CA-RTX Standard. Generated 8/13/2022. ©2022 Council on Accreditation.
2022 Edition

Residential Treatment Services Definition

Purpose

Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behaviour, improve functioning and well-being, and return to a stable living arrangement in the community.

Definition

Residential Treatment Services (CA-RTX) provide a time-limited, interdisciplinary, psycho-educational, trauma-informed, and therapeutic 24-hour-a-day structured program. Specialized services and interventions are delivered in a respectful, non-coercive, coordinated manner by an interdisciplinary team. Community linkages are established to ensure that all of residents’ individual needs are met. The level of restrictiveness for residential treatment programs is greater than other group care settings given the treatment needs of residents. Residential treatment services provide highly individualized care to individuals – following either a community-based placement or more intensive intervention – with the aim of moving individuals toward a stable, less intensive level of care or independence.
 
Short-Term Diagnostic Centres provide comprehensive assessments, observation, and monitoring in a highly structured setting and make recommendations for additional services that will address identified needs.

Crisis Stabilization Units provide assessment and stabilization services for individuals in acute psychiatric crisis. Residents are offered services in a safe, structured environment under trained professional care in order to return to their previous level of functioning.

Withdrawal management programs provide medication management and monitoring, clinical counselling, and other necessary support and referral services to help individuals safely withdraw from the substance(s) on which they are dependent. Services include, but are not limited to: individual assessment and service planning, medical and non-medical withdrawal management, counselling and education, therapeutic interventions, and linkages with ongoing substance use treatment including medication-assisted treatment when applicable. Programs are available 24 hours a day, seven days per week and are staffed by an interdisciplinary team of qualified professionals. Withdrawal management without transition to ongoing medication-assisted treatment is not recommended for individuals with opioid use disorder.
Examples: Service recipients of residential treatment services may include, but are not limited to:
  1. children, adolescents or adults with behavioural health disorders severe enough to prevent them from functioning well in their community, but not so severe as to warrant hospitalization or incarceration;
  2. adolescents or adults involved with the justice system;
  3. individuals who are pregnant or parenting;
  4. children or adolescents who have been victims of human trafficking;
  5. individuals needing highly structured, intensive treatment for substance use conditions;
  6. individuals needing specialized and intensive settings for the purposes of clinical assessment; and
  7. individuals needing psychiatric stabilization.

Examples: A trauma-informed program may be described as one that:
  1. routinely screens for trauma exposure and related symptoms;
  2. uses culturally and linguistically appropriate evidence-based assessment and treatment for traumatic stress and associated mental health symptoms;
  3. makes resources available to children, families, and providers on trauma exposure, its impact, and treatment;
  4. engages in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma;
  5. addresses parent and caregiver trauma and its impact on the family system;
  6. emphasizes continuity of care and collaboration across child-serving systems; and
  7. maintains an environment of care and provides access to needed services for staff to address, minimize, and treat secondary traumatic stress, and increase staff resilience.
Note: Organizations that only operate a Crisis Stabilization Unit will complete CA-RTX 1, CA-RTX 2, CA-RTX 3, CA-RTX 4, CA-RTX 5, CA-RTX 6, CA-RTX 8, CA-RTX 9, CA-RTX 10, CA-RTX 13, CA-RTX 16, CA-RTX 17, CA-RTX 18, CA-RTX 20 and have the option to take NAs on practice standards where noted. Organizations will also complete CA-RTX 14 and CA-RTX 15 if applicable.

Organizations that only operate a Short-Term Diagnostic Center will complete CA-RTX 1, CA-RTX 2, CA-RTX 3, CA-RTX 4, CA-RTX 5, CA-RTX 6, CA-RTX 8, CA-RTX 9, CA-RTX 10, CA-RTX 11, CA-RTX 16, CA-RTX 17, CA-RTX 18, CA-RTX 20 and have the option to take NAs on practice standards where noted. Organizations will also complete CA-RTX 14 and CA-RTX 15 if applicable.

Organizations that only operate a withdrawal management program will complete CA-RTX 1, CA-RTX 2, CA-RTX 3, CA-RTX 4, CA-RTX 5, CA-RTX 6, CA-RTX 8, CA-RTX 9, CA-RTX 10, CA-RTX 15, CA-RTX 16, CA-RTX 17, CA-RTX 18, CA-RTX 20 and have the option to take NAs on practice standards where noted. Organizations will also complete CA-RTX 14 if applicable.


Note: Residential Treatment Services are distinct from Group Living Services (CA-GLS), which provide community-based care and are less restrictive. When residents are ready to leave residential treatment, they may be stepped down to a group living program or a less restrictive setting.

Organizations that provide adventure-based programming will also complete the Experiential Education Supplement (CA-EES).


Note: Though the term trafficking is used throughout this section, there are additional terms that may be utilized, including sex trafficking, commercial sexual exploitation of children (CSEC), domestic minor sex trafficking, and minor prostitution. The term victim is commonly used when referring to individuals who have been trafficked to emphasize that they have been coerced and exploited, though the term survivor may also be used.

Note: Please see CA-RTX Reference List for the research that informed the development of these standards.

Note: For information about changes made in the 2020 Edition, please see the RTX Crosswalk.
 
2022 Edition

Residential Treatment Services (CA-RTX) 1: Person-Centered Logic Model

The organization implements a program logic model that describes how resources and program activities will support the achievement of positive outcomes.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.

Logic models have been implemented for all programs and the organization has identified at least two outcomes for all its programs.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Logic models need improvement or clarification; or
  • Logic models are still under development for some of its programs, but are completed for all high-risk programs such as protective services, foster care, residential treatment, etc.; or
  • At least one client outcome has been identified for all of its programs; or
  • All but a few staff have been trained on use of therapeutic interventions and training is scheduled for the rest; or
  • With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Logic models need significant improvement; or
  • Logic models are still under development for a majority of programs; or
  • A logic model has not been developed for one or more high-risk programs; or
  • Outcomes have not been identified for one or more programs; or
  • Several staff have not been trained on the use of therapeutic interventions; or
  • There are gaps in monitoring of therapeutic interventions, as required; or
  • There is no process for identifying risks associated with use of therapeutic interventions; or
  • Policy on prohibited interventions does not include at least one of the required elements.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • Logic models have not been developed or implemented; or
  • Outcomes have not been identified for any programs; or
  • There is no written policy or procedures for the use of therapeutic interventions; or 
  • Procedures are clearly inadequate or not being used; or
  • Documentation on therapeutic interventions is routinely incomplete and/or missing; or
  • There is evidence that clients have been harmed by inappropriate or unmonitored use of therapeutic interventions.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • See program description completed during intake
  • Program logic model that includes a list of client outcomes being measured
  • Procedures for the use of therapeutic interventions
  • Policy for prohibited interventions
  • Training curricula that addresses therapeutic interventions
  • Documentation of training and/or certification related to therapeutic interventions

  • Interviews may include:
    1. Program director
    2. Relevant personnel

 

CA-RTX 1.01

A program logic model, or equivalent framework, identifies:
  1. needs the program will address;
  2. available human, financial, organizational, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered);
  5. desired outcomes (i.e. the changes you expect to see in service recipients); and
  6. expected long-term impact on the organization, community, and/or system.
Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA’s PQI Tool Kit for more information on developing and using program logic models.

Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to:
  1. needs assessments and periodic reassessments;
  2. risks assessments conducted for specific interventions; and
  3. the best available evidence of service effectiveness.

 

CA-RTX 1.02

The logic model identifies client outcomes in at least two of the following areas:
  1. change in clinical status;
  2. change in functional status;
  3. health, welfare, and safety;
  4. permanency of life situation;
  5. quality of life;
  6. achievement of individual service goals; and
  7. other outcomes as appropriate to the program or service population.
Example: Outcomes data can be disaggregated by race or ethnicity to identify and monitor disparities in service provision or effectiveness.

 
Fundamental Practice

CA-RTX 1.03

The organization:
  1. ensures staff are trained on therapeutic interventions prior to coming in contact with the service population;
  2. monitors the use and effectiveness of therapeutic interventions;
  3. identifies potential risks associated with therapeutic interventions and takes appropriate steps to minimize risk, when necessary; and
  4. discontinues an intervention immediately if it produces adverse side effects or is deemed unacceptable according to prevailing professional standards.

 
Fundamental Practice

CA-RTX 1.04

Organization policy prohibits:
  1. corporal punishment by personnel and by parenting residents, as applicable;
  2. the use of aversive stimuli and/or therapies;
  3. interventions that involve withholding nutrition or hydration, or that inflict physical or psychological pain;
  4. the use of demeaning, shaming, degrading or bullying language or activities;
  5. forced physical exercise to eliminate behaviours;
  6. unnecessarily punitive restrictions, including restricting contact with family as a disciplinary action;
  7. unwarranted use of invasive procedures or activities as a disciplinary action;
  8. punitive work assignments;
  9. punishment by peers; and
  10. group punishment or discipline for individual behaviour.
 
2022 Edition

Residential Treatment Services (CA-RTX) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of residents and their families.

Interpretation

Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Table of contents of training curricula
  • Sample job descriptions from across relevant job categories
  • Documentation tracking staff completion of required trainings and/or competencies
  • Training curricula
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files

 

CA-RTX 2.01

Residential counsellors, youth workers, adult care, and child care workers have:
  1. diploma or degree or are actively, continuously pursuing a diploma or degree;
  2. the personal characteristics and experience to collaborate with and provide appropriate care to residents, gain their respect, guide their development, and participate in their overall treatment program;
  3. the ability to support constructive resident-family visitation and resident involvement in community activities;
  4. the temperament to work with, and care for, children, youth, adults, or families with special needs, as appropriate; and
  5. the ability to work effectively with the treatment team and other internal and external stakeholders.

Interpretation

The elements of the standard will be considered together to assess implementation. Recruitment of staff with demonstrated competence and with appropriate supervision and specialized training can compensate for a lack of a diploma or degree.
Examples: Experience per element (b) can include lived experience as residential programs can have peer support specialists, youth advocates, mentors, and/or family advocates on staff.

 

CA-RTX 2.02

Supervisors of direct service personnel are qualified by: 
  1. an advanced degree in social work or a comparable human service field and two years of relevant experience; or
  2. a bachelor’s degree in social work or a comparable human service field and four or more years of relevant experience.

 
Fundamental Practice

CA-RTX 2.03

A physician or other qualified medical practitioner familiar with the needs of the resident population assumes 24-hour on-call medical oversight to ensure that residents’ health needs are identified and promptly addressed.

Interpretation

The physician can provide services as an employee, contractor, or through another formal arrangement. There may be more than one physician fulfilling the role.

Interpretation

COA recognizes that geographic placement and resources can pose barriers. The use of an emergency room or urgent care facility is acceptable for overnight hours when protocols are established. Organizations can also leverage alternative service delivery methods such as telehealth when regional shortages of certain professional groups make in-person consultation impractical.
NA All residents have private physicians.

 
Fundamental Practice

CA-RTX 2.04

A licensed psychiatrist with experience appropriate to the level and intensity of service and the population served is responsible for:
  1. developing guidelines for participation in services;
  2. providing psychiatric services, as applicable; and
  3. providing full-time coverage on an on-call basis 24 hours a day, seven days a week.

Interpretation

The psychiatrist can provide services as an employee, contractor, or through another formal arrangement. There may be more than one psychiatrist fulfilling the duties outlined. Residential treatment programs whose primary service is residential substance use treatment are not required to have full-time psychiatric coverage, but may provide psychiatric services though a formal referral arrangement on an as-needed basis.

Interpretation

In situations where a psychiatrist is not available to assume psychiatric responsibility for residents, the organization can receive a rating of 2 if they have an advanced practice registered nurse (APRN) supervised by a physician.

 

CA-RTX 2.05

Qualified professionals and specialists are available to provide services and support depending on the program model, population served, and specialized care needs.
Examples: Examples of services and providers that may be on staff, or available through a formal arrangement, include:
  1. mental health;
  2. substance use;
  3. crisis intervention;
  4. medicine and dentistry;
  5. psychological services, such as testing and evaluation;
  6. prenatal and postnatal care, and the developmental needs of children;
  7. prenatal and postpartum depression screenings and care;
  8. nursing;
  9. education and vocational skill development;
  10. physical and developmental disabilities;
  11. speech, occupational and physical therapy;
  12. recreation and expressive therapy;
  13. nutrition; and/or
  14. religion and spirituality.

Examples: Examples of populations with specialized care needs include, but are not limited to:
  1. older adults;
  2. children and youth with pervasive developmental disorders;
  3. children and youth who engage in fire setting;
  4. individuals who exhibit sexually reactive behaviour;
  5. victims of physical, psychological or sexual abuse;
  6. LGBTQ population, especially those with gender identity issues;
  7. individuals with eating disorders; and
  8. individuals who have trouble communicating or being understood without special assistance.

 
Fundamental Practice

CA-RTX 2.06

There is at least one person on duty at each program site any time the program is in operation that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.

 

CA-RTX 2.07

All direct service personnel are trained on, or demonstrate competency in:
  1. assessing needs in crisis situations;
  2. understanding special issues regarding age, gender identity/crisis, substance use and mental health conditions, developmental disabilities, and other needs typically presented by the service population;
  3. understanding the definitions of human trafficking (both labour and sex trafficking) and sexual exploitation, and identifying potential victims;
  4. procedures for responding to residents who run away;
  5. interventions for addressing the acute needs of victims of trauma; and
  6. collaborating with local law enforcement.

 

CA-RTX 2.08

Caseloads support the achievement of client outcomes, are regularly reviewed, and generally do not exceed 12 residents.

Interpretation

Personnel who carry a caseload include the residential treatment center's milieu counsellors, case managers, and/or child, youth, or adult care workers.
Examples: Factors that may be considered when determining caseloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. case complexity and residents’ special circumstances;
  3. age, gender, and population characteristics;
  4. case status and progress toward achievement of desired outcomes;
  5. the work and time required to accomplish assigned tasks and job responsibilities; and
  6. service volume.
 
2022 Edition

Residential Treatment Services (CA-RTX) 3: Access to Service

The organization provides access to services for individuals who require and will benefit from a total milieu environment, active psychotherapeutic and psycho-educational interventions, and around-the-clock care for a specified period of time.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Admission procedures
  • Eligibility criteria
  • Materials outlining permitted and prohibited items
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 3.01

The organization defines in writing:
  1. eligibility criteria, including age, developmental stage, and populations served;
  2. scope of services and supports, special areas of expertise, and range of client issues addressed; and
  3. how the facility promotes living-unit compatibility based on age, interests, and group composition.

Interpretation

In regards to element (c), COA recognizes that organizations, particularly those that receive clients by referral only, may have limited control of group composition. In these instances, organizations should identify the population(s) served, state how residents’ diverse service needs will be met, and include strategies for promoting living unit compatibility.

 

CA-RTX 3.02

The resident and his or her family and/or legal guardian are engaged in the admission and placement process to prepare for admission, and are given the opportunity for a pre-admission visit, whenever possible.

 

CA-RTX 3.03

The organization describes:
  1. personal items residents may bring with them, consistent with a safe, therapeutic setting;
  2. items that are discouraged or prohibited; and
  3. any safety procedures the program follows, or consequences that can result, when prohibited items are brought to the program site.

Interpretation

Given the rise in information and communication technologies, organizations must specify in their admission materials what electronic devices are permitted and prohibited.
Examples: Personal items residents may bring with them may include, for example, photos, books, cellphones, computers, or other electronics.
 
2022 Edition

Residential Treatment Services (CA-RTX) 4: Intake and Assessment

The organization’s intake and assessment practices ensure that residents receive prompt and responsive access to appropriate services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • In a few rare instances, urgent needs were not prioritized; or
  • For the most part, established timeframes are met; or
  • Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Urgent needs are often not prioritized; or 
  • Services are frequently not initiated in a timely manner; or
  • Applicants are not receiving referrals, as appropriate; or 
  • Assessment and reassessment timeframes are often missed; or
  • Assessments are sometimes not sufficiently individualized; 
  • Culturally responsive assessments are not the norm, and this is not being addressed in supervision or training; or
  • Several client records are missing important information; or
  • Client participation is inconsistent; or
  • Intake or assessment is done by another organization or referral source and no documentation and/or summary of required information is present in case record. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • There are no written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Screening and intake procedures
  • Assessment and reassessment procedures
  • Copy of assessment tool(s)
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

 

CA-RTX 4.01

Residents are screened to determine whether they meet the program’s eligibility criteria, and are informed about:
  1. how well their request matches the organization's services;
  2. what service options and levels of care will be available and when;
  3. the effectiveness of treatment, when available; and
  4. opportunities for active family participation and support, and involvement in community activities.

Interpretation

Screenings will vary based on the program’s target population and services offered, and can include information to identify any of the following: trauma history, substance use conditions, mental illness, and/or individual’s risk of harm to self or others.

Interpretation

When organizations provide services under contract with a “no reject” provision the interdisciplinary team should carefully review admission decisions to ensure the organization is prepared to address any special needs or services the resident may require.
NA Another organization is responsible for screening, as defined in a contract.

 
Fundamental Practice

CA-RTX 4.02

Prompt, responsive intake practices:
  1. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
  2. give priority to urgent needs and emergency situations;
  3. support timely initiation of services; and
  4. provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.

 

CA-RTX 4.03

Residents participate in a comprehensive, individualized, trauma-informed, strengths-based, culturally and linguistically responsive assessment that is:
  1. completed within established timeframes; and
  2. focused on information pertinent for meeting service requests and objectives.

Interpretation

Standardized and evidence-based assessment tools should be used to support structured and consistent decision-making.

 
Fundamental Practice

CA-RTX 4.04

The assessment is conducted by clinical personnel, including a licensed psychiatrist, psychologist, or other qualified mental health professional, as appropriate to the program model and population served, and addresses:
  1. behavioural and physical health;
  2. a trauma screen and, when appropriate, a trauma assessment;
  3. an evaluation of suicide risk, self-injury, neglect, exploitation, and violence towards others;
  4. family strengths, risks, and protective factors;
  5. community and social support, resources, and helping networks;
  6. environmental, religious or spiritual, and cultural factors;
  7. educational and vocational accomplishments;
  8. social skills, recreational activities, hobbies, strengths and special interests;
  9. factors related to successful group living;
  10. additional tests and assessments needed; and
  11. a summary of symptoms and diagnoses.

Interpretation

The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

Interpretation

Due to the nature of withdrawal management programs, individuals seeking treatment may not have the opportunity to address trauma history and/or recent incidents of trauma during the assessment process.

Interpretation

Vulnerable populations, such as youth that are lesbian, gay, bisexual, transgender, and questioning (LGBTQ), are at high risk of violence and harassment while in residential placement. The organization should consider these factors to ensure these youth are safe and welcomed by staff.

Interpretation

Personnel that conduct evaluations should be aware of the indicators of a potential trafficking victim, including, but not limited to:
  1. evidence of mental, physical, or sexual abuse;
  2. physical exhaustion;
  3. working long hours;
  4. living with employer or many people in confined area;
  5. unclear family relationships;
  6. heightened sense of fear or distrust of authority;
  7. presence of older significant other or pimp;
  8. loyalty or positive feelings towards an abuser;
  9. inability or fear of making eye contact;
  10. chronic running away or homelessness;
  11. possession of excess amounts of cash or hotel keys; and
  12. inability to provide a local address or information about parents.

Several tools are available to help identify a potential victim of trafficking and determine next steps toward an appropriate course of treatment. Examples of these tools include, but are not limited to, the Rapid Screening Tool for Child Trafficking and the Comprehensive Screening and Safety Tool for Child Trafficking.
Examples: Organizations serving young children can tailor the assessment process to meet the age and developmental level of the service population. Assessments may include an evaluation of factors that impact the child’s social and emotional well-being (e.g., family characteristics), an observation of the child’s behaviour, and/or a thorough health and developmental history.

Examples: Factors that can impact group living success can include:
  1. possible reciprocal individual and group effects;
  2. the individual’s ability to adjust to a group;
  3. safety issues;
  4. previous placements; and
  5. trauma history.

 
Fundamental Practice

CA-RTX 4.05

When a resident’s assessment indicates a substance use condition, the organization records a thorough alcohol and drug use history, including an evaluation of the effects of alcohol and other drug use on the resident’s family and:
  1. provides an appropriate level of service and withdrawal management, as necessary; or
  2. connects the resident and/or family members to appropriate services when the program does not serve individuals with substance use conditions.

 

CA-RTX 4.06

Reassessments are conducted as needed, including at specific milestones in the treatment process, including:
  1. after significant treatment progress;
  2. after a lack of significant treatment progress;
  3. after new symptoms are identified;
  4. when significant behavioural changes are observed;
  5. when there are changes to a family situation or parental status;
  6. when significant environmental changes occur; or
  7. when a resident returns following an episode of running away.
Note: For more information regarding residents that return after an episode of running away, refer to CA-RTX 10.01 and CA-RTX 18.03.
 
2022 Edition

Residential Treatment Services (CA-RTX) 5: Family Involvement

The organization works with the resident and his or her family to determine and maintain an optimal level of family involvement in all treatment activities.
Examples: Level of family involvement may vary given the age and expressed wishes of the resident and as permitted by law. Program model and structure can also impact family involvement. For example, due to the nature of programs that provide withdrawal management or crisis stabilisation, engaging family members in the treatment process may not be possible or appropriate. 
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for facilitating family involvement
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 5.01

The organization helps every resident to:
  1. express the nature of family connection desired;
  2. prevent, manage, and reduce family conflicts and develop problem-solving skills;
  3. identify family strengths that help members meet challenges;
  4. understand separation from family or significant others and grieve the loss of family;
  5. maintain relationships with family members through time spent at home and shared activities, as often as possible;
  6. participate in neighborhood activities; and
  7. prepare for returning home or for living with another family, if appropriate.

Interpretation

Unless contraindicated by court-order or there are compelling reasons to limit contact, residents should have the opportunity to spend time with their family at home and receive visits from family and friends. For adults, and some young adults, every attempt should be made to include family members identified by the resident. In cases where adults do not want family involvement, they should receive help to identify friendship/peer support opportunities based on common interests, and for young adults efforts should be made to help them connect with a non-custodial parent and/or other extended family members.

Interpretation

The organization should work with the resident to identify individuals with whom they wish to maintain a relationship, especially when trafficking is suspected. Traffickers may pose as a significant other, older relative, or communicate through another individual and utilize visitation to continue the exploitation of the victim. In cases where the resident is a victim of human trafficking, it is important to be aware that the resident’s parent or caregiver may be the trafficker or complicit in the trafficking. In such cases, determining appropriate family supports and level of involvement should include the input of the resident.

Interpretation

Some standards elements may not be applicable for crisis stabilisation, short-term diagnostic, and withdrawal management programs due to length of stay and program design.

 

CA-RTX 5.02

The organization supports family involvement and engagement by:
  1. providing assistance or support, as needed;
  2. encouraging the family’s active participation in decision-making;
  3. providing an environment conducive to family visits and activities; and
  4. reestablishing parental and family care, or termination of parental rights, when in the best interest of or desired by the resident.
Examples: Examples of ways to engage families and encourage their participation can include asking family members directly about their needs and having family advocates available to offer assistance.

 

CA-RTX 5.03

Residents are located close to their families and home communities to retain natural connections and allow for continued participation in community programs and when services are not available close to a resident’s home or community, the organization attempts to maintain family ties and involve the family by:
  1. assisting the family with travel arrangements;
  2. coordinating or facilitating family services to be delivered in the community; and/or
  3. employing methods for telecommunication through web-based or electronic systems.
Examples: The organization can support family involvement and provide alternative services through cooperating local organizations. Transportation costs can be paid to facilitate frequent visiting and home visits, when possible.

 

CA-RTX 5.04

Family members receive information and support to help them understand the needs of the resident and promote successful reintegration with their family and community.

Interpretation

Educating parents on sex trafficking is an important component to prevention, identification, and treatment. Information provided should address how parents can raise their children in an environment free of abuse, neglect, and exploitation, through information on topics such as internet safety, how to respond when a child runs away, and developing healthy relationships. Additionally, information for parents of trafficking victims should emphasize the issue of stigma associated with prostitution to help the family provide a healthy, nonjudgmental home environment, supportive of a successful reintegration.
Examples: Organizations can educate family members on important information related to the resident’s treatment that will aid in the resident’s transition from care and offer supports to families, such as individual mentoring and family and/or parent coaching.
 
2022 Edition

Residential Treatment Services (CA-RTX) 6: Service Planning and Monitoring

Residents and their families participate in the development and ongoing review of a comprehensive service plan that is the basis for delivery of appropriate services and supports.

Interpretation

While a service plan may conform to a uniform format, plan content should be individualized through collaboration with the resident and, as appropriate, a parent, guardian, and/or legal advocate based on service needs and program model. Level of family involvement in the service planning process will vary by resident and/or program model.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, client or staff signatures are missing and/or not dated; or
  • With few exceptions, staff work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc.; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • In several instances, client or staff signatures are missing and/or not dated; or
  • Quarterly reviews are not being done consistently; or
  • Level of care for some clients is clearly inappropriate; or
  • Service planning is often done without full client participation; or
  • Appropriate family involvement is not documented; or  
  • Documentation is routinely incomplete and/or missing; or
  • Individual staff members work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc., but this is the exception.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Service planning and monitoring procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 6.01

Residents participate in the development of an initial service plan within one week of admission and a comprehensive service plan within 30 days.
NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.
Note: Service planning timeframes for crisis stabilization units are addressed in CA-RTX 13.04.

 

CA-RTX 6.02

A comprehensive, assessment-based service plan is developed with the full participation of the resident, and their family when appropriate, and includes:
  1. agreed upon goals, desired outcomes, and timeframes for achieving them;
  2. services and supports to be provided, and by whom;
  3. procedures for expedited service planning when crisis or urgent need is identified; and
  4. the resident’s and/or legal guardian’s signature.

Interpretation

Safety concerns for victims of human trafficking often do not end when they are admitted to residential settings. The organization should work with the victim to develop a safety plan that focuses on increasing physical safety by securing needed documents, property, and services; maintaining the residence’s location in confidence or restricting access by certain individuals; and linking efficiently to law enforcement, if needed. Psychological safety should also be prioritized as the emotional effects of trauma – mistrust, anxiety, and depression – can be persistent and overwhelming for victims.
Examples: When working with victims of trauma, the organization can facilitate the development of realistic goals in an empowering and trauma-informed manner by building rapport, establishing trust, and promoting physical and psychological safety.

 

CA-RTX 6.03

The service plan includes:
  1. specific treatment modalities to be used, appropriate to the cultural perspective and competencies of the individual; and
  2. the estimated length of treatments and stay.

 

CA-RTX 6.04

The worker and a supervisor, or a clinical, service, or peer team, review the case quarterly, or more frequently depending on the needs of the resident, to assess:
  1. service plan implementation;
  2. progress toward achieving service goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon service goals.

Interpretation

When experienced workers are conducting reviews of their own cases, the worker’s supervisor must review a sample of the worker’s evaluations as per the requirements of the standard.
NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.
Examples: Service plans may be reviewed more frequently for young children, individuals with specialized care needs, and as acute needs and contractual requirements dictate. Timeframes for service plan reviews may be adjusted depending upon, for example: issues and needs of persons receiving services; changes in residents’ life situations or psychological conditions; frequency and intensity of services provided; and frequency of contact with informal caregivers and cooperating providers.

 

CA-RTX 6.05

The worker and resident, and his or her family when appropriate:
  1. review progress toward achievement of agreed upon service goals; and
  2. sign revisions to service goals and plans.

Interpretation

For children and youth, family members and/or legal guardians should always be involved in case conferences and advised of ongoing progress.
NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.
 
2022 Edition

Residential Treatment Services (CA-RTX) 7: Child Permanency

The organization participates in or facilitates permanency planning to promote physical, emotional, and legal permanence for children.

Interpretation

When the organization is not responsible for facilitating permanency planning, it should document all participation in the process and any efforts to connect children to positive relationships with significant adults.

In addition, organizations should demonstrate their role in supporting timely permanency planning through regular case record documentation and official reports which comment on children’s and/or families’ progress towards permanency goal(s).
NA The organization does not provide out-of-home care for children in custody of a public agency.

NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.
Note: Permanency planning often occurs in conjunction with service planning.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for permanency planning
  • Procedures for finding and engaging kin
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 7.01

Permanency planning:
  1. occurs with families and the team of people that support them, including out-of-home care providers, service providers, and extended family members or other supportive individuals identified by the family, as appropriate;
  2. is scheduled at times when appropriate parties can attend; and
  3. is child-driven, with children actively involved in every stage of the process as appropriate to their age and developmental level.
Examples: Child-driven permanency planning can include, but is not limited to, involving children in:
  1. conversations about what permanency means to them;
  2. the discovery of extended family and other significant adults; and
  3. the formation of a permanency team that will support their desired outcomes and have an ongoing role in their lives.

 

CA-RTX 7.02

The organization collaborates with children, parents, and the local child protection agency to identify, notify, and engage relatives and other close, supportive adults that can be resources or supports for placement and permanency for children of all ages, regardless of whether or not they currently wish to be adopted.
Examples: Procedures for identification of kin may include:
  1. engaging children and family members in identification;
  2. conducting a thorough review of the case record;
  3. using technological resources for family-finding;
  4. providing notification in family members’ preferred languages; and
  5. providing notifications in multiple forms, including written form.

 

CA-RTX 7.03

Concurrent planning is documented and includes:
  1. early, preliminary, and reasoned assessment of the potential for reunification, the best interests of the child, and the need for an alternative plan;
  2. full disclosure to involved parties of all permanency options, including expectations, implications, available supports, and legal timelines;
  3. joining a resource family that is prepared to develop a life-long relationship with the child; and
  4. counselling parents about relinquishment and alternative permanency options if needed.

Interpretation

The age of a child should not limit the consideration of all permanency options.

 

CA-RTX 7.04

Permanency plans document:
  1. permanency goals;
  2. why goals are in the best interest of children and their well-being;
  3. why other permanency options are not appropriate; and
  4. how service plans and identified interventions support permanency and child well-being.

 
Fundamental Practice

CA-RTX 7.05

In compliance with applicable legistation, regulations, and/or contracts, legal permanency planning occurs with children and families according to the following standard timeframes:
  1. within 60 days of placement a court-determined permanency plan is developed;
  2. at least every six months a court or administrative review of progress towards permanency occurs;
  3. within 12 months of placement, and every 12 months thereafter, a permanency hearing evaluates the permanency goal and determines the need for an alternative goal; and
  4. after a child has been in placement for 15 of the most recent 22 months, a legally-exempted permanency decision is made or proceedings are initiated for the termination of parental rights.

Interpretation

The length of time a child has been in care cannot be the only justification for terminating parental rights. In order to support parents that are actively making progress towards reunification but need more time, the organization can work with the public authority to determine a compelling reason for not filing for the termination of parental rights. Whenever possible, the permanency timeline for parents with substance use conditions should reflect the time needed to receive substance use treatment services and make progress towards recovery. The mental health status and readiness of the child should also be taken into consideration when assessing permanency goals.

 

CA-RTX 7.06

Case records document efforts made to support parents toward reunification, including:
  1. involvement in assessment, service planning, and service selection;
  2. access to needed services and supports, including both formal and informal community resources;
  3. ongoing, constructive, and progressive contact with their children; and
  4. reduction of barriers to contact and involvement in the child’s care.
NA The organization does not provide services to parents.
 
2022 Edition

Residential Treatment Services (CA-RTX) 8: Coordinated, Individualized Team Approach

Team members are aligned in implementing a structured, individualized therapeutic program in collaboration with residents and families to ensure that residents’ daily living experiences are well integrated and promote the development of positive skills and behaviours.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Care coordination procedures
  • Case assignment procedures
  • Procedures for involving residents in decision making
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 8.01

In collaboration with the resident and their family, an interdisciplinary team:
  1. coordinates, monitors, and, when necessary, advocates for services tailored to the needs of individual residents; and
  2. makes decisions regarding service planning and delivery.
Examples: For example, service decisions made in partnership with the resident may include:
  1. the need for additional assessments;
  2. determining the appropriate level of care;
  3. obtaining access to the full array of services to which they are eligible;
  4. mediating barriers in the service delivery system;
  5. the need for family services to resolve concerns that will otherwise extend the resident’s stay;
  6. planning for transition and case closing; and
  7. necessary follow-up services.
Note: Interdisciplinary program elements are discussed in CA-RTX 9.01.

 

CA-RTX 8.02

Interdisciplinary teamwork:
  1. encourages resident participation in treatment team meetings;
  2. specifies the intended result of daily living experiences, activities, and interventions in the service plan;
  3. engages residents in developmentally-appropriate, trauma-informed, culturally sensitive activities and interactions designed to alter or improve behaviour, provide support, and promote healthy development and return to their community;
  4. provides opportunities for participation by one or more consistent caring adults, taking into account the resident’s strengths and interests; and
  5. coordinates therapeutic and educational and/or vocational activities with individual service and skill development plans.

 

CA-RTX 8.03

A coordinated team approach promotes a stable, ongoing, goal-directed caseworker-resident relationship and minimizes the need for multiple case managers assigned to the individual or family.

Interpretation

Central coordination of services is one of the most important aspects of care for victims of human trafficking. It provides the opportunity to develop an important, consistent connection with the staff person while the complex myriad of needed services are accessed and coordinated.
Examples: Organizations can streamline and coordinate services and goals by:
  1. assigning a worker at intake or early in the contact;
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel;
  3. identifying overlapping responsibilities and tasks;
  4. clarifying roles; and
  5. establishing guidelines and procedures that ensure collaboration across systems.

 

CA-RTX 8.04

Residents are given the opportunity for voice and choice relating to their treatment and program activities, as well as to share feedback including dissatisfaction with aspects of care.
Examples: The establishment of resident councils is one way to involve residents in all aspects of care and ensure that they have an opportunity to provide feedback on staff, activities, rules, food, their overall experience, sense of safety and support, and the living environment. This type of activity can also provide opportunities for peer advocacy, self-advocacy, and leadership. For programs serving for youth, family advisory councils can be established to involve families in the governance of the program.
 
2022 Edition

Residential Treatment Services (CA-RTX) 9: Service Array

The residential treatment program utilizes residents’ interests, strengths, and needs to develop a wide array of structured, supportive, therapeutic service, and educational and vocational components that combine residential and community activities, as appropriate, and offers residents choice and flexibility.

Interpretation

Withdrawal management programs should include daily clinical services such as appropriate medical care, therapy, and withdrawal support. A range of therapies (e.g., cognitive, behavioural, medical, and mental health therapies) should be provided to service recipients on an individual or group basis. Services should aim to enhance the service recipient's understanding of addiction, completion of withdrawal management, and referral to an appropriate level of care for substance use treatment. The delivery of services will vary and depends on the assessed needs of the service recipient and his or her treatment progress.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Sample of activity schedules
  • Procedures for obtaining clearance to participate in athletic activities
  • Proof of accreditation, licensure, or certification for outside providers operating adventure-based activities
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records
  • Observe the program

 

CA-RTX 9.01

A structured, interdisciplinary program appropriate to the age, developmental level, social and emotional needs, strengths, and interests of individual residents, includes:
  1. treatment for severe emotional disturbance or mental health and substance use conditions;
  2. individual and group counselling;
  3. frequent family therapy, unless contraindicated;
  4. educational and/or vocational programming;
  5. art, music, athletic, and other recreational opportunities and activities;
  6. legal advocacy, as appropriate;
  7. opportunities to participate in religious observances in a faith or spirituality of choice;
  8. community cultural enrichment;
  9. positive parenting techniques, as appropriate; and
  10. independent living preparation.

Interpretation

Some standards elements may not be applicable for crisis stabilization and short-term diagnostic programs due to length of stay and program design.

 

CA-RTX 9.02

Services provide predictability, structure, support, and a positive culture that includes:
  1. a written, individualized program for each resident;
  2. daily living experience to effect healthy behaviour change; and
  3. advanced posting of schedules for structured and supervised activities.

Interpretation

Some standards elements may not be appropriate for crisis stabilization and short-term diagnostic programs due to length of stay and program design.

Interpretation

Organizations that are resident-guided empower, educate, and facilitate voice and choice of those served by the program. Offering residents decision-making power leads to more positive long-term outcomes. Organizations that are family-driven empower, educate, engage, and promote voice and choice of families.

 

CA-RTX 9.03

When planning milieu activities, the organization takes into account:
  1. developmental level and age;
  2. emotional stability;
  3. group characteristics;
  4. personality;
  5. skills and interests; and
  6. gender.

 
Fundamental Practice

CA-RTX 9.04

The organization evaluates residents for their ability to participate in athletic activities and obtains:
  1. a medical records release;
  2. a signed document from a qualified medical professional stating that the resident is physically capable of participating; and/or
  3. an adult waiver and release of liability.
NA The organization does not offer athletic activities to residents.

 
Fundamental Practice

CA-RTX 9.05

Organizations that purchase services from providers that operate adventure-based activities with a significant degree of risk request proof of accreditation, licensure, or certification with a nationally recognized authority for the activity being conducted.
NA The organization does not purchase services from providers that operate adventure-based activities.
Examples: Adventure-based activities with a significant degree of risk can include, white water rafting, climbing walls, or ropes courses.
 
2022 Edition

Residential Treatment Services (CA-RTX) 10: Healthcare Services

Residents receive comprehensive healthcare services to promote optimal physical, emotional, and developmental health.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Initial health screening procedures
  • Procedures for the coordination and provision of healthcare and dental examinations and services
  • Informational health and wellness materials
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

 
Fundamental Practice

CA-RTX 10.01

An initial health screening is conducted by a qualified, trained staff member for all residents within 24 hours of admission to identify the need for immediate medical care and assess for communicable disease.

Interpretation

When a resident returns following a runaway episode, a health screening should be conducted within 24 hours of entry back into care to identify whether he or she was victimized or otherwise hurt or injured while on the run.

Interpretation

In situations where the resident is unable to receive an initial health screening by a qualified, trained staff member within 24 hours, the organization can receive a rating of 2 if it has procedures in place for accommodating exceptional circumstances, for example, weekend placements, and is able to provide evidence that the screening occurred within 72 hours of admission.
Examples: Conditions that require immediate or prompt medical attention include, but are not limited to: signs of abuse or neglect, serious, accidental or unexplained injury, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances.

 
Fundamental Practice

CA-RTX 10.02

Every resident receives:
  1. a comprehensive medical examination within five days after admission, unless the resident has received a medical exam within the last year, and annually thereafter; and
  2. a dental examination within six months prior to or one month after admission, with appropriate follow-up thereafter.

Interpretation

When records from the most recent medical and dental examinations are unavailable, or examinations are incomplete, the organization must ensure that examinations are completed within the required timeframes.

Interpretation

The purpose of the medical examination is to identify and assess medical, developmental, and mental health conditions that require treatment, additional evaluation, and/or referrals to other healthcare professionals or specialists. The examination must be comprehensive, build on history gathered during the initial medical screening, and focus on specific assessments that are appropriate to the individual’s age and developmental level. Findings from the exam should be used to develop individualized treatment plans, as well as inform follow-up assessments and services.
 

Interpretation

In situations where resources are not available for preventive dental care to occur every six months, the organization can receive a rating of 2 if there is an annual preventive exam and evidence that recommendations from the dental practitioner indicate the child is not in need of more frequent care. Children with dental issues or at high risk of dental problems must be receiving the care they need. Families should be engaged in the process and solution for getting their child the needed dental care.
NA The organization only operates a crisis stabilization unit or a short-term diagnostic centre.

 
Fundamental Practice

CA-RTX 10.03

The organization provides needed health services directly or by referral, and:
  1. retains documentation of the resident’s and his or her family’s known medical history, including immunizations, operations, medications, and medical conditions and illnesses; and
  2. provides the information to the resident and/or his or her legal guardian upon request.

 
Fundamental Practice

CA-RTX 10.04

To promote their ability to maintain positive health practices, residents receive appropriate support and education regarding:
  1. proper nutrition and exercise;
  2. personal hygiene;
  3. substance use and smoking;
  4. sexual development;
  5. safe and healthy relationships;
  6. family planning and pregnancy options;
  7. pregnancy, prenatal care, and effective parenting; and
  8. prevention and treatment of diseases, including sexually transmitted infections/diseases and HIV/AIDS.
NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.

 

CA-RTX 10.05

The organization provides or arranges specialized health services to meet the needs of the service population, as appropriate.
Examples: Specialized health services may be needed by older adults, pregnant and parenting individuals, individuals with eating disorders, individuals with substance-use related conditions, or children with autism and pervasive developmental disorders. These services may include, for example:
  1. tobacco cessation programs;
  2. fetal alcohol syndrome screening;
  3. speech, language, and occupational therapy;
  4. prenatal care, well-baby care, and accessing child and infant health insurance programs;
  5. gender identity counselling; and
  6. screening for the onset of or existence of common cancers.
 
2022 Edition

Residential Treatment Services (CA-RTX) 11: Education Services

The organization provides or arranges for residents to receive education services and supports to help them achieve their educational and/or vocational goals.

Interpretation

Organizations that do not offer educational services on-site should coordinate with community-based providers to meet the educational needs of all residents. When organizations do not directly provide or arrange education services, individual case records should indicate that education plans are integrated into treatment plans and document advocacy for areas of unmet educational need. Education services will vary depending on the population served.
NA The organization only operates a crisis stabilization unit or withdrawal management program.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for developing and/or integrating education plans
  • Procedures for coordinating education services with community- based providers, if applicable
  • Proof of certification, accreditation, or registration, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

 

CA-RTX 11.01

A comprehensive, coordinated education plan is developed and integrated into the service plan for any resident who has educational goals, or vocational goals that include an educational component.

Interpretation

If the organization does not participate in the development of the education plan it is responsible for integrating each individual’s education plan into their service plan.

 

CA-RTX 11.02

Residents pursuing educational goals are enrolled in an appropriate education program on-site or in the community that is approved, certified, accredited, registered, or operated by or in conjunction with the local school district.

 

CA-RTX 11.03

The educational program incorporates effective instructional practices, quality curriculum design, and educational tools and supports for diverse learning needs of children and youth.
NA The organization does not provide residential services to school-age children or youth.

NA The organization does not directly provide the educational program nor develop the education plans for children or youth.
Examples: Diverse learning needs can include children who: require support due to a learning disability, are learning English as an additional language, or are intellectually gifted.

 

CA-RTX 11.04

The organization provides or arranges, as needed:
  1. tutoring;
  2. preparation for a high school equivalency diploma;
  3. college preparation;
  4. parent/teacher meetings;
  5. vocational or continuing education opportunities; and/or
  6. advocacy and support.
 
2022 Edition

Residential Treatment Services (CA-RTX) 12: Community and Social Connections

Residents cultivate and sustain connections with their community and social support network to promote positive well-being.
NA The organization only operates a crisis stabilization unit, short-term diagnostic centre, or withdrawal management program.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for facilitating community and socialconnections
  • Policy that prohibits exploitation of individuals in employment-related training or jobs
  • Community resource list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records
  • Observe a variety of activities

 

CA-RTX 12.01

The organization facilitates residents’ ability to access all available services and successfully reintegrate into their community by:
  1. remaining knowledgeable about local and regional resources, including networking and leadership opportunities; and
  2. identifying opportunities for individuals to develop positive ties to the community based on mutual interests and abilities.

 

CA-RTX 12.02

Organizations create a normative environment for residents while they are in care and provide residents opportunities to participate in:
  1. culturally and developmentally appropriate social, recreational, educational, or vocational activities in their community;
  2. religious observances in the faith group or spirituality of choice; and
  3. family and neighborhood activities consistent with the resident’s ethnic and cultural heritage and tribal affiliation.
Examples: Activities in the community can include sports teams, drama, choir, and musical groups that promote pro-social behaviours and values.

 

CA-RTX 12.03

Residents are helped to develop social support networks and build healthy, meaningful relationships with caring individuals of their choosing.
Examples: “Caring individuals” may include mentors, community members, friends, classmates, peers, siblings, cousins, grandparents, former foster parents, and extended family members.

 

CA-RTX 12.04

The organization encourages social and community integration through the development of life skills necessary to:
  1. navigate the surrounding environment;
  2. access community resources, such as banks, employment agencies, government offices, and recreational and educational organizations;
  3. pursue educational and occupational opportunities;
  4. obtain housing;
  5. manage finances;
  6. access public assistance;
  7. communicate effectively and resolve conflicts;
  8. participate in recreational activities and/or hobbies; and
  9. prepare for leaving care and family reintegration, independent living, or another less restrictive setting, if applicable.

Interpretation

This standard is applicable for all residents regardless of age. Organizations should tailor life skills training to meet the age and developmental level of the service population.

 

CA-RTX 12.05

The organization offers employment opportunities or employment-related training to residents and:
  1. makes reasonable efforts to match training and employment opportunities to the goals and interests of individual residents;
  2. paid job opportunities are completely voluntary; and
  3. a policy prohibiting exploitation of residents is maintained.
NA The organization does not provide employment-related training or jobs to residents.
 
2022 Edition

Residential Treatment Services (CA-RTX) 13: Crisis Stabilization

The organization provides residents in crisis with structured, trauma-informed stabilization and treatment services in order to help them return to their previous level of functioning.
NA The organization does not operate a crisis stabilization unit.
Examples: Children and adults seeking crisis stabilization services may be experiencing an acute psychiatric crisis, a substance use related crisis, or severe emotional or mental distress.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for delivering crisis stabilisation services
  • Supervision and scheduling criteria
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

 

CA-RTX 13.01

Crisis stabilization services focus on crisis resolution and are delivered in a trauma-informed, developmentally appropriate, and culturally and linguistically responsive manner by qualified personnel.

 
Fundamental Practice

CA-RTX 13.02

Organizations that offer crisis stabilization provide the following services on a 24/7 basis:
  1. emergency reception;
  2. assessment and evaluation;
  3. observation and monitoring;
  4. crisis counselling;
  5. medication management;
  6. structured, therapeutic activities;
  7. support services and psycho-education for family members; and
  8. referrals to specialists and other community-based services, as needed.

Interpretation

In regards to element (a), emergency reception means that individuals in crisis are accepted on a 24-hour basis without undue delays or barriers.
Examples: Structured, therapeutic activities may be recreational, social, and/or educational in nature in accordance with the resident’s service plan. Organizations can also address these services in CA-RTX 9.

 

CA-RTX 13.03

Residents receive a crisis assessment within 24 hours of admission to determine the appropriate level of care.
Note: Organizations that operate a crisis stabilization unit will also complete the applicable assessment standards in CA-RTX 4.

 

CA-RTX 13.04

Residents participate in the development of an initial service plan within 24 hours of admission and a comprehensive service plan within five days.

Interpretation

When care extends beyond thirty days the organization must review and update the resident’s service plan according to the change in the individual’s clinical condition.
Note: This standard is specific to service planning timeframes. Organizations that operate a crisis stabilization unit will also complete the applicable service planning and monitoring standards in CA-RTX 6.

 

CA-RTX 13.05

The organization engages individuals and involved family members in crisis and/or safety planning that:
  1. is appropriate to individual needs and centered around individual strengths;
  2. identifies individualized warning signs of a crisis; and
  3. specifies interventions that may or may not be implemented in order to help the individual de-escalate and promote stabilization.

Interpretation

A safety plan includes a prioritized written list of coping strategies and sources of support that individuals who have been deemed to be at high risk for suicide can use. Individuals can implement these strategies before or during a suicidal crisis. A personalized safety plan and appropriate follow-up can help suicidal individuals cope with suicidal feelings in order to prevent a suicide attempt or possibly death. The safety plan should be developed once it has been determined that no immediate emergency intervention is required. Components of a safety plan can also include: internal coping strategies, socialization strategies for distraction and support, family and social contacts for assistance, professional and agency contacts, and lethal means restriction.

Interpretation

The plan can be part of, and reviewed with, the resident’s overall service or treatment plan.

 

CA-RTX 13.06

Organizations arrange educational services and supports, as appropriate, to ensure that residents can pursue their educational goals once they achieve a crisis resolution.

 
Fundamental Practice

CA-RTX 13.07

During the first 48 hours a resident is in care, a minimum of two staff members are on-duty 24 hours per day to ensure that adequate care and supervision are provided.
Note: For care ratio requirements, please see CA-RTX 18.02.
 
2022 Edition

Residential Treatment Services (CA-RTX) 14: Services for Pregnant and Parenting Residents

The organization utilizes a family-driven treatment model to empower pregnant and parenting residents and supports and promotes the well-being of their children and other family members.

Interpretation

“Parenting residents” refers to residents that bring their children with them to the treatment program. Organizations will be responsible for determining whether a child should be admitted to the treatment program.
NA The organization does not serve pregnant and/or parenting residents.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for referring individuals to services
  • Procedures for evaluating educational needs and collaborating with schools
  • Table of contents of parenting education curricula
  • Community resource and referral list
  • Informational materials provided to residents
  • Parenting education curricula
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents, and their children if appropriate
  • Review case records

 

CA-RTX 14.01

The organization supports residents’ efforts to care for and nurture their children, and provides or arranges for children to receive services that address, as appropriate:
  1. health and medical needs;
  2. mental health needs;
  3. trauma history;
  4. educational needs;
  5. social and recreational needs;
  6. developmental needs, including any developmental delays;
  7. attachment to parents and extended family; and
  8. behavioural issues.
NA The organization does not allow residents to bring their children to the treatment program.
Examples: Examples of services for younger children can include play groups, counselling, therapeutic services, therapeutic day care, Head Start, and other early childhood programs. Examples of programs for older youth may include peer support groups, afterschool programs and tutoring, recreational activities, employment assistance, and substance use education or treatment services, such as tobacco cessation.

 

CA-RTX 14.02

Organizations evaluate the educational status and needs of school-age children and youth and:
  1. inform residents of their children’s educational rights;
  2. help residents coordinate educational services with relevant school districts; and
  3. assist children and youth to stay current with the curricula.
NA The organization does not allow residents to bring their children to the treatment program.

 

CA-RTX 14.03

The organization provides or arranges child care while the resident is receiving treatment services.
NA The organization does not allow residents to bring their children to the treatment program.

 
Fundamental Practice

CA-RTX 14.04

Pregnant residents are provided or linked with specialized services that include, as appropriate:
  1. pregnancy counselling;
  2. prenatal health care;
  3. genetic risk identification and counselling services;
  4. fetal alcohol syndrome screening;
  5. labour and delivery services;
  6. postpartum care;
  7. mental health care, including information, screening, and treatment for prenatal and postpartum depression;
  8. pediatric health care, including well-baby visits and immunizations;
  9. peer counselling services; and
  10. children’s health insurance programs.
NA The organization does not serve pregnant residents.

 

CA-RTX 14.05

Pregnant residents are educated about the following prenatal health topics:
  1. fetal growth and development;
  2. the importance of prenatal care;
  3. nutrition and proper weight gain;
  4. appropriate exercise;
  5. medication use during pregnancy;
  6. effects of tobacco and substance use on fetal development;
  7. what to expect during labour and delivery; and
  8. benefits of breastfeeding.

Interpretation

These topics may be addressed by qualified medical personnel in the context of prenatal health care.
NA The organization does not serve pregnant residents.

 

CA-RTX 14.06

The organization provides or refers pregnant and parenting residents to parent education classes or workshops that address:
  1. basic caregiving routines;
  2. child growth and development;
  3. meeting children’s social, emotional, and physical health needs;
  4. environmental safety and injury prevention;
  5. parent-child interactions and bonding;
  6. age-appropriate behavioural expectations and appropriate discipline, including alternatives to corporal punishment;
  7. family planning; and
  8. establishing a functioning support network of family members or caring adults.
Examples: Organizations can tailor how topics are addressed based on service recipients’ needs. For example, when serving expectant parents or parents of young children, education on environmental safety and injury prevention will typically address topics such as safe practices for sleeping and bathing.
 
2022 Edition

Residential Treatment Services (CA-RTX) 15: Substance Use Services

The organization provides coordinated substance use prevention, treatment, and recovery services based on the residents’ assessed needs and goals.
NA The organization does not provide substance use services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for communication/collaboration among team members
  • Criteria for determining the level of care
  • Procedures for providing withdrawal management services
  • Educational materials or other documentation of information provided to persons served upon discharge from withdrawal management services
  • MOU(s) with MAT providers, when applicable
  • Interviews may include:
    1. Clinical/Medical director
    2. Relevant personnel
    3. Residents
  • Review case records

 
Fundamental Practice

CA-RTX 15.01

A qualified team of health professionals, with experience, training, and competence in engaging, diagnosing, and treating persons with substance use disorders provide services, including:
  1. administering or reviewing diagnostic, toxicological, and other health related examinations;
  2. determining the optimal level and intensity of care, including clinical and community support services;
  3. evaluation for psychotropic medications and medication-assisted treatment;
  4. prescribing and managing medication, including appropriate management of pharmacotherapy for individuals with co-occurring conditions;
  5. review of complicated cases where co-occurring substance use, health, and mental health conditions intersect; and
  6. coordinating care with other service providers, including primary care and mental health providers, when appropriate and with the consent of the service recipient.

Interpretation

Element (c) does not apply to withdrawal management programs.

 

CA-RTX 15.02

The organization directly provides a comprehensive range of prevention and treatment services, including:
  1. individual and group therapy;
  2. illness management and psychoeducation interventions;
  3. medication education;
  4. clinical monitoring and drug screening;
  5. coping skills training;
  6. relapse prevention;
  7. acute care; and
  8. support groups and self-help referrals.
Examples: Other prevention and treatment services may include withdrawal management, inpatient care, intensive outpatient care, medical care, psychiatric rehabilitation, and targeted case management services.

 

CA-RTX 15.03

Therapeutic services help residents develop the knowledge, skills, and supports necessary to:
  1. manage mental health and/or substance use disorders;
  2. develop and practice prosocial behaviours;
  3. cultivate and sustain positive, meaningful relationships with peers, family members, and the community;
  4. develop self-efficacy; and
  5. promote recovery, resilience, and whole-person wellness.

Interpretation

Recovery is a holistic process of change where individuals learn to overcome or manage their diagnosed symptoms and conditions in order to improve overall well-being and achieve optimal health.

 

CA-RTX 15.04

Residents and their families, when possible, are connected with peer support services appropriate to their request or need for service.
Examples: Peer support services can help to promote resiliency and recovery and are provided by individuals who have shared, lived experience. They can include peer recovery groups, peer-to-peer counselling, peer mentoring or coaching, family and youth peer support, or other consumer-run services.

 

CA-RTX 15.05

Qualified personnel determine the need for and appropriate level of withdrawal management for the person using diagnostic criteria according to clinical decision support tools and clinical practice guidelines.
NA The organization does not provide withdrawal management.
Examples: Residential Withdrawal Management programs reviewed can include programs that are:
  1. Clinically-Managed: Clinically-managed residential programs, also referred to as non-medical or social detox, emphasize peer and social support. Services are primarily provided by appropriately trained, non-medical personnel.
  2. Medically-Monitored: In medically-monitored residential/inpatient programs, 24-hour medically-supervised withdrawal management services are provided by an interdisciplinary staff under the direction of a licensed physician.
Note: COA does not accredit medically-managed intensive inpatient withdrawal management programs. Medically-managed programs involve 24-hour medically-directed evaluation and withdrawal management and require an appropriately trained and licensed physician to provide and manage all diagnostic and treatment services. Programs are provided in acute inpatient care settings, such as hospitals, and are specifically designed for individuals with symptoms that require primary medical and nursing care services.

 
Fundamental Practice

CA-RTX 15.06

Residents receive withdrawal management services provided by a qualified team of appropriately trained and licensed professionals, including:
  1. assessment and evaluation;
  2. monitoring and stabilization; and
  3. engagement with substance use treatment to assist with relapse prevention following the discontinuation of substance use.
NA The organization does not provide withdrawal management.
Examples: Staffing may vary depending on the intensity of the services offered. For example, organizations providing medically-monitored withdrawal management will typically employ an interdisciplinary staff of nurses, counsellors, social workers, addiction specialists and/or other health and technical personnel, whom all work under the supervision of a licensed physician.

 

CA-RTX 15.07

Prior to discharge from withdrawal management services, all individuals receive:
  1. education about relapse, overdose, and mortality risk and prevention; and
  2. information on relevant harm reduction activities.
NA The organization does not provide withdrawal management.

 
Fundamental Practice

CA-RTX 15.08

Organizations providing withdrawal management to individuals withdrawing from opioids:
  1. counsel individuals on the importance of medication-assisted treatment (MAT) and the risks of relapse, overdose, and death following detoxification without transitioning to maintenance medication;
  2. offer MAT following withdrawal management either directly or through linkages with MAT providers;
  3. clearly document when clients refuse MAT; and
  4. provide a naloxone kit or prescription for any individual who refuses MAT.

Interpretation

Organizations that do not offer medication-assisted treatment should have MOUs with MAT providers to ensure timely initiation of treatment. Studies have shown the risk of relapse increases dramatically following withdrawal without ongoing treatment, with 25% of readmissions occurring within the first 7 days post discharge.
NA The organization does not provide withdrawal management.
 
2022 Edition

Residential Treatment Services (CA-RTX) 16: Residential Facilities

Residential facilities contribute to a physically and psychologically safe, healthy, homelike, non-institutional, therapeutic environment.

Interpretation

“Homelike” settings are assessed within the context of the organization’s location and environment.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for maintaining a clean and safe environment
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Observe facilities and outdoor area/grounds

 

CA-RTX 16.01

Living quarters consist of separate cottages or units in a residential building that include:
  1. a common room, dining and/or kitchen area, and space for indoor recreation;
  2. private areas where residents can meet with family and friends; and
  3. private facilities for bathing, toileting, and personal hygiene, that are developmentally appropriate.

 

CA-RTX 16.02

Personal accommodations for residents are age, developmentally, gender, and culturally appropriate and include:
  1. single rooms, rooms for groups of two to four residents, and/or accommodations for larger groups, if appropriate for therapeutic reasons;
  2. adequately and attractively furnished rooms with a separate bed for each resident, including a clean, comfortable, covered mattress, pillow, sufficient linens, and blankets;
  3. a non-stacking crib for each infant and toddler that is 24 months or younger that meets safety guidelines, as applicable; and
  4. a safe place such as a locker to keep personal belongings and valuables.
Examples: Some provincial regulations require 7.4 metres of floor space for single rooms and at least 5.6 square metres for each person in rooms housing more than one individual. Group assignments and room accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness.

 

CA-RTX 16.03

Organizations that serve families house families as a unit and keep sibling or family groups together, whenever possible.
NA The program does not serve families, or housing families as a unit is not possible or prohibited by law.

 

CA-RTX 16.04

Residents participate actively in:
  1. decorating and personalizing their sleeping area;
  2. choosing clothing based on their personal preferences;
  3. food preparation and meal planning; and
  4. contributing to decisions about how to make living areas inviting, comfortable, and reflective of the residents’ interests and diversity.

Interpretation

Some standards elements may not be applicable for crisis stabilization and short-term diagnostic programs due to length of stay and program design.

Interpretation

Residents should be provided with a variety of nutritious food options. Special diets should be planned to meet the modified needs of individual residents. Recognizing that there are communities where access to affordable, quality food is limited, it is important for personnel to take into consideration where residents will reside after they are discharged so healthy eating habits can continue long after they leave care.

 

CA-RTX 16.05

Facilities support quality therapeutic programs and settings accommodate:
  1. individual, small, and large group activities;
  2. activities that invite use of community resources;
  3. a variety of after school, evening, weekend, holiday, and school break programs for use by residents, guests, family, and community members;
  4. a variety of activities that are focused around the resident's home, community, and extended family and friends;
  5. quiet reading, study hours, and help with school assignments;
  6. individual hobbies and group projects that may be large and constructed over time; and
  7. alternatives to watching television, such as art, photography, or other creative activities.

Interpretation

Some standards elements may not be applicable for crisis stabilization and short-term diagnostic programs due to length of stay and program design.

 

CA-RTX 16.06

Residential facilities provide:
  1. sufficient supplies and equipment to meet residents’ needs;
  2. access to a telephone, computer, and the internet, as permitted, for use by residents and personnel;
  3. adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage;
  4. rooms for providing on-site services, as needed;
  5. accommodations for informal gathering of residents including during inclement weather;
  6. at least one room suitably furnished for the use of on-duty personnel; and
  7. private sleeping accommodations for personnel who sleep at the facility, if applicable.

 
Fundamental Practice

CA-RTX 16.07

Indoor and outdoor settings are clean, maintained in good condition, and promote the health and safety of personnel and residents.

Interpretation

The facility’s outdoor area should contain sufficient space for recreational activities. Outdoor equipment should meet playground equipment safety standards and be appropriate for the number, age, and developmental level of residents. Programs serving children should have outdoor and indoor play spaces with adequate toys, books, and other recreational supplies.
 
2022 Edition

Residential Treatment Services (CA-RTX) 17: Privacy Provisions

The organization provides for resident comfort, dignity, privacy, and safety.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Privacy policy
  • Privacy procedures
  • Judicial order, law, or contract, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records
  • Observe facility

 
Fundamental Practice

CA-RTX 17.01

The organization ensures residents’ comfort, dignity, privacy, and safety by:
  1. prohibiting the use of surveillance cameras or listening devices in bedrooms;
  2. maintaining doors on sleeping areas and bathroom enclosures;
  3. providing one- or two-person rooms to residents who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
  4. requiring employees to knock before entering a resident’s room unless there is an immediate health or safety concern.

Interpretation

When organizations are required to employ alternate practices, documentation must be provided to justify the practice. Documentation may include a judicial order, law, regulations, and/or contracts, copy of a safety plan for a resident, or clear, clinical written justification for a resident.

Sensitivity should always be taken to ensure that all service recipients, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.

 
Fundamental Practice

CA-RTX 17.02

Searches of residents or their property are conducted in a trauma-informed manner that respects client rights, dignity, and self-determination and include, as appropriate to the frequency and invasiveness of searches:
  1. communicating to service recipients policies for searches of individuals or their property;
  2. timely notification of a parent and/or legal guardian;
  3. definition and documentation of reasonable cause and assessed risk of harm to self or others;
  4. trained, qualified staff; and
  5. an administrative review process including documentation, notification, and a timetable for review.

Interpretation

Search procedures should correspond directly to the invasiveness of the search to be conducted. For example, more invasive searches should be reserved for higher risk situations with reasonable cause, should only be conducted by highly qualified personnel, and always require an administrative review.

 
Fundamental Practice

CA-RTX 17.03

The organization communicates policies that respect residents’ privacy for reviewing mail and only does so when a previous incident involving the resident indicates that:
  1. the mail is suspected of containing unauthorized, dangerous, or illegal material or substances, in which case it may be opened by the resident in the presence of designated personnel; or
  2. receipt or sending of unopened mail is contraindicated.

Interpretation

Programs serving individuals with substance use conditions may require personnel to review mail without incident due to the reason for which residents are seeking treatment. If an organization employs this approach, they must provide justification for taking such measures, which may include health, safety, and other security concerns.
Examples: Examples of mail include letters, packages, emails, and other forms of correspondence via social media and electronic communication.

 
Fundamental Practice

CA-RTX 17.04

 Residents can have private telephone conversations, and any restriction is:
  1. based on contraindications and/or a court order;
  2. approved in advance by the program director or an appropriate designee;
  3. documented in the case record; and
  4. reauthorized weekly by the immediate supervisor of the direct service provider.
 
2022 Edition

Residential Treatment Services (CA-RTX) 18: Care and Supervision

The organization provides 24-hour-a-day care and supervision that is respectful, supportive, and tailored to each resident’s developmental, educational, clinical, and safety needs and attentive to effects of congregate living.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Resident/personnel care and supervision ratios
  • Supervision and scheduling criteria
  • Procedures for preventing and responding to missing and runaway children
  • Educational or training materials provided to residents for skills development
  • Resident/personnel care and supervision coverage schedules for the previous six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

 
Fundamental Practice

CA-RTX 18.01

Adults that provide direct care and supervision offer residents:
  1. nurturance, structure, support, respect, and active involvement;
  2. services provided in a safe, secure environment that prohibits weapons and gang activity;
  3. consistent limit-setting;
  4. flexibility, when appropriate and in the resident’s best interest;
  5. guided practice to learn effective communication, positive social interaction, and problem solving skills; and
  6. education and skills training specific to risk-taking behaviours, including practice with decision making and anger management.
Examples: This approach can help to anticipate, prevent, and reduce the occurrence of bullying and other unsafe or negative peer interactions.

Examples: Regarding element (d), being flexible with codified rules that contradict a resident’s best interest can allow the organization to provide individualized care that is tailored to the resident’s needs. For example, being flexible with bedtimes for a resident who may have experienced nighttime trauma rather than strictly enforcing a lights out time allows the organization to be responsive to the needs of residents.

 
Fundamental Practice

CA-RTX 18.02

Resident care and supervision is provided by:
  1. personnel-to-participant ratios for day time and overnight hours that are appropriate to the program model, length of treatment, population served, and their age, developmental and clinical needs;
  2. a sufficient number of qualified personnel on-site that can respond to emergency/crisis situations and meet the special needs of residents during busy or more stressful periods;
  3. an on-call, professional clinical staff member available on a 24-hour basis;
  4. rotating after-hours and holiday coverage when needed; and
  5. same-gender and cross-gender supervision when indicated by individual treatment needs.

Interpretation

The organization must demonstrate that based on their program model and the population served their staffing ratios for day time and overnight coverage are addressing potential risks and meeting the needs of their clients. 

Interpretation

Regarding element (c) the professional clinical staff person is permitted to sleep during sleeping hours.

Interpretation

The organization may use direct care workers or counsellors to provide supervision to residents. Personnel must be awake at all times unless convincing evidence demonstrates the resident group does not need awake supervision during sleeping hours. Examples of reasons certain homes or programs might not have awake personnel are: care for a long-term, stable population; majority of unit residents are ready to move to a less restrictive setting; low runaway rates; and low rates of night-time incidents. Electronic supervision is not an acceptable alternative to supervision by personnel.
Examples: National recommendations for the supervision of children in residential care is that there are no more than four children per worker during waking hours and no more than eight children per worker during overnight hours. Smaller ratios are recommended for intensive residential treatment programs and short-term diagnostic centres. Additionally, several sources indicate that improved outcomes, including better engagement and retention, are found in addiction treatment programs with low staffing ratios. For example, low staff to client ratios contribute to a high level of service and keeping clients involved in rehabilitation for longer periods which helps individuals reach their ultimate goal of overcoming addiction.

 

CA-RTX 18.03

The organization establishes procedures for preventing and responding to missing and runaway children that address:
  1. creating an environment that provides a sense of safety, support, and community;
  2. identifying risks or triggers that may indicate likeliness to run away from programs;
  3. communication and reporting to relevant staff, authorities, and parents or legal guardians; and
  4. welcoming, screening, and debriefing when children return to the program.
NA The organization does not serve children or families with children.
 
2022 Edition

Residential Treatment Services (CA-RTX) 19: Transition from the Service System

Residents, and their families and/or legal guardians, as appropriate, participate in planning for transition to the community and are prepared with positive experiences and skills to make a successful move.
NA The organization only operates a crisis stabilization unit, short-term diagnostic center, or withdrawal management program.
Examples: For adolescents, the transition from the service system often coincides with their transition to adulthood. Youth can be supported during their transition to adulthood through individualized planning and preparation that promotes emotional well-being, supportive relationships, access to needed resources, and skill development.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Transition planning procedures
  • Procedures for assessing independent living skills
  • Independent living skills assessment tool
  • Information provided to residents who are transitioning from the service system
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 19.01

The organization works with residents and their families to develop a plan for living in the community.

 

CA-RTX 19.02

The organization prepares residents, as appropriate to their individualized transition plan, for a successful transition by providing them with information and support regarding:
  1. transfer or termination of custody for youth, as applicable;
  2. their rights and services to which the person may have access as a result of a disability;
  3. access to specialized services and navigating adult-serving systems;
  4. availability of affordable healthcare and counselling;
  5. public assistance and court systems;
  6. child care services; and
  7. support through community volunteers, peers, or persons who have made a successful transition, as appropriate.

 

CA-RTX 19.03

The organization works with the resident and their family to assess the independent living skills of residents 14 years and older, at regular intervals, using a standardized assessment instrument that includes the following areas:
  1. educational and vocational development;
  2. interpersonal skills;
  3. financial management;
  4. household management; and
  5. self-care.

Interpretation

The first assessment should be completed as soon as possible after residents’ 14th birthdays to establish a benchmark for measuring progress in identified areas. Systematic assessment normally reoccurs at six or twelve month intervals.
NA Residents are not transitioning to an independent living situation.

 

CA-RTX 19.04

The organization provides residents transitioning to the community with advance notice of the cessation of any health, financial, or other benefits that may occur at transition.

 

CA-RTX 19.05

During the transition process the organization explores a range of housing options with residents and engages them in an evaluation of the risks and benefits of various living situations.
NA Residents are not transitioning to an independent living situation.
Examples: Options may include the full range of living situations from supported living to fully independent living environments.

 

CA-RTX 19.06

For every resident transitioning to independence, the organization ensures that basic resources are in place, including:
  1. a safe, stable living arrangement with basic necessities;
  2. a source of income;
  3. affordable health care; and
  4. access to education and career development.
NA Residents are not transitioning to independent living situations.

 

CA-RTX 19.07

The organization ensures that residents transition from the service system with social supports in place, including, as appropriate, access to:
  1. at least one committed, caring adult;
  2. cultural and community supports; and
  3. positive peer support and mentoring, including peer advocates and peer support programs.

 

CA-RTX 19.08

The organization assists residents in obtaining or compiling documents necessary to function independently, including, as appropriate:
  1. an identification card or a driver’s license, when the ability to drive is a goal;
  2. a social security or social insurance number;
  3. a resume, describing work experience and career development;
  4. medical records and documentation, including a health care or other health documentation;
  5. an original copy of the birth certificate;
  6. bank account access documents;
  7. religious documents and information;
  8. documentation of immigration or refugee history and status, when applicable;
  9. death certificates if parents are deceased;
  10. a life book or a compilation of personal history and photographs, as appropriate;
  11. a list of known relatives, with relationships, addresses, telephone numbers, and permissions for contacting involved parties;
  12. previous placement information and health facilities used, when appropriate; and
  13. educational records, such as high school diploma, and a list of schools attended, when appropriate.
NA Residents are not transitioning to independent living situations.
 
2022 Edition

Residential Treatment Services (CA-RTX) 20: Case Closing and Aftercare

The organization works with residents and family members, when appropriate, to plan for case closing and, when possible, to provide aftercare.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,   
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, the organization terminated services inappropriately; or  
  • Active client participation occurs to a considerable extent; or
  • A formal case closing evaluation is not consistently provided to the public authority per the requirements of the standard.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Services are frequently terminated inappropriately; or  
  • Aftercare planning is not initiated early enough to ensure orderly transitions; or
  • A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard; or  
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing. 
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Case closing procedures
  • Aftercare and follow-up procedures
  • Relevant portions of contract with public authority, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records

 

CA-RTX 20.01

Planning for case closing:
  1. is clearly defined and includes assignment of staff responsibility;
  2. begins at intake; and
  3. involves the worker, the resident, a parent or legal guardian, and others, as appropriate to the needs and wishes of the resident.

 

CA-RTX 20.02

Upon case closing, the organization notifies any collaborating service providers, as appropriate.

 

CA-RTX 20.03

When an individual or family has to leave the program unexpectedly the organization makes every effort to identify other service options and link the person with appropriate services.

Interpretation

The organization must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.

 

CA-RTX 20.04

As a continuing resource for information, crisis management, referral, and support, the organization provides each resident with:
  1. a transition/aftercare plan summary, including the individual’s options;
  2. a list of emergency contacts; and
  3. the organization’s contact information.

 

CA-RTX 20.05

The organization follows up on the transition/aftercare plan, as appropriate, when possible, and with the permission of persons served.
NA The organization has a contract with a public authority that prohibits or does not include aftercare or transition planning follow-up.
Examples: Reasons why follow-up may not be appropriate, include, but are not limited to, cases where the person’s participation is involuntary, or where there may be a risk to the individual such as in cases of domestic violence.
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