FFPSA Part IV FAQs

See the previously asked questions and their answers on the FAQ page. If you want to ask an FFPSA Part IV related question, join an upcoming webinar or email: FFPSA@dss.ca.gov or FFPSA@dhcs.ca.gov.

Use these links to see questions in a specific topic area, or scroll down to see the full list of all questions and their answers. Simply click on a question to display its response.

Qualified Individual

Aftercare

Case Plan Requirements

Courts

Placements into STRTPs

Nursing

Accreditation

Eligibility

Glossary: Acronyms Spelled Out

Qualified Individual

133. What happens if the QI or the Court does not approve the STRTP placement?
If the Court disapproves or the QI determines that a placement into a STRTP is not appropriate, a county placing agency may utilize Title IV-E FFP for foster care maintenance payments on behalf of an otherwise eligible child while the child remains in the STRTP only for the period necessary for transition of the child. In no event is Title IV-E FFP available after the end of the 30-day period from the date that it is determined that a placement is not recommended by the QI or is disapproved by the Court.
132. If the QI support can be claimed prior to the youth being in foster care. The analogous situation is a youth who is a potential Reasonable Candidates. CDSS allows for claiming the time if the youth becomes an RC during the same month. For example, If the probation officer works on the case plan staring on 2/1/22 and the case plan is signed on 2/28/22, then all the time from 2/1 – 2/28 is claimable. If the case plan is signed on 3/1/22, then the time cannot be claimed.
In short, our answer is yes, activities to support the QI referral process can be claimed to Title IV-E prior to the youth being in foster care. A typical scenario would involve a probation officer performing QI referral activities for a youth in juvenile hall when the probation officer believes the youth will likely be ordered to foster care and require an STRTP level of care.
131. Is there a certificate of proof that the QI training is completed for QI to submit for the court to determine their qualifications? Is there an update as to when the full training will be released with the ICWA components?
The QI does not need to submit a proof of completion of the QI training to the court. According to the ACL 21-113 / BHIN 21-060, it is the responsibility of the MHP to:
• Designate QI candidates
• Review the licensed, registered, or waivered status of the proposed QI candidates and/or verify that the relevant professional license held by the individual is active
• Verify the QI candidate is certified to complete the CANS as directed in ACL 18- 81/MHSUDS IN 17-052
• Verify completion of required training, including specialized training on tribal social cultural norms and the ICWA, as determined by CDSS and DHCS (up to 40 hours).

CDSS and DHCS will be issuing additional guidance on the required and recommended trainings in the coming weeks and months.
130. If we have a staff whose position is funded by either probation/child welfare (placing agency) but the position falls under the county behavioral health dept, does that mean this staff person cannot be a QI?
The staff person would not be able to be the QI due to IV-E funds paying for the position even though the position is supervised and falls under the county behavioral health dept. Therefore, a QI waiver would need to be requested and all waiver criteria met for QI waiver approval for that staff person to perform the QI activities.
129. Does a youth need a QI assessment if they have private insurance? The youth is a 602 ward, and currently his case is overseen by Juvenile Probation he currently has no Medi-Cal however the youth has private insurance.
If the probation youth is a foster youth, the youth would need a QI assessment completed prior to or within 30 days of an emergency placement in an STRTP/CTF. Counties and Medi-Cal providers are required to bill Other Health Coverage (OHC) prior to billing Medi-Cal to ensure that Medi-Cal is the payer of last resort for children who are eligible for Medi-Cal. Additional information on OHC may be found in the Information Notice 17-058 and information on claiming to Short-Doyle Medi-Cal in the Short-Doyle Medi-Cal Provider Billing Manual.
128. Counties need more information regarding voluntary/preventative placements in ER/IS (Informal Supervision which is our program that serves families for whom there is a fillable petition that is held in abeyance if the family “volunteers” to intensive in-home services once safety planning is active and amenable). It’s our understanding that the QI and IPC requirements still apply pre-Court; but it’s unclear what happens when a petition is filed (i.e. what should the date of placement with the court be identified as when a petition is filed if the placement happened several weeks or months prior to the petition being filed?
The judicial/administrative review requirements in Title IV-E that apply to placements in a QRTP (42 U.S.C. § 675a) make no distinction between placement pursuant to a voluntary family reunification (VFR) plan vs. placement made within the context of a dependency proceeding. The key is that the placement is made by a Title IV-E agency, which applies to either situation. All the FFPSA requirements need to be met, QI assessment and Court hearing review process within 45-days of placement. Any policies related to filing petitions have not changed with FFPSA.

WIC Section 4096(e)(1) state IPC needs to be completed for voluntary placements.

Further, Welf & Inst. Code section 319(k) states that “For a placement made on or after October 1, 2021, each temporary placement of the child pursuant to subdivision (h) in a short-term residential therapeutic program shall comply with the requirements of Section 4096 and be reviewed by the court pursuant to Section 361.22.”

Thus, the court should be following the section 361.22 process for children in STRTP placements at the detention hearing. Timing of notification may be an issue. Section 361.22 contemplates a child going into a placement and the court being notified within 5 days. In this situation where the child was placed in a STRTP voluntarily, the child may have already been in the STRTP setting for 30 to 40 days. If the child is currently in a STRTP on a voluntary basis at the detention hearing, the court and parties may consider waiving notification and allowing the court to set a hearing within 45 days of placement. If the child has already been in the STRTP placement for 45 days, the court should set the hearing within 60 days of placement. This does not mean the court should not consider lower levels of placement available at the detention hearing.
127. A- How often does the IP-CANS assessment tool need to be updated?
B- We understand according to ACL 21-113 / BHIN 21-060, "If the IP-CANS assessment tool has already been completed as part of the CFT process within the last two months, under WIC Section 4096(g)(3)(B), the QI may either utilize or update those results at the discretion of the QI." Does this mean that at the time of QI assessment, if the IP-CANS tool on record is older than two months, it needs to be updated by the QI? Please address what should occur when the IP-CANS is older than two months at time of QI assessment.
A. The QI ensures that the IP-CANS reflects the current status of the youth. The QI may need to update the CANS if it’s not current or no CANS is available for their review.

B. When a QI receives a referral, a change in level of care is being requested based in child’s needs or a disruption in child’s placement has occurred. The QI ensures that the IP-CANS reflects the current status of the youth. The QI, at their discretion, may utilize or update the results of an existing CANS.
126. Regarding FFPSA as it pertains to 709 WIC placements: our county has a youth who was previously under the supervision of the probation department and was found incompetent. Prior competency restoration period did not yield positive results and the case was dismissed. The youth is now back on a new case and is currently a 300WIC dependent. Our court indicated intention to take jurisdiction from hsa and explore long term 709 WIC placement. Do we follow the same FFPSA process?
Federal and state law are clear: To be eligible for federal financial participation (FFP) any congregate care placement, including for placements made pursuant to WIC Section 709(g), must meet all the requirements of a QRTP, including a QI assessment and juvenile court review process.
125. A youth was placed at a STRTP on 01/18/2022 through DCFS. In March, DCFS closed the case and probation became the lead. The youth was not removed and continues to reside at the same STRTP. Does a new QI referral, JV forms, and 45-day status hearing review report need to be completed?
No, this would not be considered a placement change and the QI assessment and court hearing review process do not need to be completed again. Also, please note that under Welfare and Institutions Code section 827(a)(1)(E), the juvenile court, attorneys, and probation officer have a right to the QI assessment.
124. A minor was emergency placed in an STRTP on February 28, 2022, and the QI Referral was submitted on March 2, 2022. On March 16, 2022, the assigned social worker advised that the minor was moved to a relative/family-based setting. Would the QI assessment still need to be completed for this minor?
Yes, the QI assessment still needs to be completed. If the assessment is not completed within 30 days of the initial placement, the title IV-E agency cannot claim title IV-E FFP foster care maintenance payments for the entirety of the STRTP placement (including not for the first 14 days) but may claim title IV-E administrative costs during the placement in the STRTP. In addition, a court hearing must also still take place within 45 calendar days of the start of the STRTP placement to be eligible for federal funding.

The placing agency may incorporate recommended services and supports identified by the QI into the development of the child’s Needs and Services Plan, case plan, permanency plan, and client treatment plan to support the child’s stable placement in the least restrictive setting. The QI may also identify any additional mental and behavioral health resources or supports needed to support the transition plan. (ACL 21-113 / BHIN 21-060, pg. 9)
123. Can the Child Welfare Agency take a position opposing a recommendation by the QI? The QI recommended a foster placement step down at the last assessment and we are waiting to receive the newest QI recommendation. Both minor’s counsel and the Child Welfare Agency believe it is in the minor’s best interests to be placed at the STRTP.
Federal and state law require the QI to be “a trained professional or licensed clinician who is not an employee of the State agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the State.” (42 U.S.C.A. § 675a and WIC § 16501(l)(2)) The QI is required to provide an independent assessment. There is therefore no attorney-client relationship between the placing agency and the QI, freeing the placing agency to advocate for their client and in opposition to the QI if necessary. After considering the QI assessment, any additional evidence presented, and arguments from counsel, it will be up to the court to make the final determination whether the youth’s placement at the STRTP is approved or disapproved. It should be noted that to be eligible for federal funding, the QI’s assessment must approve the STRTP placement.
122. When a youth elopes from an STRTP (during or after the initial QI Assessment is completed) and is placed at a different STRTP, a new QI Referral is generated.
1. Can the QI Clinician use the same information from the first QI assessment and only update the most recent changes in the 2nd QI Assessment?

2. Is the QI Clinician required to attend/engage with all members of the CFT again even though a recent CFT was held 2-3 weeks ago?
1. We recognize that there are instances when a placement change is not related to a change in the behavioral health, safety, or supervision needs of the child and a recently completed QI assessment may accurately reflect the child’s needs and level of care recommendations. DHCS and CDSS are currently working on additional policy guidance related to subsequent QI assessments, such as in your case, that will come out in the next couple of months and should make this process clearer (and hopefully easier) in the future.

Until then the QI should complete the assessment as they would complete an original assessment and follow guidance provided in ACL 21-113/BHIN 21-060.

2. Yes, the QI clinician should engage the CFT again to identify the reasons that led to the change in youth’s placement.
121. Recently on 3/4/22, our QI completed an assessment on a client that STRTP was recommended but due to the minor being changed from placement into another STRTP, DSS is requesting another QI assessment. Is another assessment required at this time? Seems the minor’s situation has not changed but it was decided to move minor to a different STRTP.
Yes, another QI assessment is required. As noted in the federal guidance in ACYF-CB-PI-18-07 (page 10), “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state laws are clear that a QI assessment and court finding are required for each placement, including a change in placement, which is defined as a move from one licensed STRTP placement to another.

We recognize that there are instances when a placement change is not related to a change in the behavioral health, safety, or supervision needs of the child and a recently completed QI assessment may accurately reflect the child’s needs and level of care recommendations. DHCS and CDSS are currently working on additional policy guidance related to subsequent QI assessments, such as in your case, that will come out in the next couple of months and should make this process clearer (and hopefully easier) in the future.
120. We had our first case in which the court ordered an STRTP against the recommendation of the QI. The QI recommended a higher level of care through a secure track setting. The youth will be 18 years old in July 2022 and should they opt into Extended Foster Care, do we need a QI assessment to identify the appropriateness for a lower-level placement, a THP as an example?
The QI’s role is to conduct an independent assessment and make a level of care determination. A QI assessment is required for any new placement in an STRTP, Community Treatment Facility, or an out of state residential treatment facility. Following the QI assessment, the placing agency maintains the ongoing responsibility for monitoring the child’s needs and placement into the STRTP or the family-based setting, as detailed in ACL 21-114.

At subsequent status review hearings in which the youth remains placed in an approved STTRP, the court is required to consider the appropriateness of the STRTP placement based on the factors in WIC section 706.5(c)(1)(B), but these factors don’t involve a continuing QI assessment and are case management responsibilities of the county department.

The youth will be eligible for extended foster care if they remain the subject of an out of home placement order on their 18th birthday.
119. Has there been any more discussion about aligning the 387 Petition filing for a group home level of care and the STRTP process? SW are having to prepare and write both the 387 and STRTP Court Report and two separate hearings heard even we are attempting to hear them close to each other.
They are two separate hearings, the 387 is on a petition and the STRTP hearing is on the assessment it's based on, there is nothing that prevents them to be on the same day. But there are two different reports: the 387 petition is the evidence that is there to support, but the evidence of the agencies, providing to support the allegation to a higher level of care; and then you have the QI assessment report that is separately completed for the STRTP hearing. But again, they can be heard on the same day. The timeframes for the 387 petition are just like the 300 petitions and with the detention hearing, and then the adjudication disposition jurisdiction on those counts.
118. When composing the QI assessment report, how much behavioral/emotional clinical history should we provide in the assessment report to recommend a level of care placement? It is expected that we capture the clinical lifespan of the youth?
The QI addresses the reason for the referral, supported by the rationale summary provided in the QI referral. The QI is responsible for answering each section of the QI report template. Further justification for QI recommendations may be found in the Specialty Mental Health Services assessment document. The QI is not required to document the entire assessment into the QI report template. The SMHS assessment document becomes the supporting documentation for the QI report. The QI report is a summary document for the essential sections required by the federal and state law. For example, the QI may include patterns of behavior over time to justify their recommendations.
117. Regarding the youth in the CTF, if they are approved for the CTF but start out in the PHF, what is the expectation around the QI timing?
The youth cannot be in an acute inpatient level of care when the QI assessment is initiated (i.e., Medi-Cal lockout). The QI Assessment may be initiated upon the placement in the CTF and is due 30 days from the date of the placement into the CTF.
116A. Are we required to hold an IPC which includes the QI before we can make an emergency placement?
The QI does not need to attend the IPC. Once the QI completes their assessment, the QI provides the QI Assessment Report to the county placing agency and the STRTP where the child is or will be placed.
116B. Since disposition has already occurred and the Court has already ordered the youth into foster care, do we need to bring the youth before the Court as described in this guidance OR can we just move on with the emergency placement and subsequently follow the normal FFPSA hearing process where the Court approves the placement within 45-60 days?
Once the child’s disposition has been determined by the court and the CFT has recommended a placement into an STRTP, a referral may be submitted to the MHP for a QI assessment. The court may order an emergency placement of the youth into an STRTP and a referral may be submitted to the MHP within one day of STRTP placement, consistent with the emergency placement process. For detailed information about the emergency placement process for youth placed by probation, please refer to the resource document, Joint CDSS and DHCS FFPSA Part IV – Issued November 22, 2021, on Process for Probation Cases Where Youth is Placed on an Emergency Basis in a Short-Term Residential Therapeutic Program (STRTP) Prior to Completion of the Qualified Individual (QI) Assessment.
115A. We followed the emergency placement process, and subsequently the judge released the minor home to a relative. Would we still follow the requirements of FFPSA and have the QI complete an assessment, even though this minor is not at an STRTP, but rather at home?
Even though the youth was placed in the STRTP for only a short time and on an emergency basis, it is still subject to the requirements of the FFPSA. For the minor's placement in the STRTP to be eligible for federal foster care maintenance payments, the QI assessment must be completed and a QI report submitted to the placing agency. The QI assessment and written report will help identify services that may benefit the youth in the family-based setting.
115B. Would we be setting up a court date within 45 days of the minor being placed at home to advise the court of the QI’s recommendation?
The 45-day court hearing is only required to review the QI's recommendations and approve the STRTP placement for FFP.
114. Which agency is mandated to do the QI?
Behavioral Health Agencies/Mental Health Plans are currently responsible for performing the QI role. Once the QI waiver process is available, there may be exceptions for the QI to be affiliated with the placing agency or a placement setting.
113. What if the date on the referral is 2 weeks prior to the QI receiving the consent to treat that is supposed to accompany the referral? Does the 30-day clock still start on the date of the referral?
Yes, the 30-day clock starts on the date the QI referral is submitted by the placing agency. Within three (3) business days of receiving the referral, the MHP shall provide the placing agency with confirmation of receipt of the QI Referral form and request any required documentation not provided in the initial QI Referral form. All Release of Information forms must be signed by appropriate parties for the QI to be able to gather information.
As a member of the treatment team, the QI may initiate a medical record review prior to receiving the signed consent to treat.
112. Is there any circumstance under which an extension may be granted to complete a QI assessment?
There are no provisions in State or Federal law that allow an extension to be granted to complete the QI assessment beyond 30 days from the date of placement in an STRTP. Additionally, the Title IV-E FFP is not available for the placement if the QI assessment is not completed within 30 days (and the court approval within 60 days) of the start of each placement (see ACIN I-84-21).
111. If the QI does not complete the Assessment within the 30-days of referral in case of an emergency placement, but the QI does believe an STRTP is needed, what is the best course of action?
The QI should complete the assessment and provide the QI Report to the placing agency and the STRTP where the child is placed.
As noted in ACYF-CB-PI-18-07 pg.10, “The qualified individual may conduct this assessment prior to the placement in the QRTP, but must complete it no later than the end of the 30-day period. If the assessment is not completed within 30 days, the title IV-E agency cannot claim title IV-E foster care maintenance payments for the entirety of the QRTP placement (including not for the first 14 days)”.
110. Do CTFs qualify for Title IV-E funding?
Community Treatment Facilities are subject to Qualified Residential Treatment Program (QRTP) requirements and may continue to be eligible for Title IV-E funding, presuming that the facility has met all of the QRTP requirements and that the placement process and oversight is in accordance with the requirements outlined in AB 153 and subsequent guidance.
A QI assessment and juvenile court review process is required for any placement of a foster child into an STRTP or Community Treatment Facility (ACL21-113 / BHIN 21-060). A placement into an STRTP or CTF must meet all the QRTP requirements and the placement process and oversight in accordance with the process outlined in ACIN I-84-21 to be eligible for Title IV-E federal financial participation (FFP).
109. Is a CFT meeting mandatory for the QI Assessment even if it means the report will be late due to waiting for the placing agency to schedule a CFT meeting?
No, a CFT meeting is not required for the QI Assessment.
108. If the QI Clinician is unable to participate in a CFT meeting within the 30 days QI assessment time frame but were able to “engage with the CFT members” to gather pertinent information and share the final recommendation with the referring agency, would this fulfill the QI Assessment requirement?
Yes. According to ACL21-113 / BHIN 21-060 (pg. 9), the QI is required to engage with the CFT or otherwise consult with CFT members during the assessment process but does not need to attend the CFT meeting(s). The QI Process Flow chart is currently being updated to reflect that.
107. Our QI said that in the QI training it said they needed to be familiar with Tribal issues. Our QI is asking about training on tribal issues. Do you know of anything available that would satisfy this recommendation?
Work is underway to develop the required and recommended trainings for QIs, including specialized knowledge of, training about, or experience with, tribes and the federal Indian Child Welfare Act of 1978. CDSS and DHCS will be issuing additional guidance on required and recommended trainings for Qualified Individuals including ICWA trainings. Furthermore, per WIC 4096(g)(3)(D), "The qualified individual shall consult and confer with a representative of the child’s tribe or, at the direction of the tribal representative, the qualified expert witness, as described in Section 224.6. Such consultation shall include, but not be limited to, determination of the social and cultural standards of the Indian child’s tribe."
106. Does CDSS plan to review the statutory guidelines for IPC? The reason for the inquiry is the timelines for approval of both IPC and QI to get completed. Specifically, for Emergency Placements IPC approval must be sought and granted within 30 days of placement. However, with the QI having 30 days from placement to complete their assessment and may need that entire time to do so, then the 30-day IPC timeline more than likely will NOT be met. Is there the possibility of considering making a change to the IPC requirement to address this challenge?
Yes, CDSS will be reviewing the statutory guidelines for the IPC determination and will look to address the challenge.
105. With the new guidance for emergency placements, the new guidance says we can place the youth in an STRTP (emergency placement) while the QI approval is pending as long as the IPC has approved it. Does this need to be a new IPC approval or will the one within the last year still apply?
Yes, a new IPC approval is needed. The need for an emergency placement in an STRTP may occur prior to the completion of the QI assessment and the IPC subsequent review pursuant to WIC 4096(e)(2)(A).
104. If a youth is approved for STRTP placement by the IPC on 11/3/21 (QI agrees with STRTP placement as well), and the youth is placed at the STRTP. By the end of November, the youth was returned to custody for VOP’s. We will conduct the CFT and do the new QI referral, but does IPC need to approve the placement again since it was just done? Does the year still apply within FFPSA?
Yes, the IPC will need to approve the placement again. In addition, the IPC must consider the recommendations specified in the QI assessment, pursuant to WIC 4096(e)(2)(A), for determination regarding the youth's care and service needs.
103. It is our understanding that if the QI does NOT approve the STRTP placement, following an emergency placement, counties can only receive Title IV-E funds for STRTP placement for the length of time needed to transition the child out (but not to exceed 30 days). Is this from the date of the QI's determination or the date of the placement review hearing in court?
Title IV-E FFP is no longer available 30 days following the QI determination. Section 472 of the Social Security Act (42 U.S.C. 672) (k)(3), WIC 11462.01(h)(3)(B)(ii), ACL 21-113/BHIN 21-060, and ACIN I-84-21 state "If the QI determines that a placement into a STRTP is not appropriate, a county placing agency may utilize FFP for foster care maintenance payments on behalf of an otherwise eligible child while the child remains in the STRTP only for the period necessary for transition of the child. In no event is FFP available after the end of the 30-day period from the date that it is determined that a placement is no longer recommended or approved."
102. If the placing agency makes an emergency placement into an STRTP and the QI referral is not submitted until AFTER 30 days has passed from the day of placement, does the QI still need to accept/complete the referral?
While the QI referral was not submitted until 30 days after the start of the placement in the STRTP, the QI should still accept the referral and complete the assessment in order to inform recommendations for the behavioral health needs of the child. This may also prevent future referrals that are not clearly based in need for STRTP level of care. Also, the QI still needs to produce some sort of assessment to the court. Per ACIN l-84-21L, the Title IV-E FFP will not be available for the placement since the QI assessment is not completed within 30 days of placement.
101. Regarding FFPSA as it pertains to 709 WIC placements: our county has a youth who was previously under the supervision of the probation department and was found incompetent. Prior competency restoration period did not yield positive results and the case was dismissed. The youth is now back on a new case and is currently a 300WIC dependent. Our court indicated intention to take jurisdiction from HSA and explore long term 709 WIC placement. Do we follow the same FFPSA process?
Requirements do not change as federal and state law are clear: To be eligible for federal financial participation (FFP) any congregate care placement, including for placements made pursuant to WIC Section 709(g), must meet all the requirements of a QRTP, including a QI assessment and juvenile court review process.
100. Please confirm that the Qualified Individual (QI) Assessment activities claimed to SDMC are not subject to County CSI reporting requirements?
QI assessments are not subject to County Client Services Information (CSI) reporting requirements at this time.
99. What if a county Mental Health Plan is unable to provide the services expected of the QI?
If the MHP is unable to designate a QI, the MHP must contact their County Support liaison and identify their concern to DHCS.
98. What happens if a QI recommends an EBP (e.g., EMDR) that is not available through the MHP?
The Assessment Report must include recommendations regarding the beneficiary treatment needs and appropriate level of care. If a recommended service modality is not available, then the service provider may confer with the QI regarding the QI's recommendation.
97. I think our confusion/questions tends to be around the requirement of moving youth out of a STRTP due to the QI assessment. The way we are reading the ACIN is that the youth would need to move if accessing/continuing to access federal funding. However, if we are not using federal funding, the QI assessment alone is not a reason/requirement to move the youth, that the placing agency and court have the final determination of the youth’s appropriate level of placement, given the current set of dynamics/assessments. Is that correct or is there a regulation that indicates that if the QI assessment recommends home base, the county must move the youth from a STRP regardless of funding stream?
Per ACIN I-84-21 if the QI determines the child’s needs can be met in a family-based setting and placement into a STRTP is not appropriate, a county placing agency may utilize FFP for foster care maintenance payments on behalf of an otherwise eligible child while the child remains in the STRTP only for the period necessary for transition of the child. In no event is FFP available after the end of the 30-day period from the date that it is determined that a placement is no longer recommended or approved. There is no federal regulation indicating that the county must move the youth from an STRTP if the QI assessment recommends home-based setting. Any additional decisions beyond the above response would be a local decision.
96. What are the authority, requirements, and protections for sharing the QI report (from the QI to the placing agency, and the placing agency to the court)? What authority provides for the placing agency to provide the QI assessment report to the court?
The QI assessment must be provided to the county placing agency and the STRTP pursuant to WIC section 4096(g)(6).

The county placing agency is required to provide the assessment to the court as required under WIC 361.22 and 727.12.

Rule 5.618(d) precludes from the QI assessment any information that is privileged or confidential under existing state and federal law or regulation without the appropriate waiver or consent. FFPSA and AB 153 do not change existing statutes or policies around sharing confidential or privileged information. Existing county release of information (ROI) and consent to treat processes remain effective. County departments responsible for providing the QI and county placing agencies should confer with their counsel regarding the extent their existing processes are consistent with law and whether something constitutes privileged or confidential information. Existing county ROI processes may need to be changed after CDSS and DHCS jointly identify a universal ROI pursuant to WIC section 4096(g)(2)(B).
95. We are seeking clarification regarding the new QRTP/QI assessment process. Specifically, we noted that ACL 21-113 references Community Treatment Facilities (CTFs). This is the first we can recall CTFs being mentioned for the new QRTP/QI assessment process. We would like clarification on the use of this new process… Were CTFs intended to be a part of the new QRTP/QI assessment placement process? If so, what is the workflow of this process? Thus, where would the QI assessment come into this process and for what purpose?
The Mental Health assessment process and probate court process for placement into a Community Treatment Facility (CTF) are different from the FFPSA required QI assessment and juvenile court process. They differ in focus and clinical determinations with the QI assessment looking at needs and strengths and if those needs can be met in a family-based setting. In order for the mental health assessment conducted as part of the CTF placement process to function as the required QI assessment, the mental health assessment would need to be conducted by an individual who is certified as a QI, as described in ACL 21-113, and address all of the components required by WIC § 4096 for a QI assessment.
94. Is a QI assessment required if the youth is changing facilities, but the facility (building) is operated by the same provider and/or under the same license? What if the reason for the move is because the youth does not get along with other residents in the current STRTP placement, or other placement suitability reasons?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
93. For a youth who was ordered into foster care prior to October 1, was placed into an STRTP, runs from the facility and is gone for a few days but the placement remains open as does the order for foster care, can the youth return to the STRTP without a QI assessment. Same underlying scenario, but the youth runs away and cannot return to the same STRTP and is subsequently placed in a different STRTP, is a new QI assessment needed?
If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41. As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
92. Is a new QI assessment required at time of STRTP replacement (STRTP to STRTP) or can the court use the initial QI assessment during the replacement court hearing?
Moving from one licensed STRTP facility to another licensed STRTP facility does require a new QI assessment, and court review process. As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
91. In the situation of a youth who is assessed by the QI, approved for and placed in an STRTP, then transitions to home-based care, but later needs an STRTP again, would it need to be a different QI doing the new assessment for a new placement into an STRTP, or is the same QI who has previously evaluated the youth for their initial STRTP placement still acceptable? They should still be an independent/objective person, but they have prior history of assessing that youth.
No, As noted in ACYF-CB-PI-18-07 page 10, “The term “qualified individual” means a trained professional or licensed clinician who is not an employee of the title IV-E agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the title IV-E agency.” California submitted a waiver pursuant to 475A(c)(1)(D)(ii) of the Act certifying that, although the QI may be an employee of the agency or affiliated with a placement setting, the agency certifies that the QI will maintain objectivity. The Act does not specify how the state IV-E agency determines that a QI maintains objectivity.
90. When a youth runs away from a placement or is removed from placement within a short timeframe after placement (ex. first 30-45 days), does the placing agency need to repeat the process with the QI confirming STRTP suitability/eligibility and the Court confirming placement every time or do their findings stand for a certain period of time? a. If the youth is going to return to the same STRTP can the initial assessment still stand? b. If the youth is unable to return to the initial STRTP and is subsequently placed in a different STRTP, does a new QI assessment need to be completed?
Federal and state law are clear that a QI assessment and court finding are required for each placement including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
89. One of the primary concerns is considering what will happen if a young person refuses to complete the CANS, and therefore we are not able to meet the requirements of FFPSA to place the youth.
As CANS is a compilation of interviews, assessment review and other historical information it may be completed without the youth involvement. However, it is important to make effort to reengage the youth once a draft is complete to solicit their input before finalizing. The QI needs to complete the QI Assessment Report for the court including a report completed in absence of critical information. The QI must state what information the assessment is based on and what information they were not able to obtain (including CANS items).
88. If an STRTP has multiple homes within their program, does the QI need to do a new assessment if a youth is moved from one home to the other?
Federal and state law are clear that a QI assessment and court finding are required for each placement, including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If an STRTP has multiple homes/cottages under one license, then a new QI assessment would not be required (but could be beneficial).
87. Can the same QI do the multiple assessments? Can they be updates or do they have to be full assesssments?
As noted in ACYF-CB-PI-18-07 page 10, “The term “qualified individual” means a trained professional or licensed clinician who is not an employee of the title IV-E agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the title IV-E agency.” California submitted a waiver pursuant to 475A(c)(1)(D)(ii) of the Act certifying that, although the QI may be an employee of the agency or affiliated with a placement setting, the agency certifies that the QI will maintain objectivity. The Act does not specify how the state IV-E agency determines that a QI maintains objectivity. The Act does not specify requirements for “updated” assessments by a QI. As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.”
86. Does the QI Assessment Report have to be completed each time the child moves from one STRTP to another? Or can one assessment be used for a period of time? Some older youth who are chronically AWOL and it will be difficult to manage multiple assessments over a short period of time. A youth might even AWOL during the first 30 days when the QI is in the middle of completing their assessment.
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
85. What is the QI Assessment time frame if the youth is placed into another STRTP?
A new QI assessment is required, and must be completed within 30 days from the date of the referral or the date the youth is placed into the STRTP- whichever is earlier
84. Can the same QI do the second assessment if the child is referred?
As noted in ACYF-CB-PI-18-07 page 10, “The term “qualified individual” means a trained professional or licensed clinician who is not an employee of the title IV-E agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the title IV-E agency.” California submitted a waiver pursuant to 475A(c)(1)(D)(ii) of the Act certifying that, although the QI may be an employee of the agency or affiliated with a placement setting, the agency certifies that the QI will maintain objectivity. The Act does not specify how the state IV-E agency determines that a QI maintains objectivity. (lack of a treatment relationship)
83. Is a new QI referral required when a youth is transitioned from one cottage to another within the same STRTP facility license?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
82. I wanted to know what happens in the QI process if a minor elopes and is gone for a significant amount of time (e,g, more than 3 days).
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
81. If a youth is currently placed in an STRTP (prior to October 1, 2021), but the program moves the youth to a different site within the same program because of a conflict with a peer at the specific site, do a QI assessment and court orders need to be initiated?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
80. If a youth runs away and is not (a) currently placed in a STRTP and (b) not available for the QI assessment, what are the requirements on the QI Clinician?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
79. If a QI assessment is done and a child runs away, how long is the assessment valid - if the child returns within a specified time frame, can the QI assessment still stand?
If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
78. We currently have a situation with a youth who is in placement and the SW has been notified that her youth, along with all of the other youth, are being moved to another other cottage facility. We had not yet heard if there was a decision made when youth are moved from cottage to cottage. We believe a QI Assessment is not needed is this case but want confirmation. We are hoping to receive a response as soon as possible, so we know if we need to move this forward.
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
77. I am currently working on a QI assessment, the minor is at risk of losing placement. If the minor were to lose the STRTP placement, while the assessment is still in progress will another assessment be needed when they are placed potentially at a new STRTP? I am aware that I need to complete this initial assessment I am just curious if it can be used for the next STRTP placement or another one has to be completed?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
76. I have a kid that was changed from one cottage to another within the same STRTP facility (new address). He is with the same provider but the change in location was a better fit for the youth’s needs. Does that require another QI assessment?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
75. We had a youth that was placed in a home, and they were moved to another home within the same Agency. Is that considered a placement move that would trigger the QI and Court process again?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150 If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
74. Has there been a definitive answer about how long the QI Assessment is good for? Does it have to be done, every time the youth moves to a new STRTP? No matter how short the stays are?
As noted in ACYF-CB-PI-18-07 page 10 and section 475A(c)(1)(A) of the Act, “A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP.” Federal and state law are clear that a QI assessment and court finding are required for each placement. including a change in placement, which is defined as a move from one licensed placement to another. Federal guidance regarding what constitutes a placement may be found here: https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=150
If a youth is away from placement for more than 14 days, the placement upon the youth's return would be considered a new placement under federal guidance. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=41
73. Will any exceptions be made on the 30 day timeline to take into account the four day Thanksgiving, the three day Christmas, and the three day New Year weekends? Or will reports be expected to be completed early (in less than 30 days) if the due date falls within those dates?
The QI assessment must be completed within 30 days from the date of the referral or the date the youth is placed into the STRTP- whichever is earlier.
72. Is the independence/objectivity still a requirement for the QI identified by the tribe?
The requirements of the QI still need to be met. The objectivity requirement pursuant to the waiver for QI affiliation with placement setting or placing agency does apply. To fulfill Congressional intent, states must ensure that the assessment is objective and performed by a person who is qualified to make the determination and conduct all of the necessary activities. Reference: Section 475A of the Social Security Act (42 U.S.C. 675a).
71. What if the QI recommends home/family-based care but the family identified would not/does not meet RFA approval standards and does not qualify for an exemption?
The QI makes a level of care determination and provides recommendations for services and the most appropriate setting for the child, but it is the placing agency's responsibility to find the appropriate placement match within the QI's level of care determination, including identifying a family that meets all RFA requirements. If at all possible, the placing agency should assist families to meet RFA requirements for approval.
70. The draft QI All County Letter (ACL) noted that only a CANS done within the last two (2) months can be updated, but the CANS are usually done every six (6) months. Do we have to start from scratch on a new CANS or can any information from a prior CANS be used by the QI?
According to ACL 21-113 / BHIN 21-060, "If the IP-CANS assessment tool has already been completed as part of the CFT process within the last two months, under WIC Section 4096(g)(3)(B), the QI may either utilize or update those results at the discretion of the QI." All IP-CANS items must be rated and any items without a rating can be addressed through the CFT process. (ACL 21-113/BHIN 21-060, Page 10-11).
69. If a QI approves placement into an STRTP before an STRTP is identified, will the QI have to do an additional assessment once a STRTP is identified and child is placed?
The QI is making a level of care placement determination, which may be completed prior to placement or upon placement. The QI is not required to complete an additional assessment once an STRTP is identified and a child is placed.
68. What if the IPC and the QI disagree over an STRTP placement selection – which entity takes priority? Or, if only one disagrees, does the county have to start again with another STRTP and QI assessment?
The QI makes a level of care determination, but it is the placing agency's responsibility to find the placement match, in collaboration with the CFT. Once an STRTP is identified by the placing agency, in collaboration with the CFT, the IPC's role is to confirm whether or not the identified STRTP has the capacity to meet the behavioral health needs of the youth consistent with the QI's recommendations.
67. We are concerned that some of the activities outlined in ACL 21-113 are not clearly outlined as Medi-Cal reimbursable activities in Behavioral Health Information Notice 21-062. The lack of alignment puts into question how these activities will be reimbursed. County behavioral health agencies need information on how they will be reimbursed for the activities included in ACL 21-113 but not included as Medi-Cal reimbursable in BHIN 21-062.
While the fiscal BHIN’s activity list is shorter than the list in the ACL 21-113/BHIN 21-060, it encompasses all of the activities listed in the ACL 21-113/BHIN 21-060, which is supposed to serve as more detailed guidance. All QI activities listed in the ACL 21-113/BHIN 21-060 fit under Mental Health Services and ICC service categories that may be claimed by the QI.
66. Would a child receiving AAP benefits (a finalized adoption) be subject to rules of FFPSA if they needed the level of care of an STRTP?
When an adoptive parent seeks to place their child in an STRTP, it is considered a private placement. A QI assessment is not required for private placement into an STRTP, such as when the placement is made by an adoptive parent, even when the AAP rate will be authorized to fund the placement.
65. If a youth is under conservatorship, do the new STRTP requirements under FFPSA/AB 153 such as QI Assessment and court hearing for STRTP placement still apply event though the courts don’t make orders while the youth is under conservatorship?
Whenever a county has a question involving a youth who is under the jurisdiction of both a probate court and the juvenile court, the county should confer with their county counsel’s office regarding 1) who has authority, based on both courts’ orders, to select a placement for the child, 2) who has the authority based on both courts’ orders to make the actual placement, i.e. sign the placement agreement on behalf of the youth, and 3) what funding stream is being used to pay for the placement. The establishment of a conservatorship over a child does not automatically terminate juvenile court jurisdiction or end the county placing agency’s responsibility to ensure the child is receiving all legally required services. Responsibility will be dependent on the court orders of both the probate court and the juvenile court. If the STRTP placement is made by the placing agency and will be funded with foster care dollars, then it must meet all the requirements, including a qualified individual assessment, for a QRTP under Title IV-E. The court review and case management requirements of the STRTP placement must also be met.
64. Can we invite a QI to attend a CFT meeting even before completing a QI referral if we know that STRTP placement might be recommended?
A completed referral would trigger the QIs engagement. According to ACL 21-113 / BHIN 21-060, during the QI assessment must "engage with the CFT during the assessment or otherwise consult with the CFT members". "Under WIC Section 4096(g)(3)(A), the QI is required to engage with the CFT including the Indian child’s tribe in the case of an Indian child." This may include attending CFT meeetings.
63. We have a youth who is currently detained in juvenile hall and potentially being ordered to out-of-home placement. We had the initial CFT this morning and not all parties agreed with the out-of-home placement recommendation. If not all parties agree, can we continue the process with the referral to the QI?
The process for referral to the QI can continue if the conditions for QI referral are met as described in ACL 21-113/BHIN 21-060. The QI during their assessment will engage with members of the CFT and will document the recommendations of the CFT in the Assessment Report. If the QI recommends STRTP, those who are a party to the case can object to the court during the Court Hearing process after placement.
62. Can a CANS other than the IP CANS be used for the QI assessment?
If the county CANS tool meets or exceeds the domains of the IP CANS, it may be utilized. All IP-CANS items must be rated and any items without a rating may be addressed through the CFT process. (ACL 21-113/BHIN 21-060, Page 10-11). In addition, if the IP-CANS assessment tool has already been completed as part of the CFT process within the last two months, under WIC Section 4096(g)(3)(B), the QI may either utilize or update those results at the discretion of the QI.
61. In our county we allow voluntary cases (VFR) to be placed into a STRTP. Obviously a VFR is not a court case and the youth is not a dependent. If a youth in a Voluntary Family Reunification (VFR) case is being considered for a STRTP, does the youth have to be assessed by the QI (meaning a QI Referral would be made)? Is a court hearing required?
The judicial/administrative review requirements in Title IV-E that apply to placements in a QRTP (42 U.S.C. § 675a) make no distinction between placement pursuant to a voluntary family reunification (VFR) plan vs. placement made within the context of a dependency proceeding. The key is that the placement is made by a Title IV-E agency, which applies to either situation. All of FFPSA requirements would need to be met.
60. Does the QI identified by a tribe still needed to be a clinician who would contract with the County MHP to provide the QI services? What is meant by the reference that the Tribe may designate a person as the QI consistent with the characteristics of a Qualified Expert Witness under WIC 224.6(c). A QEW for purposes of ICWA cases does not require a clinician or registered/waivered professional under the direction of a LMHP.
The QI must meet the established qualification and competency requirements: AB 153 WIC Section 16501 states Consistent with Section 675a(c)(1)(D) of Title 42 of the United States Code, “qualified individual” means a trained professional or licensed clinician responsible for conducting the determination described in subdivision (g) of Section 4096 and determining the most effective and appropriate placement for a child. In the case of an Indian child, as defined in Section 224.1, a person may be designated by the child’s tribe as the qualified individual pursuant to this subdivision and as defined in subdivision (c) of Section 224.6. In the absence of that designation, the qualified individual shall have specialized knowledge of, training about, or experience with, tribes and the federal Indian Child Welfare Act of 1978 (25 U.S.C. Sec. 1901 et seq.). CDSS and DHCS have further clarified in ACL 21-113/BHIN 21-060 under the authority in WIC Section 4096(h), the QI must be a licensed mental health professional (LMHP), or be a registered, waivered, or a trained professional who is working under the clinical supervision of a LMHP. Any individual serving as a QI shall have the expertise and training in clinical assessment, treatment planning and Intensive Care Coordination (ICC), consistent with scope of work requirements necessary to perform the functions of the QI
59. When does the State plan to develop training related to the QI working with tribes, when applicable?
Work is underway to develop the required and recommended trainings for QIs, including specialized knowledge of, training about, or experience with, tribes and the federal Indian Child Welfare Act of 1978. In addition, Tribal workgroups are beginning in November to develop the process for Tribes to designate an individual to serve as the QI.
58. We have licensed clinicians that are stationed at our CWS offices, but are employees of the County’s Mental Health department. Would our Agency need to go through the exemption request process if we planned to use them as the QI for our County? They aren’t employed by the placement agency, but they do work in the same building.
Under section 475A(c)(1)(D) of the FFPSA, and Welfare and Institutions Code section 16501(l)(2) [AB 153], a qualified individual must not be an employee of the agency administering or supervising the title IV-B plan, the title IV-E plan and/or the title XX program, and further the qualified individual must not be connected to, or affiliated with, any placement setting in which children are placed by the state more broadly, including any state agency. In the case of a superagency where child welfare and behavioral health departments are under a single agency director, an employee of the behavioral health department may serve as a Qualified Individual so long as 1) the behavioral health department employee acting as the QI does not also work for the child welfare services department in any capacity, 2) the overarching agency maintains a clearly delineated separation of oversight and management between the two departments within the agency, 3) the independence and objectivity of employees in each department are protected by the agency’s structure, and 4) the agency’s structure prevents any actual or potential conflict of interest for a behavioral health employee serving as a QI. In counties with Superagencies where it is not possible to clearly delineate a separation of oversight between the two departments, due to the size of the county or other reasons, the county may need to pursue alternatives such utilization of behavioral health contractors to serve as the QI, or approval of a waiver for the QI.
57. Does the IPC determine the specific STRTP or does the county placing agency?
The county placing agency, in collaboration with the CFT, identifies the specific STRTP. The IPC determines a child’s eligibility for STRTP placement pursuant to WIC Section 4096(e)(1) and ensures that the specific placement facilities or programs identified by the placing agency and CFT have the capacity to address the needs of the child as specified in WIC Section 4096(e)(2).
56. What is the status of the QI waiver request that was sent to the Feds to allow the QI to be employed by a placing agency?
The waiver request is still under review by ACF.
55. Does an STRTP need to be identified before a QI referral is submitted?
No. A referral by the social worker or probation officer must be sent to the qualified individual for an assessment whenever placement of a child into an STRTP is being considered. Reference ACL 21-113/21-060
54. Will there be any issues with presumptive transfer of MHP billing or accepting youth from multiple counties into an STRTP as a result of FFPSA in regards to QI assessment?
The role of the QI will be performed by the county of jurisdiction.
53. What if the minor's legal representative is unknown/ missing, who can sign on the minor's behalf? Can the minor sign?
See WIC 369 as to social worker's authority to sign. Minor may sign in many circumstances that are detailed in the memo that was linked in Hong's first question. In addition to the memo above, this chart might be helpful: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=369.
52. At what age can a minor sign an ROI? Can Social worker or probation officer sign ROI on behalf of the minor?
See WIC 369 as to social worker's authority to sign. Minor may sign in many circumstances that are detailed in the memo that was linked in Hong's first question. In addition to the memo above, this chart might be helpful: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=369.
51. When a youth is stepping down from a PHF to a CTF or STRTP level of care, is a QI assessment required?
Yes, a QI assessment is required for placement into an STRTP or Community Treatment Facility. (pg. 2 of ACL 21-113 / BHIN 21-060)
50. If the youth refused to participate in the assessment, should the QI process continue and recommendations be made without the youth's input?
The QI must make reasonable efforts to engage the youth and the family. The QI should identify the reason why the youth is not able to participate and document the reason in the QI Assessment Report. The process may continue without the youth’s input. It is important to make an effort to reengage the youth once a draft is complete to solicit their input before finalizing the QI assessment.
49. Is a QI assessment required for a Voluntary Family Reunification case?
Yes. The judicial/administrative review requirements in Title IV-E that apply to placements in a QRTP (42 U.S.C. § 675a) make no distinction between placement pursuant to a voluntary family reunification (VFR) plan vs. placement made within the context of a dependency proceeding.
48. Once the QI makes the initial determination for STRTP placement, does that same QI follow the youth throughout their stay in that STRTP? What’s the on-going expectation of the QI to oversee the youth’s treatment and care?
The caseworker, in collaboration with CFT and the STRTP, has the responsibility of the ongoing assessment. Following the QI assessment, the placing agency maintains the ongoing responsibility for monitoring the child’s needs and placement into the family-based setting or STRTP, as detailed in ACL 21-114. If the child requires a new STRTP placement, the placing agency shall submit a subsequent QI Referral form. (pg. 13 ACL 21-113 / BHIN 21-060)
47. Would a "shortage of TFC or ISFC homes" be considered an acceptable reason for determing needs of minor cannot be met in a family based setting?
Under WIC Section 361.22 (e) (2) and WIC 727.12 (e) (2) A shortage or lack of resource family homes shall not be an acceptable reason for determining that the needs of the minor or nonminor dependent cannot be met in a family-based setting.
46. Can a QI assessment that results in a determination for a STRTP level of care be used more than once if the child is changing STRTPs or does the QI assessment need to be conducted again?
Federal law is clear that a QI assessment and court finding is required for each placement. In the event there is ambiguity in how we write statute, the ambiguity must be resolved consistent with the federal and state law.
45. Submitted by county as URGENT: who can sign for consent of treatment and release of information forms? Would the assigned Social Worker be the correct person to sign the consent to treatment and the release of information?
The advent of a QI assessment does not change existing policies concerning consent and releases of information. CDSS and DHCS would direct you to follow your existing local policy for signature of releases and consent to treat. If you are unsure about your local practice, please consult your direct supervisor, and/or your county counsel. Reference Welfare and Institutions Code Section 369, https://www.courts.ca.gov/documents/CFCC_Brief_HealthCare.pdf, and State Health Information Guidance (SHIG) 5.0 – Sharing Minors and Foster Youth Health Information in California”
44. Is the QI report due within 30 calendar days or 30 business days?
The QI has 30 calendar days from the day they receive the referral or 30 calendar days from placement for an emergency placement to complete the QI Assessment Report, which ever occurs first. (ACL 21-113/BHIN 21-060, Page 8)
43. Can the QI be from an FFA?
The QI is a person provider (Title IX 1810.235) and their affiliation with the placement setting is a determining factor whether they can perform the QI activities or require a waiver. The QI who has a direct affiliation with the placing agency or placement setting cannot perform the QI activities without a waiver.
42. For the continued placement of a child in a QRTP for more than 12 consecutive months or 18 non-consecutive months, the statutory language of Family First requires sign-off from the head of the state (CDSS Director) or tribal agency and cannot be done at the county level. [§475A(c)(5)(B); P.L. 115-123 §50742] Could you confirm with the Feds?
CDSS has confirmed the following response with ACF. PI-18-07 clarifies that the state or local agency administering the title IV-E plan must submit the signed approval for a long term QRTP placement to the HHS Secretary. This means that the head of a state, regional or local agency must sign the approval for a long term placement, and the approval cannot be further designated either to another agency or to another staff person within the agency such as an assistant director. Per page 12 of PI-08-07, the agency must document in the child’s case plan that the head of the state, tribal, or local agency approved the child’s continued placement in the QRTP to claim title IV-E FCMPs after the first 12 consecutive months or 18 nonconsecutive months of the placement (or, in the case of a child who has not attained age 13, the first six consecutive or nonconsecutive months) (section 472(k)(1)(B) of the Act).
41. Will a foster youth or nonminor dependents (NMD) who are placed in a Transitional Housing Program (THP)-NMD (THP+FC) or THP Program (THPP) placement after 10/1 will also need QI assessments. I am not seeing anything specifically about these types of (non-family setting) housing options needing QI assessments, but there is a lot of FFPSA information out there and I just want to confirm I have not missed anything.
The Transitional Housing Placement Program is divided into two categories - one for minors and one for nonminor dependents. See HSC 1559.110. THP-NMD is a setting for individuals aged 18 up to 21 and meets one of the federally eligible child care institution placement settings other than a QRTP. Therefore, FFP is available and no QI assessment is needed. THP for minors is neither a QRTP nor a setting for individuals aged 18 and over. It fails to qualify as one of the other placement settings either. Thus THPs for minors are not eligible for FFP and there is no need for a QI referral or a QI assessment.
40. Is a QI needed to step down level of care? For example, if a youth is successfully working on CFT transition plan and transitioning from STRTP to Transitional housing.
A QI assessment is not required to step down from an STRTP. The QI assessment report includes mental and behavioral health goals which indicate when the youth is ready to step down to a lower level of care. The QI assessment report also provides recommendations for aftercare services to support transition of the child from an STRTP to a family-based setting.
39. Is a QI assessment necessary for youth being placed in a Resource Family home?
A QI assessment is not required for placement with a family or a family-based setting. A QI assessment is only required for placement into an STRTP or Community Treatment Facility.
38. Is the QI assessment report due within 30 days of referral to the QI or within 30 days of placement?
Unless the placement is an emergency placement, the QI must conduct the assessment and make a determination regarding the needs of the child prior to placement into an STRTP. When the QI receives the referral prior to placement, the QI has 30 calendar days from the date of the referral, or from the date the child is placed into an STRTP, whichever comes first, to complete the assessment. In the event of an emergency placement, the QI must conduct the assessment and determination regarding the needs of the child within 30 calendar days of the start of the placement. (ACL 21-113/BHIN 21-060 page 8)
37. If a QI determines that an STRTP placement is not appropriate for a youth, but the youth is placed in an STRTP anyway, will there still be federal funding for that placement? Another way to look at it is, if IPC says that an STRTP is appropriate but the QI says it’s not, the Court then chooses to order the STRTP placement will it be covered by federal funds? When I spoke to our behavioral health services, who will be doing our QI process, they were under the understanding that their recommendation did not affect funding.
FFP is affected by a QI recommendation against placement at an STRTP level of care. IPC disagreement with the QI has no impact on FFP. If the court orders placement in an STRTP when the IPC recommends for it and the QI recommends against it, the child must be placed in the STRTP. If the court orders placement in an STRTP after the QI determines the needs can be met in a family-based setting, then the child must be placed in the STRTP. Title IV-E funding will not be available for the placement. If the court orders placement in an STRTP before the QI determination and the QI determination recommends care in a family-based setting, then Title IV-E funds will no longer be available for the STRTP placement starting 30 days after the QI’s determination for home-based care.
36. If the child is non-fed not federally eligible, is the QI assessment and court approval still required?
Yes, counties still have to follow the requirements of FFPSA. AB 153 does not differentiate between federally eligible and non-federally eligible children.
35. Does the State have written confirmation that IV-E funding will be paid if the assessment is completed before the child is placed into a STRTP?
Federal program instructions in ACYF-CB-PI-18-07 (page 12) state: “30-day assessment by a qualified individual. A qualified individual must assess a child placed in a QRTP within 30 days of the start of each placement in a QRTP (section 475A(c)(1)(A) of the Act). The qualified individual may conduct this assessment prior to the placement in the QRTP, but must complete it no later than the end of the 30-day period. If the assessment is not completed within 30 days, the title IV-E agency cannot claim title IV-E FCMPs for the entirety of the QRTP placement (including not for the first 14 days), but may claim title IV-E administrative costs during the placement in the QRTP (section 472(k)(3)(A) of the Act). These are administrative costs as defined in 45 CFR 1356.60 for the administration of the title IV-E program, and not the costs of the administration and operation of the QRTP/CCI. Those costs are only allowable when a title IV-E FCMP is provided for the child.”
34. If a youth is placed in an STRTP, and the QI subsequently completes their assessment and recommends family-based care, at what point will funding for the STRTP be impacted?
After the QI makes a determination of family based care, FFP may be claimed for the STRTP placement for up to 30 calendar days following the QI determination.
33. If the judge makes an order for an STRTP, when the QI has determined a youths needs can be met in a family-based setting, can Title IV-E funding be used for the placement?
If the court orders placement in an STRTP after the QI determines the needs can be met in a family-based setting, then the child must be placed in the STRTP. Title IV-E funding will not be available for the placement. If the court orders placement in an STRTP before the QI determination and the QI determination recommends care in a family-based setting, then Title IV-E funds will no longer be available for the STRTP placement starting 30 days after the QI’s determination for home-based care.
32. Do counties still have to follow the requirements of FFPSA part IV if a youth or NMD is not federally eligible?
Yes, counties still have to follow the requirements of FFPSA. AB 153 does not differentiate between federally eligible and non-federally eligible children.
31. What if the QI recommends home-based family care but the court orders the youth into an STRTP?
The QI is not responsible for placement decisions. The youth must be placed according to the court's decision. If an otherwise eligible child has been placed in the STRTP pending the QI assessment, Title IV-E funds will not be available for the STRTP placement 30 days after a determination for home-based care is made by the QI. If an otherwise eligible child was not placed in the STRTP pending the QI assessment and the court orders the placement in the STRTP, the placement may not be supported with Title IV-E funds.
30. Does the QI speak to the match of the particular STRTP or just to level of care?
The QI will make certain determinations regarding whether the child’s needs can be met with family members or in a family setting, and, if not, the most appropriate level of care, interventions, and treatment for the child. (pg. 5 ACL 21-113 / BHIN 21-060) “If the QI recommends the child needs an STRTP level of care, the IPC must determine the child’s eligibility for STRTP placement under WIC Section 4096(e)(1) and the appropriateness of the specific STRTP recommended by the placing agency.” Pg. 11 ACL 21-113 / BHIN 21-060
29. Per federal law, the QI is supposed to make a placement recommendation related to the child/youth’s behavioral health needs. Please clarify the purpose of the Medical Health section for the QI referral.
"The QI will conduct an assessment to determine the child’s behavioral health needs and goals and make certain determinations regarding whether the child’s needs can be met with family members or in a family setting, and, if not, the most appropriate level of care, interventions, and treatment for the child. A clinical assessment should take into consideration any medical needs the child has when making a level of care recommendation." pg. 5 ACL 21-113 / BHIN 21-060
28. Would the QI person need to be certified in the IP-CANS or if they are certified in the CANS 50 is this sufficient?
For CANS certification purposes, the certification is considered valid by the Praed Foundation without consideration to a particular version of the CANS. Certification in the CANS 50 is sufficient at this time. QIs who are not trained and certified in the IP-CANS domains will be offered a "booster training" to support their knowledge of the items reflected in the IP-CANS.
27. What is the background of the QI?
Under the authority in WIC Section 4096(h), CDSS and DHCS have determined the QI must be a licensed mental health professional (LMHP), or be a registered, waivered, or a trained professional who is working under the clinical supervision of an LMHP. In the case of an Indian child, as defined above and in WIC Section 224.1, a person may be designated by the child’s tribe as the QI. In the absence of that designation, the QI must have specialized knowledge of, training about, or experience with, tribes and the federal Indian Child Welfare Act (ICWA) of 1978 (25 U.S.C. Sec. 1901 et seq.). Any individual serving as a QI shall have expertise and training in clinical assessment, treatment planning, and Intensive Care Coordination (ICC), consistent with scope of work requirements necessary to perform the functions of the QI.
26. 1. For the QI assessment, if a youth was ordered in to foster care on September 9 but is not actually placed into an STRTP until October 7, does probation need to move forward with a QI referral and assessment? Or are the QI requirements effective for all orders into foster care dated October 1 and going forward?
The federal statute requires that if a child is placed on or after October 1, 2021, then a QI assessment would need to be completed within 30 calendar days from the date of the QI referral or 30 days from the date of the placement, whichever occurs first.
25. When does the IPC process come into play? Will they be part of sending the referral to the QI or will it go to the QI prior to IPC process becoming involved?
"While county IPC processes will vary, the IPC process is involved in the following circumstances at a minimum.
Emergency Placement:
An emergency placement is a placement made prior to a
determination by the IPC, but only if a licensed mental health professional determines within 72 hours of placement that the child appears to require the level of services and supervision provided by the STRTP.
QI Referral:
The IPC is not required to be part of the QI referral process.
Upon receiving a referral prior to placement, the QI has 30 calendar days from the date of the referral or from the date the child is placed into an STRTP, whichever comes first, to complete the assessment.
QI Referral Process Flow:
CFT members agree that the child needs a QI assessment to determine the strengths and needs and the most effective and appropriate level of care. All Release of Information forms are signed. The placing agency submits a QI referral. The placing agency caseworker follows their county process for initiating an IPC meeting. IPC ensures the implementation of the QI recommendations and makes a determination pursuant to WIC Section 4096(e)(1)(2). The IPC is charged with confirming that the specific STRTP identified by the placing agency and CFT has the array of services to meet the child’s needs as identified by the QI. "
24. Is the QI needed every 6 months like the Court and IPC review, or is it just upon initial placement and placement changes?
No, there is no requirement to update the QI Assessment at regular intervals. Circumstances that indicate the need for a referral for a QI assessment are noted on pg. 7 of the ACL 21-113 / BHIN 21-060.
23. Who is the QI? Are they a county employee? It is not an STRTP employee, is that correct?
The QI will be an employee of or contracted with the MHP. Under the authority in WIC Section 4096(h), CDSS and DHCS have determined the QI must be an LMHP, or be a registered, waivered, or a trained professional who is working under the clinical supervision of an LMHP. Any individual serving as a QI shall have expertise and training in clinical assessment, treatment planning, and Intensive Care Coordination (ICC), consistent with scope of work requirements necessary to perform the functions of the QI. Unless California obtains a waiver, the QI may not be an employee of the Title IV-E agency or connected to, or affiliated with, any placement setting in which the Title IV-E agency places children.
22. Who is responsible for completing the QI Assessment? Should the QI assessment be completed prior to a client being admitted to the STRTP?
Under the authority in WIC Section 4096(h), CDSS and DHCS have determined the QI must be a licensed mental health professional (LMHP), or be a registered, waivered, or a trained professional who is working under the clinical supervision of an LMHP. In the case of an Indian child, as defined above and in WIC Section 224.1, a person may be designated by the child’s tribe as the QI. Unless California obtains a waiver, as described in ACL 21-113/BHIN 21-06, the QI may not be an employee of the Title IV-E agency or connected to, or affiliated with, any placement setting [e.g., STRTP] in which the Title IV-E agency places children. The QI must conduct the assessment and make a determination regarding the needs of the child prior to placement into an STRTP or in an out-of-state residential facility, as defined by Family Code Section 7910(b)(2). In the event of an emergency placement, the QI must conduct the independent assessment and determination regarding the needs of the child within 30 days of the start of the placement.
21. If a youth leaves a facility and returns to the same facility, is a new assessment required?
If the placement remains open and the youth returns to the same STRTP after whatever episode or incident occurs, there should not be a need for a new QI assessment.
20. Is a waiver required for a SMHS contract provider when that provider also has a placement setting? If yes, can we submit a waiver?
The QI is a person provider (Title IX 1810.235) and their affiliation with the placement setting is a determining factor whether they can perform the QI activities or require a waiver. The QI who has a direct affiliation with the placing agency or placement setting cannot perform the QI activities without a waiver. CDSS/DHCS do not have an approved waiver plan from ACF at this time.
19. My county has a superagency meaning that our Child Welfare and Behavioral Health are all part of a single department. The information states that the QI should not be a member if the Title IV program, I would assume that in our case that means Behavioral Health can not be the QI?
Under section 475A(c)(1)(D) of the FFPSA, and Welfare and Institutions Code section 16501(l)(2) [AB 153], a qualified individual must not be an employee of the agency administering or supervising the title IV-B plan, the title IV-E plan and/or the title XX program, and further the qualified individual must not be connected to, or affiliated with, any placement setting in which children are placed by the state more broadly, including any state agency. In the case of a superagency where child welfare and behavioral health departments are under a single agency director, an employee of the behavioral health department may serve as a Qualified Individual so long as 1) the behavioral health department employee acting as the QI does not also work for the child welfare services department in any capacity, 2) the overarching agency maintains a clearly delineated separation of oversight and management between the two departments within the agency, 3) the independence and objectivity of employees in each department are protected by the agency’s structure, and 4) the agency’s structure prevents any actual or potential conflict of interest for a behavioral health employee serving as a QI. In counties with Superagencies where it is not possible to clearly delineate a separation of oversight between the two departments, due to the size of the county or other reasons, the county may need to pursue alternatives such utilization of behavioral health contractors to serve as the QI, or approval of a waiver for the QI.
18. After the Qualified Individual (QI) has recommendations, is it expected that another Child and Family Team (CFT) meeting is set so that the QI can present the recommendations??
The QI can attend a CFT and/or engage with CFT members to share the Assessment Report, recommendations and collaborate with the CFT to align the case plan, permanency plan and treatment goals (ACL 21-113/BHIN 21-060, Page 9).
17. Determining all identified or potential caregivers will be the responsibility of the placing agency and part of the referral form. The QI is then only obligated to work with those identified as part of the CFT, which will be provided by the placing agency. Is this also DHCS/CDSS’ understanding?
The QI referral form provides contacts for information sources and the QI is not limited to the referral form for information sources.
16. Can CDSS clarify how the QI assessment is separate and different from the CANS and other assessments? Youth and families should not be subjected to any more assessments than are necessary.
The QI assessment is meant to be a SMHS and must meet the requirements for a SMHS assessment as defined in the State plan. The QI assessment is comprehensively addressing the referral question. If the IP-CANS assessment tool has already been completed as part of the CFT process within the last two months, under WIC Section 4096(g)(3)(B), the QI may either utilize or update those results at the discretion of the QI. All IP-CANS items must be rated and any items without a rating can be addressed through the CFT process. (ACL 21-113/BHIN 21-060, Page 10-11).
15. There is nothing precluding the use of telehealth to conduct QI activities, is this also DHCS/CDSS’ understanding?
It is encouraged to conduct QI activities in person, however; the use of telehealth is permissible under the Covid-19 Public health emergency.
14. I have heard two different timelines for the report. Most say the QI has 30 days to complete the report, but California Behavioral Health Directors Association (CBHDA) said the QI had only 7 days to complete the report? If it is an emergency placement then you have 30 days.
The QI has 30 calendar days from the day they receive the referral or 30 calendar days from placement for an emergency placement to complete the QI Assessment Report, whichever occurs first. (ACL 21-113/BHIN 21-060, Page 8)
13. Assuming a youth is placed in an STRTP, and the provider submits a 14-day notice that goes into effect before the QI assessment is completed. If the youth is placed in a new STRTP, does the QI have a new 30-day window in which to complete the assessment
The QI has 30 calendar days from the day they receive the referral or 30 calendar days from placement for an emergency placement to complete the QI Assessment Report, whichever occurs first (ACL 21-113/BHIN 21-060, Page 8). The 30 day mark does not restart.
12. Can the QI recommend a type of therapy? Like EMDR?
Yes, the QI is recommending a therapy service and specifying a modality that would be beneficial for the child, Eye Movement Desensitization and Reprocessing (EMDR).
11. Can the QI assessment be updated to reflect a specific Counties’ version of their CANS?
If the county CANS tool meets or exceeds the domains of the IP-CANS, it may be utilized.
10. Who must the MHP/QI provide copies of the assessment summary report and the comprehensive assessment to? Will there be additional documentation beyond the summary report and assessment?
The QI provides the QI Assessment Report form to the placing agency case worker (ACL 21-113/BHIN 21-060, Page 10).
9. The placing agency will be required to complete IP-CANS and share this with the MHP/QI for review, is this also DHCS/CDSS’ understanding?
The QI may receive the CANS as part of the initial referral. If the IP-CANS assessment tool has already been completed as part of the CFT process within the last two months, under WIC Section 4096(g)(3)(B), the QI may either utilize or update those results at the discretion of the QI. All IP-CANS items must be rated and any items without a rating can be addressed through the CFT process. (ACL 21-113/BHIN 21-060, Page 10-11).
8. There may be areas that are outside of the scope of the QI/MHP for certain interventions listed within the assessment summary report. Can the State please explain the way in which the QI should request additional assessments to be conducted timely by other entities and how this should be included within the report? (e.g., speech and language, physical therapy, ABA, regional center, and educational services?).
The QI as part of their assessment of the child's needs may identify a specialized service need and recommend an appropriate referral.
7. According to ACIN I-73-21, "The QI will determine and document whether the assessed needs of the child or NMD can be met with family members, in a tribally approved home in the case of an Indian child, or in another family-based setting. In making this determination the QI will perform and document the following: An assessment of the strengths and needs of the child or NMD using IPCANS and methodology approved by the CDSS and DHCS." So, who performs the CANS Is it the County staff who will perform CANS and the QI will "perform and document" our "assessment of the strengths and needs of the child"? OR is it the QI who will perform CANS themselves and document those findings?
The placing agency case worker obtains the most current CANS as part of the QI referral, and then, as part of the QI assessment, the QI updates the CANS, including IP CANS domains. If there is not an existing CANS, the QI completes the CANS including the IP CANS domains in collaboration with the CFT during their assessment. Juvenile probation departments are not required to complete the CANS.
6. We believe the placing agency will be responsible for securing necessary authorizations to release records including those developed by the QI. If this is not the case, will county behavioral health need to obtain the youth’s signature on an authorization to release records prior to providing the summary report and/or comprehensive assessment to other entities (e.g., placing agency, CFT, courts, etc.)? If so, what steps should the county take if the youth refuses to sign an authorization to release copies?
The agency submitting a QI referral is responsible for completing the Release of Information (ROI) forms. All ROIs must be signed by appropriate parties for the QI to be able to gather information. Counties must use current ROI forms and processes until CDSS and DHCS identify a specific universal ROI and further guidance is issued. (ACL 21-113/BHIN 21-060, Pg. 8) It is recommended that the ROI is completed as part of the CFT process that results in the referral to the QI.
5. As part of the QI referral packet, the caseworker is supposed to include a signed consent to treat form. Is there a template form that the state recommends to be used by county placing agencies?
The CDSS and DHCS do not plan to designate a specific Consent to Treat form to be used as part of the QI assessment. County placing agencies should continue to utilize their existing Consent to Treat forms.
4. What is the status of California's QI waiver request?
CDSS and DHCS worked with the associations, advocates, and other stakeholders to draft a Request for Qualified Individual Waiver. The Request was submitted to the Administration for Children and Families (ACF) on October 1, 2021.
3. If the QI assessment takes over 30 days, do we lose federal funding?
FFP for the placement would not be able to be claimed past the initial 14 days of the placement, however FFP for admin costs can still be claimed in that circumstance.
2. If we already qualified youth prior to October 1st which means CFT completed and IPC completed, and youth was deemed appropriate for STRTP however still waiting for an opening in a STRTP is a QI assessment required for these youth or just new referrals after October 1st?
The federal statute requires everything to start as of date of placement. So, If a child is placed on or after October 1, 2021, then a QI assessment would need to be done within 30 days and a court hearing within 45 days.
1. When will the required trainings for the Qualified Individuals be available, and by when do the Qualified Individual need to be certified? Can a QI complete a report/assessment prior to receiving the training?
All individuals identified to serve as a Qualified Individual must complete the Getting Started as a Qualified Individual training. Mental Health Plans will track to ensure that Qualified Individuals have completed this training prior to being assigned any QI assessments.By completing the Getting Started training, Qualified Individuals will be oriented to their role and able to conduct QI assessments. CDSS and DHCS will be issuing additional guidance on required and recommended trainings for Qualified Individuals.

Aftercare

32. "We have our first FFPSA Wraparound referral, presumptive transfer to our County. We are working on integrating codes into EHR system and have a couple of questions.
-When a child comes for aftercare / Wraparound services, will all the services they qualify for need the HV modifier (such as ICC, IHBS, Case management, Rehab, TBS) ?
-Do we need to collect FFPSA Medical Department Data?
-Is the State ready to accept HV modifier codes/data at this time?"
"#1 - If the county would like to receive reimbursement for the State share of the approved amount, the claim will need an HV modifier. The HV modifier will be used to track aftercare services provided for the six months post-discharge.
#2 - More information has been requested to help clarify the question.
#3 - The SD/MC billing system has not been updated to accept the HV modifier. DHCS will e-mail all SD/MC users once the system has been updated to accept the HV modifier. "
31. Wraparound has traditionally been voluntary. With FFPSA Part IV aftercare, are the families required/mandated to accept services, much like required/court ordered case plans?
"WIC section 4096.6, which states that by October 1, 2021, each county child welfare agency, probation department, and mental health plan (MHP), in consultation with the local interagency leadership team established pursuant to Section 16521.6, will jointly provide, arrange for, or ensure the provision of at least six months of post-discharge aftercare services to be provided to children discharged from a placement in an STRTP or from an out-of-state residential facility to a family-based setting. There is no provision requiring children and families to participate.

In alignment with the principles and standards of Wraparound, case workers and probation officers should actively engage the child and family, explaining the services and benefits of participation in Wraparound/aftercare. Additionally, case workers would not enter the "S-Wraparound" special projects code into CWS/CMS, but rather document their efforts and response in the case contact notes section."
30. Is aftercare required for discharge from voluntary placements in a STRTP (there is no court involvement)?
The judicial/administrative review requirements in Title IV-E that apply to placements in a QRTP (42 U.S.C. § 675a) make no distinction between placement pursuant to a voluntary family reunification (VFR) plan vs. placement made within the context of a dependency proceeding. The key is that the placement is made by a Title IV-E agency, which applies to either situation. So, counties would still be required to offer aftercare services under this circumstance.
29. If we are a provider, can our DSS contract holder determine that we need to travel to the other county and/or provide telehealth services to kids outside of the county the agency resides?
Potentially. Counties and contracted providers negotiate the terms and deliverable of their contracts.
28. Will this S-Wraparound Program track ALL Wrap cases or just Aftercare. If yes, will there be a way to differentiate?
The "S-Wraparound" special project code (SPC) will track all Wraparound cases, per ACL 08-66. However, the CDSS will create reports and methodology limiting the denominator/population to those youth discharging from STRTPs to family-based settings, so counties and the state can develop various reports and measures, including to track youth for whom Wraparound (aftrcare) has and has not been initiated.
27. Will CDSS and DHCS consider giving counties 30 days from release of Aftercare ACL and CFL to submit their plans. Given all the FFPSA requirements, it may take time to pull together the meetings necessary to complete this plan.
Although the due date for the Wraparound/Aftercare County Plan is November 15, 2021, CDSS and DHCS understands counties may need additional time to complete the plans for a variety of reasons, including waiting on the information included in the County Fiscal Letters. Although the due date of November 15, 2021 cannot change at this point, the Departments understand that some plans will be submitted after the due date.
26. Is Wraparound Aftercare provided for children placed in an STRTP before 10/1/21, even if the children remained stable and discharged without any placement moves, but the discharge date is after 10/1/21?
"Counties are required to provide aftercare services to children who discharge from an STRTP to a family-based setting who were placed in the STRTP after October 1, 2021. If the placement ocurred prior to October 1, 2021, counties may, but are not required to, provide aftercare services. Per BHIN 21-062 ""MHPs may begin to submit FFPSA QI and aftercare services claims for dates of service on or after October 1, 2021."" County Fiscal Letters (CFLs) regarding child welfare and probation allocations and claiming instructions will be released in upcoming weeks. "
25. On Wrap: when will the state provide more info to counties about what elements are required to meet the “high fidelity” requirements? And since the ACL requires that high fidelity be in place by Oct 1, 2022, how far in advance will DSS provide the instructions to allow for new contracts to be executed, and for Wrap providers to be trained?
The high-fidelity requirements are still under development by CDSS, DHCS, counties, providers, and other stakeholders. We plan to release a more detailed timeline in the upcoming months. We understand counties need time to plan and implement the requirements upon release, and we anticpate flexibility and a "get started, get better" approach to this planning and implementation. Counties and providers can, however, get started with planning and implementation now utilizing the resources listed below. Generally, high-fidelity Wraparound refers to alignment with the California Wraparound Standards (https://www.cdss.ca.gov/getinfo/acin/2015/I-52_15.pdf), the Wraparound Principles and Phases (https://nwi.pdx.edu/NWI-book/Chapters/SECTION-2.pdf), and other standards and requirements regarding community and cross-system partnerships (such as the AB 2083 System of Care requirements), fiscal policies and sustainability (such as blending and braiding of funding, flexible funding, and reinvestment/trust funds), access to needed supports and services, workforce development and support (such as standardized competencies, curricula, and coaching requirements), and accountability and continuous quality improvement (such as performance-based contracting, consistent data collection and analysis, consistent use of fidelity tools, and development of common outcome measures). The National Wraparound Initiative (https://nwi.pdx.edu/wraparound-basics) provides a wealth of information about high fidelity Wraparound implementation and sustainability, which will inform the implementation. Additionally, trainings, coaching, and technical assistance are available through the UC Davis Resource Center for Family-Focused Practice (https://humanservices.ucdavis.edu/resource-center-family-focused-practice) and the CDSS Wraparound team (https://www.cdss.ca.gov/inforesources/cdss-programs/foster-care/wraparound). For more information email WraparoundQuestions@dss.ca.gov.
24. How do we provide Wraparound/aftercare services if the youth is placed outside of the county of jurisdiction?
This is a complex question and will likely vary case-by-case. Guidance is currently under development. If the child meets medical necessity criteria and all applicable state and federal requirements, specialty mental health services (SMHS) that are provided as part of Wraparound service delivery would be subject to presumptive transfer requirements and processes, which are covered in: BHIN 17-032, BHIN 18-027, BHIN 19-041. More information about aftercare claiming for specialty mental health services can be found in BHIN 21-062 https://www.dhcs.ca.gov/Documents/BHIN-21-062-Claiming-for-Family-First-Prevention-Services-Act-Qualified-Individual.pdf. For services not billable to Medi-Cal, counties of jurisdiction should first contact the Wraparound/aftercare coordinator (https://www.cdss.ca.gov/Portals/9/Child-Welfare-Programs/Foster-Care/Wraparound/County-Wraparound-Coordinators.pdf) of the county in which the youth is placed to initiate discussions about all available options, which may include: A single-case agreement/MOU with the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction. A single-case agreement/MOU with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction. A subcontract with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of a contracted provider in the county of jurisdiction. A county should also consider structuring their county-administered or contracted provider-administered Wraparound/aftercare program to provide telehealth when appropriate and travel to youth placed outside of the county of jurisdiction (to contiguous counties, at minimum)
23. How quickly can counties initiate Wraparound services in another county if a youth is placed in another county. I’m not sure for other counties, but the contract process is 8-12 weeks here (at a minimum) and this would then have us out of compliance.
"This is a complex question and will likely vary case-by-case and county-by-county. Guidance is currently under development.

If the child meets medical necessity criteria and all applicable state and federal requirements, specialty mental health services (SMHS) that are provided as part of Wraparound service delivery would be subject to presumptive transfer requirements and processes, which are covered in:
• BHIN 17-032
• BHIN 18-027
• BHIN 19-041

More information about aftercare claiming for specialty mental health services can be found in BHIN 21-062 https://www.dhcs.ca.gov/Documents/BHIN-21-062-Claiming-for-Family-First-Prevention-Services-Act-Qualified-Individual.pdf.

For non-specialty mental health services, counties of jurisdiction should first contact the Wraparound/aftercare coordinator (https://www.cdss.ca.gov/Portals/9/Child-Welfare-Programs/Foster-Care/Wraparound/County-Wraparound-Coordinators.pdf) of the county in which the youth is placed to initiate discussions about all available options, which may include:

-A single-case agreement/MOU with the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction.
-A single-case agreement/MOU with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction.
-A subcontract with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of a contracted provider in the county of jurisdiction.
-A county should also consider structuring their county-administered or contracted provider-administered Wraparound/aftercare program to provide telehealth when appropriate and travel to youth placed outside of the county of jurisdiction (to contiguous counties, at minimum). "
22. Will there be minimum services for Wraparound?
"Pursuant to WIC Section 4096.6, minimum requirements for familybased aftercare services must include a process for Wraparound provider certification, guidelines to ensure children and nonminor dependents are provided aftercare services, workforce development and training, funding planning, and fidelity and data collection and outcome measures.

On and after October 1, 2021, each county child welfare agency, probation department, and MHP jointly provide, arrange for, or ensure the provision of at least six months of aftercare services for a child/NMD in the placement and care responsibility of the child welfare or probation agency transitioning from an STRTP to a family-based setting. Aftercare services must be family-based and individualized and must support each child/NMD’s permanency plan.

By October 1, 2022, aftercare services in California must utilize the state’s high fidelity Wraparound model, which is still under development. Generally, high-fidelity Wraparound refers to alignment with the California Wraparound Standards (https://www.cdss.ca.gov/getinfo/acin/2015/I-52_15.pdf), the Wraparound Principles and Phases (https://nwi.pdx.edu/NWI-book/Chapters/SECTION-2.pdf), and other standards and requirements regarding community and cross-system partnerships (such as the AB 2083 System of Care requirements), fiscal policies and sustainability (such as blending and braiding of funding, flexible funding, and reinvestment/trust funds), access to needed supports and services, workforce development and support (such as standardized competencies, curricula, and coaching requirements), and accountability and continuous quality improvement (such as performance-based contracting, consistent data collection and analysis, consistent use of fidelity tools, and development of common outcome measures).

The National Wraparound Initiative (https://nwi.pdx.edu/wraparound-basics) provides a wealth of information about high fidelity Wraparound implementation and sustainability, which will inform the implementation. Additionally, trainings, coaching, and technical assistance are available through the UC Davis Resource Center for Family-Focused Practice (https://humanservices.ucdavis.edu/resource-center-family-focused-practice) and the CDSS Wraparound team (https://www.cdss.ca.gov/inforesources/cdss-programs/foster-care/wraparound).
For more information email WraparoundQuestions@dss.ca.gov."
21. We have a youth in an STRTP that will return home to their father in another county at the next court date. The county child welfare agency plans to close the case as father has met court mandates. Does the youth still qualify for six months of aftercare in the new county?
"For children who enter an STRTP prior to October 1, 2021, the county is not required to provide aftercare services, but the county may choose to do as best practice. For children who enter an STRTP on or after October 1, 2021, WIC 4096.6 and ACL 21-116 do not limit the aftercare services requirement to children with an open child welfare or probation case. Counties must provide aftercare services to all child who exit from an STRTP to a family-based setting. Claiming instructions for child welfare and probation agencies will be released in the coming weeks. Claiming instructions for Medi-Cal billible services provide under the Wraparound program can be found in BHIN 21-062.

Additionally, please see the FAQs regarding youth placed out of county and CWS/CMS documentation."
20. Is CDSS doing any evaluation for high-fidelity Wraparound or will this be something counties are responsible for?
The requirements in AB 153 include minimum standards regarding data collection and outcome measures for Wraparound. The responsibility for data collection and analysis, oversight, monitoring, and continuous quality improvement will be shared by CDSS, DHCS, county child welfare, behavioral health, and probation agencies, Wraparound providers, and others. Counties are responsible for cooperating with these efforts.
19. Will counties need to develop a whole new model for service delivery? 
For most counties, no. Counties will build upon existing Wraparound programs while preparing to deliver high-fidelity Wraparound aftercare. This structure seeks to avoid the creation of a new program and leverage the many successes Wraparound has achieved in California for decades. The majority of counties have been providing Wrapround services for many years to prevent entry into foster care and congregate care settings and to support transitions from congregate care settings to family-based settings and reunification. CDSS and DHCS will work in partnership with counties, providers, Tribes, parents, and youth to further develop California’s Wraparound model and improve consistency, practice, fidelity, and outcomes across the state and support the few counties who do not currently have a Wraparound program.
18. When is the second column of the template for High-Fidelity Wraparound Due?
The second column is requested to be filled out, but not required and will have the same due date of 11/15/21.
17. Do we need a wet signature for County Aftercare Plan?
No. Electronic Signature is fine.
16. County CWS, Probation and MH are required to develop after care plans with their local AB 2083 Interagency Teams and submit those by Oct 1, but that can be difficult without knowing how much funding is available to them, and how the funds can be spent? Can counties have more time to submit plans after the ACLs and CFLs are released? When is the due date for the plan?
The due date for the Wraparound Plan Template changed to November 15, 2021. County Fiscal Letters with allocation amounts and claiming instructions will be released in the coming weeks.
15. How does AB 12 take effect when a youth planned for Extended Foster Care services, age 18 or older, completes both their treatment in an STRTP and probation? Can the youth still transition to extended foster care and be provided the aftercare as an NMD?
Yes. Per ACL 21-116, "a nonminor dependent exiting an STRTP to a supervised independent living setting, defined in WIC section 11400(x), should also be offered FFPSA aftercare services, including Wraparound." The allocation for FFPSA Part IV aftercare is also available to fund aftercare/Wraparound services for nonminor dependents who exit an STRTP to a family-based or supervised independent living setting.
14. What is the eligibility criteria for a youth to receive aftercare services?
"WIC section 4096.6 states that, by October 1, 2021, each county child welfare agency, probation department, and mental health plan (MHP), in consultation with the local interagency leadership team, will jointly provide, arrange for, or ensure the provision of at least six months of post-discharge aftercare services to be provided to children discharged from a placement in an STRTP or from an out-of-state residential facility to a family-based setting.

A family-based setting refers to situations when a child or nonminor dependent reunifies with a parent, guardian, Indian custodian, or other caregivers or is placed with an approved resource family, including relatives and nonrelative extended family members, or a tribally approved home. In addition, a nonminor dependent exiting an STRTP to a supervised independent living setting, defined in WIC section 11400(x), should also be offered FFPSA aftercare services, including Wraparound."
13. Do counties have to track the actual provision of after care for 6 months?
"Per ACL 21-116 and ACL 08-88, county child welfare and probation agencies must track the provision of all Wraparound service delivery, including aftercare, in CWS/CMS under the Case Management section using the “S-Wraparound Program” Special Project Code. Child welfare and probation agencies should ensure the beginning and end dates of each Wraparound episode is accurate, and, if possible, update the end date of Wraparound services even after the case is closed in CWS/CMS.

Because probation department use of CWS/CMS is subject to different requirements than child welfare departments, many probation departments close the case in CWS/CMS once the youth exits placement. And in some child welfare cases, the case is closed upon reunification. As such, the CWS/CMS case may not be open to document the end date of Wraparound services. In these circumstances the child welfare or probation agency can leave the end date field blank. CWS/CMS will auto-populate the end date as the CWS/CMS case closure date, once the case is closed. If a child and family are receiving services from both child welfare and probation and the probation case closes before the child welfare case, the child welfare department should ensure the accurate end date of Wraparound services is entered. The same is true in reverse.

Based on successful experiences of many counties who consistently and accurately identify Wraparound cases using this Special Project Code, CDSS recommends that counties task a Wraparound coordinator, an Interagency Placement Committee team member, or other administrative professional who tracks Wraparound referrals and enrollment to enter the Special Project Code into the CWS/CMS cases of families receiving Wraparound services, as these individuals may have privileges allowing for updating case information after a case has closed and as case worker documentation of Special Project Codes can be inconsistent and inaccurate."
12. If the family/youth needed more than 6 months of after care, could the county provide that and use the funding allocated by the State for this purpose?
If the family/youth needed more than 6 months of aftercare services, the county child welfare agency would not be able to use their allocated aftercare funding. The county could use other sources of Wraparound funding, such as realignment, county general fund, Wraparound Trust Funds, etc.

Federal Financial Participation (FFP) under the Medi-Cal program may be available for family-based aftercare services if the treatment is medically necessary, regardless of the six months post-discharge requirement.
11. Who is responsible for the implementation of the six months of aftercare?
As of October 1, 2021, each county child welfare agency, probation department, and mental health plan (MHP), in consultation with the local interagency leadership team established pursuant to Section 16521.6, will jointly provide, arrange for, or ensure the provision of at least six months of post-discharge aftercare services to be provided to children discharged from a placement in an STRTP or from an out-of-state residential facility to a family-based setting. By November 15, 2021, under WIC Section WIC Section 4096.6(d), county agencies must submit a plan for the provision of aftercare services using the template created by CDSS and DHCS.

Each county will be responsible for developing an aftercare plan, obtaining CDSS and DHCS approval of the plan, and then implementing the approved plan. Further, as proposed, a process will be developed through which organizations providing aftercare services must be certified.

STRTPs are responsible for provision of, arrangement for, or assistance with development of an individualized family-based aftercare support plan for at least six months postdischarge, as specified in HSC Section 1562.01(d)(2)(C)(vii). HSC Section 1562.01(d)(2)(C)(vii)(ib) requires that each STRTP has a program statement that includes a description of how the STRTP will provide for, arrange for the provision of, or assist in the development of an individualized family-based aftercare support plan that identifies necessary supports, services, and treatment to be provided for at least six months post-discharge as a child/NMD moves from STRTP placement to a family based setting or to a permanent living situation or to a transitional housing program.
10. Will additional funding be allocated to support this aftercare requirement and/or Wraparound?
Yes. Allocation and claiming guidance to child welfare agencies regarding FFPSA Aftercare costs will be provided in the coming weeks via county fiscal letters. For guidance for MHPs on claiming for FFPSA aftercare costs, please see DHCS Behavioral Health Information Notice No: 21-062: https://www.dhcs.ca.gov/Documents/BHIN-21-062-Claiming-for-Family-First-Prevention-Services-Act-Qualified-Individual.pdf. This BHIN also includes specific claiming procedures and requirements MHPs must adhere to when submitting claims for aftercare services
9. Are the aftercare services funded for six or seven months?
The 2021-2022 State Budget appropriated funding for six months of aftercare plus one additional month to support discharge, transition, and aftercare planning prior to exiting from the STRTP. More information will be released in upcoming weeks via CDSS county fiscal letters.

https://www.cdss.ca.gov/inforesources/fiscal-financial/local-assistance-estimates/2021-may-revision-for-the-2021-22-governors-budget
8 Are aftercare services held to the same evidence-based program standard as prevention programs?
No. Unlike the prevention services funded through FFPSA, aftercare services are not required to be reviewed by or listed in the Title IV-E Prevention Services Clearinghouse as an evidenced based practice. However, high-fidelity Wraparound is listed as a program or service planned for review in the Title IV-E Prevention Services Clearinghouse (https://preventionservices.abtsites.com/about/programs-planned-review).
7. What does CDSS envision high-fidelity Wraparound to look like?
Generally, high-fidelity Wraparound refers to alignment with the California Wraparound Standards (https://www.cdss.ca.gov/getinfo/acin/2015/I-52_15.pdf), the Wraparound Principles and Phases (https://nwi.pdx.edu/NWI-book/Chapters/SECTION-2.pdf), and other standards and requirements regarding community and cross-system partnerships (such as the AB 2083 System of Care requirements), fiscal policies and sustainability (such as blending and braiding of funding, flexible funding, and reinvestment/trust funds), access to needed supports and services, workforce development and support (such as standardized competencies, curricula, and coaching requirements), and accountability and continuous quality improvement (such as performance-based contracting, consistent data collection and analysis, consistent use of fidelity tools, and development of common outcome measures).
The National Wraparound Initiative (https://nwi.pdx.edu/wraparound-basics) provides a wealth of information about high fidelity Wraparound implementation and sustainability, which will inform the implementation. Additionally, trainings, coaching, and technical assistance are available through the UC Davis Resource Center for Family-Focused Practice (https://humanservices.ucdavis.edu/resource-center-family-focused-practice) and the CDSS Wraparound team (https://www.cdss.ca.gov/inforesources/cdss-programs/foster-care/wraparound).
For more information email WraparoundQuestions@dss.ca.gov.
6. How do counties who do not currently have Wraparound programs and utilize Full Service Partnership deliver aftercare services? i.e. What if the youth does not meet medical necessity or what if the approved timeline for services ends prior to the 6 month aftercare requirement timeline
1) The county could review the way they apply the medical necessity criteria to individual determinations.
1) Consult with MHSA oversight committee about changing their plan/requirements for MHSA FSP funds/services.

Federal Financial Participation (FFP) under the Medi-Cal program may be available for family-based aftercare services if the treatment is medically necessary, regardless of the six months post-discharge requirement.
5. Are we required to enter the Wraparound Start date into CWS/CMS even if the family declines services?
No, if the family declines services you would not enter them into Wraparound in CWS/CMS, but rather document your efforts and response in your case contact note. Please note that in alignment with the principles and practices of Wraparound, it is important that the CW social worker or probation officer engage the family, explaining the services and benefits of the program.
4. How do we provide Wraparound/aftercare services if the youth is placed outside of the county of jurisdiction?
This is a complex question and will likely vary case-by-case. Guidance is currently under development.

If the child meets medical necessity criteria and all applicable state and federal requirements, specialty mental health services (SMHS) that are provided as part of Wraparound service delivery would be subject to presumptive transfer requirements and processes, which are covered in:
• BHIN 17-032
• BHIN 18-027
• BHIN 19-041

More information about aftercare claiming for specialty mental health services can be found in BHIN 21-062 https://www.dhcs.ca.gov/Documents/BHIN-21-062-Claiming-for-Family-First-Prevention-Services-Act-Qualified-Individual.pdf.

For non-specialty mental health services, counties of jurisdiction should first contact the Wraparound/aftercare coordinator (https://www.cdss.ca.gov/Portals/9/Child-Welfare-Programs/Foster-Care/Wraparound/County-Wraparound-Coordinators.pdf) of the county in which the youth is placed to initiate discussions about all available options, which may include:

-A single-case agreement/MOU with the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction.
-A single-case agreement/MOU with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of the county of jurisdiction.
-A subcontract with a contracted provider in the county of placement to provide Wraparound/aftercare services on behalf of a contracted provider in the county of jurisdiction.
3. Are all wrap cases being limited to six months? Or only after stepdown from STRTPs?
The funding allocated to child welfare agencies for aftercare/Wraparound can only fund aftercare/Wraparound services for 6 months for youth discharged from an STRTP to a family-based setting. This funding would not cover Wraparound services for other target populations or longer than the 6 months of aftercare services... other funding sources would need to be used, all of which CDSS Family-Centered Practice Unit can provide support and technical assistance. Just email WraparoundQuestions@dss.ca.gov
2. Is the six month limit due to federal restrictions or is that a California limitation?
It's associated with the amount of state general fund appropriated to aftercare. However, if counties want to provide Wraparound/aftercare beyond the 6 month requirement, counties certainly can; counties would just need to use a different funding stream.
1. Are you defining "aftercare" as having a closed child welfare case?
For these purposes, "aftercare" is referring to the aftercare provided when a youth is discharged from an STRTP to a family-based setting, regardless as to whether the child welfare/probation case remain open or is closed.

Case Plan Requirements

7. We are currently utilizing the CFT Action Plan as the attachment to the case plan, as mandated by the legislation. We are curious how this applies when a case is pre-disposition and the case plan has not yet been ordered. We have many circumstances in which youth are placed into STRTPs quickly after entering care, and their case plans are not ordered until six weeks+ after placement. In these cases, we do not have a case plan to attach the CFT Action Plan to. What guidance do you have around how to handle this?
If there is no case plan, then the CFT action plan should be saved within the case record. Once the case plan has been completed it can be saved to the CFT action plan.
6. Does ACL 17-122 (Page 9, Age-Based Placement Timeframes for Second Level Reviews) refer to each independent time a youth is placed in a STRTP and not the collective amount of time the youth is in that level of care? Also, does the timeframe start over if the youth leaves the said placement and returns to that home?
WIC 16501.1 (d) (2) (E) and 706.6 (d) (3) (D) make reference to six or 12 consecutive or nonconsecutive months, therefore the ACL 17-122 refers to the collective amount of time a youth is in care and the time period does not start over if a youth leaves placement and returns. Therefore, the time periods referred to in ACL 17-122 refer to 6 or 12 consecutive or nonconsecutive months. The approval of the agency’s deputy director or chief probation officer should then be documented in the youth’s case plan each 6 or 12 consecutive or nonconsecutive months thereafter.

16501.1 (d) (2) (E):
(E) When the child or nonminor dependent has been placed in a short-term residential therapeutic program for more than 12 consecutive months or 18 nonconsecutive months, or, in the case of a child who has not attained 13 years of age, for more than six consecutive or nonconsecutive months, the case plan shall include both of the following:
(i) Documentation of the information submitted to the court pursuant to subdivision (l) of Section 366.1, subdivision (k) of Section 366.3, or paragraph (4) of subdivision (b) of Section 366.31, as applicable.
(ii) Documentation that the deputy director or director of the county child welfare department has approved the continued placement of the child or nonminor dependent in the setting.

WIC 706.6 (d) (3) (D):
(D) When the minor or nonminor dependent has been placed in a short-term residential therapeutic program for more than 12 consecutive months or 18 nonconsecutive months, or, in the case of a minor who has not attained 13 years of age, for more than six consecutive or nonconsecutive months, the case plan shall include both of the following:
(i) Documentation of the information submitted to the court pursuant to subparagraph (B) of paragraph (1) of subdivision (c) of Section 706.5.
(ii) Documentation that the chief probation officer of the county probation department, or their designee, has approved the continued placement of the minor or nonminor dependent in the setting.
5. With the implementation of FFPSA, there are several new forms that are required for children/youth placed in an STRTP. CDSS provided these forms to Counties as attachments in ACLs, and most are PDF forms that Counties cannot upload as templates in CWS/CMS. Is CDSS planning to make these forms available in CWS/CMS as templates?
DSS is currently researching adding templates to CWS/CMS. The ACL 21-114 (Page 28) and ACL 21-113 (Page 31) each include instructions for importing the PDF forms into the CWS/CMS.
4. "If a case plan needs to be completed within 30 calendar days of the youth’s STRTP placement date, but we have don't have Disposition yet, how will this impact the dependency legal timelines? Will this case plan include only information about the QI assessment and the level of placement, or will it also need to address the services provided to parents and what parents are required to do if the goal is reunification? If we do not have Disposition, and we are completing this case plan, do we need to do another case plan after Disposition is achieved? For post Dispo cases, if we complete a case plan within 30 days of the STRTP placement, when is the next case plan due? At the time of the next status review report? If yes, do we update the same case plan or create a brand new one?"
If the county does not yet have disposition, the county may update the case plan with the required documentation information, per WIC 706.6, that is available within the first 30 days, and complete the remaining documentation items post disposition. The county does not need to create a new case plan, but may update the same case plan to the extent that there is new or updated information.
3. "With regard to the Case Plan Attachment and/or the CFT Action Plan--do these need to be filed with each status review report after the initial approval, or just with the initial STRTP approval report?"
The case plan attachment, CFT action plan, or county form being used to comply with case plan documentation requirements set forth in WIC 16501.1 and 706.6 is only required to be included with the initial court report filed pursuant to WIC 727.12 and WIC 361.22.
2. What are the additional requirements of the case plan documentation and when do they apply?
On and after October 1, 2021, the case plan must document:

• The reasonable or good faith effort by the social worker or probation officer to identify and include all required individuals in the CFT;
• The contact information for members of the CFT, as well as contact information for relatives and nonrelative extended family members not part of the CFT;
• Evidence that meetings of the CFT, including the meetings related to the QI determination, are held at a time and place convenient for the family;
• If reunification is the goal, evidence that the parent from whom the child was removed provided input on the members of the CFT;
• Evidence that the assessment conducted by the QI was conducted in conjunction with the CFT;
• The placement preferences of the child and the CFT, whether the placement preferences of the child and CFT were the same as those recommended by the QI, and if not, why the preferences of the child and CFT were not recommended by the QI.
• whether the court approved or disapproved the placement in an STRTP.

Prior to discharge from an STRTP, the social worker or probation officer must document in the case plan:

• A description of the type of in-home or institution-based services to encourage the safety, stability, and appropriateness of the next placement, including the recommendations of the CFT and a plan for the provision of discharge planning and family-based aftercare support, to be developed in collaboration with the STRTP
1. What are the case plan requirements for youth who have been in care for an extended period?
When the placement of the child exceeds 12 consecutive months, or 18 nonconsecutive months, or for children under 13 years of age, six consecutive or nonconsecutive months, the social worker or probation office must document in the case plan:

• (1) The relevant supplemental report and/or social study information required to be submitted to the court for the specified hearings, as required per statute;
• (2) Signed approval of the county child welfare director or deputy director for the continued placement in the STRTP.

Courts

16. We currently have two foster youth who are conserved and are placed at a Community Treatment Facility. While FFPSA Part IV does not apply to them since they were placed at the CTF prior to 10/1/21, I would like to know how the QI and Juvenile Court process will interface with the conservatorship process when we have this situation arise in the future to comply with the FFPSA Part IV requirements, so: Since an assessment is done through the Mental Health system to determine if the individual meets the criteria for a conservatorship, will this assessment take the place of the QI assessment, or will both still need to happen?
A QI assessment and juvenile court review process is required for placement into an STRTP or Community Treatment Facility (ACL21-113 / BHIN 21-060). A placement into an STRTP or CTF must meet all the requirements of FFPSA to be eligible for Title IV-E federal financial participation (FFP).
15. Some counties have had a few instances where the judges have ordered a QI assessment to be completed. Please clarify that judges do not have this authority because they will not know whether the placing agency is recommending a STRTP placement.
The court always has authority to order any assessment that they feel is appropriate for the child. So, although the agency hasn’t requested a STRTP, the court may feel like one is necessary, and, it should be completed. However, if the child is never placed in a STRTP, then funding would never be jeopardized.
14. What are the authority, requirements, and protections for sharing the QI report (from the QI to the placing agency, and the placing agency to the court)? What authority provides for the placing agency to provide the QI assessment report to the court? Does the placing agency need to address privilege (if so, how)? Does the placing agency need to redact any part of the QI assessment before providing the report to the court (if so, what and why)?
The QI assessment must be provided to the county placing agency and the STRTP pursuant to WIC section 4096(g)(6). The county placing agency is required to provide the assessment to the court as required under WIC 361.22 and 727.12. Rule 5.618(d) precludes from the QI assessment any information that is privileged or confidential under existing state and federal law or regulation without the appropriate waiver or consent. FFPSA and AB 153 do not change existing statutes or policies around sharing confidential or privileged information. Existing county releases of information and consent to treat processes remain effective. County departments responsible for providing the QI and county placing agencies should confer with their counsel regarding the extent their existing processes are consistent with law and whether something constitutes privileged or confidential information. Existing county ROI processes may need to be changed after CDSS and DHCS jointly identify an universal ROI pursuant to WIC section 4096(g)(2)(B).
13. How do the QI and Juvenile Court process interface with the conservatorship process, and what is required to comply with the FFPSA Part IV requirements? Since an assessment is done through the Mental Health system to determine if the individual meets the criteria for a conservatorship, will this assessment take the place of the QI assessment, or will both still need to happen?
The Mental Health assessment process and probate court process for placement into a Community Treatment Facility (CTF) are different from the FFPSA required QI assessment and juvenile court process. They differ in focus and clinical determinations with the QI assessment looking at needs and strengths and if those needs can be met in a family-based setting. In order for the mental health assessment conducted as part of the CTF placement process to function as the required QI assessment, the mental health assessment would need to be conducted by an individual who is certified as a QI, as described in ACL 21-113, and address all of the components required by WIC § 4096 for a QI assessment.
12. The ACL says we are to attach the assessment to our report. It should not be up to the SW or DPO to decide and redact the report. Can we develop a separate summary for the court report?
The requirements for the court report are stated in Welfare and Institutions Code sections 361.12 and 727.12. The report shall include:

(A) A copy of the assessment, determination as to the services and care needs of the child or nonminor dependent, and documentation prepared by the qualified individual pursuant to paragraph (1) of subdivision (g) of Section 4096.
(B) The case plan documentation required pursuant to subparagraph (C) of paragraph (2) of subdivision (d) of Section 16501.1.
(C) In the case of an Indian child, a statement regarding whether the child’s tribe had an opportunity to confer regarding the departure from the placement preferences described in Section 361.31, and the active efforts made prior to placement in a short-term therapeutic program to satisfy subdivision (f) of Section 224.1.
(D) A statement regarding whether the child or nonminor dependent or any party to the proceeding, or the child’s tribe in the case of an Indian child, objects to the placement of the child or nonminor dependent in the short-term residential therapeutic program.
California Rules of Court, Rule 5.618 (d)(3) clarifies that the documentation required in sections 361.12 and 727 must not contain information that is privileged or confidential under state or federal law.
Each county should discuss with their county counsel how confidential information is currently protected, for example, in psychological evaluations produced for the court and all parties or for nonparties under welfare and institutions code section 827, and, if and how that information is currently redacted. No statute nor rule of court dictate the responsibility of redaction in any circumstance.
11. Is there is a sample available of the Status Hearing Report? Do we include information on how the youth is doing along with the other 4 items?
The status review reports have not changed. There is, however, additional evidence that must be considered for the court to make the finding that the placement is necessary and appropriate. That additional evidence can be in the court report or case plan narrative. The evidence in 366.1 (l) must include:
• Ongoing assessment of the strengths and needs of the child that continues to support the determination that the needs of the child cannot be met by family members or in another family-based setting, placement in a STRTP continues to provide the most effective and appropriate care setting in the least restrictive environment, and placement is consistent with the short- and long-term mental and behavioral health goals and permanency plan for the child.
• Documentation of the child’s specific treatment or service needs that will be met in the placement and the length of time the child is expected to need the treatment or services.
• Documentation of the intensive and ongoing efforts made by the child welfare department, consistent with the child’s permanency plan, to prepare the child to return home or to be placed with a fit and willing relative, a legal guardian, an adoptive parent, in a resource family home or tribally approved home, or in another appropriate family-based setting.
10. How are the QI assessments filed with the court? The QI completes the assessment and provides it to the placing agency. How does the placing agency file this document with the court? JV 237? Is the QI supposed to file the assessment with the court in some other fashion?
The QI assessment and report are filed by the placing agency. The placing agency will serve the QI assessment and report on all parties. The placing agency will then file with the court the JV-237 with the report and QI assessment.
9. Are counties required to submit the second JV 237 (to all parties) at the time of submitting the probation report to the Court?
Yes. This is the proof of service form to tell the court that you served the report on all parties. The department will typically have to submit the JV-237 twice, first to verify that the JV-235 and JV-236 forms were served within five calendar days of the start of the placement, and then again to verify service of the report no later than 7 calendar days before the hearing (10 court days if there is a request to approve without a hearing). To submit the JV-237 form just once would require the JV-235, JV-236 and the report be submitted around the same time. This would require the report to be prepared within five calendar days of the start of the placement. In most cases, the JV-237 proof of service form will have to be submitted twice.
8. Will the order for placement in a CTF from the conservatorship court meet the criteria for court approval for the placement, or does the juvenile court process still occur?
Whenever a county has a question involving a youth who is under the jurisdiction of both a probate court and the juvenile court, the county should confer with their county counsel’s office regarding 1) who has authority, based on both courts’ orders, to select a placement for the child, 2) who has the authority based on both courts’ orders to make the actual placement, i.e. sign the placement agreement on behalf of the youth, and 3) what funding stream is being used to pay for the placement. The establishment of a conservatorship over a child does not automatically terminate juvenile court jurisdiction or end the county placing agency’s responsibility to ensure the child is receiving all legally required services. Responsibility will be dependent on the court orders of both the probate court and the juvenile court. If the CTF placement is made by the placing agency and will be funded with foster care dollars, then it must meet all the requirements, including a qualified individual assessment, for a QRTP under Title IV-E. The court review and case management requirements must also be met.
7. Does the juvenile court have to make specific findings at each Status Review hearing when a youth is in an STRTP longer than the timeframes expected by the state? Do these findings have to be made for those youth who were placed in STRTPs prior to October 1, 2021?
"At review hearings, the finding is: For a child placed in a short-term residential therapeutic program, the court has considered the evidence and documentation submitted under Welfare and Institutions Code section 366.1(l) when determining the continuing necessity for and appropriateness of the placement.

It is best practice to make these findings for all children placed in STRTPs, but in reality, the evidence to be considered under Section 366.1(l) may not be available for children placed prior to October 1, 2021. Of you have that evidence is available for children placed prior to October 1, 2021, please include it in the report.

The evidence required under Section 366.1(l) is:
(l) On and after October 1, 2021, for a child whose placement in a short-term residential therapeutic program has been reviewed and approved pursuant to Section 361.22, the supplemental report shall include evidence of all of the following:
(1) Ongoing assessment of the strengths and needs of the child that continues to support the determination that the needs of the child cannot be met by family members or in another family-based setting, placement in a short-term residential therapeutic program continues to provide the most effective and appropriate care setting in the least restrictive environment, and placement is consistent with the short- and long-term mental and behavioral health goals and permanency plan for the child.
(2) Documentation of the child’s specific treatment or service needs that will be met in the placement and the length of time the child is expected to need the treatment or services. For a Medi-Cal beneficiary, the determination of services and expected length of time for those services funded by Medi-Cal shall be based upon medical necessity and on all other state and federal Medi-Cal requirements, and shall be reflected in the documentation.
(3) Documentation of the intensive and ongoing efforts made by the child welfare department, consistent with the child’s permanency plan, to prepare the child to return home or to be placed with a fit and willing relative, a legal guardian, an adoptive parent, in a resource family home or tribally approved home, or in another appropriate family-based setting."
6. Does the juvenile court have to make specific findings at each Status Review hearing when a youth is in an STRTP longer than the timeframes expected by the state? Do these findings have to be made for those youth who were placed in STRTPs prior to October 1, 2021?
FFPSA was implemented on October 1, 2021. For children in STRTP placements prior to October 1, 2021, the additional evidence required under FFPSA does not need to be included in at the status review hearings. However, best practice would be to include the evidence for the court to make the finding that the placement is necessary and appropriate. There are no other specific findings at a status review hearing.
5. In our county, we do not place a youth until they are ordered to out-of-home placement, which is at their Dispositional Hearing. The JV-235 needs to be filed within 5 days of the youth being placement, which in our county would be after being recommended into placement; however, from what I have read, the JV-235 needs to be filed prior to a report recommending placement being filed which is at the Dispositional Hearing. For our probation youth, when should we be filing the JV-235?
The court process begins once the child is placed in a STRTP. Therefore, the JV-235 needs to be filed with the court within 5 days of the child being placed in the STRTP requesting the court hold a hearing under section 361.22 or 727.12 within 45 days. The QI assessment and court report must be filed within 7 days of the court hearing.
4. My colleagues and I would like clarification on whether a new QI assessment report is needed at each status review hearing.
It is the Judicial Council’s understanding that the additional evidence required in the social study report at the status review hearings does not require a new QI assessment. The new evidence requires is to inform the court’s determination whether the child’s placement is necessary and appropriate.
3. Where can I find the CA Rules of Court website, specifically for Rule 5.618?
JCC shared the following link: https://www.courts.ca.gov/cms/rules/index.cfm?title=five&linkid=rule5_618
2. "How do placing agencies capture comments in the report from parties who object, since the parties would have to submit the JV 236 form, if they want to object?"
Through engagement with the CFT and through the placement process, the QI or agency may know that someone is objecting, and that must be reflected in the report as a statutory requirement, under WIC 361.22(c)(1)(D). There is however no problem mentioning the JV-236 in the report.
1. Regarding Court reporting: What is the supplemental report we need to submit to the court with all of the attachments. Is it a JV form?
The supplemental court report in child welfare cases, or the social study in juvenile probation cases, is submitted at a status review hearing for a child placed in an STRTP and must include the evidence and documentation listed within the ACL 21-114. There is currently not a template or form for this report, but this report would be included within the process of submitting other necessary judicial forms.

Placements into STRTPs

14. Does a licensed mental health professional need to be a member of the IPC team?
Yes, please see ACL 17-122, and WIC Section 4096.
13. In an emergency placement, must we seek authorization from a licensed mental health professional to place within 72 hours of placement if the IPC has not made a determination? If the IPC makes the determination that a child needs STRTP placement (prior to placement into an STRTP), is the approval of the licensed mental health professional required within 72 hours?
An emergency placement only occurs when the placement happens prior to the IPC approval then the determination by the licensed mental health professional is needed within 72 hours of placement and the IPC has to approve within 30 days of placement. If the IPC approves the STRTP placement prior to placement there is a process for the licensed mental health professional on the IPC to make the determinations needed for STRTP during that process so that a separate assessment within 72 hours is not necessary. See WIC Section 4096 (c) and 11462.01(h)(3).
12. We have a youth placed at a facility. They are not an STRTP but do take an STRTP rate for their CTF program. Our youth moved from their Psychiatric Health Facility (PHF) to their Community Treatment Facility (CTF) in October. Do STRTP/CTF requirements under FFPSA apply?
A QI assessment and juvenile court review process is required for any placement of a foster child into an STRTP or Community Treatment Facility (ACL21-113 / BHIN 21-060). A placement into an STRTP or CTF must meet all the QRTP requirements and the placement process and oversight in accordance with the process outlined in ACIN I-84-21 to be eligible for Title IV-E federal financial participation (FFP).
11. We were hoping to clarify, for Emergency STRTP placement, is the IPC required to occur before the emergency placement, or after the QI assessment is made? I got this flow chart from Monterey County, and it shows that the IPC occurs later, but in our experience STRTPs will ask for verification that the IPC has approved the placement.
Per ACL 21-113 / BHIN 21-060 an emergency placement is defined as "a placement made prior to a determination by the Interagency Placement Committee (IPC), but only if a licensed mental health professional determines within 72 hours of placement that the child appears to require the level of services and supervision provided by the STRTP. An emergency placement must be necessary to address the immediate and acute needs of the young person and delaying the placement pending the IPC determination would be contrary to the well-being of the child for reasons including, but not limited to, instances when the child would otherwise remain in a more restrictive setting or lack appropriate care or services." Each county has a unique framework for the establishment and performance of IPC duties. The existing requirements of the IPC remain unchanged, and counties may update the local IPC process to align with the new QI role, in compliance with WIC Section 4096 and 11462.01(h)(3)(A)(B).
10. Pursuant to ACL 17-122, a youth meets the criteria for an emergency placement into an STRTP only if “a licensed mental health professional (as defined in WIC section 4096(g)), has made a written determination within 72 hours of placement that the [youth] requires the level of services and supervision provided by the STRTP, in order to meet his or her behavioral or therapeutic needs.” If the MH professional (within 72 hours) determines that an STRTP level of care is NOT indicated for the youth, do we proceed with the QI assessment? If not, what is the timeline for transitioning the youth out of the STRTP?
Yes, according to ACL 21-113 / BHIN 21-060, in an emergency placement situation, the QI assessment must be completed no later than 30 calendar days from the date the child is placed into an STRTP. If the QI assessment is not completed within 30 days, the placement is not eligible for FFP for the entirety of the STRTP placement (including not for the first 14 days). If the QI determination recommends care in a family-based setting, then Title IV-E funds will no longer be available for the STRTP placement starting 30 days after the QI’s determination for home-based care.
9. We have a question pertaining to making an emergency STRTP placement. Pursuant to ACL 17-122, a youth meets the criteria for an emergency placement into an STRTP only if “a licensed mental health professional (as defined in WIC section 4096(g)), has made a written determination within 72 hours of placement that the [youth] requires the level of services and supervision provided by the STRTP, in order to meet his or her behavioral or therapeutic needs.” With the implementation of FFPSA and the need for the QI assessment to be completed within 30 days of placement, does the need for a licensed mental health professional to make a determination within 72 hours still need to occur?
Yes, a licensed mental health professional still needs to make a written determination within 72 hours of an emergency placement stating that the youth require the level of services and supervision provided by the STRTP. This is part of the IPC determination that needs to be made within 30 days of the emergency placement pursuant to WIC Section 4096(e) and WIC Section 11462.01(h).
8. In ACL 21-113, it is stated that within 72 hours of an emergency placement into an STRTP, a licensed mental health professional must determine that the youth/NMD appears to require STRTP-level supervision and supportive services. Are we meant to interpret this as being the QI who will be making this call?
The requirement for a determination of service needs and supervision within 72 hours of an emergency placement is not a QI requirement. This requirement is based in WIC 11462.01(h)(3). (Reference: https://www.dhcs.ca.gov/Documents/STRTP-Regulations-version-II.pdf)
7. I have a question regarding ACL No. 21-113 in reference to what may constitute as emergency placement. In a situation where emergency placement in an STRTP is required prior to the determination by the IPC, can the determination be made by any licensed mental health professional, including one who may be employed at the STRTP where the minor may be potentially placed?
Yes, the 72-hour determination may be made by any licensed mental health professional, as specified in WIC Section 4096(j), including one employed at the STRTP.

Per WIC Section 4096(j), "A “licensed mental health professional” includes a physician licensed under Section 2050 of the Business and Professions Code, a licensed psychologist within the meaning of subdivision (a) of Section 2902 of the Business and Professions Code, a licensed clinical social worker within the meaning of subdivision (a) of Section 4996 of the Business and Professions Code, a licensed marriage and family therapist within the meaning of subdivision (b) of Section 4980 of the Business and Professions Code, or a licensed professional clinical counselor within the meaning of subdivision (e) of Section 4999.12."
6. Following the release of ACIN I-84-21, can it be clarified – if the placing agency is placing a youth in a Regional Center group home (that is NOT licensed as an STRTP), is the QI assessment required?
Per ACIN 1-73-21, although CCR exempted group homes that are vendored by Regional Centers from the requirement to convert to an STRTP, there is no similar exemption from the FFPSA requirements. Regional Center group homes are subject to FFPSA requirements. Thus, vendored group homes must qualify as one of the listed settings (STRTP or CTF) in order to be a placement eligible for Title IV-E funding in the maintenance payment. AB 153 requires under WIC Section 4648(a) that CDSS and the California Department of Developmental Services establish interagency agreements and processes to maximize federal funding for the placement, consistent with State and federal law. As this provision is implemented, more guidance will be made available.
5. Are QRTPs that serve the specialized populations defined in 42 U.S.C. §672 (k) (i.e. youth impacted by commercial sexual exploitation and youth receiving prenatal/parenting supports) required to comply with QRTP requirements, including accreditation, provision of aftercare, assessment by a qualified individual, provision of nursing services, court review requrements, and case planning?
While FFPSA does allow for specialized residential placements that do not have to meet the QRTP requirements, any facility that is licensed as an STRTP (our equivalent of a QRTP) must meet the requirements of FFPSA as outlined in AB 153. These placements must also continue to meet all federal and state licensure and regulatory requirements – including the QI assessment, court determinations, aftercare, accreditation and nursing requirements.
4. In regard to the new case plan documentation requirements when the child’s placement duration exceeds 12 consecutive months, or 18 nonconsecutive months, or for children under 13 years of age, six consecutive or nonconsecutive months, have the age-based timeframes changed given the new regulations?
The age-based timeframes listed in ACL 17-122 as it relates to STRTP placements, remain applicable. However, FFPSA increased the overall supervision of congregate care placements aligning with California's vision that youth be placed in the least restrictive placement based on their needs. County placing entities must now adhere to both the guidance listed in ACL 17-122 as well as ACL 21-114, for all placements made on and after October 1, 2021.
3. In the court report to address the QI assessment/confirm STRTP, a requirement is to note any objections. How does the placing agency do that when the have to serve the parties the report ahead of time?
JCC clarified that under Welfare & Institutions Code section 366.21 and 727.12, it is required that the report include any objections to placement. It is anticipated that when the QI is doing the assessment and when the agency is working with the family, they will know either from conversations or through the CFT that parties are objecting or disagreement with the recommendations. If the agency doesn't know of any objections, they can note that in the report; similarly, if they know that no one is objecting and all parties are in agreement, that can be noted in the report.
2. Has the Department formally stated that Community Treatment Facilities are QRTPs?
A. Community Treatment Facilities are subject to Qualified Residential Treatment Program (QRTP) requirements and may continue to be eligible for Title IV-E funding, presuming that the facility has met all of the QRTP requirements and that the placement process and oversight is in accordance with the requirements outlined in AB 153 and subsequent guidance.
1. What differences are there between an STRTP and a QRTP?
A. Qualified Residential Treatment Program (QRTP) is the federal designation for childcare institutions as it relates to congregate care settings for foster youth. In California we are requiring Short-Term Residential Therapeutic Programs (STRTP)s to meet the QRTP requirements, however the name of the nomenclature did not change.

Nursing

7. If a provider's direct care staff and/or management needs to contact the Nursing Hotline for a client, is there access to documentation from the call, and if so, how will documentation be sent to providers? How long after a call can a provider expect to receive documentation?
When a call is placed to the STRTP 24/7 Nurse Hotline, a nurse will ask the caller for the STRTP’s contact information. After the call, the nursing staff will share the call documentation information with the STRTP as instructed on the call. This information will be shared directly with the STRTP at the conclusion of the call.
6. Is the 24-7 nursing line available to children’s Temporary Shelter Care Facility (TSCF) programs as well?
At this time, the STRTP 24/7 Nurse Hotline is only available to foster youth/NMDs placed in STRTPs by county child welfare or probation.
5. "If we are a provider, can our DSS contract holder determine that we need to travel to the other county and/or provide telehealth services to kids outside of the county the agency resides?"
No, the contract holder does not make that determination.
4. 1. What does Telehealth mean? What is the extent of it? Who is on the line, a provider (Nurse Practitioner) that can prescribe, or an advice nurse? 2. Are there any printed materials/flyers we can offer our Strtps about this nursing telehealth? 3. Can they help with MediCal? 4. Can they assist strtps with pharmacy/Tar issues?
"1) Telehealth means via the STRTP 24/7 Nurse Hotline, a phone number STRTP youth/NMDs or staff members can call to receive clinical advice and triage from a registered nurse who may provide advice. 2)The CDSS will be distributing printed materials about the STRTP 24/7 Nurse Hotline that can be offered to STRTPs. 3 and 4) At this time, the scope does not allow for assistance with Medi-cal nor with pharmacy or TAR issues. We have however noted this need for future contract considerations."
3. The ACL 21-115 did not include the contact information for accessing the CDSS contracted nursing services. What is that hotline number?
The CDSS will be releasing the STRTP 24/7 Nurse Hotline number in the coming days.
2. Has DHCS or CDSS engaged Home Health providers on the need for supports for children with the needs of a nurse that the PCP is expected to refer the youth to?
DHCS and CDSS are beginning to work on additional guidance regarding the ability to access on-site nursing services for children in STRTPs. We have not yet engaged external stakeholders, but where necessary, will do so as guidance is drafted.
1. Who is responsible for establishing the nursing services when it is determined that a youth requires on site nursing care?
County placing agencies remain responsible for the case management activities that ensure the needs of children and non-minor dependents are met and reflected in the case plan, including ensuring that children receive access to any necessary medical services. If a child requires on-site nursing, the county is to make arrangements for such nursing to be provided and the STRTP is responsible to implement arrangements made by the county placing agency.

Accreditation

7. For the STRTP’s that were in provisional license and had youth already in the facility and then went fully licensed, does there not have to be a QI assessment due to the youth being in the facility even though they were provincially licensed?
A STRTP must meet accreditation requirements for any new placement into a STRTP on and after October 1, 2021. This is whether a provider is provisionally or permanently licensed. Any placement into a STRTP prior to October 1, 2021 is not subject to the FFPSA requirements, including accreditation. Again, the provisional license status has no bearing on the requirement.
6. Does the "N" on the STRTP tracker indicate that a facility is not accredited?
"The information in the STRTP Accreditation Tracker reflects whether or not CDSS has received accreditation information for a facility. It is not necessarily an indication that a provider is not accredited. In instances when you are trying to verify whether a facility is accredited, reaching out to a provider to verify their accreditation status may be the best course of action. We have and are continuing to conduct outreach to all of the providers in an attempt to obtain the most up to date information and as such information continues to be updated on a weekly basis."
5. How will counties be notified of the status of STRTPs that are not accredited? Can counties receive lists on a regular basis?
CDSS released a link to an FFPSA Accreditation Web page which includes accreditation resources, including a list of providers who have provided CDSS with their accreditation status. This list will be updated on a weekly basis. Please visit the accreditation webpage at: https://www.cdss.ca.gov/inforesources/cdss-programs/family-first-prevention-services-act/ffpsa-accreditation
4. Can counties be informed of the expected dates of accreditation for facilities who are close to accreditation?
At this time, we do not have a list of expected accreditation dates for non accredited providers but have been and continue to be actively trying to get current accreditation information.
3. Can counties place into non-accredited facilities for up to 2 weeks and receive FFP, after which FFP is no longer available?
As of October 1, 2021, any new or change of placements of otherwise federally eligible children into a non-accredited STRTP will be ineligible to be paid with federal financial participation (FFP) beyond two-weeks. The two-week period is contingent upon an assessment of the Qualified Individual being conducted within 30 days of the placement. These placements may continue to be eligible for Title IV Administrative Costs.
2. Will the requirements that allow new STRTPs to have 2 years to become accredited be changed to require immediate accreditation? Or, are there other plans to help expedite accreditation for newer facilities?
The state law requirement for accreditation within 24 months of licensure has not changed. CDSS has been working with accrediting bodies, some of whom have agreed to prioritize applications from STRTP providers in California. For more information, we encourage providers to email STRTPAccreditationStatus@dss.ca.gov.
1. If a youth was placed prior to Oct 1 into a facility that isn’t accredited yet will we need to move the youth as of Oct 1?
The FFPSA placement process and Qualified Residential Treatment Program (QRTP) requirements are only required of placements made on or after October 1, 2021. Youth placed before October 1, 2021 are not required to adhere to the requirements of the FFPSA, unless the youth moves from one Short-Term Residential Therapeutic Programs (STRTP) to another STRTP after or on October 1, 2021, at which time the FFPSA placement and oversight requirements would take effect in order for the placement to be eligible for Title IV-E funding.

Eligibility

8. If a child is already determined ineligible for Title IV-E funding, do we even need to go forward with the QI assessment since they are not eligible for Title IV-E funding to begin with?
Yes, counties are required to follow the requirements of FFPSA. The state law does not differentiate between federally eligible and non-federally eligible children.
7. As of 10/1/21, for Voluntary Placements into an STRTP done with youth by Child Welfare Agency, after the QI Assessment has been conducted does that youth need to also be approved by IPC as well since IPC is now approving the specific placement for the youth?
WIC Section 4096(e) (1) Each interagency placement committee shall establish procedures whereby a ward of the court or dependent child of the court, a child who is the subject of a petition filed pursuant to Section 300, a child detained pursuant to Section 636, or a voluntarily placed child whose placement is funded by the Aid to Families with Dependent Children-Foster Care program, who is to be placed or is currently placed in a program, as specified in subdivision (a), shall be determined to meet one of the following: (A) The child or ward meets the medical necessity criteria for Medi-Cal specialty mental health services, as the criteria are described in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations. (B) The child or ward is assessed as seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3. (C) The child’s or ward’s individual behavioral or treatment needs can only be met by the level of care provided in a program, as specified in subdivision (a).
6. What are the placing agencies’ requirements around CFT engagement, signed ROIs/consents, and submission of QI referrals?
Placing agencies must hold a CFT to engage team members and inform decisions about the placement setting that is most appropriate to meet a youth’s needs. According to ACL21-113 / BHIN 21-060 (pg. 7-8), within two (2) business days from the CFT meeting in which the CFT has recommended that the child be referred for a QI assessment, the placing agency caseworker shall complete the QI Referral form, inclusive of all required supporting documentation, and submit the referral to the county MHP. In the case of an emergency placement in an STRTP, the placing agency caseworker shall notify and engage with CFT members about the emergency placement within one (1) business day of the placement and submit a QI Referral form within two (2) business days of the placement. All Release of Information (ROI) forms must be signed by appropriate parties for the QI to be able to gather information. Counties must use existing ROI forms and following current local processes until CDSS and DHCS identify a specific universal ROI and further guidance is issued. County leadership should ensure a clear process for completion of ROI and consent to treat forms.
5. "Is there any risk to STRTPs related to funding disruptions caused by QI assessments not timely conducted, the court not making a timely determination, etc.?"
Neither AB 153 or FFPSA alter the rate for an STRTP and as such, youth placed in STRTPs continue to be eligible for the full rate, even if FFPSA requirements are not met. If FFPSA requirements are not met, the child welfare placing agency cannot claim FFP for the foster care maintenance payment. The changes due to FFPSA may impact the funding source of payments, but should not restrict or result in a loss of the payment for the provider should a child continue to be placed there.
4. "Will FFPSA affect the presumptive transfer of MH billing or accepting youth from multiple counties into an STRTP?"
AB 153 does not make any changes to presumptive transfer and the billing of specialty mental health services for children and youth. Counties should refer to the guidance set forth in ACL 18-60 - Presumptive Transfer Policy Guidance and ACL 17-77 - Implementation of Presumptive Transfer for Foster Children Placed Out of County.
3. "Sometimes the Court, determining that there is good cause to do so, continues hearings outside of statutory guidelines. If the court does not approve the STRTP placement within the statutory timeframe, will federal funding be unavailable for the placement? If the youth is subsequently moved to another placement, and if that court hearing is held timely, will federal funding be available for the subsequent STRTP placement?"
WIC 727.12 (a) and WIC 361.22 (a) mandate that the court review the initial placement and each subsequent placement into an STRTP within 45 days, and in no event later than 60 calendar days, from the start of each new STRTP placement. If the court does not approve the placement within this statutory timeframe, the title IV-E agency may only claim title IV-E foster care maintenance payments for the first 60 days of the placement. If the youth is subsequently moved to another placement and if that hearing is held timely and all other requirements are met, federal funding for the title IV-E foster care maintenance payment may again be claimed.
2. What is meant when CDSS says "these are placements still eligible for title IV-E Admin cost?"
If a placement is disallowed, title IV-E may not be used for board and care for the youth, however county administration costs associated with that placement may still continue to be claimed.
1. How will the disapprovals be tracked for funding purposes?
The CDSS is working with county stakeholders and others to determine the best mechanism for tracking. Both an All County Letter and County Fiscal Letter are forthcoming.

Glossary: Acronyms Spelled Out

AB: Assembly Bill

ACIN: All County Information Notice

ACF: Administration for Children and Families

ACL: All County Letter

ACYF: Administration on Children, Youth and Families

BHIN: Behavioral Health Information Notice

CANS: Child and Adolescent Needs and Strengths

CASA: Court Appointed Special Advocate

CDSS: California Department of Social Services

CFL: County Fiscal Letter

CFT: Child and Family Team

CSEC: Commercial Sexual Exploitation of Children

CSI: Client Services Information

CTF: Community Treatment Facilities

CWS/CMS: Child Welfare Services/Case Management System

DHCS: Department of Health Care Services

FFP: Federal Financial Participation

FFPSA: Family First Prevention Services Act

IP-CANS: Integrated Practice - Child and Adolescent Needs and Strengths

IPC: Interagency Placement Committee

LRS: Least Restrictive Setting

MHP: Mental Health Plan

MHSA: Mental Health Services Act

MOU: Memorandum of Understanding

NMD: Non-Minor Dependent

PCP: Primary Care Provider

QI: Qualified Individual

QRTP: Qualified Residential Treatment Program

ROI: Release of Information

STRTP: Short-Term Residential Therapeutic Program

SMHS: Specialty Mental Health Service(s)

WIC: Welfare and Institutions Code