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h)

Current Educational Passport and School Enrollment Letter (CS-0657) including Individual Education Plan, Social Security Card and Birth Certificates and other supporting documents.  (* See d above)

i)

TFACTS Health Summary including supporting documentation (* See d above).

D.  DCS Custodial Placement: ICPC Residential Treatment Facility Referral:

Per ICPC Article II(a)-(d)supported by Regulation No.4, 1(d), 2 (b)(c)(d), the placement of a custodial child for treatment of that child’s chronic mental or behavioral condition into a licensed residential treatment facility having treatment programs for acute and chronic conditions must be made pursuant to the Interstate Compact on the Placement of Children.

1.

During the course of assessments and planning for services to address the needs of the a child in the custody/ guardianship of DCS, the TN DCS Regional PSD/RPS staff in partnership with Provider agency staff identifies potential licensed residential treatment facilities (RTC) available to provide treatment for the child’s chronic mental or behavioral conditions.

2.

All placement considerations for children in the custody/ guardianship of the State of TN Department of Children’s Services including temporary placements into licensed Residential Treatment Centers are initiated within the context of a CFTM, Judicial or Foster Care Review wherein the TN DCS Regional staff, along with other key Dept. stakeholders including medical/ psychological resources determine a suitable RTC placement both in-state and/or  out-of-state which has potential to meet the needs of the child. Results of the CFTM will be appropriately documented in TFACTS, per policy.

3.

The TN DCS Regional PSD/RPS staff is responsible to provide directly to the RTC the documents needed for that RTC application prior to placement in order for the RTC to determine the child’s eligibility to enter the RTC program, either in-state or out-of-state.  Family and Child specific documents such as Current Family Functional Assessment,  TFACTS Permanency Plan, child specific medical/behavioral/psychological assessments,  prescription. Medical and psychotropic regimens if appropriate are to be filed with the RTC in advance for determination of acceptance as documented by the RTC acceptance letter.    

4.

The TN DCS Regional staff, is responsible to develop and initiate an ICPC Residential Treatment Facility Referral seeking compliance for the RTC placement of the child with an identified RTC resource that is out of State.  Compliance with the ICPC is required when the out-of-state RTC resource is subject to licensure under a regulatory authority other than the State of TN.

5.

The ICPC Residential Treatment Facility Referral is entered into TFACTS by the TN DCS Regional staff and assigned to the appropriate TN ICPC Administrator/Alternate. The TN DCS Regional PSD/RPS staff will enter the RTC in the TFACTS as a Resource.  

6.

The designated TN DCS Regional staff will maintain a copy of ICPC documents including those with original signatures in the Family Case File per TN DCS Policy 31.5 Organization of Family Case Files.  

7.

The TN DCS Regional staff will scan/e-mail or mail the ICPC Residential Treatment Facility Referral to the designated TN ICPC Administrator/Alternate.

8.

The ICPC Residential Treatment Facility Referral for children in the custody/guardianship of TN DCS will include the following required documents:

a)

ICPC Referral Checklist (CS-0796);

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 20

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