- Detailed description of any injury to staff
members;
-- Any action taken by the program as a result of any
injury.
669 Incident
Reports shall be reviewed and signed by the supervisor/administrator within 8
hours. Documentation of the administrative review must include follow up
actions which may include:
-- Debriefing with child/youth;
-- Debriefing with witnesses;
-- Debriefing with staff;
-- Medical needs;
-- Identified need for additional training; or
-- Personnel action (if warranted).
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RESTRAINT AND SECLUSION
MONITORING
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670
A Residential Treatment Program will establish documentation and monitoring
systems, enabling all incidents of restraint and seclusion to receive
administrative review. The data and management systems will have the potential
to monitor staff, individual, and critical programmatic involvement in
incidents. The program shall track the following:
-- Shift;
-- Location;
-- Day of the week;
-- Time of day/night
-- Incident antecedents;
-- Length child/youth was held in restraint or
seclusion;
-- Type of restraint or seclusion;
-- Age;
-- Gender;
-- Ethnicity;
-- Number of incidents per child/youth;
-- Staff members involved;
-- Child/youth injuries requiring medical attention;
and
-- Staff injuries requiring medical
attention.
Section
700 Physical Environment and Safety
701 A
Residential Treatment Program, including all structures and property shall be
constructed, furnished, equipped, used and maintained so that the privacy,
safety, health and physical comfort of all children/youth are ensured and in
compliance with federal, state, local and municipal regulations.
702 A Residential Treatment Program shall
pass and maintain documentation of an annual inspection of all buildings
utilized by the program by an independent, qualified fire safety
inspector.
703 A Residential
Treatment Program shall have a designated space to allow private discussions
and counseling sessions between individual children/youth and their family
members, visitors and staff.
704
First Aid supplies shall be accessible in each living unit of a Residential
Treatment Program.
705 A
Residential Treatment Program shall keep medication, cleaning supplies and
other potentially harmful materials securely locked. Keys to such storage
spaces shall be available only to authorized employees.
706 A Residential Treatment Program shall
ensure that there are sufficient and appropriate storage facilities.
707 Each separate living unit within a
Residential Treatment Program shall have 24-hour telephone service.
708 A Residential Treatment Program shall not
permit any firearm or chemical weapon on the property, including program and
employee vehicles.
709 A
Residential Treatment Program shall ensure that children/youth are not exposed
to second hand smoke in the facility, on the property or in program vehicles
used to transport children/youth.
710 Facility and staff vehicles shall be
locked while on the property.
711 A
responsible adult will provide continuous and uninterrupted supervision when
children/youth are swimming or otherwise engaged in water
sports/activities.
712 On-ground
pools shall be enclosed and regularly tested to ensure that the pool is free of
contamination.
713 A Residential
Treatment Program shall have written procedures for employees and
children/youth to follow in case of emergency or disaster.
714 A Residential Treatment Program shall
conduct actual or simulated evacuation drills at least monthly and varied by
shift.
-- A record of such emergency drills shall be maintained
including the date and time of the drill and whether evacuation was actual or
simulated.
-- All personnel in the building shall participate in
emergency drills.
-- The Residential Treatment Program shall make and document
special provisions for the evacuation of any developmentally or physically
disabled children/youth from the program.
715 A Residential Treatment Program shall
ensure that children/youth are properly secured and adequately supervised in
any vehicle used by the program to transport children/youth.
716 A Residential Treatment Program shall
maintain, update and share with parent(s), custodians and the Licensing
Authority the contact information of a specific individual to contact in the
event of the emergency evacuation of children/youth.
717
A Residential Treatment Program shall ensure that all sleeping areas used by
children/youth are of sufficient size to allow for a bed and to afford space
for dressing and quiet activities.
718 No child/youth's bedroom shall be
stripped of its contents and used for seclusion.
719 A Residential Treatment Program shall
ensure that no room without a window shall be used as a bedroom.
720 A Residential Treatment Program shall not
permit more than four children/youth to occupy a designated sleeping area or
bedroom space.
721 A Residential
Treatment Program will assign roommates taking into account gender, age,
developmental and treatment needs.
722 Each child/youth residing in a
Residential Treatment Program shall have his/her own bed.
723 A Residential Treatment Program shall
ensure that there is sufficient space between a mattress and another mattress
(bunk bed) or ceiling for each occupant to sit up comfortably in bed.
724 A Residential Treatment Program shall
provide each child/youth with his/her own dresser or other adequate storage
space in his/her bedroom unless there is a documented safety concern.
725 The use of open flames shall not be
allowed in sleeping areas of a Residential Treatment Program.
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TOILET, SHOWER AND BATHING
FACILITIES
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726
A Residential Treatment Program shall have available to children/youth a
minimum of one wash basin with hot and cold water, one flush toilet and one
bath or shower with hot and cold water for every six children/youth.
727 A Residential Treatment Program shall
provide toilets and baths or showers which allow for individual privacy unless
a child/youth requires assistance.
728 A Residential Treatment Program shall
have bathrooms with doors which can be opened from both sides.
729 A Residential Treatment Program serving a
co-ed population shall ensure private toileting, shower and bathing facilities.
730
A Residential Treatment Program shall have a sufficiently well-equipped kitchen
to prepare meals for the children, youth and employees.
731 A Residential Treatment Program shall be
arranged and equipped so children, youth and employees can have their meals
together.
732
A Residential Treatment Program shall have a living room/common area where
children/youth may gather for reading, study, relaxation, conversation and
entertainment.
733
A Residential Treatment Program shall ensure all rooms used for seclusion meet
all applicable state and local fire and safety codes.
734 A Residential Treatment Program shall
ensure all rooms used for seclusion are safe, clean, and
well-maintained.
735 A Residential
Treatment Program shall ensure all rooms used for seclusion have adequate
light, ventilation and maintain an appropriate room temperature.
736 A Residential Treatment Program shall
ensure all rooms used for seclusion are designed for continuous supervision.
737
A Residential Treatment Program utilizing live-in employees shall provide
adequate and separate living space for these employees.
738 Residential Treatment Program shall
provide office space which is distinct from children/youth's living areas.
Exemptions and Additional Regulations for Secure
Facilities.
Secure Facilities shall be exempt from the following
regulations.
508 A
Residential Treatment Program shall accept and serve only those children/youth
whose needs can be met by the services provided by the program.
622 A Residential Treatment Program shall
ensure that children/youth have his/her own adequate, clean, and appropriate
clothing.
648 A Residential
Treatment Program shall prohibit all cruel, severe, unusual or unnecessary
practices including, but not limited to:
-- Strip searches;
-- Mechanical restraint.
-- Locked buildings, rooms, recreation areas.
Secure Facilities shall follow these additional
regulations.
901
Orientation and on-going training shall include;
-- Security procedures;
-- Trauma informed use of mechanical restraint;
-- Trauma informed execution of strip search.
902 During the admission process,
a child/youth shall be offered the opportunity to call his/her
parent(s).
903 Admitting staff
shall conduct a search of the child/youth and his/her possessions upon
admission. Written policies and procedures regarding searches upon admission
shall be consistent with the following provisions:
-- All searches shall be of the least intrusive type
necessary to satisfy the safety and security needs of the facility or the
safety of the child/youth and not as a form of punishment.
-- All searches shall only be conducted by same gender staff
of the child/youth.
-- A pat search is the standard method of searching
children/youth upon admission.
904 Strip searches upon admission are
authorized (but not required) when there is reasonable suspicion that a
child/youth has on his/her person contraband, weapons, or other items concealed
which present a threat to the safety and security of the facility. Reasonable
suspicion is determined on an individualized basis and shall be deemed present
when:
-- Current charges involve a crime of violence; or
-- Current charges involve use of a weapon; or
-- Current charges are drug related; or
-- The child/youth's prior history includes arrest, charges
or convictions of the above.
905 Mechanical Restraints shall only be used
by the program to bring a child/youth into the facility, when exiting the
facility, and off the premises while in the custody of the facility.
906 A Secure Residential Treatment Program
shall ensure that children/youth have-clean and appropriate clothing.
Exemptions and Additional Regulations for Wilderness
Programs.
Wilderness Programs shall be exempt from the following
regulations.
704 First Aid
supplies shall be accessible in each living unit of a Residential Treatment
Program.
714 A Residential
Treatment Program shall conduct actual or simulated evacuation drills at least
monthly and varied by shift.
-- A record of such emergency drills shall be maintained
including the date and time of the drill and whether evacuation was actual or
simulated.
-- All personnel in the building shall participate in
emergency drills.
-- The Residential Treatment Program shall make and document
special provisions for the evacuation of any developmentally or physically
disabled children/youth from the program.
720 A Residential Treatment Program shall not
permit more than four children/youth to occupy a designated sleeping area or
bedroom space.
723 A Residential
Treatment Program shall ensure that there is sufficient space between a
mattress and another mattress (bunk bed) or ceiling for each occupant to sit up
comfortably in bed.
724 A
Residential Treatment Program shall provide each child/youth with his/her own
dresser or other adequate storage space in his/her bedroom unless, there is a
documented safety concern.
725 A
Residential Treatment Program shall have available to children/youth a minimum
of one wash basin with hot and cold water, one flush toilet and one bath or
shower with hot and cold water for every six children/youth.
726 A Residential Treatment Program shall
provide toilets and baths or showers which allow for individual privacy unless
a child/youth requires assistance.
727 A Residential Treatment Program shall
have bathrooms with doors which can be opened from both sides.
729 A Residential Treatment Program shall
have a sufficiently well-equipped kitchen to prepare meals for the children,
youth and employees.
731 A
Residential Treatment Program shall have a living room/common area where
children/youth may gather for reading, study, relaxation, conversation and
entertainment.
Secure Facilities shall follow these additional
regulations.
907 A
Residential Treatment Program functioning in a wilderness environment shall
have a minimum of two field staff members within immediate earshot of all
children/youth throughout the night.
908 First Aid supplies shall be available,
accessible and in the possession and control of a field staff member at all
times.
909 When not locked in
storage, medications shall be in the sole, continuous possession of a field
staff member who is responsible for their distribution.
910 A Residential Treatment Program
functioning in a wilderness environment shall provide a reasonable amount of
personal space in group shelters. Sleeping area per person shall be 8' x 4'
minimum.
911 A Residential
Treatment Program functioning in a wilderness environment shall provide a heat
source in winter conditions.
912 A
Residential Treatment Program functioning in a wilderness environment shall
ensure each child/youth has his/her own gear.
913 A Residential Treatment Program
functioning in a wilderness environment shall ensure each child/youth with
his/her own storage materials (backpack, duffle bag, etc.) unless, there is a
documented safety concern.
914 A
Residential Treatment Program functioning in a wilderness environment shall
provide a hot shower on a regular basis, at least once a week.
915 A Residential Treatment Program
functioning in a wilderness environment shall ensure a system for the disposal
of human waste, which may include outhouses, privies, cat holes, etc. and
children/youth shall be instructed in their use on the first day in the
program. Such systems shall be in accordance with commonly accepted
professional practices, such as "Leave No Trace".
Definitions.
Behavior Management: The use of specialized interventions to
guide, redirect, modify, or manage behavior of children/youth. Behavior
Management includes the entire spectrum of activities from preventative and
planned use of the environment, routines, and structure of the particular
setting; from less restrictive interventions such as positive reinforcement,
verbal interventions, de-escalation techniques, therapeutic activities, loss of
privileges; to more restrictive interventions such as time out, restraint, and
seclusion.
Child Abuse and Neglect: Improper treatment of
children/youth, as defined by law. Abused or neglected child is a child whose
physical health, psychological growth and development or welfare is harmed or
is at substantial risk of harm by the acts or omissions of his or her parent or
other person responsible for the child's welfare. Also, a child who is sexually
abused or at substantial risk of sexual abuse by any person (
33 VSA §
4912(2)) .
Child Sexual Abuse: Sexual abuse is any act or acts by any
person involving sexual molestation or exploitation of a child including, but
not limited to, incest, prostitution, rape, sodomy, or any lewd and lascivious
conduct involving a child. Sexual abuse also includes the aiding, abetting,
counseling, hiring, or procuring of a child to perform or participate in any
photograph, motion picture, exhibition, show, representation, or other
presentation which, in whole or in part, depicts a sexual conduct, sexual
excitement or sadomasochistic abuse involving a child (
33 VSA §
4912(8)) .
Case Records: Are a cohesive, comprehensive collection of
information concerning a child/youth receiving services in a Residential
Treatment Program.
Contraband: Illegal or prohibited possessions, for example
cigarettes, drugs, alcohol, weapons etc.
Custodian: Is a person other than a parent or legal custodian
to whom legal custody of the child has been given by order of a Vermont family
or probate court or a similar court in another jurisdiction." (
33 VSA
§
5102(8).
De-escalation Intervention Plan: (however called), is an
individualized plan based on input from the child/youth, parents and
custodians, that identifies situations that cause the child/youth to engage in
unsafe or disruptive behaviors. This plan identifies interventions that have
(and those which have not) been successful in the past and planned
interventions for the future.
Escort: is the application of physical force by one or more
individuals that reduces or restricts the child/youth's freedom of movement,
(see definitions of physical restraint and physical prompt).
Ethics: Standards for conduct within the organization.
Family: The parent(s) and sibling(s) of the child/youth, or
the person(s) performing the parental and sibling roles. Family may include
birth or adoptive parent(s), grandparent(s), foster parent(s), and
guardians.
Governing Authority: The governing authority is the board of
directors, ultimately responsible for conducting the affairs of a Residential
Treatment Program.
Incident Report: A standardized form which documents
significant and unusual events such as, the use of restraint, seclusion, death,
injury to child/youth or staff, accidents, elopements, medication errors,
emergency evacuation, criminal activity etc.
Informed Consent: A process of mutual understanding and
agreement between the child/youth, parent(s) and custodian and the service
provider.
Inventory Search: A thorough search of a child/youth's
clothing or personal property brought into the program at the time of
admission, visitation, or activity outside the program.
License: A written certification of a Residential Treatment
Program's authorization to operate under state law together with the conditions
of such authorization.
Milieu: The physical and social environment.
Pat Search: The clothed, pat down search of a child/youth's
body and outer clothing. This type of search is also referred to as a "frisk"
search.
Physical Prompt: A light touch to encourage a response, to
provide direction or guidance. A physical prompt allows the child to maintain
maximum influence over their own behavior. If the prompt is met with resistance
the adult may choose to withdraw physical contact or meet the resistance with
an escort depending on the circumstances. A physical prompt does not require
documentation or notification.
Plan of Care: A child/youth specific, comprehensive,
time-limited, goal oriented, outcome based, individualized plan for the care,
treatment and education of a child/youth while in care of a Residential
Treatment Program; developed by program employees in collaboration with the
child/youth, parent(s), custodian and local treatment team.
Provider: Person, program or agency providing
service(s).
Residential Treatment Program: (formerly called a Residential
Child Care Facility) is a place, however named, which provides a planned
program aimed at behavioral change, administered by qualified staff, for
children in a twenty-four hour residential setting.
Restraint, Chemical: The administration of medications that
may or may not be a standard treatment for the child/youth's medical or
psychiatric condition or a part of his/her daily medication regimen, which are
used for the primary purpose of temporarily controlling the child/youth's
behavior.
Restraint, Mechanical: The use of any device, article, or
garment attached or adjacent to the child/youth's body that restricts freedom
of movement.
Restraint, Physical: The application of physical force by one
or more individuals that reduces or restricts the child/youth's freedom of
movement, including an escort.
Room Search: A routine and/or unscheduled search of a
child/youth's room to discover contraband and/or destruction of
property.
Seclusion: (however named) is the confinement of a
child/youth in a segregated room, for the purpose of preventing harm to self or
others, with the child/youth's freedom to leave physically restricted.
Seclusion is not a punishment. Voluntary time-out is not considered seclusion,
even though the voluntary time out may occur in response to verbal direction;
the child/youth is considered in seclusion if freedom to leave the segregated
room is denied.
Secure Program: is a building secure Residential Treatment
Program which employs locked or inoperable doors and windows to prevent
children/youth from leaving the building i.e. a detention program or
hospital.
Sexual Activity: For the purposes of documentation and
reporting as referenced in these regulations "sexual activity" includes sexual
contact with another child/youth's breasts and/or genitalia.
Sleeping Area: Typically a bedroom however it may be a tent,
yurt or other comparable structure used in Wilderness Programs.
Strip Search: A search for contraband that requires the
child/youth to remove his/her clothing in order to closely examine the
child/youth's clothing and allow for a visual inspection of the child/youth's
body.
Time-out: (however named) is the temporary removal of a
child/youth from the current activity until he/she is less agitated or
disruptive. Time-out is used to teach children/youth to calm themselves and
self regulate. Time-out is not a punishment. It is the opportunity to
learn/practice new skills. The duration of a time-out is limited to the amount
of time it takes the child/youth to compose him/herself.
Substitute Care: Any kind of custodial or residential care
for a child/youth that is:
-- Sanctioned by a court or
-- Arranged by a parent or guardian
in which a child/youth does not continue to live with either
of their parents. It can involve family foster care or residential care.
Therapeutic Milieu: A structured group setting in which the
existence of the group is a key force in the outcome of treatment. Using the
combined elements of positive peer pressure, trust, safety and repetition, the
therapeutic milieu provides an idealized setting for group members to work
through their psychological issues.
Wilderness Therapy Program: Wilderness therapy is an
experiential program that takes place in a wilderness or remote outdoor
setting. Programs provide counseling, therapy, education, leadership training
and primitive living challenges that foster community and group
interdependence. The terms wilderness therapy, wilderness program and outdoor
behavioral health program are commonly used to describe this type of
care.
