You asked about:

1. the criteria the departments of Children and Families and Mental Health and Addiction Services use to site group homes;

2. the agencies responsible for licensing these homes and the governing statutes and regulations;

3. the types of clients who live in these homes and the criteria used to place them; and

4. if the agencies directly own and operate group homes, the amount they spent in the past six years to purchase them and the amount they spend annually to maintain them.

SUMMARY

The Department of Children and Families (DCF) contracts with nonprofit agencies to operate group homes. It does this through a request for qualification (RFQ) process. DCF licenses these homes.

DCF group homes treat residents with psychiatric diagnoses, many of whom have also been abused or neglected. Residents are referred from institutional settings such as residential treatment centers or hospitals. They must be able to attend a clinical day school or special education program in a public or residential treatment center school. They must not exhibit assaultive behavior that threatens others or be a risk to run away. They may not have an adult court record of sexual offense.

The Department of Mental Health and Addiction Services (DMHAS) uses a request for proposals (RFP) process to contract with nonprofit agencies to operate group homes for youths aging out of the DCF system, adults with serious and persistent mental illness, and adults with both acquired brain injury (ABI) and mental illness. The Department of Public Health licenses the homes for youths and adults with mental illness. The ABI group homes are not licensed. Placement in a youth or adult group home is based on the individual's clinical assessment, service plan, and inability to live alone in the community and medical necessity.

DCF owns a group home in Prospect, but contracts with North American Family Inistitute (NAFI) for its operation. To date, the department has been unable to provide the home's purchase price. DMHAS does not directly own or operate any group homes.

We have enclosed an OLR Report (2005-R-0596) that, in part, discusses the laws on group home siting that governs these agencies and the agencies' siting rules and practices.

DCF

Group Home Siting

The vast majority of DCF therapeutic group home operators have been selected through a request for qualification (RFQ) process. This process enables providers to become qualified to develop a group home when the need for one arises.

The process for siting homes has recently changed. Until last year, DCF's 14 area offices determined when a particular cohort or type of youth needed group home services. Cohorts reflected age, gender, developmental functioning, psychiatric diagnosis, and particular behavioral needs. An area office requested funding for a home and, if it was granted, DCF's central office matched the request with a qualified provider. The selection process took into account the location of the area office that requested the home; ideally, DCF looked for a provider that would site the home near the particular area office where most of the youth were located.

DCF has recently begun to develop a system that gives each area office some access to therapeutic group homes in its general area. The agency is also making a conscious effort to ensure that particular locales are not overbuilt. The north central and central portions of the state currently have the greatest clustering of homes.

Under this new approach, homes are sited to fill the needs of the broader service system, not to house a particular cohort. The central office initiates the process by giving qualified providers a general region or an area office where it should look to site a home. DCF never directs a provider to a specific town. It is the provider's responsibility to locate a suitable property. DCF's Licensing Bureau and other units review the provider's selection for appropriateness before the provider negotiates final purchase or lease agreements.

Licensing

DCF licenses the group homes it funds. Its licensing regulations govern homes' finances; management and personnel; physical plant; food, education, recreation, and other services; health and medical treatment, including medication administration; discipline; and case records (CGS § 17a-145; Conn Agency Regs. , 17a-145-59 to -98).

Placement Criteria

DCF's therapeutic group homes are intense, clinical settings where residents can receive all their therapeutic services in a home-like setting. They serve primarily children and youth coming out of institutional care such as hospitals, residential treatment centers, shelters, and safe homes. Virtually all of their clients have histories of trauma; most have been abused or neglected. All have a significant behavioral health diagnosis; a number also have mental retardation.

To be referred to a therapeutic group home, a youth must be able to attend some form of community school, although not necessarily an inclusive public school classroom. Some group home residents attend clinical day schools, schools in residential treatment centers, and self-contained special education programs in public schools.

A youth must not currently exhibit behavior that is a danger to other residents, staff, or members of the community. For example, a highly assaultive youth who requires frequent restraint would not be a candidate for group home living, nor would one with a recent history of running away from placement. Youth with adult adjudication of sexual offenses are not placed in DCF group homes.

DMHAS

Group Home Siting

DMHAS currently funds 31 group homes ranging in size from three to 17 beds. The facilities house three types of clients: (1) youth with psychiatric disabilities who are transitioning out of treatment by DCF, (2) adults with both ABI and mental illness, and (3) adults with severe psychiatric disabilities.

DMHAS finds locations for these homes through a statewide RFP process. The RFP requires applicants to find sites for the homes; DMHAS does not specify their location. For example, one of the components of a 2001 RFP for a 15-bed residential program requires respondents to “describe the proposed site and/or demonstrate the capacity to site the program. ” The RFP focuses on the applicants' fiscal and management capacity and the services they must provide to residents such as recovery assistance, rehabilitation activities in life and social skills, vocational and educational planning, and linkages to community resources.

Group Home Licensing

The Department of Public Health (DPH) licenses DMHAS group homes for youth and adults. ABI group homes are not licensed. DPH licensing regulations cover topics such as the home's management; finances; personnel practices; physical plant; food service operations; emergency and disaster procedures; and service operations, including residents' rights, recordkeeping, staffing, and medication controls (CGS §§ 19a-490, 491, 493 to 503, and 507a-d; Conn. Agency Regs. 19a-495 to -551).

Placement Criteria

An individual's placement in a youth or adult group home is based on a clinical assessment, medical necessity, a service plan, and inability to live alone in the community. The person must be (1) stable enough to function outside of a 24-hour medically managed setting (e. g. , a hospital or nursing home) but (2) so disabled as to need a nonmedical, 24-hour, seven day a week, supervised community–based residential setting with rehabilitative services and supports.

Medical necessity for a client with mental illness means that the client needs health care services to help overcome the effects of a psychiatric illness. It assumes a primary psychiatric diagnosis and level of functioning as outlined for a specific level of care (in this case, group home care). It also assumes that

1. the diagnosis and the treatment plan that specifies the necessary services are developed and overseen by licensed healing arts practitioners (such as psychiatrists, psychologists, clinical social workers, and advanced practice registered nurses) and

2. the intensity and duration of any interventions delivered are sufficient to be effective.

The local mental health agency and the group home are responsible for determining medical necessity for each client and reviewing it periodically.

Clients in ABI group homes are individuals with an acquired brain injury and mental health problems. The placement screening process includes evaluations by the inpatient clinicians on the Connecticut Valley Hospital's ABI Unit and review of the client's medical needs by an registered nurse on DMHAS' ABI Community Services team. The group home's staff also review the client to ensure that the home is equipped to manage the client's medical, psychiatric, and cognitive disabilities.

SS: ro