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Completed by:
The Unsilenced Policy Team
West Virginia Legislation Report
2022
2022
Introduction
The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.
Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.
Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.
An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.
It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.
Introduction
The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.
Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.
Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.
An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.
It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.
West Virginia Legislation
| General Oversight and Transparency | Title 78 Legislative Rule - Technical Changes Only as Allowed by W. Va. Code §29A-1-3a - Department of Health and Human Resources |
| Oversight Agency | Department of Health and Human Resources |
| Which state agency oversees investigations? | Secretary of the Department of Health and Human Services - §78-3-4. 4.6 Complaint Investigation |
| Are investigations and outcomes visible to the public online? | No. The Secretary will not make an investigation public until after the facility can review the report and submit a corrective action plan. Information in the reports can then be available to the public except: 4.7.c.2. Information of a personal nature from a child or employee’s file; and 4.7.c.3. Information required to be kept confidential by state or federal law - §78-3-4 4.7.d |
| Is this type of program required to be licensed by the state? | Yes |
| Is a list of licensed facilities available to the public? | Yes |
| Are regulations only applicable to facilities receiving public funds? | No - §78-3-2. Application and Enforcement |
| Can complaints be filed online? Is the reporting portal easy to find? | No |
| Does the state conduct unannounced site visits? How many per year? | The state has the right to visit but not necessarily will. Announced and unannounced visits may occur by the Secretary to investigate a complaint - §78-3-4. State Administrative Procedures. 4.6.b. |
| Are background checks required, including volunteers? | No Information |
| Is a full-time licensed clinician required to be on staff? | No Information |
| Is parental consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? | No Information |
| Does the state require that parents be notified of an emergency involving their child within 24-hours of the incident occurring? | No Information |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | No Information |
| Does the state require that a licensed psychiatrist provide an initial mental health evaluation and to maintain detailed records of the child's care and treatment plan? | Yes. All intakes and diagnostic assessments are completed by suitably trained and experienced professional employees - §78-3-10. 10.1.b.1. |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | No Information |
| Does the state require medical response training for all staff working with children in residential settings? | No Information |
| Does the state require 1:4 staffing ratio or higher? | No Information |
| Ban on Conversion Therapy for LGBTQA+ youth? | No |
| Are there admissions requirements? | Eligibility criteria must be defined by organization. A policy must detail admission procedures and that shall provide for initial screening or placement on a waiting list - 5.2.c.2. |
| Are the parents and the admitted child required to be informed of their rights, the process to report violations of those rights, and the program's role in protecting those rights before admission? | Yes. The organization is to inform the guardian and admitted child of their rights - §78-3-5. Ethical Practice, Rights and Responsibilities. 5.1. Rights and Responsibilities |
| Does the State define institutional abuse and neglect? | No Information |
| Are there civil penalties for violations of institutional child abuse and neglect? | No Information |
| Does the State prohibit mail censorship? | No Information |
| Are phone calls private from other youth and staff? | Not specifically defined. Organizations conduct quarterly reviews to make sure freedom is not limited. 6.2.a. The organization shall conduct a quarterly review of the use of service modalities or other organizational practices that involve risk or limit freedom of choice including but not limited to: 6.2.a.5. Restrictions of privacy including mail, phone and visitation restrictions; |
| Does the state require that youth have access to guardians, legal counsel, welfare advocates, religious clergy and family/friends via telephone as frequently as can be facilitated? | The state says "reasonable" access. Specifically, 5.1.a. states there are consequences of areas non-compliance - §78-3-5. Ethical Practice, Rights and Responsibilities. 5.4.a.12 states reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Does the state require that children be allowed visitors in private during normal visiting hours? | No Information |
| Is it required that youth receive individualized and appropriate mental health treatment that is evidence-based? | Yes. Initial Assessment and Plan of Care. If staying more than a month, treatment plan will be re-assessed as an extended plan of care - §78-3-13.c |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | No Information |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | No Information |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | No Information |
| Are youth provided with access to advocacy services and representation? | The state says "reasonable" access. Specifically, 5.1.a. states there are consequences of areas non-compliance - §78-3-5. Ethical Practice, Rights and Responsibilities. 5.4.a.12 states reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Is a grievance procedure required for youth and families? | Yes. The organization shall post by the telephone in all direct care and residential service locations, emergency telephone numbers for the fire department, poison control hot-line, local police, and child abuse hot line. Each child capable of using them shall be oriented to their presence and use of the telephone system in emergencies - §78-3-12. 12.1.e. |
| Is youth consent required for all treatment received? | No Information |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | Yes. 12.9.d. Except for outdoor therapeutic educational programs, there shall be a minimum of sixty square feet per occupant in bedrooms. Bedrooms for single occupants shall have a minimum of eighty square feet. 12.9.e. No more than four children may occupy a designated bedroom space |
| Are there any laws banning aversion therapy? | Not completely. Only banned as punishment. 6.2. Safety 6.2.a.2. Aversive procedures used by the organization as consequences to inappropriate behavior; and 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.4. The use of aversive conditioning such as electric shock devices, sound, heat, cold, light, water, noise, hot pepper, pepper sauce, pepper spray or ammonia; |
| Is physical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is chemical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is mechanical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is seclusion allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is there a Bill of Rights for youth in care? | Yes |
| General Oversight and Transparency | Title 78 Legislative Rule - §78-3-23. Therapeutic Residential School |
| Oversight Agency | Department of Health and Human Services, Bureau for Children and Families, Office of Children and Family Policy, Division of Children and Adult Services |
| Which state agency oversees investigations? | Department of Health and Human Services - §78-3-4 4.6. specifically calls out complaint investigation |
| Are investigations and outcomes visible to the public online? | No. Reports and records the secretary keeps them and they are only made public after the school has a chance to review and submit a corrective plan - Title 78 Leg Rule: §78-3-4 4.7. |
| Is this type of program required to be licensed by the state? | Yes. The Secretary of the Department of Health and Human Services and the license expires every two years. 4.3.d. pg 11/108 of Title 78 Leg Rule: §78-3-4. Secretary is to perform an inspection 90 days prior to license expiration (4.5.e) State Administrative Procedures. 4.1. General Licensure Provisions. 4.1.a. Before establishing, operating, maintaining or advertising a residential child care and treatment program within the State of West Virginia, an organization shall first obtain from the Secretary a license authorizing the operation. |
| Is a list of licensed facilities available to the public? | Yes, with a free account |
| Are regulations only applicable to facilities receiving public funds? | No. They apply to private and NPO - §78-3-2 Application and Enforcement 2.1.b. |
| Can complaints be filed online? Is the reporting portal easy to find? | No |
| Does the state conduct unannounced site visits? How many per year? | The Secretary has the right to do so but visits are not required - §78-3-4. State Administrative Procedures. 4.5. Inspections 4.5.a. |
| Are background checks required, including volunteers? | Yes. 8.7.d. The organization shall ensure a complete personnel file on each contracted clinical employee and consultant who provides direct services to children on site, including 8.7.d.5. Evidence of a criminal background check10.2.j. The organization shall submit a request for a Protective Services (Adult and Child) background check on each applicant to the Department. Documentation of the results of the check shall be maintained with the personnel file of the applicant. 10.3.f. The organization shall have a policy requiring volunteer screening, which shall include the same criminal and protective services background checks as required for employees and independent contractors. |
| Is a full-time licensed clinician required to be on staff? | Not specified. §78-3-10. Management of Human Resources. 10.1. Deployment of Employees 10.1.b. The organization shall ensure that sufficient, licensed or certified professional clinical employees are employed or available on a consistent basis to provide, at a minimum, that: 10.1.b.2. Professional employees are available and mandated to provide direct supervision and consultation to direct care employees, professional interns and paraprofessionals at a ratio appropriate to the number of employees or interns supervised and the demands of the population served;" |
| Is parental consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? | 13.5.d. Changes to the plan of care shall be the result of recommendations by the review team and shall be dated and approved in writing by the members of the team including the child (as developmentally appropriate) and his or her guardian. AND 12.6. Emergency Response 12.6.a. The organization shall have procedures in place for responding to accidents, serious illness, fire, medical emergencies, floods, natural disasters and other life threatening situations that:12.6.a.5. Require notification of the child’s parent or guardian and other appropriate authorities at the earliest opportunity. 13.4. Plan of Care 13.4.a. Parents are part of the team and therefore part of the review for changes to treatment |
| Does the state require that parents be notified of an emergency involving their child within 24-hours of the incident occurring? | Not 24-hours specifically. 12.6.a.5. Require notification of the child’s parent or guardian and other appropriate authorities at the earliest opportunity. |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | 14.2.c. The organization is responsible for notifying parents and guardians of:14.2.c.2. Changes in the plan of care; and14.2.d. The notification shall be completed within one working day after the event and documented. And 14.9. Termination or Discharge 14.9.c. The organization and interdisciplinary team, guardian, placement organization (such as the court), multidisciplinary team, and the person or family shall jointly plan for termination or discharge. 14.9.d. The organization shall enter a closing summary into the case record upon termination of service or within thirty days of termination or discharge 14.9.e. The organization that has collaborated with other organizations or has shared case management responsibility for the child shall notify those organizations, upon termination of services, with the written consent of the person served or his or her guardian. The person served or his or her parent or guardian shall have the right to refuse the notification, which the organization shall document. |
| Does the state require that a licensed psychiatrist provide an initial mental health evaluation and to maintain detailed records of the child's care and treatment plan? | Potentially. §78-3-13. Initial Assessment and Plan of Care - 13.2, 13.2.b.11, 10.1.b.1 |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | 14.16. Special Services and Populations 14.16.a. If an organization provides specialized services to a unique population (e.g., children with issues of substance abuse, children with developmental disabilities, sexually reactive children) the organization shall ensure that: 14.16.a.1. The service and clinical model reflects knowledge and use of the best practices available in the field; 14.16.a.2. Clinical and professional employee are appropriately trained and when possible certified or licensed in the area of service provided; |
| Does the state require medical response training for all staff working with children in residential settings? | 11.2. Employee Training and Content 11.2.a. The organization shall provide training to clinical and direct care employees in the following health related topics within thirty days of employment: 11.2.a.1. Basic medical needs and problems of the population served, including management of sick children and symptoms of common medical problems, such as allergy reactions, diabetes and asthma; 11.2.a.2. Basic first aid (completed according to OSHA-approved pediatric first aid requirements and adult requirements as appropriate) and medication reactions (including desired and undesired effects). This training must be updated every three years; 11.2.a.3. Cardio-Pulmonary Resuscitation (CPR) Adult Training is required every two years and First Aid certification every three years, specific to population served (adult, child and/or infant); 11.2.a.4. Supervision of self-administration of medication as applicable including typical medications prescribed, appropriate dosages and schedules and common side effects. This training shall be updated annually; |
| Does the state require de-escalation training for all staff working with children in residential settings? | 11.2. Employee Training and Content 11.2.a. The organization shall provide training to clinical and direct care employees in the following health related topics within thirty days of employment:11.2.a.5. Basic de-escalation techniques and passive restraints. This training must be updated annually; |
| Does the state require 1:4 staffing ratio or higher? | No. 78-3-23. Therapeutic Residential School. 23.1. Employee Ratios and Training 23.1.c.1. A minimum employee to child ratio of 1:10 during the waking hours when children are on the grounds with a minimum of one employee present per residential living unit at all times23.1.c.3. An employee to child ratio of 1:12 during sleeping hours with a minimum of at least one employee per residential living unit to be awake at all times |
| Ban on Conversion Therapy for LGBTQA+ youth? | No |
| Are there admissions requirements? | No. Referral is the only requirement. 13.3.a.1. Justification for continuation of medications prescribed prior to admission and continued until the assessment process is completed or justification for medications prescribed by the admitting physician |
| Are the parents and the admitted child required to be informed of their rights, the process to report violations of those rights, and the program's role in protecting those rights before admission? | Yes. §78-3-5. Ethical Practice, Rights and Responsibilities. 5.1.a. The organization shall inform all children and their family and/or guardians of their rights and responsibilities. Information on rights and responsibilities shall be tailored for each of the organization’s services as appropriate, and shall reflect the consequences of areas of non-compliance with programmatic rules, as well as limitation on individual rights occasioned by involuntary placement or court orders. |
| Does the state define institutional abuse and neglect? | No |
| Are there civil penalties for violations of institutional child abuse and neglect? | No Information |
| Does the state prohibit mail censorship? | No. 5.4.a.10. Uncensored mail, unless there is reason to suspect it may contain unauthorized, dangerous or illegal substances or materials or is clinically contra-indicated, or unless consent has been given by parent or guardian to inspect mail; |
| Are phone calls private from other youth and staff? | Not specifically. Facilities have to revisit limitations quarterly- 6.2. Safety. 6.2.a. The organization shall conduct a quarterly review of the use of service modalities or other organizational practices that involve risk or limit freedom of choice including but not limited to: 6.2.a.5. restrictions of privacy including mail, phone and visitation restrictions; |
| Does the state require that youth have access to guardians, legal counsel, welfare advocates, religious clergy and family/friends via telephone as frequently as can be facilitated? | No. Not unrestricted specifically and not necessarily by telephone (depending on whom they want to contact) §78-3-5. Ethical Practice, Rights and Responsibilities. 5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to: 5.4.a.9. Communication with family and significant others by telephone, e-mail, texting or other means of communication as specified in the plan of care and/or the child’s case plan or under conditions described in policy; 5.4.a.12. Reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Does the state require that children be allowed visitors in private during normal visiting hours? | No. Only that 5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to: 5.4.a.8. Visitation with family and significant others as specified in the plan of care and/or the child’s case plan, unless clinically contra-indicated or otherwise described in policy; |
| Is it required that youth receive individualized and appropriate mental health treatment that is evidence-based? | §78-3-13. Initial Assessment and Plan of Care. 13.2. However, it is not mandatory. For example, “if considered appropriate by a healthcare professional," recommended for further assessment/update if deemed necessary due to significant changes 13.2.e.3 also 13.3.c if the stay is to be over 30 days, an extended care plan is formulated. 13.5. Review of Plan of Care as determined by the organization on a case-by-case basis - generally not longer than 90 days apart (13.5.a) except as permitted in sections for each provider type. |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | 5.7. Research Protections 5.7.d. Participation in research by children or their families is voluntary. The organization may not threaten to withdraw services or otherwise coerce persons or their guardians into participating and shall prohibit the use of financial incentives for recruiting research participants. 5.7.e. Each research participant or when appropriate his or her parent or guardian shall sign a consent form that includes: 5.7.e.1. A statement that he or she voluntarily agrees to participate in the research project;5.7.e.6. The signature of the parent or guardian or emancipated child. |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | 14.10 Educational Services 14.10.a. The organization shall develop an educational program for each school-age child in care. 14.10.b. All children in residential childcare shall be enrolled in an educational or vocational program (depending on age and the child’s expressed desire) and provided with an educational or vocational plan, as appropriate, that is integrated into his or her plan of care and complies with the requirements set forth by the State Department of Education. The organization is responsible for ensuring that the child’s educational credits are accepted by the child’s home school or county. 14.10.c. When appropriate and unless clinically, programmatically, or educationally contraindicated, children and transitioning adults shall be enrolled in the public school system. Organization employees shall maintain regular contact with school employees at a frequency appropriate 5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to: 5.4.a.4. Education; 14.11. On-Ground Schools; 14.11.a. On-ground schools shall meet the guidelines required by the State Department of Education. At a minimum, on grounds schools shall attain Exemption A status, be a school operated by Institutional Services of the Department of Education or be conducted in conjunction with or under the auspices of the local educational authority in the county in which the organization is operating. When possible, the school shall be accredited by a state or regional accrediting body. Educational employees shall be certified to teach in the state of West Virginia. Outdoor therapeutic educational programs are exempt from this requirement and shall comply with the requirements set forth in Section 20 of this rule. |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | Not sexual education but yes on personal hygiene. 14.20. Personal Hygiene - 14.20.a. Procedures to ensure that children receive assistance and training in personal care, hygiene and grooming appropriate to their age, sex, race, and culture shall be established. 14.20.b. The organization shall ensure that children are provided with all necessary toiletry items. 19.1. Maternity Care to a pregnant or parenting adolescent or transitioning adult includes, but is not limited to: 19.1.a. Appropriate health care and health education;5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to:5.4.a.7. Adequate medical care; |
| Are youth provided with access to advocacy services and representation? | 5.4.a.12. Reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Is a grievance procedure required for youth and families? | Not specifically. 12.1.e. The organization shall post by the telephone in all direct care and residential service locations, emergency telephone numbers for the fire department, poison control hot-line, local police, and child abuse hot line. Each child capable of using them shall be oriented to their presence and use of the telephone system in emergencies. |
| Is youth consent required for all treatment received? | No. 14.5.d. When medication is prescribed and/or administered, the organization shall: 14.5.d.1. Obtain the written consent of the parent or legal guardian and the child over age 12 unless the child is incapable of supplying informed consent or there are compelling and documented clinical or legal reasons to overlook the child’s lack of consent. If reasons for continued medication administration are clinical, the organization shall obtain court ordered permission to treat the child against his or her will within the shortest period possible; |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | Yes. §78-3-4. State Administrative Procedures 4.2.f. The application shall be accompanied by a current fire inspection report by the State Fire Marshal’s Office and a current food service and environmental inspection by the local health department. 4.10.a.2.The organization must abide by federal, state or local law relating to building, health, fire protection, safety, sanitation or zoning. 12.3.c. The organization shall maintain in the administrative file reports regarding: 12.3.c.1. Certification of occupancy requirements; 12.3.c.2. Must maintain administrative reports regarding Zoning and building codes; Permitted use of group residential facilities; restrictions. Both a group residential facility and a group residential home shall be a permitted residential use of property for the purposes of zoning and shall be a permitted use in all zones or districts. No county commission, governing board of a municipality or planning commission shall require a group residential facility, its owner or operator, to obtain a conditional use permit, special use permit, special exception or variance for location of such facility in any zone or district. 531.1.1 Physical Environment/Equipment Bedrooms must be adequately furnished and provide a minimum of 80 square feet of floor space per person for one person occupancy and a minimum of 60 square feet of floor space per person for two or more person occupancy. Each member of a facility shall be provided a permanent, separate bed with a clean, comfortable, covered mattress, clean bedding, clean towels, and other furnishings appropriate to the length of stay and needs of the member. Each bedroom window must have covering for privacy. Furnishings shall be homelike and personalized. Monitored Annually. ALSO §78 12.5.b fire extinguishers are to be checked annually and see 2.2.j and 2.2.n.2 ALSO:12.1.h. The organization shall have documentation that the facilities owned or leased by the organization and used for services are in full compliance with the State Fire Code. That evidence shall be renewed as required by the State Fire Marshal. |
| Are there any laws banning aversion therapy? | Not completely. Only banned as punishment. 6.2. Safety 6.2.a.2. Aversive procedures used by the organization as consequences to inappropriate behavior; and 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.4. The use of aversive conditioning such as electric shock devices, sound, heat, cold, light, water, noise, hot pepper, pepper sauce, pepper spray or ammonia; |
| Is physical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is chemical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is mechanical restraint allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is seclusion allowed? | Yes. §78-3-15. Restrictive Behavioral Interventions. 15.1. Legal Compliance - 15.1.a. Restrictive behavior management techniques include: restraint (physical, mechanical, or chemical) and seclusion. The organization shall have a policy with specific procedures to govern the use of these techniques. The policy shall delineate the circumstances under which these techniques may be used and shall describe which techniques may be used in precise language. Unless indicated otherwise in this rule, restraints are to be used only in an emergency when there is imminent risk of the child physically harming himself or herself or others, including employees. Non-physical interventions are the first choice as an intervention unless safety issues demand an immediate physical response. Restrictive behavior management techniques are not to be used as a part of an approved plan of care. 15.1.b. Group restraints incorporating peers as restrainers or observers are prohibited in any treatment environment. 6.2.a.1. The use of restrictive behavior management interventions such as restraints (physical, mechanical, or chemical) and seclusion to manage inappropriate and/or aggressive behavior; AND 14.4. Discipline 14.4.a. The organization shall follow a policy that outlines its practices regarding punishment or discipline of persons served and this policy shall prohibit the following: 14.4.a.15. Use of physical restraint involving peers; 14.4.a.16. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or 14.4.a.17. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used. 15.4. Physical Restraint - 15.4.a. Written procedures shall govern the use of physical restraint. They shall specify that: 15.4.a.1. Physical restraint may be used only in emergency or crisis situations to protect individuals from harming themselves or others; 15.4.a.2. Employees shall use the least restrictive, safest, and most effective methods generally accepted in the field; 15.4.a.3. Physical restraint may be used in each instance only when less restrictive measures have proven to be ineffective or in an immediately dangerous situation which precludes the use of other interventions; 15.4.a.4. The decision to use physical restraint shall take into account an analysis which determines that the risk of the individual’s behavior to himself, herself or others outweighs the potential risk of the use of physical restraint. This analysis shall be documented as soon as possible after the use of the restraint; 15.4.a.5. Physical restraint shall be discontinued as soon as possible; 15.4.d. Physical restraint may not be used: 15.4.d.1. To force a child into compliance; 15.4.d.2. In response to cursing or screaming; 15.4.d.3. For refusal to participate in an activity; or 15.4.d.4. For failure to join a group activity. 15.4.e. The use of physical restraints shall be discontinued as soon as possible and shall be limited to the following maximum time per episode: 15.4.e.1. Fifteen minutes for children aged nine and younger; and 15.4.e.2. Thirty minutes for persons aged ten and older. 15.4.f. Employees shall make periodic attempts to free the child during the period in which the restraint is employed. |
| Is there a Bill of Rights for youth in care? | Yes |
| General Oversight and Transparency | § 78-3-22. Outdoor Therapeutic Educational Programs |
| Oversight Agency | Department of Health and Human Services, Bureau for Children and Families, Office of Children and Family Policy, Division of Children and Adult Services |
| Which state agency oversees investigations? | Department of Health and Human Resources |
| Are investigations and outcomes visible to the public online? | No. §78-3-4 4.7.d. The Secretary will not make an investigation public until after the facility can review the report and submit a corrective action plan. Information in the reports can then be available to the public except: 4.7.c.2. Information of a personal nature from a child or employee’s file; and 4.7.c.3. Information required to be kept confidential by state or federal law. |
| Is this type of program required to be licensed by the state? | Yes. §78-3-1. 2.1.c. This rule applies to the following congregate living facilities serving children and transitioning adults: 2.1.c.5. Outdoor therapeutic educational programs |
| Is a list of licensed facilities available to the public? | No |
| Are regulations only applicable to facilities receiving public funds? | No. 2.1.b. This rule applies equally to for-profit, not-for-profit, publicly-funded and privately-funded facilities |
| Can complaints be filed online? Is the reporting portal easy to find? | No |
| Does the state conduct unannounced site visits? How many per year? | The secretary may conduct and unannounced visit in response to a complaint but the state is not required to conduct the visits otherwise. |
| Are background checks required, including volunteers? | No Information |
| Is a full-time licensed clinician required to be on staff? | No Information |
| Is parental consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? | 13.5.d. Changes to the plan of care shall be the result of recommendations by the review team and shall be dated and approved in writing by the members of the team including the child (as developmentally appropriate) and his or her guardian. |
| Does the state require that parents be notified of an emergency involving their child within 24-hours of the incident occurring? | No Information |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | No Information |
| Does the state require that a licensed psychiatrist provide an initial mental health evaluation and to maintain detailed records of the child's care and treatment plan? | No Information |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | No Information |
| Does the state require medical response training for all staff working with children in residential settings? | No Information |
| Does the state require 1:4 staffing ratio or higher? | No Information |
| Ban on Conversion Therapy for LGBTQA+ youth? | No |
| Are there admissions requirements? | 20.6.a. The environment of an outdoor therapeutic educational program is by definition limited in its handicapped accessibility. The organization shall have an admissions policy which clearly describes its degree of accessibility to clients with physical handicaps. |
| Are the parents and the admitted child required to be informed of their rights, the process to report violations of those rights, and the program's role in protecting those rights before admission? | Yes. §78-3-5. Ethical Practice, Rights and Responsibilities. 5.1. Rights and Responsibilities 5.1.b.1. Posted in a public area (as appropriate) |
| Does the state define institutional abuse and neglect? | No Information |
| Are there civil penalties for violations of institutional child abuse and neglect? | No Information |
| Does the state prohibit mail censorship? | No Information |
| Are phone calls private from other youth and staff? | Not specifically defined. Organizations conduct quarterly reviews to make sure freedom is not limited. 6.2.a. The organization shall conduct a quarterly review of the use of service modalities or other organizational practices that involve risk or limit freedom of choice including but not limited to: 6.2.a.5. Restrictions of privacy including mail, phone and visitation restrictions; |
| Does the state require that youth have access to guardians, legal counsel, welfare advocates, religious clergy and family/friends via telephone as frequently as can be facilitated? | The state says "reasonable" access. Specifically, 5.1.a. states there are consequences of areas non-compliance - §78-3-5. Ethical Practice, Rights and Responsibilities. 5.4.a.12 states reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Does the state require that children be allowed visitors in private during normal visiting hours? | No Information |
| Is it required that youth receive individualized and appropriate mental health treatment that is evidence-based? | Yes. Within 72 hours of placement. (13.3. Initial Plan of Care). The organization is responsible for a regular review policy. 13.5.a. The organization shall have a policy regarding regular review of the plan of care. The policy shall dictate schedules of review of the plan depending on the average or projected length of stay for the child. At no time shall the schedule allow a period of review to extend more than ninety days except as permitted in sections for each provider type. |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | No Information |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | 20.4.a. The organization shall have an on grounds educational program that is of sufficient quality to allow students to transfer educational credits to their County of origin. A teacher certified to teach in the state of West Virginia shall be coordinating and providing oversight to the educational program. Whenever possible, the educational program shall be accredited by an appropriate educational accreditation body. |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | No Information |
| Are youth provided with access to advocacy services and representation? | Yes. 5.4.a.12 states reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Is a grievance procedure required for youth and families? | No Information |
| Is youth consent required for all treatment received? | A child over age 12 must consent unless the child is incapable of supplying informed consent or there are compelling and documented clinical or legal reasons to overlook the child’s lack of consent. |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | 5.4.a.12. Reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Are there any laws banning aversion therapy? | No Information |
| Is physical restraint allowed? | No Information |
| Is chemical restraint allowed? | No Information |
| Is mechanical restraint allowed? | No Information |
| Is seclusion allowed? | No Information |
| Is there a Bill of Rights for youth in care? | No Information |
| General Oversight and Transparency | Juvenile Codes |
| Oversight Agency | Division of Juvenile Services |
| Which state agency oversees investigations? | Division of Juvenile Services |
| Are investigations and outcomes visible to the public online? | No |
| Is this type of program required to be licensed by the state? | Yes |
| Is a list of licensed facilities available to the public? | Yes |
| Are regulations only applicable to facilities receiving public funds? | Not applicable |
| Can complaints be filed online? Is the reporting portal easy to find? | No Information |
| Does the state conduct unannounced site visits? How many per year? | Yes. Annually. §15-9-2. Facility inspection |
| Are background checks required, including volunteers? | No Information |
| Is a full-time licensed clinician required to be on staff? | No Information |
| Is parental consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? | No |
| Does the state require that parents be notified of an emergency involving their child within 24-hours of the incident occurring? | No Information |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | No Information |
| Does the state require that a licensed psychiatrist provide an initial mental health evaluation and to maintain detailed records of the child's care and treatment plan? | Not automatically. §49-2-907 states that if the client is deemed high risk by a risk and needs assessment or who is violent, they may receive an evaluation |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | No Information |
| Does the state require medical response training for all staff working with children in residential settings? | No Information |
| Does the state require 1:4 staffing ratio or higher? | No Information |
| Ban on Conversion Therapy for LGBTQA+ youth? | No |
| Are there admissions requirements? | Yes, the child must be adjudicated in court |
| Are the parents and the admitted child required to be informed of their rights, the process to report violations of those rights, and the program's role in protecting those rights before admission? | Youth get a copy of their rights upon admission to the detention facility. No information on guardians |
| Does the state define institutional abuse and neglect? | No Information |
| Are there civil penalties for violations of institutional child abuse and neglect? | No Information |
| Does the state prohibit mail censorship? | No Information |
| Are phone calls private from other youth and staff? | No Information |
| Does the state require that youth have access to guardians, legal counsel, welfare advocates, religious clergy and family/friends via telephone as frequently as can be facilitated? | Telephone access is limited but guaranteed at least once per week |
| Does the state require that children be allowed visitors in private during normal visiting hours? | No Information |
| Is it required that youth receive individualized and appropriate mental health treatment that is evidence-based? | Yes |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | No Information |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | Yes |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | No information on sexual education. Yes on feminine hygiene products |
| Are youth provided with access to advocacy services and representation? | Telephone access is limited but guaranteed at least once per week |
| Is a grievance procedure required for youth and families? | Telephone access is limited but guaranteed at least once per week |
| Is youth consent required for all treatment received? | No |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | No Information |
| Are there any laws banning aversion therapy? | No Information |
| Is physical restraint allowed? | Yes |
| Is chemical restraint allowed? | No Information |
| Is mechanical restraint allowed? | No Information |
| Is seclusion allowed? | Allow but not as a punishment. WV code 49-4-721 |
| Is there a Bill of Rights for youth in care? | Chapter 49. Child Welfare Article 4. Court Actions - §49-4-721. Rules governing juvenile facilities; rights of juveniles. (a) The Director of the Division of Juvenile Services within the Department of Military Affairs and Public Safety shall propose legislative rules for promulgation in accordance with article three, chapter twenty-nine-a of this code, outlining policies and procedures governing the operation of those correctional, detention, predispositional detention centers and other facilities wherein juveniles may be housed. These policies and procedures shall include, but are not limited to, standards of cleanliness, temperature and lighting; availability of medical and dental care; provision of food, furnishings, clothing and toilet articles; supervision; procedures for enforcing rules of conduct consistent with due process of law; and visitation privileges. A juvenile in custody or detention has, at a minimum, the following rights, and the policies prescribed ensuring that: (1) A juvenile may not be punished by physical force, deprivation of nutritious meals, deprivation of family visits or imposition of solitary confinement; (2) A juvenile shall be afforded an opportunity to participate in physical exercise each day; (3) Except for sleeping hours, a juvenile in a state facility may not be locked alone in a room unless that juvenile is not amenable to reasonable direction and control;(4) A juvenile shall be provided with his or her own clothing or individualized clothing which is clean and supplied by the facility, and shall also be afforded daily access to showers;(5) A juvenile shall be afforded constant access to writing materials and may send mail without limitation, censorship or prior reading, and may receive mail without prior reading, except that mail may be opened in the juvenile's presence, without being read, to inspect for contraband;(5) A juvenile shall be afforded constant access to writing materials and may send mail without limitation, censorship or prior reading, and may receive mail without prior reading, except that mail may be opened in the juvenile's presence, without being read, to inspect for contraband;(6) A juvenile may make and receive regular local phone calls without charge and long distance calls to his or her family without charge at least once a week, and receive visitors daily and on a regular basis;(7) A juvenile shall be afforded immediate access to medical care as needed;(8) A juvenile in a juvenile detention facility or juvenile corrections facility shall be provided access to education, including teaching, educational materials and books;(9) A juvenile shall be afforded reasonable access to an attorney upon request; and(10) A juvenile shall be afforded a grievance procedure, including an appeal mechanism.(b) Upon admission to a detention facility or juvenile corrections facility, a juvenile shall be furnished with a copy of the rights provided him or her by virtue of this section and as further prescribed by rules proposed and promulgated pursuant to this section. |
| General Oversight and Transparency | Chapter 531 Psychiatric Residential Treatment Facility |
| Oversight Agency | Department of Health and Human Services, Bureau for Medical Services |
| Which state agency oversees investigations? | 531.1.13 The facility cooperates with authorized external review systems (including the Bureau’s Utilization Management Contractor (UMC), the Bureau for Children and Families (BCF), and the West Virginia Department of Education (DOE)), and, where applicable and where possible, organizes its internal review schedules to complement those conducted by external review systems. AND §78 3.45. Institutional Investigative Unit -- A unit of the Department authorized by the Secretary to investigate complaints of child abuse or neglect. |
| Are investigations and outcomes visible to the public online? | No |
| Is this type of program required to be licensed by the state? | Yes. Title 78 Leg Rule: §78-3-4 2.1.a. This rule contains the minimum requirements to obtain a license or certificate of approval to provide residential child care and treatment for children in West Virginia. 2.1.c.1. Psychiatric residential treatment facilities for persons less than 21 years of age; 22.2. Accreditation Requirements - A psychiatric residential treatment facility shall be appropriately accredited as required by federal standards. Where differing accreditation, certification or licensing standards exist, the more stringent standard applies. |
| Is a list of licensed facilities available to the public? | Yes |
| Are regulations only applicable to facilities receiving public funds? | No. Title 78 Leg Rule 78-3-4 2.1.b. This rule applies equally to for- profit, not-for- profit, publicly-funded and privately-funded facilities.2.1.c.1. Psychiatric residential treatment facilities for persons less than 21 years of age; |
| Can complaints be filed online? Is the reporting portal easy to find? | Yes |
| Does the state conduct unannounced site visits? How many per year? | No Information |
| Are background checks required, including volunteers? | Yes. 531.1.4 Fingerprint-Based Background Check West Virginia Code, Chapter 49 (Child Welfare), Article 2 Section 113 requires a criminal background check of personnel criminal records for licensed, certified and registered child welfare agencies. The Adoption and Safe Families Act requires criminal background checks on all individuals and agency staff providing care for foster children. A thorough Fingerprint-Based Background Check and review by a Federal Registry is required with results of an on-line preliminary check available for review PRIOR to employment of any individual (including volunteers) who will be working in a facility providing treatment or care for all West Virginia Medicaid members (custodial and non-custodial). The on-line preliminary results may be used for a period of three months (90 days) while awaiting the final results of fingerprinting. During that time period the individual may not work unsupervised. Results of the Fingerprint-Based Background check must be documented in the personnel file within three months (90 days) of hiring the employee. (Refer to requirements listed below regarding exclusions/sex offender registries lists which must be completed with a negative result prior to hiring or allowing to volunteer.) An applicant must complete a Statement of Criminal Record every two years after the initial submission to the respective agency or department. A subsequent Fingerprint-Based Background Check must be completed at least every five years, but may be submitted at any point if there is an indication that the Fingerprint-Based Background Check information may have changed. |
| Is a full-time licensed clinician required to be on staff? | 22.5. Treatment Services The residential treatment facility shall provide the following clinical services: 22.5.a. A physician shall be available twenty-four hours a day, seven days a week to respond to medical and psychiatric emergencies; |
| Is parental consent required to make any changes to a child's medical or mental health treatment plan, unless an emergency? | 531.4.5 Consent for Medication When medications are prescribed or changed, a member of the professional staff will review with each member’s parent/guardian and document in the medical record the following information: The name/class of medication; The method of administration (oral, injection, etc.); The symptom(s) targeted/expected outcomes; Possible side effects of the medication; Possible long-term effects of the medication; Treatment alternatives; Likely outcomes of using/not using the medication. The minimum and maximum dose to be administered. When a face-to-face encounter cannot be held with a parent/guardian prior to starting a medication regimen, the "informed consent" conference may be held by telephone, with the parent/guardian's responses noted and dated. This form must be signed by the parent/guardian within 30 days after the telephone consent is obtained. The PRTF professional staff must document this telephone consent obtained with one witness signature/date on the form after talking with the parent/guardian. Documentation regarding the parent’s verbal consent must be located in the member record. |
| Does the state require that parents be notified of an emergency involving their child within 24-hours of the incident occurring? | 531.1.12 Incident/Accident Reporting and Policy PRTF’s are required to maintain a written Incident/Accident Reporting Policy in a centralized location for easy access to all staff personnel. The written policy must be approved by the governing body of the facility. The facility accepting/admitting West Virginia Medicaid members for care must ensure that they are cared for in an environment which meets high standards of safety and maintenance and that special precautions are taken that no harm or injury to the member occurs. The facility promptly reports to appropriate state and/or legal authorities any serious accident, emergency, or dangerous situation, including immediate verbal reporting of instances of child abuse, and reports to parents or legal guardians any of the above which affect their child or the child for which they are responsible. The PRTF must verbally report to the parent/legal guardian any accident or incident involving a child which results in injury within 24 hours of the facility’s knowledge of the accident or incident. The PRTF must verbally report suspected abuse or neglect of a child to the parent/guardian and the appropriate authorities in the state where the facility is located within 24 hours of the facility’s knowledge of its occurrence with a detailed written report within five days. The PRTF must verbally report the findings of abuse and neglect investigations conducted by the state where the facility is located within 24 hours of completion of the investigation, with a detailed written report within five days. Incident/Accident reports will be forwarded the following business day to BMS, Attention: Office Director, for Facility Based and Residential Care. Reports must be mailed to: West Virginia Department of Health and Human Resources Bureau for Medical Services Office Director, Facility Based & Residential Care, 350 Capitol Street, Room 251, Charleston, West Virginia 25301 |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | 14.2.c. The organization is responsible for notifying parents and guardians of:14.2.c.2. Changes in the plan of care; and 14.2.d. The notification shall be completed within one working day after the event and documented. And 14.9. Termination or Discharge 14.9.c. The organization and interdisciplinary team, guardian, placement organization (such as the court), multidisciplinary team, and the person or family shall jointly plan for termination or discharge. 14.9.d. The organization shall enter a closing summary into the case record upon termination of service or within thirty days of termination or discharge 14.9.e. The organization that has collaborated with other organizations or has shared case management responsibility for the child shall notify those organizations, upon termination of services, with the written consent of the person served or his or her guardian. The person served or his or her parent or guardian shall have the right to refuse the notification, which the organization shall document. |
| Does the state require that a licensed psychiatrist provide an initial mental health evaluation and to maintain detailed records of the child's care and treatment plan? | The assessment process must be initiated within 24 hours of admission. The initial treatment plan completed within 72 hours of admission and will document minimally one primary treatment goal/problem listed on the MCM-1. A more comprehensive treatment plan in the first 14 days after admission to a PRTF must document the need for the PRTF level of care by the Multidisciplinary Team (42 CFR §441.155(b)(1)). The assessment process must include, but is not limited to, the following: A psychiatric evaluation; A medical history and examination; A psycho-social assessment which includes a psychological profile, a developmental profile with a validity statement; A behavioral assessment; An assessment of the potential resources of the West Virginia member’s family (42 CFR §441.156(b)(2)); A Child and Adolescent Needs and Strengths (CANS) assessment, or other nationally recognized functional assessment; An educational evaluation; A nursing assessment; A nutritional assessment; and, An occupational/physical/speech assessment as indicated. The facility will maintain a policy to ensure the transfer of educational records, information, and individual support when a West Virginia member enters the PRTF within seven days of admission. The transfer of records from one school to another is vital to proper and prompt placement in a new school system. The facility will obtain and review previous educational records for each student prior to admission to the facility. West Virginia members who require special education services must be identified, and the facility must ensure that those services are provided according to the rules and regulations of the West Virginia Department of Education. Upon admission, an academic assessment must be administered by a qualified instructor that measures (at a minimum) math, reading, and written expression skills. A nationally recognized vocational assessment must be administered to any student at least 14 years of age who has not been previously assessed. |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | 531.1.6 Direct Care Staff, Case Manager, and All Clinical Staff - All direct care staff shall have a minimum of a high school diploma or GED and professional staff shall have appropriate education and certification consistent with professional licensing standards. (78 CSR §3-22.4.a. Employee Training and Credentials). Personnel development is an ongoing, integral, and identifiable part of the facility’s program of services, and the facility has specific guidelines as to the time commitment expected of personnel in various positions. Pre-Service Training including all of the following that demonstrates training sessions last at a minimum eight and one-half hours excluding first aid and CPR training which are prescriptive in nature with specific training criteria. The following pre-service training is required: All personnel are required to have pre-service and annual in-service trainings in the following topics. All appropriate/applicable facility policies, Conflict resolution, Member rights, Managing behavior, Psychiatric emergencies, First aid (All staff having direct contact with West Virginia members must receive training in first aid.), CPR (facility staff member must be immediately available who has been trained in CPR.), Incident reporting/completion/follow up, Recognition of substance abuse, Elopement procedure/reporting, Child abuse prevention/reporting, Suicide prevention, HIPAA/Confidentiality, Emergency/Disaster Preparedness, Infection Control, Sexual harassment including prevention, Cultural awareness, De-escalation procedures. All training sessions must include both lecture and active participation (return demonstration) activities for the staff. 531.1.12 Incident/Accident Reporting and Policy: PRTF’s are required to maintain a written Incident/Accident Reporting Policy in a centralized location for easy access to all staff personnel. The written policy must be approved by the governing body of the facility. The facility accepting/admitting West Virginia Medicaid members for care must ensure that they are cared for in an environment which meets high standards of safety and maintenance and that special precautions are taken that no harm or injury to the member occurs. The facility promptly reports to appropriate state and/or legal authorities any serious accident, emergency, or dangerous situation, including immediate verbal reporting of instances of child abuse, and reports to parents or legal guardians any of the above which affect their child or the child for which they are responsible. |
| Does the state require medical response training for all staff working with children in residential settings? | 531.1.5 Staff Training A PRTF that contracts with DHHR ensures that qualified personnel meet or exceed the requirements for pre-service and in-services trainings with respect to facility objectives, policies, services, community resources, DHHR policies, and best practice standards. See 78 CSR 3-11 for training and Supervision of Employees 531.1.6 Direct Care Staff, Case Manager, and All Clinical Staff All direct care staff shall have a minimum of a high school diploma or GED and professional staff shall have appropriate education and certification consistent with professional licensing standards. (78 CSR §3-22.4.a. Employee Training and Credentials). Personnel development is an ongoing, integral, and identifiable part of the facility’s program of services, and the facility has specific guidelines as to the time commitment expected of personnel in various positions. Pre-Service Training including all of the following that demonstrates training sessions last at a minimum eight and one-half hours excluding first aid and CPR training which are prescriptive in nature with specific training criteria. The following pre-service training is required: All personnel are required to have pre-service and annual in-service trainings in the following topics. All appropriate/applicable facility policies, Conflict resolution, Member rights, Managing behavior, Psychiatric emergencies, First aid (All staff having direct contact with West Virginia members must receive training in first aid.), CPR (facility staff member must be immediately available who has been trained in CPR.), Incident reporting/completion/follow up, Recognition of substance abuse, Elopement procedure/reporting, Child abuse prevention/reporting, Suicide prevention, HIPAA/Confidentiality, Emergency/Disaster Preparedness, Infection Control, Sexual harassment including prevention, Cultural awareness, De-escalation procedures. All training sessions must include both lecture and active participation (return demonstration) activities for the staff.All policy on de-escalation, restraint, seclusion, CPR certification, and requirements must be readily available to all staff 24 hours a day, seven days a week. The facility shall post in a centralized location the name of at least one person who is on-duty with proper CPR certification for the use of all staff at all times West Virginia Medicaid members are in the facility. Evidence of current certification in CPR must be maintained and available upon request. All staff utilizing or monitoring restraints must do so as required under federal regulations. Such staff shall be CPR certified and fully trained and certified in nationally recognized physical restraint methods. Facility policy regarding Restrain/Seclusion must be readily available to all staff 24 hours a day, seven days a week.) |
| Does the state require de-escalation training for all staff working with children in residential settings? | 531.1.5 Staff Training A PRTF that contracts with DHHR ensures that qualified personnel meet or exceed the requirements for pre-service and in-services trainings with respect to facility objectives, policies, services, community resources, DHHR policies, and best practice standards. See 78 CSR 3-11 for training and Supervision of Employees 531.1.6 Direct Care Staff, Case Manager, and All Clinical Staff All direct care staff shall have a minimum of a high school diploma or GED and professional staff shall have appropriate education and certification consistent with professional licensing standards. (78 CSR §3-22.4.a. Employee Training and Credentials). Personnel development is an ongoing, integral, and identifiable part of the facility’s program of services, and the facility has specific guidelines as to the time commitment expected of personnel in various positions. Pre-Service Training including all of the following that demonstrates training sessions last at a minimum eight and one-half hours excluding first aid and CPR training which are prescriptive in nature with specific training criteria. The following pre-service training is required: All personnel are required to have pre-service and annual in-service trainings in the following topics. All appropriate/applicable facility policies, Conflict resolution, Member rights, Managing behavior, Psychiatric emergencies, First aid (All staff having direct contact with West Virginia members must receive training in first aid.), CPR (facility staff member must be immediately available who has been trained in CPR.), Incident reporting/completion/follow up, Recognition of substance abuse, Elopement procedure/reporting, Child abuse prevention/reporting, Suicide prevention, HIPAA/Confidentiality, Emergency/Disaster Preparedness, Infection Control, Sexual harassment including prevention, Cultural awareness, De-escalation procedures. All training sessions must include both lecture and active participation (return demonstration) activities for the staff.All policy on de-escalation, restraint, seclusion, CPR certification, and requirements must be readily available to all staff 24 hours a day, seven days a week. The facility shall post in a centralized location the name of at least one person who is on-duty with proper CPR certification for the use of all staff at all times West Virginia Medicaid members are in the facility. Evidence of current certification in CPR must be maintained and available upon request. All staff utilizing or monitoring restraints must do so as required under federal regulations. Such staff shall be CPR certified and fully trained and certified in nationally recognized physical restraint methods. Facility policy regarding Restrain/Seclusion must be readily available to all staff 24 hours a day, seven days a week.) |
| Does the state require 1:4 staffing ratio or higher? | 78-3-22 22.3. Employee Ratios 22.3.a. The average employee ratio for a psychiatric residential treatment facility shall be one employee to three patients (1:3) during day and evening hours (one employee whose primary responsibility is providing direct care for every 3 children during the day and evening). During nighttime sleeping hours, the ratio shall be one employee to six patients (1:6). During all hours there shall be capability to increase employee ratio in response to acuity, extending to the provision of one-on-one (1:1) care when necessary. Employees assigned to work a defined unit and providing care to the children on that unit including nursing, teachers, and activity’s therapists may be included in the employee to client ratio. Employees assigned to supervisory duties or whose duties cause them to be away from the unit (nursing supervisor) may not be included in the count. AND 531.1.3 The staffing ratio for a PRTF shall be one staff to three members (1:3) during day and evening hours (one staff whose primary responsibility is providing direct care for every three children) and (1:6) during sleep hours with the capability to increase staff ratio in response to acuity, extending to the provision of one-on-one (1:1) care when necessary. (78 CSR §3.22.3 Employee Ratios) Staff assigned to work a defined unit and providing care to the children on that unit including nursing, teachers, and activity’s therapists can be included in the staff to client ratio. Staff assigned to supervisory duties or whose duties cause them to be away from the unit (nursing supervisor) cannot be included in the count. |
| Ban on Conversion Therapy for LGBTQA+ youth? | No |
| Are there admissions requirements? | Yes. 531.2 Medical Eligibility/Medical Necessity - The West Virginia DHHR, BMS, utilizes a Utilization Management Contractor (UMC) to certify West Virginia Medicaid member medical necessity for admission and continued stays in all PRTF’s. 531.3.1 PRTF services are appropriate when a West Virginia Medicaid member does not require emergency or acute psychiatric care but does require nursing supervision and meet medical necessity for treatment on a 24 hour basis. A board certified psychiatrist (experienced in child/adolescent psychiatry) or a psychiatrist who has successfully completed an approved residency in child/adolescent psychiatry with admitting privileges at the PRTF must order and provide oversight for each admission AND For each West Virginia Medicaid member admitted to a PRTF facility a MCM-1 must be completed by the referring physician/psychiatrist, with no affiliation to the receiving facility, certifying the need for this level of care. |
| Are the parents and the admitted child required to be informed of their rights, the process to report violations of those rights, and the program's role in protecting those rights before admission? | 531.1.2 Non-Discrimination - A copy of the Resident’s Rights and Responsibilities is visibly displayed in the facility. At time of admission the West Virginia Medicaid member and the parent/guardian must be provided with a clearly written and readable statement of rights and responsibilities. The statement must be read to the resident or parent/guardian if either cannot read. |
| Does the state define institutional abuse and neglect? | §78-3-3. Definitions. 3.15. Child Abuse -- The threat to a child’s health or welfare by a person who knowingly or intentionally inflicts, attempts to inflict or knowingly allows another person to inflict physical injury or mental or emotional injury upon the child; or sexual abuse or sexual exploitation. 3.16. Child Neglect -- The failure to provide adequate nutrition, clothing, shelter, supervision, medical care or education, or abandonment. §78-3-16. Critical Incidents and Crisis Management. 16.1. Abuse and neglect; 16.1.a. The organization shall have a policy regarding identification and reporting of instances of alleged abuse and/or neglect of children in its care that shall be in compliance with W.Va. Code § 49-2-801 (Part VIII). 16.1.b. Definitions of abuse and neglect and procedures regarding reporting of abuse and neglect shall be consistent with those established by state law. 16.1.c. The employees, volunteers and management of any organization are considered to be mandatory reporters by State Law and are required to report any and all allegations of abuse and neglect to the appropriate state authorities as required in W.Va. Code § 49-2-801 (Part VIII). All allegations of abuse and neglect shall be immediately reported by telephone to the Institutional Investigative Unit of the Department via a telephone call to the Child Abuse Hotline. Within 48 hours of the incident, the organization shall prepare a written incident report, which shall be available to the Institutional Investigative Unit upon request. The Institutional Investigative Unit will inform the organization if an investigation of the incident shall be conducted. If the Institutional Investigative Unit indicates that there shall be no Institutional Investigative Unit investigation the allegation shall be downgraded to a critical incident and the organization shall proceed with a full investigation.16.1.d. All incidents which have harmed or may have represented potential harm to a child or children shall result in the completion of an incident form. Incidents suspected of being subject to mandatory reporting requirements as defined by W.Va. Code § 49-801-1 (Part 8) shall be reported to the Institutional Investigative Unit according to organization policy and procedures. This shall include medication errors with negative outcome for the child and any injuries occurring in the course of a restraint. 16.2.b. For the purposes of sorting mandatory reporting incidents from other incidents, the issue of lack of appropriate employee oversight shall always be considered. If the incident is attributed to lack of employee oversight, it shall be upgraded to a mandatory reporting incident. |
| Are there civil penalties for violations of institutional child abuse and neglect? | No Information |
| Does the state prohibit mail censorship? | With exceptions only in 78 - 5.4.a.10. Uncensored mail, unless there is reason to suspect it may contain unauthorized, dangerous or illegal substances or materials or is clinically contra-indicated, or unless consent has been given by parent or guardian to inspect mail; |
| Are phone calls private from other youth and staff? | Not specified. They have to revisit limitations quarterly- 6.2. Safety. 78 - 6.2.a. The organization shall conduct a quarterly review of the use of service modalities or other organizational practices that involve risk or limit freedom of choice including but not limited to:6.2.a.5. Restrictions of privacy including mail, phone and visitation restrictions; |
| Does the state require that youth have access to guardians, legal counsel, welfare advocates, religious clergy and family/friends via telephone as frequently as can be facilitated? | Not unrestricted. 531.4.9 Visitation with Parents and Extended Family Visitation arrangements must be agreed upon as soon as possible after placement of the child and documented in the member’s record. These arrangements must be made in agreement with the family/guardian, the residential facility and the member’s DHHR caseworker. Any restrictions on visitation arrangements by the DHHR caseworker or the court must be noted in the member’s treatment plan. All visits will be coordinated through consultation with the parent/guardian and the member’s DHHR caseworker. The facility must design and implement services in a manner that supports and strengthens family relationships and empowers and enables parents and family members to assume their roles. When a member’s presenting problem affects or is affected by a member’s family, the facility will provide coordination of social services to children, adults, and families that may be necessary to achieve family reunification, stabilize family ties, or obtain a permanent family for a member receiving out-of-home care. The family of a member in out-of-home care is expected to participate in making case plans, is kept advised of ongoing progress, and is invited to case conferences. When a member is in out-of-home care, the agency fully involves the family or individuals identified in the permanency plan as permanency options with a focus on timely permanency as the primary goal. The facility cannot deny visits, telephone calls, or mail contacts with a DHHR approved family. The facility is responsible for coordinating visitation; 531.4.9 Visitation with Parents and Extended Family. The facility cannot deny visits, telephone calls, or mail contacts with a DHHR approved family. The facility is responsible for coordinating visitation with the member’s family including provision of transportation as available to enable the visitation to occur. 5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to: 5.4.a.9. Communication with family and significant others by telephone, e-mail, texting or other means of communication as specified in the plan of care and/or the child’s case plan or under conditions described in policy; 5.4.a.12. Reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable. |
| Does the state require that children be allowed visitors in private during normal visiting hours? | No. 531.3.8 Treatment Team Development - The treatment plan delineates all aspects of the West Virginia Medicaid member’s treatment and includes, at a minimum: (42 CFR §441.156): The member’s treatment plan must include a specific strength-based family integration/reintegration treatment plan when appropriate. It must also include guidelines for family participation while the member is at the facility. These family participant guidelines must contain frequency of family visits, whether visits are supervised, and location of visitations. Family counseling and family visits must not be contingent on the West Virginia Medicaid member’s behavior. 531.4.9 Visitation with Parents and Extended Family Visitation arrangements must be agreed upon as soon as possible after placement of the child and documented in the member’s record. These arrangements must be made in agreement with the family/guardian, the residential facility and the member’s DHHR caseworker. Any restrictions on visitation arrangements by the DHHR caseworker or the court must be noted in the member’s treatment plan. All visits will be coordinated through consultation with the parent/guardian and the member’s DHHR caseworker. The facility must design and implement services in a manner that supports and strengthens family relationships and empowers and enables parents and family members to assume their roles. When a member’s presenting problem affects or is affected by a member’s family, the facility will provide coordination of social services to children, adults, and families that may be necessary to achieve family reunification, stabilize family ties, or obtain a permanent family for a member receiving out-of-home care. The family of a member in out-of-home care is expected to participate in making case plans, is kept advised of ongoing progress, and is invited to case conferences. When a member is in out-of-home care, the agency fully involves the family or individuals identified in the permanency plan as permanency options with a focus on timely permanency as the primary goal. The facility cannot deny visits, telephone calls, or mail contacts with a DHHR approved family. The facility is responsible for coordinating visitation with the member’s family including provision of transportation as available to enable the visitation to occur. 531.11 Transportation and Vehicle Maintenance - Transportation of members to and from medical appointments, court appearances, emergency transportation and transportation to family visits is a requirement of the PRTF. It is considered included in the PRTF per diem rate and not separately reimbursable. |
| Is it required that youth receive individualized and appropriate mental health treatment that is evidence-based? | Yes on individualized. No mention of evidence-based |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | No. 531 531.4.4 Pharmacy Services Medication is an important cornerstone of psychiatric treatment. Documents pertaining to this aspect of treatment (patient/family education and consent, medication orders, administration, monitoring) must be accurate, readily located and available for review. When medication is a prescribed intervention for a problem identified in the member’s treatment plan, it must be noted as such in the treatment plan. When medication changes are made, they should be made during treatment planning meetings whenever possible. When circumstances preclude this, the changes must be reviewed for all team members’ updated at the next available staffing opportunity. Psychotropic medication must be used only as one component of a total therapeutic program, and the diagnosis and projected/targeted behaviors must be included in a written treatment plan. Psychotropic medication must not, under any circumstances, be prescribed or administered for the purposes of program management control, for discipline or punishment reasons, for convenience of staff, or for experimentation or research purposes. |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | 531.1 PROVIDER PARTICIPATION REQUIREMENTS All providers are required to meet eligibility requirements. In addition to the licensing and certification requirements, all PRTF’s must maintain good standing with the West Virginia Bureau for Medical Services, the West Virginia Bureau for Children and Families (BCF), and the West Virginia Department of Education, (DOE) in order to continue to participate as a West Virginia Medicaid provider. The Bureau for Medical Services requires that all educational instruction for West Virginia Medicaid members meet West Virginia standards, unless the standards are higher in the state where the PRTF is located. West Virginia is the final arbitrator of whether the treatment services or educational standards are sufficient for West Virginia Medicaid members. Failure to remain in good standing with the BCF and/or DOE resulting in admission restrictions by BCF will result in admission restrictions by the Bureau for Medical Services. If the state agency licensing the facility places admission restrictions on the PRTF facility as a result of a negative review of services, the West Virginia Bureau for Medical Services will place admission restrictions on the facility until the negative action is corrected and BCF/BMS is notified by the licensing agency that the admission restrictions have been lifted. |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | 531.12 CLOTHING The facility is responsible for program and normal age-related personal incidental costs for members in the program such as bedding, diapers for infants, toiletries, and personal feminine hygiene items for females, etc and in 78 14.20. Personal Hygiene 14.20.a. Procedures to ensure that children receive assistance and training in personal care, hygiene and grooming appropriate to their age, sex, race and culture shall be established. 14.20.b. The organization shall ensure that children are provided with all necessary toiletry items. 19.1. Maternity Care - Care to a pregnant or parenting adolescent or transitioning adult includes but is not limited to: 19.1.a. Appropriate health care and health education; 5.4.a. A child or transitioning adult receiving services from the organization shall have basic rights including, but not limited to: 5.4.a.7. Adequate medical care; |
| Are youth provided with access to advocacy services and representation? | 5.4.a.12. Reasonable access to a legal representative, clergy or spiritual advisor and representative of the placing organization, if applicable; |
| Is a grievance procedure required for youth and families? | No Information specific to grievances. However, 78 - 12.1.e. The organization shall post by the telephone in all direct care and residential service locations, emergency telephone numbers for the fire department, poison control hot-line, local police, and child abuse hot line. Each child capable of using them shall be oriented to their presence and use of the telephone system in emergencies. |
| Is youth consent required for all treatment received? | No. Only the parent/guardian: 531.3.3 Resident Rights and Responsibilities Upon admission to the PRTF, staff must provide the West Virginia Medicaid member and parent/guardian with a statement of rights and responsibilities which must cover at a minimum: The member’s right to access treatment regardless of race, religion, or ethnicity; The member’s right to recognition and respect of personal dignity in the provision of treatment; The member’s right to be provided treatment and care in the least restrictive environment possible; The member’s right to an individualized treatment plan; The member and family’s right to participate in planning for treatment; A description of care, procedures, and treatment the member will receive; The member’s right to informed consent related to the risks, side effects, and benefits of all medications and treatment procedures used; and The right, to the extent permitted by law, to refuse the specific medications or treatment procedures and the responsibility of the facility if the member refuses treatment. |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | No Information |
| Are there any laws banning aversion therapy? | No Information |
| Is physical restraint allowed? | Yes with restrictions. 531.9.4 Appropriate Use - Seclusion or restraint must be used only in situations where less restrictive interventions have been attempted and determined to be ineffective. Documentation in the record must reflect the attempted use of less restrictive interventions date/time/signature of staff responsible for use of the interventions. Neither procedure may be used as a method of coercion, discipline, or retaliation as compensation for lack of staff presence or competency, for the convenience of staff in controlling a member’s behavior, or as a substitute for individualized treatment. (42 CFR §482.356(a)(1)) Any use of seclusion or restraint must be: In accordance with the member’s treatment plan (if the treatment plan does not provide for the use of seclusion/restraint prior to its use, the plan must be modified within one working day of the first occurrence); In accordance with the policy and procedures restraint/seclusion may only be applied by staff who have been trained and approved to use such techniques (42 CFR §482.356(a)(3)); Implemented in the least restrictive manner possible (CFR §483.364(b)(2)); In a room where the member will be constantly viewed and monitored, that is safe and sanitary, with adequate lighting, ventilation and temperature control; All vital signs must be obtained every hour, times 12 hours unless documentation by licensed physician/psychiatrist indicates this can be modified; Access to fluids and toilet facilities must be offered and provided hourly with clear documentation of fluids ingested; Evaluated on a continual basis and ended at the earliest possible time based on the assessment and evaluation of the member’s condition (42 CFR §483.356(a)(3)(ii)). 531.9.5 Prohibited Practices - Restraint and seclusion must not be used simultaneously. (42 CFR §482.356(a)(4)) - Any personal or mechanical restraint of a member in a face-down position is prohibited; Any personal or mechanical restraint of a member in a “spread-eagle” (legs and arms apart) position is prohibited; Standing or “as needed” (PRN) orders for seclusion or restraint are prohibited. (42 CFR §483.356(a)(2)) 531.9.6 Procedural Requirements - The following actions are required and must be documented for any form of special procedure with the exceptions as noted below. (42 CFR §483.358(a)) - Orders for restraint or seclusion must be by a physician/psychiatrist, or other licensed practitioner permitted by the State Law and the facility to order restraint and seclusion and trained in the use of emergency safety interventions. If seclusion or personal/mechanical restraint is initiated verbally by order from a physician/psychiatrist or other licensed practitioner, a verbal or telephone order must be obtained from the physician/psychiatrist or other licensed practitioner and documented in the chart as soon as possible, but no later than one hour after the start of the procedure. If the physician’s/psychiatrist’s or other licensed practitioner’s order cannot be obtained within the one hour, the procedure must be discontinued. The physician’s/psychiatrist’s or other licensed practitioner’s order for seclusion or personal/mechanical restraint may under no circumstance exceed one hour for members younger than nine years of age, or two hours for members nine to 17 years of age and four hours for members ages 18 to 21. The staff person responsible for terminating seclusion must be physically present in or immediately outside the seclusion room throughout the duration of the procedure. (42 CFR §483.364(a)) - Clinical staff trained in the use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the member, and the safe use of restraint throughout the duration of the emergency safety intervention. (42 CFR §483.362(a)) - Within one hour of the initiation of the emergency safety intervention, a physician/psychiatrist or other licensed practitioner must conduct a face-to-face assessment of the physical and psychological wellbeing of the member, to include but not be limited to the following: The member’s physical and psychological status, The member’s behavior, The appropriateness of the intervention measures, and any complication resulting from the intervention. (42 CFR §483.358(f)) - Even if the intervention is terminated in less than one hour, the face-to-face assessment must be conducted within 60 minutes of its initiation. The health and comfort of the member must be assessed every 15 minutes by direct observation, and staff must record their findings at the time of observation. There must be a policy and procedure for ending the special procedure (except for pharmacological restraint, which has an end-time identified by the physician/psychiatrist or other licensed practitioner), and the member must be made aware of them when the procedure is initiated and at follow-up intervals as appropriate. A physician/psychiatrist or other licensed practitioner must evaluate and document the member’s well-being immediately after the seclusion or restraint is terminated. (42 CFR §483.362(c)) - No later than 24 hours following the conclusion of the special procedure, the member must be given the opportunity to discuss with all staff involved in the procedure the antecedents, emotional triggers, and consequences of his/her behavior and any learning that occurred as a result of the intervention. (42 CFR §483.370(a)) The goal is to enable the member to understand the precursors to loss of control and to rehearse acceptable means of handling frustration and emotional distress. Within 24 hours after the use of restraint or seclusion, documentation must indicate that all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, conducted a debriefing session that included, at a minimum, a review and discussion of the emergency safety situation that required the intervention, including discussion of the precipitating factors that led up to the intervention, alternative techniques that might have prevented the use of the restraint or seclusion, the procedures, if any, that staff are to implement to prevent any recurrence of the use of restraint or seclusion; and the outcome of the intervention, including any injuries that may have resulted from the use of restraint or seclusion. (42 CFR §483.370(b)) The Registered Nurse or other licensed personnel in the PRTF must notify with documentation of the same, the member’s parent/guardian as soon as possible, but no later than 24 hours after the initiation of any special procedure. The documentation will include the name/date/time the parent/guardian was contacted and the content of the conversation. If the member’s treatment plan does not already provide for the use of seclusion/restraint, then it must be amended or modified within 24 hours following the first use of any special procedure to reflect the use of that method as a part of the member’s treatment. 531.9.7 Documentation of Seclusion/Restraint Documentation of each incident of seclusion or restraint (personal, mechanical, and pharmacological restraint) will include, but not be limited to, the following information: (42 CFR §483.358) - The date/time the procedure started and ended; The name of the physician/psychiatrist or other licensed practitioner who authorized it, the name(s) of staff who initiated the procedure, were involved in applying or monitoring, and were responsible for terminating; The reason the procedure was initiated; Which less restrictive options were attempted, and how they failed; Criteria for ending the procedure (except for pharmacological restraint, when the end time is identified by the physician/psychiatrist or other licensed practitioner); The results of a face-to-face assessment conducted by a physician/psychiatrist or other licensed practitioner within one hour after initiation of the procedure to include: 1. the member’s physical and psychological status, 2. the member’s behavior, 3. the appropriateness of the intervention measures and 4. any complications resulting from the intervention; The member’s condition at the time of each 15 minute reassessment and at the end of the procedure; The signature/date of the person documenting the incident; A record/documentation of both debriefing sessions (staff/member and staff only) which are required to take place within 24 hours of the use of seclusion/restraint, to include the names of staff who were present for or excused from the debriefing and any changes to the member’s treatment plan that resulted from the debriefings. (42 CFR §483.370(c)); and, The facility must provide notification of the member’s parent/guardian within 24 hours of the initiation of each incident, including the date and time of notification and the name of the staff person providing the notification. (42 CFR §483.366(b)). This documentation must be part of the West Virginia member’s permanent record. A separate log documenting all episodes of seclusion/restraint in the PRTF must be maintained. (42 CFR §483.358(i)) A multidisciplinary team must review the seclusion/restraint log monthly and must maintain documentation of such meetings in the form of minutes signed and dated by the participants. Information regarding the number of times seclusion or restraint have been employed by a facility must be included monthly as part of the facility’s census report. |
| Is chemical restraint allowed? | Yes with restrictions. 531.9.4 Appropriate Use - Seclusion or restraint must be used only in situations where less restrictive interventions have been attempted and determined to be ineffective. Documentation in the record must reflect the attempted use of less restrictive interventions date/time/signature of staff responsible for use of the interventions. Neither procedure may be used as a method of coercion, discipline, or retaliation as compensation for lack of staff presence or competency, for the convenience of staff in controlling a member’s behavior, or as a substitute for individualized treatment. (42 CFR §482.356(a)(1)) Any use of seclusion or restraint must be: In accordance with the member’s treatment plan (if the treatment plan does not provide for the use of seclusion/restraint prior to its use, the plan must be modified within one working day of the first occurrence); In accordance with the policy and procedures restraint/seclusion may only be applied by staff who have been trained and approved to use such techniques (42 CFR §482.356(a)(3)); Implemented in the least restrictive manner possible (CFR §483.364(b)(2)); In a room where the member will be constantly viewed and monitored, that is safe and sanitary, with adequate lighting, ventilation and temperature control; All vital signs must be obtained every hour, times 12 hours unless documentation by licensed physician/psychiatrist indicates this can be modified; Access to fluids and toilet facilities must be offered and provided hourly with clear documentation of fluids ingested; Evaluated on a continual basis and ended at the earliest possible time based on the assessment and evaluation of the member’s condition (42 CFR §483.356(a)(3)(ii)). 531.9.5 Prohibited Practices - Restraint and seclusion must not be used simultaneously. (42 CFR §482.356(a)(4)) - Any personal or mechanical restraint of a member in a face-down position is prohibited; Any personal or mechanical restraint of a member in a “spread-eagle” (legs and arms apart) position is prohibited; Standing or “as needed” (PRN) orders for seclusion or restraint are prohibited. (42 CFR §483.356(a)(2)) 531.9.6 Procedural Requirements - The following actions are required and must be documented for any form of special procedure with the exceptions as noted below. (42 CFR §483.358(a)) - Orders for restraint or seclusion must be by a physician/psychiatrist, or other licensed practitioner permitted by the State Law and the facility to order restraint and seclusion and trained in the use of emergency safety interventions. If seclusion or personal/mechanical restraint is initiated verbally by order from a physician/psychiatrist or other licensed practitioner, a verbal or telephone order must be obtained from the physician/psychiatrist or other licensed practitioner and documented in the chart as soon as possible, but no later than one hour after the start of the procedure. If the physician’s/psychiatrist’s or other licensed practitioner’s order cannot be obtained within the one hour, the procedure must be discontinued. The physician’s/psychiatrist’s or other licensed practitioner’s order for seclusion or personal/mechanical restraint may under no circumstance exceed one hour for members younger than nine years of age, or two hours for members nine to 17 years of age and four hours for members ages 18 to 21. The staff person responsible for terminating seclusion must be physically present in or immediately outside the seclusion room throughout the duration of the procedure. (42 CFR §483.364(a)) - Clinical staff trained in the use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the member, and the safe use of restraint throughout the duration of the emergency safety intervention. (42 CFR §483.362(a)) - Within one hour of the initiation of the emergency safety intervention, a physician/psychiatrist or other licensed practitioner must conduct a face-to-face assessment of the physical and psychological wellbeing of the member, to include but not be limited to the following: The member’s physical and psychological status, The member’s behavior, The appropriateness of the intervention measures, and any complication resulting from the intervention. (42 CFR §483.358(f)) - Even if the intervention is terminated in less than one hour, the face-to-face assessment must be conducted within 60 minutes of its initiation. The health and comfort of the member must be assessed every 15 minutes by direct observation, and staff must record their findings at the time of observation. There must be a policy and procedure for ending the special procedure (except for pharmacological restraint, which has an end-time identified by the physician/psychiatrist or other licensed practitioner), and the member must be made aware of them when the procedure is initiated and at follow-up intervals as appropriate. A physician/psychiatrist or other licensed practitioner must evaluate and document the member’s well-being immediately after the seclusion or restraint is terminated. (42 CFR §483.362(c)) - No later than 24 hours following the conclusion of the special procedure, the member must be given the opportunity to discuss with all staff involved in the procedure the antecedents, emotional triggers, and consequences of his/her behavior and any learning that occurred as a result of the intervention. (42 CFR §483.370(a)) The goal is to enable the member to understand the precursors to loss of control and to rehearse acceptable means of handling frustration and emotional distress. Within 24 hours after the use of restraint or seclusion, documentation must indicate that all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, conducted a debriefing session that included, at a minimum, a review and discussion of the emergency safety situation that required the intervention, including discussion of the precipitating factors that led up to the intervention, alternative techniques that might have prevented the use of the restraint or seclusion, the procedures, if any, that staff are to implement to prevent any recurrence of the use of restraint or seclusion; and the outcome of the intervention, including any injuries that may have resulted from the use of restraint or seclusion. (42 CFR §483.370(b)) The Registered Nurse or other licensed personnel in the PRTF must notify with documentation of the same, the member’s parent/guardian as soon as possible, but no later than 24 hours after the initiation of any special procedure. The documentation will include the name/date/time the parent/guardian was contacted and the content of the conversation. If the member’s treatment plan does not already provide for the use of seclusion/restraint, then it must be amended or modified within 24 hours following the first use of any special procedure to reflect the use of that method as a part of the member’s treatment. 531.9.7 Documentation of Seclusion/Restraint Documentation of each incident of seclusion or restraint (personal, mechanical, and pharmacological restraint) will include, but not be limited to, the following information: (42 CFR §483.358) - The date/time the procedure started and ended; The name of the physician/psychiatrist or other licensed practitioner who authorized it, the name(s) of staff who initiated the procedure, were involved in applying or monitoring, and were responsible for terminating; The reason the procedure was initiated; Which less restrictive options were attempted, and how they failed; Criteria for ending the procedure (except for pharmacological restraint, when the end time is identified by the physician/psychiatrist or other licensed practitioner); The results of a face-to-face assessment conducted by a physician/psychiatrist or other licensed practitioner within one hour after initiation of the procedure to include: 1. the member’s physical and psychological status, 2. the member’s behavior, 3. the appropriateness of the intervention measures and 4. any complications resulting from the intervention; The member’s condition at the time of each 15 minute reassessment and at the end of the procedure; The signature/date of the person documenting the incident; A record/documentation of both debriefing sessions (staff/member and staff only) which are required to take place within 24 hours of the use of seclusion/restraint, to include the names of staff who were present for or excused from the debriefing and any changes to the member’s treatment plan that resulted from the debriefings. (42 CFR §483.370(c)); and, The facility must provide notification of the member’s parent/guardian within 24 hours of the initiation of each incident, including the date and time of notification and the name of the staff person providing the notification. (42 CFR §483.366(b)). This documentation must be part of the West Virginia member’s permanent record. A separate log documenting all episodes of seclusion/restraint in the PRTF must be maintained. (42 CFR §483.358(i)) A multidisciplinary team must review the seclusion/restraint log monthly and must maintain documentation of such meetings in the form of minutes signed and dated by the participants. Information regarding the number of times seclusion or restraint have been employed by a facility must be included monthly as part of the facility’s census report. |
| Is mechanical restraint allowed? | Yes with restrictions. 531.9.4 Appropriate Use - Seclusion or restraint must be used only in situations where less restrictive interventions have been attempted and determined to be ineffective. Documentation in the record must reflect the attempted use of less restrictive interventions date/time/signature of staff responsible for use of the interventions. Neither procedure may be used as a method of coercion, discipline, or retaliation as compensation for lack of staff presence or competency, for the convenience of staff in controlling a member’s behavior, or as a substitute for individualized treatment. (42 CFR §482.356(a)(1)) Any use of seclusion or restraint must be: In accordance with the member’s treatment plan (if the treatment plan does not provide for the use of seclusion/restraint prior to its use, the plan must be modified within one working day of the first occurrence); In accordance with the policy and procedures restraint/seclusion may only be applied by staff who have been trained and approved to use such techniques (42 CFR §482.356(a)(3)); Implemented in the least restrictive manner possible (CFR §483.364(b)(2)); In a room where the member will be constantly viewed and monitored, that is safe and sanitary, with adequate lighting, ventilation and temperature control; All vital signs must be obtained every hour, times 12 hours unless documentation by licensed physician/psychiatrist indicates this can be modified; Access to fluids and toilet facilities must be offered and provided hourly with clear documentation of fluids ingested; Evaluated on a continual basis and ended at the earliest possible time based on the assessment and evaluation of the member’s condition (42 CFR §483.356(a)(3)(ii)). 531.9.5 Prohibited Practices - Restraint and seclusion must not be used simultaneously. (42 CFR §482.356(a)(4)) - Any personal or mechanical restraint of a member in a face-down position is prohibited; Any personal or mechanical restraint of a member in a “spread-eagle” (legs and arms apart) position is prohibited; Standing or “as needed” (PRN) orders for seclusion or restraint are prohibited. (42 CFR §483.356(a)(2)) 531.9.6 Procedural Requirements - The following actions are required and must be documented for any form of special procedure with the exceptions as noted below. (42 CFR §483.358(a)) - Orders for restraint or seclusion must be by a physician/psychiatrist, or other licensed practitioner permitted by the State Law and the facility to order restraint and seclusion and trained in the use of emergency safety interventions. If seclusion or personal/mechanical restraint is initiated verbally by order from a physician/psychiatrist or other licensed practitioner, a verbal or telephone order must be obtained from the physician/psychiatrist or other licensed practitioner and documented in the chart as soon as possible, but no later than one hour after the start of the procedure. If the physician’s/psychiatrist’s or other licensed practitioner’s order cannot be obtained within the one hour, the procedure must be discontinued. The physician’s/psychiatrist’s or other licensed practitioner’s order for seclusion or personal/mechanical restraint may under no circumstance exceed one hour for members younger than nine years of age, or two hours for members nine to 17 years of age and four hours for members ages 18 to 21. The staff person responsible for terminating seclusion must be physically present in or immediately outside the seclusion room throughout the duration of the procedure. (42 CFR §483.364(a)) - Clinical staff trained in the use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the member, and the safe use of restraint throughout the duration of the emergency safety intervention. (42 CFR §483.362(a)) - Within one hour of the initiation of the emergency safety intervention, a physician/psychiatrist or other licensed practitioner must conduct a face-to-face assessment of the physical and psychological wellbeing of the member, to include but not be limited to the following: The member’s physical and psychological status, The member’s behavior, The appropriateness of the intervention measures, and any complication resulting from the intervention. (42 CFR §483.358(f)) - Even if the intervention is terminated in less than one hour, the face-to-face assessment must be conducted within 60 minutes of its initiation. The health and comfort of the member must be assessed every 15 minutes by direct observation, and staff must record their findings at the time of observation. There must be a policy and procedure for ending the special procedure (except for pharmacological restraint, which has an end-time identified by the physician/psychiatrist or other licensed practitioner), and the member must be made aware of them when the procedure is initiated and at follow-up intervals as appropriate. A physician/psychiatrist or other licensed practitioner must evaluate and document the member’s well-being immediately after the seclusion or restraint is terminated. (42 CFR §483.362(c)) - No later than 24 hours following the conclusion of the special procedure, the member must be given the opportunity to discuss with all staff involved in the procedure the antecedents, emotional triggers, and consequences of his/her behavior and any learning that occurred as a result of the intervention. (42 CFR §483.370(a)) The goal is to enable the member to understand the precursors to loss of control and to rehearse acceptable means of handling frustration and emotional distress. Within 24 hours after the use of restraint or seclusion, documentation must indicate that all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, conducted a debriefing session that included, at a minimum, a review and discussion of the emergency safety situation that required the intervention, including discussion of the precipitating factors that led up to the intervention, alternative techniques that might have prevented the use of the restraint or seclusion, the procedures, if any, that staff are to implement to prevent any recurrence of the use of restraint or seclusion; and the outcome of the intervention, including any injuries that may have resulted from the use of restraint or seclusion. (42 CFR §483.370(b)) The Registered Nurse or other licensed personnel in the PRTF must notify with documentation of the same, the member’s parent/guardian as soon as possible, but no later than 24 hours after the initiation of any special procedure. The documentation will include the name/date/time the parent/guardian was contacted and the content of the conversation. If the member’s treatment plan does not already provide for the use of seclusion/restraint, then it must be amended or modified within 24 hours following the first use of any special procedure to reflect the use of that method as a part of the member’s treatment. 531.9.7 Documentation of Seclusion/Restraint Documentation of each incident of seclusion or restraint (personal, mechanical, and pharmacological restraint) will include, but not be limited to, the following information: (42 CFR §483.358) - The date/time the procedure started and ended; The name of the physician/psychiatrist or other licensed practitioner who authorized it, the name(s) of staff who initiated the procedure, were involved in applying or monitoring, and were responsible for terminating; The reason the procedure was initiated; Which less restrictive options were attempted, and how they failed; Criteria for ending the procedure (except for pharmacological restraint, when the end time is identified by the physician/psychiatrist or other licensed practitioner); The results of a face-to-face assessment conducted by a physician/psychiatrist or other licensed practitioner within one hour after initiation of the procedure to include: 1. the member’s physical and psychological status, 2. the member’s behavior, 3. the appropriateness of the intervention measures and 4. any complications resulting from the intervention; The member’s condition at the time of each 15 minute reassessment and at the end of the procedure; The signature/date of the person documenting the incident; A record/documentation of both debriefing sessions (staff/member and staff only) which are required to take place within 24 hours of the use of seclusion/restraint, to include the names of staff who were present for or excused from the debriefing and any changes to the member’s treatment plan that resulted from the debriefings. (42 CFR §483.370(c)); and, The facility must provide notification of the member’s parent/guardian within 24 hours of the initiation of each incident, including the date and time of notification and the name of the staff person providing the notification. (42 CFR §483.366(b)). This documentation must be part of the West Virginia member’s permanent record. A separate log documenting all episodes of seclusion/restraint in the PRTF must be maintained. (42 CFR §483.358(i)) A multidisciplinary team must review the seclusion/restraint log monthly and must maintain documentation of such meetings in the form of minutes signed and dated by the participants. Information regarding the number of times seclusion or restraint have been employed by a facility must be included monthly as part of the facility’s census report. |
| Is seclusion allowed? | Yes with restrictions. 531.9.4 Appropriate Use - Seclusion or restraint must be used only in situations where less restrictive interventions have been attempted and determined to be ineffective. Documentation in the record must reflect the attempted use of less restrictive interventions date/time/signature of staff responsible for use of the interventions. Neither procedure may be used as a method of coercion, discipline, or retaliation as compensation for lack of staff presence or competency, for the convenience of staff in controlling a member’s behavior, or as a substitute for individualized treatment. (42 CFR §482.356(a)(1)) Any use of seclusion or restraint must be: In accordance with the member’s treatment plan (if the treatment plan does not provide for the use of seclusion/restraint prior to its use, the plan must be modified within one working day of the first occurrence); In accordance with the policy and procedures restraint/seclusion may only be applied by staff who have been trained and approved to use such techniques (42 CFR §482.356(a)(3)); Implemented in the least restrictive manner possible (CFR §483.364(b)(2)); In a room where the member will be constantly viewed and monitored, that is safe and sanitary, with adequate lighting, ventilation and temperature control; All vital signs must be obtained every hour, times 12 hours unless documentation by licensed physician/psychiatrist indicates this can be modified; Access to fluids and toilet facilities must be offered and provided hourly with clear documentation of fluids ingested; Evaluated on a continual basis and ended at the earliest possible time based on the assessment and evaluation of the member’s condition (42 CFR §483.356(a)(3)(ii)). 531.9.5 Prohibited Practices - Restraint and seclusion must not be used simultaneously. (42 CFR §482.356(a)(4)) - Any personal or mechanical restraint of a member in a face-down position is prohibited; Any personal or mechanical restraint of a member in a “spread-eagle” (legs and arms apart) position is prohibited; Standing or “as needed” (PRN) orders for seclusion or restraint are prohibited. (42 CFR §483.356(a)(2)) 531.9.6 Procedural Requirements - The following actions are required and must be documented for any form of special procedure with the exceptions as noted below. (42 CFR §483.358(a)) - Orders for restraint or seclusion must be by a physician/psychiatrist, or other licensed practitioner permitted by the State Law and the facility to order restraint and seclusion and trained in the use of emergency safety interventions. If seclusion or personal/mechanical restraint is initiated verbally by order from a physician/psychiatrist or other licensed practitioner, a verbal or telephone order must be obtained from the physician/psychiatrist or other licensed practitioner and documented in the chart as soon as possible, but no later than one hour after the start of the procedure. If the physician’s/psychiatrist’s or other licensed practitioner’s order cannot be obtained within the one hour, the procedure must be discontinued. The physician’s/psychiatrist’s or other licensed practitioner’s order for seclusion or personal/mechanical restraint may under no circumstance exceed one hour for members younger than nine years of age, or two hours for members nine to 17 years of age and four hours for members ages 18 to 21. The staff person responsible for terminating seclusion must be physically present in or immediately outside the seclusion room throughout the duration of the procedure. (42 CFR §483.364(a)) - Clinical staff trained in the use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the member, and the safe use of restraint throughout the duration of the emergency safety intervention. (42 CFR §483.362(a)) - Within one hour of the initiation of the emergency safety intervention, a physician/psychiatrist or other licensed practitioner must conduct a face-to-face assessment of the physical and psychological wellbeing of the member, to include but not be limited to the following: The member’s physical and psychological status, The member’s behavior, The appropriateness of the intervention measures, and any complication resulting from the intervention. (42 CFR §483.358(f)) - Even if the intervention is terminated in less than one hour, the face-to-face assessment must be conducted within 60 minutes of its initiation. The health and comfort of the member must be assessed every 15 minutes by direct observation, and staff must record their findings at the time of observation. There must be a policy and procedure for ending the special procedure (except for pharmacological restraint, which has an end-time identified by the physician/psychiatrist or other licensed practitioner), and the member must be made aware of them when the procedure is initiated and at follow-up intervals as appropriate. A physician/psychiatrist or other licensed practitioner must evaluate and document the member’s well-being immediately after the seclusion or restraint is terminated. (42 CFR §483.362(c)) - No later than 24 hours following the conclusion of the special procedure, the member must be given the opportunity to discuss with all staff involved in the procedure the antecedents, emotional triggers, and consequences of his/her behavior and any learning that occurred as a result of the intervention. (42 CFR §483.370(a)) The goal is to enable the member to understand the precursors to loss of control and to rehearse acceptable means of handling frustration and emotional distress. Within 24 hours after the use of restraint or seclusion, documentation must indicate that all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, conducted a debriefing session that included, at a minimum, a review and discussion of the emergency safety situation that required the intervention, including discussion of the precipitating factors that led up to the intervention, alternative techniques that might have prevented the use of the restraint or seclusion, the procedures, if any, that staff are to implement to prevent any recurrence of the use of restraint or seclusion; and the outcome of the intervention, including any injuries that may have resulted from the use of restraint or seclusion. (42 CFR §483.370(b)) The Registered Nurse or other licensed personnel in the PRTF must notify with documentation of the same, the member’s parent/guardian as soon as possible, but no later than 24 hours after the initiation of any special procedure. The documentation will include the name/date/time the parent/guardian was contacted and the content of the conversation. If the member’s treatment plan does not already provide for the use of seclusion/restraint, then it must be amended or modified within 24 hours following the first use of any special procedure to reflect the use of that method as a part of the member’s treatment. 531.9.7 Documentation of Seclusion/Restraint Documentation of each incident of seclusion or restraint (personal, mechanical, and pharmacological restraint) will include, but not be limited to, the following information: (42 CFR §483.358) - The date/time the procedure started and ended; The name of the physician/psychiatrist or other licensed practitioner who authorized it, the name(s) of staff who initiated the procedure, were involved in applying or monitoring, and were responsible for terminating; The reason the procedure was initiated; Which less restrictive options were attempted, and how they failed; Criteria for ending the procedure (except for pharmacological restraint, when the end time is identified by the physician/psychiatrist or other licensed practitioner); The results of a face-to-face assessment conducted by a physician/psychiatrist or other licensed practitioner within one hour after initiation of the procedure to include: 1. the member’s physical and psychological status, 2. the member’s behavior, 3. the appropriateness of the intervention measures and 4. any complications resulting from the intervention; The member’s condition at the time of each 15 minute reassessment and at the end of the procedure; The signature/date of the person documenting the incident; A record/documentation of both debriefing sessions (staff/member and staff only) which are required to take place within 24 hours of the use of seclusion/restraint, to include the names of staff who were present for or excused from the debriefing and any changes to the member’s treatment plan that resulted from the debriefings. (42 CFR §483.370(c)); and, The facility must provide notification of the member’s parent/guardian within 24 hours of the initiation of each incident, including the date and time of notification and the name of the staff person providing the notification. (42 CFR §483.366(b)). This documentation must be part of the West Virginia member’s permanent record. A separate log documenting all episodes of seclusion/restraint in the PRTF must be maintained. (42 CFR §483.358(i)) A multidisciplinary team must review the seclusion/restraint log monthly and must maintain documentation of such meetings in the form of minutes signed and dated by the participants. Information regarding the number of times seclusion or restraint have been employed by a facility must be included monthly as part of the facility’s census report. |
| Is there a Bill of Rights for youth in care? | No Information |
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