Durham System of Care

Information About Care Review

Overview of Care Review Approach & Expectations In Durham's System of Care

Policy Statement

Out of home placements for children with mental health needs should be a last resort, used only for safety and treatment purposes that cannot be achieved in a home environment. Such placements must directly relate to measurable outcomes, with concrete plans to bring the child back to a stable/permanent home in their community, or least restrictive environment as appropriate.

When out of home placements are needed those placements will preferably be within 60 miles/60 minutes of the child's home, unless the level of placement needed limits local residential options.

Care Review Team Member Roles & Expectations

Care Review Teams share responsibility and accountability to promote Durham's System of Care, actively support and model best practice approaches;
Care Review Teams provide support, technical assistance and barrier-resolution assistance to Child and Family Teams;
Care Review Teams assist Child and Family Teams in developing alternatives to out of home placement discharge, transition and permanency plans from out of home placements.
The outcome of the Care Review meeting will be documented on a written action plan and distributed to the CFT and the Utilization Management Unit at the Durham Center.

Child & Family Team Roles & Expectations

CFT Coordinators, often the Community Support Professional, are responsible for working within the Child and Family Team to deliver adequate services and supports that the child/family need in their home, school and community, seeking out of home placement as a last resort.
CFT coordinators shall access assistance from the Community Collaborative's Care Review Teams in the event that request for an out of home placement is anticipated.
In addition to the referral form, the CFT Coordinator shall present the Child and Family Team community based plan developed through a Person/Family Center Planning process (i.e. Wraparound):
- the strengths/needs assessment and
- a crisis/safety plan and
- (if residential placement is requested) why the current plan has not been successful, the rationale for an out of home placement and a discharge plan.
At the Care Review meeting Child and Family Teams are expected to demonstrate:
- how they have exhausted all non-residential options through wraparound and home-based approaches,
- discuss specific outcomes that can only be met through out of home placement,
- a clear transition and step-down plan back to home or discharge resource family/home, school and community.
If residential treatment is recommended, the Child and Family Team shall integrate into the child and family plan (in writing) specific measurable outcomes that will targeted by a residential provider.
- These shall be outcomes that could not be accomplished outside a residential treatment setting.
- All out of home placement outcomes MUST be directed at the goal of placement in a family setting within a reasonable timeframe (to be specified in the plan).
- In addition, a clearly defined transition and discharge plan shall be developed prior to out of home placement authorization.
- The plan must also include specific measurable outcomes related to work with the child's family/home or discharge resource family/home and school to ensure readiness for transition back into the home, school and community.
If a residential placement occurs, the CFT Coordinator will be responsible for obtaining from the residential provider, a MONTHLY summary of measurable progress toward outcomes specified in the comprehensive plan developed by the Child and Family Team.
The CFT Coordinator will actively engage the parent/legal guardian in the child's treatment and CFT and assure that:
- The parents/legal guardian or discharge resource persons as identified by the Child and Family Team signs a contract that they will visit the child at least weekly.
- The child visits home or discharge resource family/home at least once a month, as appropriate.
- The CFT Coordinator visits the residential placement at least once a month.
- There is a discharge plan at the time of admission
- The Child and Family Team meets at least once a month.

When the child is placed out of home, the Qualified Professional coordinating mental health services is responsible for the placement notification required in 10A NCAC 27G .0506 - Communication Procedures for Out of Home Community Placements. The Qualified Professional shall make the notification by e-mail, fax or hard copy within three business days after out of home placement occurs. In case of an emergency, notification may be by telephone with written notification occurring the next day. The following entities shall be notified:

Legal guardian;
Other representatives involved in the care and treatment of the child or adolescent;
Host community provider; and
Host community representatives (may include the court counselor, county DSS, regional Children's Developmental Services Agency (CDSA) or the LEA.

Notification shall be completed on a form provided by the Division of MH/DD/SAS and will include the following information:

Child or adolescent information: name, date of birth, grade, identification number, social security number, date of placement out of home community;
Parent/legal guardian information: name, address, and telephone number.
Home and host DSS information: county; contact person name, address, and telephone number;
Home and host area authority/county program information: name of program; contact person name, address, telephone number.

* Excerpted from The Durham Center's Out of Home Placement Policy - Approved 10/07

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