An Expert Explains the Evaluation Process
By Sara Tiano
In June 2024, a congressional subcommittee released an investigation slamming residential treatment facilities for youth, calling them “warehouses of neglect.” It warned children in these settings face alarming living conditions, shoddy education and, too often, physical and sexual abuse.
High on the list of concerns identified in the report: Too many children sent far from home to these institutions — which are meant to treat severe mental health needs — had no clinical reason to be there.
Recently, specially trained professionals have been put into place to help prevent this. Since 2021, the federal Family First Prevention Services Act requires certified “qualified individuals” (QI) to weigh in every time social workers want to send a youth in foster care to residential treatment. Their job is to inform the civil courts whether these placements — intended to be a last resort, as children are more likely to thrive in a family home — are necessary and appropriate.
Lawanna Pitts of Minneapolis holds this role in Minnesota, assigned to cases to help determine if children should remain in a family home or be moved to an institution.
Currently a paralegal at a family law and immigration law firm, Pitts, 47, approaches this work with years of experience in public service through community-based work. She was a church volunteer and later spent four years working for the Minneapolis Youth Coordinating Board. In that role, she walked the city’s northern streets, engaging with young people to prevent altercations with police, learn about their needs and connect them with resources.
“I’m already in the community so much, working with families and knowing what supports are available,” Pitts said in a recent interview with FFT’s sister publication, The Imprint. “That’s kind of what you do when you’re in the role of the QI. You’re confirming the supports that are available to them, and make sure that they’re in the least-restrictive setting — with the best support system that they can have.”
The following is an excerpt of her interview, where Pitts shared an insider’s perspective on how experts in positions such as hers make these consequential decisions, and what resource parents can look for if they’re worried about their child’s treatment needs.
How do you go about assessing the child’s needs and whether that is the right setting?
I gather information about the case by talking with people on the child’s family permanency team. I start by interviewing the case manager with the county child welfare agency, because most times they have the most background of why the referral actually took place. I like to get kind of the background of why you believe that this is necessary, right?
After they tell me their side of the story, why they believe residential treatment is necessary — then I start interviewing the youth and everyone else on their family permanency team. This could include parents, family members, guardians, foster parents, as well as professional supporters like a guardian ad litem.
If other people come up, like grandma says the youth spends a lot of time with his uncle, then I’ll ask for the uncle’s contact information. Everybody sees everything in a different lens. Based on your support of youth or child, you may see different behaviors, they might come to you for different reasons. So it’s kind of my way of getting the bigger picture.
How does the information you gather during these interviews translate into your recommendation on whether or not they need residential care?
There’s two documents that you fill out based on that information, or two documents you fill out for your assessment. The first is called the Child and Adolescent Needs and Strength Assessment (CANS), which is a form that helps you score categories for them. The categories include family strengths and functioning, intellect and development, decision making, adjustment to trauma and danger to others, as well as mental health concerns like psychosis, anxiety, depression and self-harm.
At the end of that form, it tells you, based on your scoring of their strengths and needs, if they should be put into the Qualified Residential Treatment Center program (QRTP).
Then there’s a secondary document, which is the actual QRTP Assessment and Recommendation form. That form is kind of going into detail from the previous form and explaining how you got to your decision. So it goes through who you interviewed, who was in support of residential treatment placement, who was not in support of it.
What are the categories on the assessment form that you’re scoring?
- Family Strengths
- Interpersonal
- Educational Setting
- Community Life
- Resilience
- Natural Supports
- Family Functioning
- Living Situation
- Social Functioning
- Developmental/Intellect
- Medical/Physical
- Sleep
- School
- Decision Making
- Sexual Developmental
- Psychosis
- Impulsivity/Hyperactivity
- Depression
- Anxiety
- Oppositional Behavior
- Conduct
- Adjustment to Trauma
- Anger Control
- Substance Use
- Interpersonal Problems
- Suicide Risk
- Non-Suicidal Self harm
- Other Self-harm
- Danger to Others
- Sexual Aggression
- Delinquent Behavior
- Runaway
- Intentional Misbehavior
- Fire Setting
- Victimization/Exploitation
Do your recommendations ever deviate from what the CANS score says?
I’ve had it happen, one time either way. In one case I had conflicting information, two people were saying one thing about youth’s community interactions, like he’s always getting in trouble at basketball; two were saying the other, like he was totally fine when they took him to basketball practice or out swimming at the park. It was literally one point on the rubric in favor of sending them. So that was not significant enough for me, I felt like this is too close to put them in there. Because the most important part is it not being a restrictive setting as much as we are able to prevent it.
Then there was another one where I scored it, and it did not put them in a QRTP based on the score. But he was not getting the support that he needed outside, he wasn’t getting evaluations that he needed. His parents were just not on board with any of that, mom and dad were like, ‘No, we’re not taking them to therapy, we don’t believe that that works.’ Everyone else, all seven other people, plus me talking to him made me feel like he did need those kinds of support. And just the parents were just not wanting to do that.
Why is that important to you in making this decision to ensure the youth is in the least restrictive environment?
I don’t want the restrictions to be more than what they require. If they can get the same supports somewhere where they’re not required to be locked in, not required to be in the room at a certain time — because the QRTP setting, there’s a lot of restrictions. And so if I can prevent them from going into that setting, specifically, I’m going to do everything possible.
Is it part of your job to assess what resources are available in the community that could meet the needs of the children you’re assessing?
I always ask what supports have already been tried, what [living settings] have already been in place, what type of supports they’re already receiving. Like, if they get respite, if they’re getting skills training, they might be getting horse therapy, or whatever the case may be. I try to figure out everything they’ve already received and try to see if there is an opportunity for something else that would support them better, that maybe would not have been thought of. I actually keep a spreadsheet and I have a couple of books that give me resources in the state of Minnesota.
Part of my recommendation is telling them what I think needs to be done, including different types of placement settings like foster care group homes. So if there’s an option that they can do that doesn’t put them in a QRTP, I put my recommendation there.
Do you have any advice for parents/foster parents/caregivers who have kids going through this assessment?
Stay involved and open. Provide a supportive environment and be honest about your own needs and challenges, take care of yourself. Consider long-term support as well after care, and stay flexible and open-minded.
Sara Tiano is Fostering Families Today’s assistant editor and a senior reporter for its sister news site, The Imprint. Her journalism has been focused on foster care, child welfare and other issues facing youth and families for more than six years.