Revision: Feb. 8, 2024, 3:35 p.m.
Rep. M. Pearson, Rock. 34
February 2, 2024
2024-0427h
05/08
Amendment to HB 1573-FN
Amend the bill by replacing all after the enacting clause with the following:
1 Statement of Purpose and Findings. The general court makes the following findings regarding children in state care:
I. Children in the care of the state have fundamental rights, as recognized by RSA 170-G:21.
II. When a child is placed under the care and custody of the state, it is the responsibility of the state to ensure that a child receives appropriate housing, nutrition, medical and mental health care, education, and basic standards of care.
III. Children who are removed from their homes must be placed in the least restrictive alternate setting. When removal and placement cannot be avoided, the disruption that the child may experience is minimized, and emotional trauma may be reduced, by placing the child in the most familiar, least restrictive setting. The first alternative considered is placement with a relative or a close friend, “kin” or “fictive kin”, to offer the child some degree of familiarity and continuity. When placement with a relative or a family friend is not possible, the least restrictive placement of choice is placement in a licensed foster home.
IV. Residential facilities are appropriate only for children who cannot safely receive the clinically appropriate treatment in their own home or a community-based alternative, and who may have difficulties in school and in the community. Residential facilities are congregate care placements, are considered the most restrictive settings for receiving treatment, and are generally not appropriate for children under 12 years of age. Therefore, placement in a residential setting is used only as a last alternative for children age 12 and older. Special consideration will be given to children under age 12, if deemed clinically appropriate due to a therapeutic or medical necessity.
V. Placing children in facilities must be viewed as a time-limited and only for the purpose of treatment and services. The purpose is to stabilize the child’s behaviors, provide treatment and to prepare him or her for a less restrictive setting. The goal is to facilitate family/caregiver integration or another plan consistent with the agency's policy of permanency planning.
VI. To best meet the needs of the children placed in a residential setting, the department of health and human services (DHHS), in coordination with the office of child advocate (OCA), will expand and enhance certification requirements. In addition to certification, DHHS and OCA will coordinate to improve caseworker visits with children placed by the state in a residential setting. To allow for the expansion of these services to be implemented in a thoughtful and detailed manner that meets the requirements of both DHHS and OCA, the appropriation effective date will allow for time to establish the program through hiring and training, with the remaining sections effective 6 months later. DHHS and OCA will continue this coordination through regular meetings and coordinated visits.
2 Residential Care and Child-Placing Agency Licensing; Deemed Licensed. Amend RSA 170-E:31-a to read as follows:
170-E:31-a Deemed Licensed. Any qualified residential treatment program accredited by organizations as specified in Title 42 of the Social Security Act, 42 U.S.C. section 672(k)(4)(G), as amended, shall submit a completed license application or renewal application. Such child care institutions and child care agencies defined as group homes, specialized care, or homeless youth programs, shall be deemed licensed under this subdivision [and shall be exempt from inspections carried out under RSA 170-E:31, IV]. This section shall only apply to the activities or portions of the facility or agency accredited under Title 42 of the Social Security Act, 42 U.S.C. section 672(k)(4)(G), as amended. Any child care institution or child care agency deemed licensed under this section shall be subject to the monitoring and oversight requirements of this chapter, RSA 169-F, and RSA 170-G:4, XVIII.
3 New Section; Residential Treatment Programs. Amend RSA 170-E by inserting after section 31-a the following new section:
170-E:31-b Residential Treatment Programs; Certification Required.
I. No child shall be placed by the department in a residential treatment program, including a qualified residential treatment program or psychiatric residential treatment program, unless the program has been licensed or certified by the department. Any out-of-state program not certified by the department shall not be eligible to receive state funds or federal funds disbursed by the state of New Hampshire.
II. The department shall assess and certify every in-state and out-of-state program including qualified residential treatment program or psychiatric residential treatment program prior to entering into an agreement for payment, and prior to the placement of any child in that facility. To be licensed or certified by the department, the program shall demonstrate compliance with staff training and program requirements and offer an appropriate therapeutic milieu and culture-centered in trauma-informed care, in accordance with standards adopted by the department, in consultation of the office of the child advocate.
III. The department shall make monitoring visits, in-state and out-of-state, at least quarterly, as well as periodic unannounced visits no fewer than once per year, to all facilities where New Hampshire children are placed by the state in residential treatment. Clear and comprehensive records shall be maintained by the department on each facility showing the dates and findings of each visit. Such records shall be made available to the facility. If the facility is found not to be in compliance either with the statute or rules adopted by the commissioner, a corrective action plan shall be submitted to the department. Failure to submit an acceptable plan shall result in revocation of certification and/or removal of the child.
IV. No placement outside of New England shall be made on or after the effective date of this section. The department shall make every effort to ensure that any child placed outside New England on the effective date of this section is transferred to an appropriate placement in this state or in New England on or before January 1, 2025.
4 New Sections; Out-of-Home Placements; Oversight. Amend RSA 169-F by inserting after section 4 the following new sections:
169-F:5 Oversight of Children in Care; Department Responsibilities.
I. Any child in a court-ordered placement or placement for an episode of treatment by the department shall be seen in-person on at least a monthly basis, by the case worker assigned to that child’s case. In the event the assigned case worker is not available, another case worker or supervisor familiar with the child and/or case may perform the visit. The visit to the child shall include a private meeting with the child, in a safe place, as well as an in-person tour of the child’s living quarters. The monthly contact shall also include contact with the child’s placement provider, therapeutic providers, and educational providers, preferably in real-time, but at least by written correspondence. For any child placed in a residential placement by the department, these visits shall include a tour of the entire facility; discussions with leadership about program culture and therapeutic programming; discussions with program direct care staff; discussions with the clinical director and/or the child’s therapeutic provider about the program culture, therapeutic programming, and the child’s individual progress, strengths and challenges in the program; as well as the individual check-in with the children to inquire about care received.
II. The department shall develop, in consultation with the office of child advocate, a standard operating procedure and form for monthly visits conducted by the department, including a section for the assessment of certified residential placement facilities, to be completed during each monthly in-person visit.
169-F:6 Court Oversight of Children in Residential Treatment Programs.
I. Prior to placing a child in qualified residential treatment programs or psychiatric residential treatment programs, the court shall:
(a) Consider all assessments and plans for the child, including assessment of whether a qualified residential treatment program is the most appropriate and the least restrictive placement for the child, and any child-specific short- and long-term goals for the child and the family.
(b) Ensure that the assessment specifies in writing:
(1) Why the child’s needs cannot be met in a foster family home, not dependent upon availability of community resources;
(2) Why recommended placement in a qualified residential treatment program is the setting that will provide the child with the appropriate level of care in the least restrictive environment; and
(3) How that placement is consistent with the short- and long-term goals for the child, as specified in the permanency plan for the child.
(c) Determine that the needs of the child cannot be met through placement with a parent, legal guardian, legal custodian, kin or fictive kin caregiver, or in a foster care home; and that placement of the child in a qualified residential treatment program provides the appropriate level of care for the child in the least restrictive environment, and that placement is consistent with the short- and long-term goals, including mental, behavioral, and physical health goals, for the child as specified in the permanency plan for the child, or as outlined in the family services plan. A shortage or lack of foster family homes shall not be an acceptable reason for determining that the needs of the child cannot be met in a foster family home.
(d) Review information relating to the facility, including staff-to-child ratio; staff training; program culture; therapeutic, clinical and milieu programming; educational programming; recreational programming; and, family connections, in order to ensure the program meets the child-specific short- and long-term goals for the child and the family.
(e) Approve or disapprove of the placement, in a written order, containing all of the necessary findings provided in this section.
II. In determining that a qualified residential treatment program is appropriate, the court shall consider any available assessments and plans, giving the greatest weight to assessments completed by a licensed psychologist or licensed neuropsychologist. If the court deviates from such recommendation, the court shall make specific findings of fact regarding the appropriate and least restrictive placement for the child, and that the placement is consistent with child-specific short and long-term goals for the child and the family. When making such findings of fact, the court shall consider all relevant information, including, but not limited to:
(a) Whether the protocol for the qualified residential treatment program assessment was followed;
(b) The strengths and specific treatment or service needs of the child and the family;
(c) The expected length of stay; and
(d) The placement preference of the child and the family.
III. When a child is placed in a qualified residential treatment program or psychiatric residential treatment program:
(a) The department shall notify the court promptly of such placement.
(b)(1) The court shall review the placement of that child within 60 days after placement and every 60 days thereafter; or
(2) If the child or the child's representative does not support the qualified residential treatment program level of care or the child, guardian ad litem, or any party objects to the placement, the court shall review the placement within 30 days, and every 30 days thereafter.
IV. As long as a child remains in a qualified residential treatment program, the department shall submit evidence to the court and all parties, at least 5 days prior to every regular review hearing:
(a) Demonstrating that:
(1) Ongoing assessment of the strengths and needs of the child continues to support the determination that the needs of the child cannot be met through placement with a parent, legal guardian, legal custodian, kin or fictive kin caregiver, or in a foster family home;
(2) The placement in a qualified residential treatment program provides the appropriate level of care for the child in the least restrictive environment; and
(3) The placement is consistent with the short- and long-term goals for the child as specified in the permanency plan for the child, or as outlined in the family services plan.
(b) Documenting:
(1) The specific treatment or service needs that will be met for the child in the placement;
(2) The length of time the child is expected to need treatment or services; and
(3) The efforts made by the department to prepare the child and prospective placement for the child’s home or to be placed with a fit and willing kin or fictive kin caregiver, a legal guardian, legal custodian, or an adoptive parent, or in a foster family.
5 Reallocation of Monies Saved. Any monies saved by the department of health and human services, including the division for children, youth and families and the bureau of children’s behavioral health, in preventing the out-of-home placement of children pursuant to this act shall be used by the department to provide services pursuant to RSA 135-F, the system of care for children’s mental health, and any other community-based intervention services.
6 Classified Positions Established; Facility Certification Team.
I. The following classified positions are established in the department of health and human services to support a facility certification team:
(a) Four program specialist III (labor grade 23, step 5).
(b) Four program specialist IV (labor grade 25, step 5).
II. The sum of $773,333 for the biennium ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of funding the positions established in paragraph I. In addition to the appropriation and notwithstanding RSA 14:30-a, the department may accept and expend matching federal funds without prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for the general fund portion of said sum out of any money in the treasury not otherwise appropriated.
7 Classified Positions Established; Youth Visits.
I. The following classified positions are established in the department of health and human services to support the out of state placement of youth:
(a) Four child protective service worker II (labor grade 20, step 5).
(b) Eighteen child protective service worker II (labor grade 18, step 5).
II. The sum of $1,635,416 for the biennium ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of funding the positions established in paragraph I. In addition to the appropriation and notwithstanding RSA 14:30-a, the department may accept and expend matching federal funds without prior approval of the fiscal committee of the general court. The governor is authorized to draw a warrant for the general fund portion of said sum out of any money in the treasury not otherwise appropriated.
8 Appropriations; Department of Health and Human Services; Facility Certification Travel Costs and Youth Visit Travel Costs.
I. The sum of $862,083 for the fiscal year ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of paying for travel costs for facility oversight and certification in order to support implementing the provisions of this act. This appropriation shall be nonlapsing. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.
II. The sum of $826,666 for the fiscal year ending June 30, 2025, is hereby appropriated to the department of health and human services for the purpose of paying for travel costs for youth visits in order to support implementing the provisions of this act. This appropriation shall be nonlapsing. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.
9 Report. The department of health and human services, in consultation with the office of child advocate, shall provide an interim report on or before November 1, 2024, with an annual report thereafter, on the implementation of this act including, but not limited to, progress on the implementation of this act, reports from certified out-of-state residential facilities, and the progress on the reduction of placement of New Hampshire youth in out-of-state residential facilities, to the chairs of the house children and family law committee, the senate judiciary committee and the oversight commission on children’s services, established by RSA 21-V:10.
I. Sections 6, 7, 8, and 9 shall take effect July 1, 2024.
II. The remainder of this act shall take effect January 1, 2025.
2024-0427h
AMENDED ANALYSIS
This bill revises criteria for the out-of-home placement of children and increases oversight and certification criteria for out-of-state residential treatment programs. The bill also makes appropriations to the department of health and human services for this purpose and requires the department to submit a report to the legislature regarding implementation.