Department of Mental Health Child & Youth Services Division ‘Treatment Center Re-Investment Program Visit Monitoring Report Facility Name: Foundations For Living Date of Vi April 18, 2007 Date of Report: May 15,2007 Completed by: Njideka N. White, LGSW Social Worker Introduction: A scheduled site visit occurred at the above referenced RTC on April 18, 2007. This ‘writer reviewed the record of and interviewed 1 CFSA committed youth, QIN? (QGP and conducted interviews with her therapist, Matt Nelson and Case Manager, Cheryl Cooper. An entrance interview was conducted with Karen Spires, Director of Therapeutic Services. Members of staff were very cooperative and assisted with the facilitation of the process. L U/ reports: Findings: * Ulreports have not been submitted to DMH + There were no U/l reports to review at the time of visit, * Uflreporting procedures were submitted to the Director of Clinical Services at the time of visit Recommendations: * Utilize standard reporting procedures for the Office of Accountability ‘when reporting Major Unusual Incidents consistent with DMH U/l Policy 480.14, + Fax all Major Unusual Incidents and Unusual Incidents to Samantha Madhosingh, Psy.D., Clinical Program Manager, CFSA Monitor, and the clients’ Social Worker All incidents must be properly reported on DMH-1243 form * Alldocumentation, including U/I Reports, of holds, restraints, seclusions must indicate a start and end time of the procedure I. Records Review: Findings: + Records were organized in a systematic and orderly manner * Inaccurate data; client's date of birth incorrect on documentation Recommendations: * Continue maintaining charts/records Ensure the accuracy of data on record; correct client’s date of birthDepartment of Mental Health Child & Youth Services Division Residential Treatment Center Re-Investment Program Ii, ‘Treatment Planning/Appropriate services: Findings: Treatment Plan is comprehensive in nature with information provided from several program areas Medication information, nursing information, client’s diagnosis, and ‘treatment goals are documented on the Treatment Plan Current and admission weight and height documented on the Treatment Plan Client's strengths are documented on the Treatment Plan Client's current level documented on the Treatment Plan Special procedures are documented on Treatment Plan ‘Treatment Plan information is shared with clients (per client’s report) Estimated delivery date of client’s baby is included on the Treatment Plan DMH is not notified, in advance, of Treatment Team meetings and has therefore been unable to participate in treatment team meetings Clinical issues are left unaddressed on Treatment Plan ‘Treatment Plans are not mailed to DMH RTC Program Recommendations: Provide detailed information regarding client's progress. If client is awaiting discharge, specify this is in treatment plan and include any barriers to discharge planning. Also include client’s reactions/responses to discharge delays Continue to provide youth’s current and admission weight and height and any changes in eating habits on Treatment Plan Address clinical issues such as grief and loss, trauma, substance abuse, self-esteem and attachment issues on Treatment Plan Notify DMH RTC Residential Monitor of all Treatment Team meetings and progress review meetings for CFSA youth by mail, fax, or email (njideka.white@dc.gov) in a timely manner Mail all Treatment Plans, Psychiatric, Psychological and Progress Updates to the DMH RTC Program to the attention of: Dr. Samantha Madhosingh Clinical Program Manager RTC Reinvestment Program Department of Mental Health 64 New York Ave. NE, 4" Floor Washington DC 20002 Client receives therapy once or twice per week (one hour per week is required)Department of Mental Health Child & Youth Services Division Residential Treatment Center Re-Investment Program © Residential treatment services provided to pregnant females © Prenatal Care is provided * Pregnancy education and baby care classes are offered to pregnant females * Strength based treatment modalities are applied to youth © “Baby Think it Over” classes are offered to all youth © STD Education offered © Group Therapy offered * Local hospitals are able to provide medical consults to youth enrolled in the facility Professional hair maintenance and hygiene education is offered Diagnostic issues such as substance abuse left unaddressed on Treatment Plan * Family therapy and contact is not encouraged as a part of treatment planning and services © 3 Specialized Treatment Programs offered for youth ages 12-18: * The Visions Program serves dual diagnosis females from 12-18 years of age * The Passages Program provides mental health and behavioral modification treatment to females from 12-18 years of age * The Expeditions Program provides mental health and behavioral modification treatment to males 12-18 years of age Recommendations: * Offer substance abuse treatment groups to youth with a history of substance abuse who are not in the Visions Program * Train new staff on new treatment modalities and best practices when working with traumatized youth © Offer expressive therapy including art, recreation and music Provide out-of- area families with visitation and contact opportunities * Address familial issues in family therapy, In addition, provide client with support options that include siblings, mentors, former foster-perents and any other consistent and positive persons who are approved through the CFSA Social Worker V. Discharge Planning/Aftercare Need Findings: ¢ Discharge Plan section included as an area of Treatment Plan * Specific criteria regarding goals and objectives that should be achieved prior to discharge are not noted on the Treatment Plan * Estimated discharge date is not recorded on the Treatment Plan Recommendations: * Treatment Plan must include specific criteria regarding goals and objectives that should be achieved prior to discharge * Estimated discharge date must be recorded on the Treatment PlanDepartment of Mental Health Child & Youth Services Division Residential Treatment Center Re-Investment Program * Detailed discharge planning must begin at least 90 days prior to discharge. All youth must have a discharge staffing to identify an appropriate placement, school placement, and mental health services in a timely manner * The DMH RTC Re-Investment Program, Dr. Samantha Madhosingh, should be notified of discharge staffings, which should be held 90 days prior to client’s discharge * As child approaches discharge date, if youth is being placed in a therapeutic foster home or a relative’s home, the Discharge Plan should include therapeutic visits of increasing length (at least four) with the foster parents or relatives * A detailed discharge plan should be provided to the youth's Social Worker and the DMH Residential Program Monitor 30 days prior to the youth's scheduled discharge date * Include information about what types of therapy model (play therapy, expressive therapy ctc.,) would be beneficial if child has specific needs * Include information about areas that should continue to be addressed in therapy as well as issues that have been successfully addressed ° Notify DMH RTC Re-Investment Program and CFSA Monitoring Unit immediately, by phone, fax ot email, of the discharge of any CFSA client: Njideka White (DMH) (202) 671-3189 (office) (202) 673-2192 (fax) njideka.white@dc.gov (email) Ve Miscellaneous: Finding * Facility has no contact information for CFSA Office of Clinical Practice- Nursing Department in the event of a nursing emergency or need Recommendations: * Facility must utilize contact information for CFSA Office of Clinical Practice - Nursing Department in the event of medical emergency or need Pamela Hodge, RN Supervisory Healthcare Specialist 202-727-7046 Summary: ‘The site visit was concluded on April 18, 2007. An exit interview included Karen Spires, Director of Clinical Services; Matt Nelson, therapist; Ms. Suarez, Principal; and Ms Melinda Ruchlos, LPN. A brief overview of the facility was provided, The staff also. presented clinical, medical and treatment concerns and questions,Department of Mental Health Child & Youth Services Division Residential Treatment Center Re-Investment Program Foundations for Living offers specialty based treatment approaches in their programs: They are licensed to accept females ages 12-18 who are pregnant and have substance abuse and dependency issues. In addition, Foundations for Living provides treatment for males ages 12-18 with severe emotional and behavioral challenges and who have been ‘unsuccessful in previous treatment settings, The staff ratio on all programs is 1:7. Foundations for Living provided adequate medical care and safety for GEN howeve there were several treatment concerns raised during the time of the site v history of substance abuse was minimally addressed during treatment; family issues were not discussed or explored during therapy; family contact was not encouraged, specifically with her biological mother and siblings; and the history of difficulty with authority figures was not included as a treatment goal on the treatment plan. A detailed discharge summary should be provided to DMH and CFSA RTC Monitoring Units to provide follow up regarding the aforementioned concerns and include spe recommendations for Jamilla’s continued care in the community Timeline for Submission of Corrective Action Plan (CAP) Please forward your CAP no later than 30 days from the date of this notice to: Lynne Person, RTC Re-Investment Program Administrator Department of Mental Health 64 New York Avenue, NE -4"" Floor Washington, DC 20002