W. Va. Code R. § 78-3-18 - Residential Crisis Support/Emergency Shelter Care for Vulnerable Children

18.1. Service Description.

18.1.1. Children's emergency shelter care services are provided to children in need of room, board, supervision, and support during a familial or personal crisis.

18.1.2. Children's emergency shelter care services are provided to all children unless services are limited to a specific target population through a written program description or through contract with the Secretary.

18.1.3. Children's emergency shelter care is responsible for making reasonable efforts to assist individuals to find appropriate placement if admission is impossible because of census, program description, or client variables.

18.1.4. When children are provided shelter without permission of a parent or guardian, the organization shall:

18.1.4.a. Establish the child's legal status;

18.1.4.b. Conduct a brief interview to ascertain the circumstances of the need for admission;

18.1.4.c. Notify the parent or guardian of the admission unless the Shelter documents that the child;

18.1.4.c.1. Is an emancipated minor;

18.1.4.c.2. Has reached age of majority; or

18.1.4.c.3. Could be endangered as a result of notification.

18.1.4.d. Notify the local representative of the Department; and

18.1.4.e. Obtain authorization to provide care for the child if appropriate and necessary.

18.1.4.f. The child shall be informed of the planned notification that shall occur immediately after admission.

18.1.5. Stays in the shelter are voluntary unless the child has been ordered into the facility by a legal entity with authority to do so. If a child voluntarily enrolled as a participant chooses to leave the facility, employees shall document efforts to persuade him or her to remain or to arrange safe alternative placement, or both. If in the employee's assessment, the child is not capable of adequate self-protection, the employee will take action as delineated by the Department's policy.

18.1.6. Children in Shelter care shall be supervised at all times unless the child is engaged in an activity away from supervision authorized by the clinical team (e.g., home visit, public school, employment, etc.). The shelter shall ensure that when children leave the building, there is a procedure for signing or being checked in and out. The checklist or sign-in sheet shall be dated and shall include the time in/out, the person responsible for the child, as appropriate, and the location at which the child may be contacted if necessary.

18.1.7. The shelter shall have policies and procedures for expelling an individual from a shelter. Policies and procedures shall be described in an understandable fashion to the individual at admission and he or she shall also receive a copy of policies regarding standards of conduct in the shelter at that time. Policies and procedures shall:

18.1.7.a. Define the reasons or conditions for which an individual may be expelled;

18.1.7.b. Delineate a clearly defined process for expulsion, including timely due process provisions;

18.1.7.c. Describe the conditions or process for re-admission to the shelter; and

18.1.7.d. Require that all reasonable efforts be made to provide an appropriate alternative placement.

18.1.8. All shelters provide services that are designed to meet the immediate safety and basic needs of the child. As such, they shall provide, either directly or by referral, the following:

18.1.8.a. Sleeping accommodations;

18.1.8.b. Food;

18.1.8.c. Clothing;

18.1.8.d. Personal hygiene supplies and facilities;

18.1.8.e. Crisis intervention;

18.1.8.f. Case management and assistance;

18.1.8.g. A mailing address;

18.1.8.h. Information and referral for services;

18.1.8.i. Linkage to medical services;

18.1.8.j. Eyes-on supervision;

18.1.8.k. Supportive group counseling;

18.1.8.l. Supportive individual counseling;

18.1.8.m. Access to recreational activities; and

18.1.8.n. Educational assistance, if necessary.

18.1.9. The Shelter shall:

18.1.9.a. Provide prompt admission;

18.1.9.b. Emphasize short term stay by working aggressively to arrange more appropriate alternative placement;

18.1.9.c. Provide an organized written program of daily activities for each child that includes social, recreational, and educational activities;

18.1.9.d. Provide sex trafficking prevention programming that shall include (i) education about sex trafficking including what it is and the prevalence of it; (ii) education about understanding one's vulnerabilities and how to protect self from traffickers; (iii) education about how to enhance the child's existing support system of family, friends, and community; (iv) education about services for housing, homelessness prevention, and educational support; and (v) education to prevent running away.

18.1.9.e. Promote continued contact and communication between a parent or guardian and his or her child unless legally or clinically contraindicated; and

18.1.9.f. Assist in developing supportive aftercare or other services to ameliorate the problems that led to the need for the shelter.

18.1.10. Shelters are exempt from subsection 14.9. (educational services) of this rule. Shelters shall:

18.1.10.a. Informally evaluate educational needs upon admission of school-age children;

18.1.10.b. Arrange admission to the public school system; and

18.1.10.c. Provide educational activities for each school age child in the Shelter environment as required by the state Department of Education.

18.2. Employee Ratios and Training.

The Shelter shall have the following employees who are trained on prudent parenting standards:

18.2.1. Direct care employees who provide continuous supervision for children 24 hours per day at ratio of not less than 1-to-5 with one employee present at all times in each residential living unit and one employee present at all times who is authorized to apply the reasonable and prudent parent standards to decisions involving the participation of the child in age- or developmentally-appropriate activities;

18.2.2. A shelter manager to provide coordination and supervision of employees and operations, possessing a minimum of a bachelor's degree and two years' experience in working either in management or with children and families;

18.2.3. A consulting licensed psychologist, available as needed by employees or the children;

18.2.4. A case manager or service coordinator, to provide case management services and supportive counseling. The minimum educational requirements are a bachelor's degree and one-year experience working with children and families. The case manager shall be appropriately supervised on a regularly documented basis by a qualified behavioral health clinician or social worker;

18.2.5. A consulting registered nurse available onsite at least weekly who is responsible for:

18.2.5.a. Performing nursing assessments on each child within five working days of admission;

18.2.5.b. Completing medication administration records for each child, updated as necessary;

18.2.5.c. Monitoring medication administration including supervising Approved Medication Assistance employees if necessary;

18.2.5.d. Assessing children for their ability to self-medicate under supervised conditions and developing appropriate educational materials or facilities for educating children about their medications or other health conditions;

18.2.5.e. Educating employees to meet the demands of children with unusual health conditions such as diabetes, epilepsy, etc.; and

18.2.5.f. Monitoring medication availability, storage, record-keeping, and disposal and medication errors.

18.3. Treatment Teams.

Shelter treatment teams shall consist of the child if developmentally appropriate, a direct care employee, the case manager, and the shelter manager at a minimum. The consulting psychologist shall review and approve all activities of the treatment team if he or she was not an active participant. When appropriate for children with medical issues, the consulting nurse shall also be a member of the team or shall approve the team's activities in writing. The organization shall notify parents or guardians and the child's social worker and request they participate in team activities unless timelines for team activities prohibit such involvement or parental or guardian participation is not clinically or legally appropriate. The social worker shall receive a copy of the team's actions within 24 hours if not a direct participant.

18.4. Care Plans.

18.4.1. Shelters are exempt from the plan of care subsections 13.3. and 13.4. of this rule as long as the child is present in the facility less than 30 days. If the child is present in the facility for 30 or more days, a master plan of care shall be developed as required by subsection 13.4. of this rule and all other aspects of the rule apply with regard to service delivery, master plans of care, and reviews of plans of care.

18.4.2. Upon admission, the Shelter shall complete the collection of any background material and history available either from the child, a social worker, or a parent or guardian. From that information, the Shelter shall develop an intake plan that shall describe the following:

18.4.2.a. Further testing, evaluation, or collection of information necessary to complete the comprehensive assessment of the child and tentative timelines for completion of that assessment;

18.4.2.b. Safety plans or behavioral protocols, if necessary, to deal with any predictable inappropriate behaviors (e.g., need for eyes on at all times, employee-to-child ratio of 1-to-1, likelihood of sexual reactivity, etc.);

18.4.2.c. Plans for referrals for the necessary medical screenings; and

18.4.2.d. Permission to administer properly bottled prescription and non-prescription medications brought in by the child.

18.4.3. The intake plan shall be completed within 24 hours and approved by the admitting parent or guardian within 72 hours.

18.4.4. Within seven days, the shelter shall develop a list of problems identified in the assessment. The list may include not only behavioral health problems but also legal, familial, financial, medical, and academic problems, among others. The shelter shall determine through an interdisciplinary team meeting those problems that the shelter intends to address prior to discharge and those problems that may need to be addressed in an aftercare plan. At all times, consideration shall be given to improving the child's relationship with his or her family unless clinically or legally contraindicated.

18.4.5. The shelter shall provide objectives for each problem that it has determined that it shall address prior to discharge.

18.4.6. Objectives shall be stated in simple language, understandable to the child whenever possible.

18.4.7. The intervention to be used in addressing the objective shall be described and the person or persons responsible named, if appropriate.

18.4.8. If an objective includes an individual or group therapy intervention, the intervening organization or provider, whether the shelter's employee or a contractual or other provider to whom the organization refers, shall be responsible for developing a specific therapy plan that describes the processes the therapist intends to use, in specific language, and the skills to be learned or behaviors to be increased or reduced by the child. If necessary, a plan or protocol shall be provided to direct care employees to attempt to generalize behaviors discussed in therapy to the shelter environment. Outside providers shall be responsible for providing written feedback to the shelter prior to discharge, in writing, regarding progress made in therapy or lack thereof and rationale for the lack of progress.

18.4.9. Physicians or qualified medical practitioners providing services to children in the shelter, whether by contractual or referral relationship, shall be responsible for communicating with the shelter nurse regarding medication changes, and for providing written records regarding changes in medications and the rationale for the changes.

18.4.10. The shelter shall provide a nationally recognized behavioral health program for known victims of sex trafficking; and

18.4.11. The programming shall provide opportunities for children to experience some of the same normalizing experiences as their peers not in foster care.

18.5. Behavior Plans.

18.5.1. If a child requires a specific behavior support plan or a protocol for employees to use in dealing with an inappropriate behavior, the plan or protocol shall be in writing and shall be in terms that make it clear to direct care employees:

18.5.1.a. The behaviors to be monitored and modified;

18.5.1.b. The precise action to be taken by employees if the behavior occurs; and

18.5.1.c. The documentation employees are responsible for supplying, if any.

18.6. Reviews of Plans of Care.

The treatment team shall meet to review progress in implementing the plan of care and to modify it, as necessary, on a monthly basis when a youth stays beyond 30 days. The plan of care shall be a flexible document to which may be added additional problems or objectives, as they become identified in the assessment process. Other problems may be resolved, and objectives discontinued as they become irrelevant or are achieved. A copy of any revisions to the plan shall be sent to the child's social worker for approval if the social worker is not available for the team meeting. Parents or guardians shall also receive amendments unless clinically or legally contraindicated.

18.7. Planning for Discharge.

The treatment team of the shelter shall begin planning for discharge at admission. When possible, seven days prior to discharge the child, his or her parent or guardian (as appropriate and possible), the child's social worker (if any) and the treatment team shall meet to develop a discharge plan. Issues to consider in developing the plan are:

18.7.1. Remaining problems to be addressed from the initial problem list and any problems added later during the child's stay;

18.7.2. Appropriate placement for the child considering issues of safety, permanency, and clinical need;

18.7.3. Recommendations for aftercare including recommended behavioral health and medical services; and

18.7.4. Any other relevant and compelling information or considerations.

Notes

W. Va. Code R. § 78-3-18