Specialized Care Increment (SCI) – D-Rate

0900-522.10 | Revision Date: 12/23/14

Overview

The Specialized Care Increment (SCI) D-Rate is a higher foster care rate paid, in addition to the basic foster care rate, for the care of a child/youth with severe emotional and/or behavioral problems.  This policy provides instruction for referring potentially eligible children for a D-Rate assessment, creating a Specialized Care Case Plan and ongoing services.

TABLE OF CONTENTS

Policy

Specialized Care Increment (SCI) – D-Rate

D-Rate Determinations

Additional Required Eligibility Assessments

D-Rate Criteria

D-Rate Program

D-Rate Program Staff

Caregiver Requirements

Caregiver Training

Kinship Guardian Assistance Program (Kin-GAP) Legal Guardians

Placement Capacity

Out-of-County Placements

Out-of-State Placements

Procedure

D-Rate Referrals

CSW Responsibilities

D-Rate Evaluator Responsibilities

SCSW Responsibilities

D-Rate SCSW Responsibilities

ARA Responsibilities

Annual D-Rate Re-Certification Alert

D-Rate Evaluator Responsibilities

Approvals

Helpful Links

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version, to include placements that are not eligible to receive the D-Rate on behalf of the child/youth placed in their care. Also, non-substantive changes have been made to streamline the D-Rate process.

POLICY

Specialized Care Increment (SCI) - D-Rate

The D-Rate is the Specialized Care Increment (SCI) rate paid in addition to the basic care rate for the care of a child/youth with severe emotional and/or behavioral problems.  It is a flat rate determined by the child/youth’s age.

D-Rate Determinations

The assessment for the D-Rate must be made by a California licensed mental health professional (Clinical Social Worker, Marriage and Family Therapist, Psychologist or Psychiatrist.)  If the child/youth is placed out-of-state, an assessment by a mental health professional licensed by the host state will be accepted. The diagnosis must indicate one of the following regarding the child/youth:

• Displays psychotic features

• Is a suicide risk

• Is at risk of violence

• Has substantial impairment in at least two of the following areas:

• Self-care

• School functioning

• Family relationships

• Functioning in the community

And one of the following:

• The child/youth is at risk of removal from the current placement or has already been removed

• The impairments have been present for six months or are likely to continue for more than one year if untreated

A referral for the initial D-Rate assessment is made to the DCFS D-Rate Unit.  The mental health portion of the assessment is completed by the Department of Mental Health (DMH).  Multidisciplinary Assessment Team (MAT) or clinical assessments performed by California licensed mental health professionals conducted within twelve (12) months of the initial D-Rate assessment referral will be considered by DCFS in lieu of the DMH assessments.

Additional Required Eligibility Assessments

• Supplemental Security Income (SSI) – For all children/youth eligible or potentially eligible for a SCI rate, consult with the SSI Unit.  In addition, a mandated Supplemental Security Income (SSI) screening is required for all youth 16 ½ years old.

• Regional Center/Dual Agency – For all children/youth receiving Regional Center services, CSW will need to assess if they qualify for the dual agency rate in lieu of a D-rate.

• Public Health Nurse Consultation for F-Rate – When a child/youth is found by the Regional Center to not meet the criteria under the Lanterman Act to receive Regional Center services, and they may have a diagnosis of a Autism Spectrum Disorders.  As with any situations wherein there are medical or developmental concerns, CSWs shall consult with the PHN regarding these children/youth to determine if a referral for F-rate eligibility is warranted.  The CSW may refer the child/youth to the D-Rate Evaluator, independent of the PHN, in any situation.

D-Rate Criteria

For a child/youth to receive the D-Rate, the following criteria must be met:

• Children must be between the ages of five (5) and eighteen (18) years old or a Nonminor Dependent (NMD), if they continue to meet the eligibility and funding criteria.

• Children ages thirty-seven (37) to fifty-nine (59) months may be referred with ARA approval.

• For dependent children/youth that are not eligible for AFDC-FC, DCFS reviews other state assistance, family assistance, and other variables to determine the GRI and the appropriate rate.

• The child/youth is diagnosed with behavior(s) inappropriate to the child/youth’s developmental age that impairs the child/youth in critical life areas, according to the Diagnostic and Statistical Manual of Mental Disorders (currently DSM V).

Children who qualify for the D-Rate have severe emotional disturbances and the examples below are some common behaviors or indicators.

• The child/youth reveals disturbances or behaviors which are characterized by varying degrees of personality disorganization and departures from normal modes of thinking, feeling, perceiving and acting.

• These children/youth often exhibit impairment in reality testing, judgment and communication, and react to daily living experiences with excessive fearfulness, aggression, depression, or withdrawal. Outbursts of rage, excessive verbal or physical aggressiveness (including overt or covert hostility) are common.

• Suicidal ideation or attempts are not uncommon.

• The child/youth responds with extreme impulsivity and assumes rigid postures of fight or flight when frustrated. 

• The child/youth exhibit maladaptive behaviors which are hostile, provocative, distrustful, manipulative, defiant or vengeful and these behaviors place them in chronic conflict with caregivers, teachers, peers and society at large.

• The child/youth's volatile, unpredictable, destructive, and antisocial quality of behavior triggers concern that they are a danger to self, others and/or property. 

• Diagnostic impressions vary but most revolve around psychosis, borderline conditions, severe personality and character disorders, and unsocialized aggressive reactions.

• The child/youth has a current (i.e. within the past 12 months) clinical evaluation, including a Multidisciplinary Assessment Team (MAT) assessment, supporting D-Rate eligibility or is receiving SSI for emotional needs.

• Placement histories of the child/youth generally reveal rejection, placement disruptions, prior hospital commitments, and multiple replacements.

• Educational inventories frequently reveal major learning deficits consistent with the cycle of rejection, disruptions and replacements. 

• The child/youth being placed in a D-Rate home from a Rate Classification Level (RCL) 12 or above facility (including psychiatric hospitals) can be presumed eligible from the date of placement.  If a child/youth is already receiving Supplemental Security Income (SSI) for psychiatric reasons, the child/youth should be referred for D-Rate.

D-Rate Program

The D-Rate Program provides assistance with the following:

• Assists the case-carrying CSW with the formulation of a specialized care case plan that will meet the child/youth’s mental health needs, including three (3) to five (5) goals to be attained within the next 12 month period.

• Provides resources, community support and linkages to comprehensive mental health services such as individual, group and family therapy, in-home therapy, case management, respite care, educational linkages, collaboration with Regional Centers, community social and recreational resources, TBS/one-on-one support, and health care resources.

• Works with the D-Rate recipient caregivers to help them achieve better outcomes with the children/youth in their care, as well as, addressing the caregiver needs and concerns by providing direct access to a D-Rate Evaluator who will address their concerns. This would include the need for resources, services and supports outlined above and methods helpful in working with children/youth with severe emotional and/or behavioral problems.

D-Rate Program Staff

The D-Rate Unit staff teams with DMH Medical Case Workers and a Supervising Psychiatric Social Worker.  Each child/youth’s case is reviewed/recertified annually to evaluate progress, re-assess goals and modify treatment options as indicated.

• D-Rate Evaluators: CSW III’s assigned to regional offices.

• D-Rate Supervisors: SCSW’s

There is also a D-Rate Specialized Care Case Planning Team (D-Rate Team) that collaborates to determine the appropriate placement type, requirements and expectations of the caregiver and treatment that corresponds with the D-Rate assessment.

• D-Rate Team: CSW, D-Rate Evaluator, DMH Medical Caseworker and other persons involved in the child/youth’s treatment plan (caregiver, child/youth, therapist, teacher, doctor, parent or other significant adult in the child/youth’s life, etc.)

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Caregiver Requirements

D-Rate eligible caregivers (that can receive the D-Rate on behalf of the child/youth) include:

• Foster parents

• Most relatives

• Non-related legal guardians

• Kin-GAP legal guardians

• Nonrelative extended family members (NREFMs)

The following individuals or groups are not eligible to receive the D-rate on behalf of the child/youth/NMD:

• Foster Family Agency (FFA) certified homes are not eligible for SCI rates, however children/youth residing in FFA certified homes who are potentially eligible for a SCI, should be referred for D-Rate evaluation at the time of the Concurrent Planning Permanency Planning/Adoption Assessment.

• Nonminor dependent (NMD) in a Supervised Independent Living Placement (SILP).

• Group Homes

• Treatment Foster Homes

Caregiver Training

Training includes sixteen (16) hours of initial D-Rate certification training and eighteen (18) hours yearly thereafter to be remain certified.  If the specialized training is not available (summer break, etc.), the training is to be completed within three (3) months of the next training session.

Caregivers in closed dependency cases who are receiving a SCI as part of their AAP or KIN-Gap payment are no longer required to participate in the D-rate Certification training once their case is closed.

Caregiver can also meet the training requirement by having the requisite knowledge, training, education, or ability to meet the child/youth/NMD's special needs as determined by the CSW and the D-Rate Evaluator but the D-Rate training is strongly recommended.

The CSW and the D-Rate Evaluator must document, in the CWS/CMS Contacts, why a caregiver is relieved from the D-Rate training requirements.

Caregivers are also expected to:

• Participate in the child/youth’s treatment including family counseling (when clinically indicated).

• Arrange transportation to various facilities and providers.

• Provide social and recreational activities consistent with the child/youth’s needs.

• Familiarize themselves with special education and the Individualized Education Plan (IEP) process.

• Advocate for the child/youth’s educational needs and rights in partnership with the child/youth’s teachers.

• Learn daily interaction skills to meet the child/youth’s needs and avail themselves of support groups and/or foster parent associations to develop support techniques.

Kinship Guardian Assistance Program (Kin-GAP) Legal Guardians

For recipients of both the state and federally-funded Kin-GAP Programs, the D-Rate is available to the relative caregiver or relative guardian once DCFS determines that the assessed child/youth meets the criteria.

If the relative guardian resides outside the county with payment responsibility, the county with payment responsibility pays the host county’s specialized care increment (SCI) rate or its own SCI rate if the host county has no Specialized Care Rate Plan or Caregiver Training.

If the child/youth meets the criteria for SCI, they may receive the SCI rate upon a re-assessment indicating eligibility even if he or she did not receive the rate prior to entering Kin-GAP.

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Placement Capacity

An out-of-home caregiver cannot have more than two (2) children/youth receiving a specialized care rate, regardless of their license capacity. Additional placements will be considered only:

• If a child/youth receiving the basic rate in a home is later assessed as needing specialized care and a determination is made that the child/youth should remain in that home or;

• When placement will keep siblings together and it is not clinically contraindicated.

Verification of these requirements must be documented in the CWS/CMS Case Notes.

Placement of a third child, with or without special needs, requires ARA approval. When seeking ARA approval for the placement of a third child/youth, CSW's must consider all children/youth in the home, including birth, adopted, relative and guardian and not just the foster care placement.

Potential D-Rate eligible children should always be referred for a D-Rate assessment regardless of the D-Rate capacity in their current placement.

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Out-of-County Placements

Out-of-County placements require the cooperation of both county agencies. This applies to children being sent to live with parents or relatives as well as non-relative placements. When children are placed outside of LA County, the host county’s rate and training, along with any educational and/or other requirements apply. See http://www.childsworld.ca.gov/res/pdf/ChildWelfareAgencyRep.pdf for Special Increment Rates (SCI) for counties in California.

If the host county does not have an SCI rate, the LA County SCI applies in conjunction with the host county’s basic rates. As needed, the host county’s child protective agency may assist in making a referral to have the child assessed by the host county’s mental health agency or other DCFS approved entity.

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Out-of-State Placements

Out-of-State placements require the cooperation of agencies in both states. All issues related to care, services and funding are based on the Interstate Compact on the Placement of Children (ICPC).

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PROCEDURE

D-Rate Referrals

CSW Responsibilities

1. Within one (1) business day of notification or observation that a child/youth may have a severe emotional/behavioral problem, discuss the observations with the caregiver and explain the D-Rate Evaluation process.

2. Create the D-Rate Referral packet by including the following required forms:

1. DCFS 417, Schedule “D” Caregiver Referral

2. DCFS 1695, D-Rate Indicators and Child Referral

3. Summary of Findings (SOF) report, if available, and/or a mental health assessment completed within the past 12 months.

3. Forward the D-Rate Referral packet to the SCSW for review and approval.

4. Upon receipt of the approved D-Rate Referral packet from the SCSW, forward the packet to the D-Rate Evaluator.

5. If not approved, consult with the SCSW regarding what corrective action to take for resubmission of the D-Rate Referral packet for approval or next steps for arranging an alternative placement.

6. If the caregiver is noncompliant with requirements to meet the child's needs and it is determined that court involvement is necessary, immediately arrange for the matter to be heard in court.

1. If the next hearing date is not immediate, request a walk-on.

2. Inform County Counsel of the planned court involvement and level of risk the child/youth is exposed to.

7. Within one (1) business day of receiving an approved D-Rate Referral packet from the D-Rate Evaluator, complete a DCFS 280, attach the DCFS 1695 and submit them both to the SCSW (and ARA if required) for approval and signature.

8. Within one (1) business day of receiving a denied D-Rate Referral packet from the D-Rate Evaluator, notify the caregiver that the D-Rate was denied and that a Notice of Action (NOA) will be mailed by DCFS Revenue Enhancement with instructions on how to appeal the denial.

• Complete a DCFS 280 directing Revenue Enhancement staff to issue a Notice of Action to the caregiver and submit it, along with the DCFS 1695 to the SCSW for approval.

9. Within one (1) business day of receiving the signed DCFS 280 from the SCSW, forward the DCFS 280 and all other appropriate documentation to the Technical Assistant/Eligibility Worker (TA/EW) for processing.

10. Place copies of all documentation in the case file.

D-Rate Evaluator Responsibilities

1. Receive and log the D-Rate Referral packet on the “D-Rate Referral Log”.

2. Review the D-Rate Referral packet to confirm that it contains the following:

1. A mental health or MAT assessment, completed within the past twelve (12) months that includes:

1. A DSM diagnosis

2. Documentation that the caregiver(s) is/are able and willing to meet the child/youth’s needs.

2. Documentation indicating that the child/youth’s condition(s) warrant the D-Rate.

3. If the D-Rate Referral packet meets the above requirements, complete the D-Rate Evaluator’s portion of the DCFS 1695 and forward the D-Rate Referral packet to the D-Rate SCSW for approval.

4. If a mental health assessment of the child/youth is required, forward the D-Rate Referral packet to the Los Angeles County Department of Mental Health (DMH).

1. Upon receipt of the DMH mental health assessment from the D-Rate SCSW, complete the D-Rate Evaluator portion of the DCFS 1695 and indicate the approval or denial of the D-Rate.

2. Provide a copy of the assessment to the CSW and discuss the treatment recommendations made by DMH.
3. Send the approval letter to the caregiver specifying recommendations made by DMH.

5. Ensure that the child/youth is linked to any services identified to address his or her emotional/behavioral needs.  If the child/youth is not linked, consult with the DMH Specialized Foster Care staff for linkage.

6. If available, obtain a copy of the D-Rate Training Certificate from the caregiver and include in the D-Rate Referral packet.  Annotate the DCFS 1695 regarding the following:

1. If the caregiver has not attended the D-Rate training, recommend to the caregiver that the training be completed within three months of placement.

2. If it is determined that training or services are not necessary because the caregiver already possesses the requisite knowledge, training, education or ability to meet the special needs of the child/youth, coordinate with the CSW and document, in the CWS/CMS Contacts, the basis for the conclusion that the caregiver may be relieved from the D-Rate training requirements.

3. If the caregiver refuses to complete or has not followed through with training and/or services required to meet the child/youth’s needs, inform the caregiver that a recommendation as to the appropriateness of the placement and the necessary course of action to be taken.

4. Consult with the CSW, SCSW, ARA and County Counsel, as needed, to assess the child/youth's safety in the placement and determine if court involvement is necessary.

• Court involvement includes but, is not limited to court orders for cooperation with training to mitigate marginal care leading to safety risks or, depending on a placement change, seeking a removal order due to immediate safety concerns.

7. File a copy of the D-Rate Referral packet and all supporting documents in the “D-Rate Unit files.

SCSW Responsibilities

1. Within one (1) business day of receiving the DCFS 280 and DCFS 1695, review, complete, and sign the DCFS 280 and return it to the CSW.

• When the requested D-Rate Referral packet is for a child 37-59 months of age, and/or when there is a placement capacity issue, forward the D-Rate Referral packet to the ARA for approval.

D-Rate SCSW Responsibilities

1. Within one (1) business day of receiving the D-Rate packet, review all documentation.

1. If approved, sign the DCFS 1695 and return the packet to the D-Rate Evaluator.

2. If not approved, return to the D-Rate Evaluator for corrective action.

ARA Responsibilities

ARA approval is only required when requesting an assessment for any child age 37-59 months or when placing a third child receiving an SCI rate in the home.

1. Within one (1) business day of receiving the packet, review all documentation.

1. If approved, sign the DCFS 1695 and return the D-Rate packet to the SCSW.

2. If not approved, return to the SCSW for corrective action.

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Annual D-Rate Re-Certification Alert

The D-Rate Evaluator will receive an alert three (3) months prior to the D-Rate re-certification due date.  The current D-Rate certification will expire at the end of twelve (12) months unless another assessment is completed and determines the D-Rate shall continue.

D-Rate Evaluator Responsibilities

1. Consult with the CSW, caregiver, mental health providers and child/youth/NMD, if appropriate, to determine continued D-Rate eligibility.

2. Send the completed recertification to the D-Rate SCSW for review and approval or denial.

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APPROVALS

SCSW Approval

• DCFS 417

• DCFS 1695

• DCFS 280

D-Rate SCSW Approval

• D-Rate Referral Packet

• D-Rate Initial Certification

• D-Rate Re-certification

ARA Approval

• When there is a child ages 37-59 months and/or when there is a placement capacity issue

• DCFS 1695

• DCFS 280

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HELPFUL LINKS

Forms

CWS/CMS

DCFS 280, Technical Assistant Action Request

LA Kids

DCFS 417, Schedule “D” Caregiver Referral

DCFS 1695, D Rate Indicators and Child Referral Form

Referenced Policy Guides

0100-510.10, Placement Capacity

0100-520.35, Kinship Guardianship Assistance Payment (Kin-GAP) Program

0100-525.10, Interstate Compact on the Placement of Children (ICPC)

0100-510.46, Out-Of-County Placements

0900-522.11, Specialized Care Increment (SCI) F-Rate

0900-523.10, Social Security(SS)/Supplemental Security Income (SSI) Benefits for Children in Care

Statutes

All County Letter (ACL) 11-15, New Kinship Guardianship Assistance Payment (Kin-GAP) Program Requirements dated 01/31/11, clarifies that the SCI rates are available for eligible children participating in the Kin-GAP program.

California Department of Social Services (CDSS) Manual of Policies and Procedures (MPP) 11-401.323, state that any county wishing to modify or adopt a specialized care system shall submit a proposal to the Department which describes the county's current specialized care system, if applicable, and the county's proposed system.

Health and Safety (HS) Code Section 1501.1, states in pertinent part, that when placing children/youth in out-of-home care, particular attention should be given to the individual child/youth’s needs, the ability of the facility to meet those needs, the needs of other children/youth in the facility, the licensing requirements of the facility as determined by the licensing agency, and the impact of the placement on the family reunification plan.

Welfare and Institutions Code (WIC) Section 5600.3(a)(2), provides a definition for “seriously emotionally disturbed children or adolescents”.

WIC Section 11461(e) (1) provides a definition for "specialized care increment".  It specifies that the specialized care increment shall not be paid to a nonminor dependent placed in a SILP.

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