Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File C

OMB 0970-0564 [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 contractor monitors to document care provider compliance with ORR policies and procedures related to case file maintenance during unlicensed facility quarterly site visits. Public reporting burden for this collection of information is estimated to average 1.0 hour per response for the care provider and 6.0 hours for the 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 UCPolicy@acf.hhs.gov.

Staff Secure Addendum (Revised: 12/9/2022) to the ORR/UCP Master Case File Checklist (10/11/2022) The ORR/UCP Master Case File Checklist is fully applicable to children in staff secure care. This Addendum details the additional requirements related to the Notice of Placement in a Restrictive Setting (NOP), related NOP 30 day reviews, bond hearing requests (if any), placement review panels (if any) and transfers. The staff secure addendum must be completed for: 100% of the UC currently in care and all transfers out of the staff secure facility during the last six months. (Note: all references to 'UC' are fully applicable if the child is a 'UAM'.)

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UC Name:

A#:

Case Manager:

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DOB:

Clinician:

Admitted Date:

Gender:

Transfer?

Date of Release:

Language(s):

Religion:

CF

Portal

Date

Notes

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

Within 48 hours of admission, the Notice of Placement in a Restrictive Setting (NOP)(P-4/Version 5/Revised 11/21/2022) is completed with the following requirements: • NOP uploaded into UC Portal and copy maintained in UC case file • Appropriate box(es) noting reason for placement marked and summary of placement decision provided • Documentation that NOP was explained in UC's language entered in UC Portal and UC case file • UC's signature and date on NOP (If the UC refused to sign the NOP, the care provider checked the box for “Please check this box ONLY if the child refused to sign the Notice of Placement”) • Section C: Reasons for Restrictive Placement, the Staff Secure Facility section completed (rather than the Secure Facility or Residential Treatment Center (RTC) sections) • NOP distributed as required by the UC Manual of Procedures Section 1: Placement in ORR Care Provider Facilities (Version 5.1) (Note: Check to confirm the admission NOP is in substantial compliance with these and other requirements detailed in UC MAP Section 1)

The decision to initially place or continue placement of a UC in the staff secure is supported by clear and convincing evidence. Prior to the NOP completion, the case review summary is fully documented to include the detailed evidentiary record, uploaded to the UC Portal and included in the UC file. Case Manager maintains the following review information: • UC’s basic biographical information • Background information on the case • Summary of case review discussion • Summary of evidence • Care provider’s recommendation, including names and titles of those making recommendations, and basis for it • Case coordinator’s name, recommendation and basis for it • Federal Field Specialist’s name, decision and basis for it • Signature of note taker (typically the case manager) Note: Appendix 1.6 30-Day Restrictive Placement Case Review form is available in The UC Manual of Procedures (UC MAP). It is not required to be completed but can be utilized to ensure the review details and evidentiary record are detailed, uploaded to the UC Portal and maintained in the UC file.

If Spanish version of NOP is (or Dari and Pashto versions are) completed, a summary of evidence supporting the placement was completed in English and uploaded to the UC Portal and maintained in the UC case file. Note: ORR Policy team and the special populations team require that this be accomplished by uploading both an English NOP and Spanish NOP (or Dari and Pashto versions) to the UC Portal and that maintained in UC case file.

Notice of Bond Hearing

The staff secure facility 'initial orientation packet' includes the Request for Flores Bond Hearing form. (Note: care provider should be providing UC the current undated form which can be located in Key Documents for the Unaccompanied Children Program: https://www.acf.hhs.gov/orr/policy-guidance/unaccompanied-children-program.) Within 48 hours of Admission, documented that UC was informed in a language that UC understands that can request a Flores bond hearing immediately or at a later date.

If Flores bond hearing has been requested by UC, staff secure care provider has documented compliance with ORR guidance. (Note: check UC file and UC Portal to see if Flores bond hearing was requested. If applicable, the monitor needs to review both related email and file documents by requesting to review the request form and 'motion' documents. Ask the care provider to provide monitor the email submission to ORR. Check the email to see if care provider notified ORR of the request at ORR BondHearings@acf.hhs.gov within 1 business day (absent exigent circumstances).

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

The 30-Day Restrictive Placement Case Review is completed in accordance with UC MAP Section 1, documented in the UC file, and uploaded to the UC Portal. A new NOP is documented every 30 days the UC remains in the staff secure – restrictive placement. Requirements for completing NOP previously are also applicable to the 30 day review NOPs. For example: • NOP uploaded into UC Portal and copy maintained in UC case file • Appropriate box(es) noting reason for placement marked and summary of placement decision provided • Documentation that NOP was explained in UC's language entered in UC Portal and UC case file • UC's signature and date on NOP (If the UC refused to sign the NOP, the care provider checked the box for “Please check this box ONLY if the child refused to sign the Notice of Placement”) • Section C: Reasons for Restrictive Placement, the Staff Secure Facility section completed (rather than the Secure Facility or Residential Treatment Center (RTC) sections) • NOP distributed as required by the UC Manual of Procedures Section 1: Placement in ORR Care Provider Facilities (Version 5.1) (Note: confirm that the 30 day review NOP is in substantial compliance with requirements detailed in UC MAP Section 1. Placement in ORR Care Provider Facilities (Version 5.1)

Case managers working in coordination with the FFS, obtain the following information, as applicable: o Attestations from law enforcement. o Criminal history, including but not limited to police records, arrest records, court records (including Saravia and Flores hearings), probation records, etc. This may include documents retrieved from foreign governments. o Records pertaining to a UC’s dangerousness obtained from non-law enforcement entities, including schools, child welfare agencies or other government institutions. o Interviews with the UC’s family or other caregivers. o Track behavioral SIRs indicative of dangerousness or flight risk, this includes destruction of property and SA SIRs in which the UC is a perpetrator. o Information that indicates a UC may not be a danger, including reports from schools, counselors (including from the UC’s current placement).

Documentation that clinical sessions focus, in part, on the UC's dangerousness, threats to self, others or the community and any issues effecting the need for restrictive placement. UC MAP Section 1: Placement in ORR Care Provider Facilities (Version 5.0) page 45). Clinicians continue weekly or biweekly counseling sessions that focus, in part, on the UC’s dangerousness, threats to self, others or the community and risk of escape. The information collected or reported by the clinician, includes: o Clinical and psychological reports and documents, including those by medical and/or mental health providers. o Clinical notes maintained by the clinician, documented in accordance with ORR policy and procedure.

If there is a decision to continue the placement in a restrictive facility, the Evidentiary Record demonstrates that the available information about the UC makes it highly and substantially more likely that the child poses a danger to themselves or other, and/or poses an escape risk. This Evidentiary Record is documented in the UC file and uploaded to the UC Portal.

Transfer Request

If there is a transfer to a secure care provider, the evidentiary record has been documented in the UC’s case file and uploaded to the UC Portal prior to a request to transfer to secure and has been included with the Transfer Request File. (If applicable.)

For a step down approved to a less restrictive environment, if the transfer has not been completed within 7 days due to problems finding a suitable care provider to transfer the UC to, the case manager has documented efforts to resolve the delay in the UC Case Review notes. (If applicable.)

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