Form M-8D Form M-8D Secure and Staff Secure Addendum to Case File Checklist

OMB 0970-#### [valid through MM/DD/YYYY]

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow ORR Monitoring Team staff to document care provider compliance with ORR policies and procedures related to case file maintenance during biennial site visits. Public reporting burden for this collection of information is estimated to average 1.0 hour per response (plus an additional 6.0 hours if the site visit is performed by a contractor monitor), including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information please contact [email protected].

Staff Secure and Secure Case File Check List

Version: 11/09/2020

CF

Portal

Date

Notes

Admission/Orientation - Notification of Placement in a Restrictive Setting (NOP) and Intakes Placement Checklist

Completes NOP; signed and dated by UAC and CP staff; if UAC refuses to sign, CP notes 'UAC refused to sign'; uploaded after signature to UAC Portal, copy to UAC file; copy to UAC to be kept with personal belongings. (NOP completed within 48 hours of admission; maintained in UAC Case File. Best Practice: After UAC signature, NOP is immediately uploaded to UAC Portal on same day as signed.)

NOP completed fully and correctly. (Page 1 - appropriate boxes marked; Page 2 - provides detailed summary of the placement decision.) If Spanish is primary language, complete Spanish version of NOP; and include English version in UAC file.

For Initial Placements (not transfers) a copy of the ORR Intakes Placement Checklist has been uploaded to UAC Portal. Best Practice: a copy of the ORR Intakes Placement Checklist should be maintained in UAC Case File.

Any summary of their placement must be provided in English and Spanish if using the Spanish version of the form. (Best Practice: Documented in UAC Case File if UAC speaks language other than English or Spanish; and documented in UAC Case File that the NOP has been explained to UAC in a language UAC understands.)

Notice of Bond Hearing for UAC

The CP's 'initial orientation packet' includes current Request for Flores Bond Hearing form. The Legal Resource Guide includes the Request for a Flores Bond Hearing for secure and staff secure care providers. Documentation that UAC was informed in a language that UAC understands that can request a Flores bond hearing immediately or at a later date. (within 48 hours of Admission)

If UAC requests a Flores bond hearing, current request form fully and accurately completed; signed and dated by UAC. Copy in UAC file. (Best practice: upload to UAC Portal same day as signed. Legal Service Provider (LSP) explains options in greater detail at KYR presentation. LSP should provide copy to CP same day signed by UAC.)

If Flores bond hearing is requested by UAC, ask the CP to provide monitor a copy of the request form and 'motion' documents. Ask the CP to provide monitor the email submission to ORR. Check the email to see if CP notified ORR of the request at [email protected] within 1 business day (absent exigent circumstances)

30 Day Reviews - Notification of Placement in a Restrictive Setting (NOP) and Case Review Documentation

Timely and accurate 30 day NOP forms documented in UAC file and UAC Portal. (Best Practice: NOP 30 day review uploaded to UAC Portal immediately - same day as signed.)

For each 30 day review, the NOP boxes(s) checked appropriately; summary of placement decision and justification for continued placement. Each 30 day NOP signed/dated by UAC and staff. If UAC does not sign, statement that 'UAC refuses to sign'; and signed/dated by staff. NOP timeline: Best Practice: A NOP must be given to a minor no more than 30 days after the previous NOP was given, regardless of when the previous NOP was provided to the minor.

Documentation that clinical sessions focus in part on the UAC's dangerousness, threats to self, others or the community and any issues effecting need for restrictive placement. If completed, Ohio Youth Assessment results are noted on page 2 narrative. Check to see if other assessments completed: Recidivism Assessment; Psych or Psychiatric Assessments. The NOP page 2 should include any clinical assessment information that supports the decision.

For each 30 day NOP, there is a 'summary note - 30 day restrictive placement case review'' in UAC file and uploaded to UAC Portal. The summary note needs to be signed/dated on same day as the 30 day review decision. Both initial referral information and additional details need to be documented in the summary note. Note: this case review refers to the 30 day restrictive placement case review and not the UAC Case Review document in UAC Portal.

If the 'restrictive placement' case review is not completed prior to the 30 day mark, CP has documented reason for the delay in summary note.

For the 30 day NOP reviews, the CP can use the ORR Template for Summary Notes: 30 Day Restrictive Placement Case Review or their own CP form that includes all information in template. Needs to be signed by note taker - usually the CP case manager.

If UAC approved by FFS for 'step-down' - has the transfer request been completed timely and transfer accomplished within 7 days of FFS decision. CP needs to document in UAC file reasons for any delays . A 7-day update to the 30 Day Restrictive Case Review notes should be completed if the UAC is not transferred within that 7-day period. (Best Practice: upload the 30 Day Restrictive Case Review notes to UAC Portal - UAC Documents.)

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