Revision: April 2, 2024, 1:40 p.m.
Rep. Wallner, Merr. 19
March 25, 2024
2024-1313h
05/08
Floor 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 pursuant to RSA 169-B, RSA 169-C or RSA 169-D, 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; a shortage or lack of foster family homes or community-based resources shall not be an acceptable primary reason for placement in a residential facility. 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 and oversight process. 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 requirements of this chapter, RSA 169-F, and RSA 170-G:4, XVIII.
3 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 pursuant to RSA 169-B, RSA 169-C, or RSA 169-D 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 determined by the case worker, to inquire about care received, 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. In addition, for any child placed in a residential placement by the department, these visits shall include a tour of that portion of the facility the child may access; a check-in with appropriate leadership about program culture and therapeutic programming; a check-in with program direct care staff about the child's progress in the program; and a check-in 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, which may occur outside of the in-person visit in virtual real-time if circumstances require.
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, pursuant to RSA 169-F:5, I, to be completed during each monthly in-person visit.
169-F:6 Residential Treatment Programs; Certification Required.
I. No child shall be placed by the department in a residential treatment program, including a residential treatment program or psychiatric residential treatment program, unless the program has been licensed in accordance with RSA 170-E or the laws of the state in which they operate, and certified by the department under this chapter. Any 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. On or before January 2, 2025, the department shall establish a certification team, responsible for the certification, recertification, and oversight of all residential treatment programs utilized by the department, and certified for placements and payment by the department. Such assessments shall include an in-person visit of the facility and review of all appropriate records and certification criteria. The team shall give priority to all residential treatment programs where children are placed on the effective date of this section.
III. The team shall develop a standard operating procedure and form for assessment of the programs to be completed during each in-person visit, in consultation with the office of the child advocate.
IV. The department shall assess and certify for payment every in-state and out-of-state program including residential treatment program or psychiatric residential treatment program prior to the placement of any child in that facility. To be 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.
V. The department shall make monitoring visits, in-state and out-of-state, at least twice per year, of which at least one shall be unannounced, to all facilities where New Hampshire children are currently placed by the state in residential treatment. The department shall continue to make annual recertification or technical assistance visits to all certified residential placement facilities that have received a New Hampshire child within the certification period; if a child is being placed at a residential facility that does not currently have a New Hampshire child in placement, the department shall make a visit prior to the placement of that child unless a department visit has occurred within the past 120 days. Upon renewal of certification, if a program has not served a New Hampshire child within the prior 12 months, the department may waive the recertification visit and conditionally recertify the program subject to conducting an on-site visit prior to the placement of a New Hampshire child. Clear and comprehensive records shall be maintained by the department on each facility showing the dates and findings of each such visit. Such records shall be made available to the facility and the office of the child advocate, as well as included in the paperwork for the certification and/or re-certification process. If the facility is found not to be in compliance either with the statute or the rules adopted by the commissioner, a corrective action plan shall be submitted to the department, and the department shall notify the licensing agency of that facility if the corrective action plan includes concerns of health or safety. Failure to submit an acceptable plan or a failure to take the necessary corrective actions shall result in the immediate removal of all New Hampshire children from that facility, and/or revocation of the certification.
VI. Any placement of a child outside of New England shall require the approval of the division for children youth and families’ director prior to that placement, with specific findings of the need for that placement.
169-F:7 Court Oversight of Children in Residential Treatment Programs.
I. Except in cases of emergency placement, prior to placing a child in 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 residential treatment program is the most effective and appropriate level of care, in the least restrictive environment for the child, and any child-specific, short- and long-term goals for the child and the family. The assessment shall specify, in writing:
(1) Whether the child’s needs can be met in a kin, fictive kin or foster family home, not primarily dependent upon availability of community resources.
(2) If the assessment recommends a residential treatment program:
(A) The specific reasons why the child’s needs cannot be met in a kin, fictive kin or foster family home, not primarily dependent upon availability of community resources; and
(B) Why recommended placement in a residential treatment program is the setting that will provide the child with the most effective and appropriate level of care, in the least restrictive environment.
(3) How the placement is consistent with the short- and long-term goals for the child, as specified in the case plan or permanency plan for the child.
(b) Confirm that the school district has complied with its legal obligations to assess the educational impact of the placement and consider the school district’s input on that impact.
(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 family home; and that placement of the child in a residential treatment program provides the most effective and 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 primary 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 that the program is the most effective and appropriate level of care, in the least restrictive environment for the child, and 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 the case of an emergency necessitating immediate placement of a child in a residential treatment program, the department shall notify the court within 2 business days of such placement, in order for the court to make the findings required under paragraph I.
III. Prior to determining that a residential treatment program is the most effective and appropriate level of care, in the least restrictive environment for the child, the court shall consider any available assessments and plans, giving the greatest weight to assessments completed by a licensed psychologist or licensed neuropsychologist with specialized training in the evidence-based treatment of childhood trauma. If the court deviates from such recommendation, the court shall make specific findings of fact regarding the most effective and appropriate level of care, in the least restrictive environment 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 residential treatment program assessment was followed;
(b) Whether the school district is meeting the child’s educational needs, based on their statutory requirements under RSA 169-B:22, RSA 169-D:18, and RSA 169-C:20;
(c) The strengths and specific treatment or service needs of the child and the family;
(d) The expected length of stay; and
(e) The placement preference of the child and the family.
IV. When a child is placed in a 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 at every subsequent court review hearing; or
(2) Upon a motion by the child, the child’s representative, or the child’s guardian ad litem establishing reason to believe the ordered residential treatment program is not the most effective and appropriate level of care for the child in the least restrictive environment, the court shall review the placement within 30 days, and every at every subsequent court review hearing.
(3) The court may review the placement at any time sua sponte or in response to a motion for review by any party.
V. As long as a child remains in a residential treatment program, the department shall submit evidence to the court and all parties, at least 5 business days prior to every placement review hearing:
(a) Demonstrating:
(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) Any recommended psychological or clinical evaluations or assessments have been completed, and if not, the status of those evaluations or assessments;
(3) The department has worked with the school district to assure, consistent with the best interest of the child, the child’s educational stability;
(4) The placement in a residential treatment program provides the most effective and appropriate level of care for the child in the least restrictive environment; and
(5) 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 the treatment basis for the determination of that length of time; and
(3) The specific efforts made by the division to prepare the child and prospective placement for the child’s return 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.
4 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.
5 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) Three program specialist IV positions (labor grade 23, step 5).
(b) One program specialist IV position (labor grade 25, step 5).
II. The sum of $356,000 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.
6 Classified Positions Established; Oversight of Children in Residential Programs.
I. The following classified positions are established in the department of health and human services to support the placement of youth in residential facilities:
(a) Eight child protective service worker IV (labor grade 24, step 5).
(b) Two juvenile probation and parole officer IV (labor grade 24, step 5)
II. The sum of $522,000 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; Oversight of Children in Residential Programs.
I. The following classified positions are established in the department of health and human services to support placement of youth in residential facilities: 2 attorney III positions (labor grade 30, step 5).
II. The sum of $210,000 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 $266,000 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 $174,000 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 Appropriation; Judicial Branch. The sum of $376,145 for the fiscal year ending June 30, 2025, is hereby appropriated to the judicial branch for the purpose of funding new positions required to carry out the duties set out in this act. In addition to the appropriation and notwithstanding RSA 14:30-a, the judicial branch 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.
10 Report. The department of health and human services 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 the oversight commission on children’s services, established by RSA 21-V:10, the health and human services oversight committee established by RSA 126-A:13, and the office of the child advocate.
I. Sections 5-10 of this act shall take effect July 1, 2024.
II. The remainder of this act shall take effect January 1, 2026.
2024-1313h
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 beginning January 1, 2026.
The bill also makes appropriations to the department of health and human services and the judicial branch for this purpose and requires the department of health and human services to submit an annual report regarding implementation.