BUREAU OF QUALITY ASSURANCE PROGRAM REPORT FOR

Transcription

1 STATE OF FLORIDA DEPARTMENT OF JUVENILE JUSTICE BUREAU OF QUALITY ASSURANCE PROGRAM REPORT FOR Hidle House Anchorage Children's Home (Contract Provider) 2121 Lisenby Ave. Panama City, FL Review Date(s): September 1-3, 2009 ADDENDUM ATTACHED, Deemed Review Date(s): September 2, 2010 PROMOTING CONTINUOUS IMPROVEMENT AND ACCOUNTABILITY IN JUVENILE JUSTICE PROGRAMS AND SERVICES FRANK PETERMAN, JR., SECRETARY JEFF WENHOLD, BUREAU CHIEF Florida CINS/FINS Quality Assurance Report Page 1 of 7

2 Hidle House Quality Assurance Performance Rating Profile Program Type: CINS/FINS Program Code: 36 Contract Provider: Ancohorage Childrens Home Contract Number: V2021 County/Circuit #: Bay/14 Number of Beds: 20 Review Date: September 1-3, 2009 Lead Reviewer Code: 44 Program Performance by Indicator Management Accountability Temporary Shelter Care 1.01 P Background Screening Classification P Risk Management and Incident Reporting Shelter Environment P Provision of Abuse Free Environment Grievance Process Interagency Agreements and Outreach Behavior Management Strategies First Year Training Requirements Behavioral Interventions On-Going Training Requirements P Staffing and Youth Supervision Safety & Emergency/Disaster Preparedness Staff Secure Shelter and Beds - Staffing NA 1.08 Flammable, Toxic, and Poisonous Control Special Diets Log Books National School Lunch and Breakfast Program NA Total 69 Total 64 Screening, Intake and Assessement Health, Mental Health and Substance Abuse Services 2.01 Eligibility Screening and Intake Assessment P Healthcare Admission Screening Service Plans P Mental Hlth/Substance Abuse/Suicide Screen Service Plan Implementation and Review Suicide Assessment P Family Involvement Emergency Mental Hlth/Substance Abuse Srv Case Management Staffing Medications Sub. Abuse Ed/Referral for Trt (non-res) P Medical and Mental Health Alert Process 10 Total Epiisodic/Emergency Care 8 Total 60 Standard 1. Management Accountability 2. Screening, Intake and Assmt 3. Temporary Shelter Care 4. Health, MH, SA Services Overall Score Program Performance by Standard Program Score Max Score Rating Failed Minimal Acceptable Commendable Exceptional 0-59% 60-69% 70-79% 80-89% % % X % X % X % X % X Overall Program Performance Commendable Performance 82% Scoring legend: Performance Indicators: 0 = Failing, 5 = Minimal, 7 = Acceptable, 8 = Commendable, 10 = Exceptional Florida Revised July, 2009 CINS/FINS Grid

3 Hidle House Quality Assurance Methodology PERSONS INTERVIEWED Program Director 2 # Case Managers Residential Program Supervisor 2 # Direct Care Staff Non-Residential Program Supervisor 0 # Healthcare Staff Clinical Director 2 # Maintenance Personnel Clinical Staff 0 # Others (listed by title): 1 # Program Supervisors DOCUMENTS REVIEWED Previous Year's QA Report Incident Report Logs 3 # Youth Files (Residential) Contract: Scope of Services Logbooks 5 # Youth Files (Non-Residential) Supplemental Contracts (i.e. health) Visitation Logs 0 # Youth Files - Closed Florida Network Monitoring Reports Telephone Logs 3 # Health Files Accreditation Reports (if applicable) Program Schedules 3 # Mental Health / Sub. Abuse Files DCF Licensure Youth Handbook 7 # Employee Personnel Files Interagency Agreements Grievance Files 7 # Employee Training Files Fire Safety Inspections/Reports Food Menus 0 # Others Health Inspection Reports Individual Determination Reports Vehicle Inspection Reports Room Restriction Logs (if applicable) SURVEYS 0 # Youth 0 # Parent surveys mailed 0 # Staff 0 # Parents surveys returned OBSERVATIONS DURING WEEK OF REVIEW Program Activities Vehicles Case Staffing Committee Meeting Recreation Meals Youth Movement and Counts Posting of the Abuse Hotline Staff Interactions & Social Skill Modeling Security of Chemicals Admissions/Orientation Medication Administration Items not checked were either not observed during the week of the review or are nolonger applicable to this program trype. QA REVIEW TEAM MEMBERS Lead: Peer: Peer: Peer: Peer: Bruce Morton, Daniel May, Patrica Rock, Currie House Harvey Norris, White Foundation Jessica Fansler, Florida Network of Youth and Family Services Florida Revised January 1, 2008 CINS/FINS Methodology

4 This review focused on the performance of the program concerning four standards, which covered such areas as Management Accountability, Residential Community, Case Management, Mental Health and Substance Abuse, Food Services, Healthcare, and many other functions. Performance indicators, used to measure each standard, were rated using the scale below, with ten representing the highest performance possible. Exceptional Performance 10 Commendable Performance 8 Acceptable Performance 7 Minimal Performance 5 Failing 0 The review team used the following definitions of the above performance levels as a guide when rating performance indicators: Exceptional Performance: The program consistently meets and a majority of the time exceeds the requirements of the indicator. The items, documentation and/or actions necessary to accomplish the requirements of the indicator are completed with either an innovative approach or an exceptional performance that is efficient, effective, and readily apparent. There is evidence of very few exceptions to this. Commendable Performance: The program consistently met all requirements of the indicator without exception. Acceptable Performance: The program consistently meets the requirements of the indicator. The items, documentation and/or actions necessary to accomplish the requirements of the indicator are completed as required, though few exceptions may occur. Minimal Performance: The program does not consistently meet the requirements of the indicator. Frequent and/or significant exceptions occur or the program is ineffective in completing the items, documentation and/or actions necessary to accomplish the requirements of the indicator. Failing: The items, documentation and/or actions necessary to accomplish the requirements of the indicator are missing or are done so poorly that they do not contribute to accomplishing the requirements of the indicator, or include falsified documentation. Factors that may seriously impair a program s ability to perform, but which are beyond its control, are identified as external control factors. These factors, and the degree to which they influence a program s performance rating on a standard, are identified in the appropriate standard as part of the quality assurance report. Revised August

5 KEY INDICATORS AND/OR AREA S NEEDING IMMEDIATE ATTENTION indicators noted below for more detail regarding the deficiencies.) (See individual key 1.01 Background Screening 1.08 Flammable, Toxic and Poisonous Control 1,09 Logbooks 2.03 Service Plan Implementation and Review The review team used the following definition as a guide when identifying the deficiencies: Conditions that are trends, and not an occasional occurrence, that are related to a threat to the life, safety, health, or welfare of the youth, staff or the public, including a reasonable probability a threat could occur if remedial action is not initiated without delay. ACKNOWLEDGEMENT The following individuals participated in the on-site review. The wishes to thank each of them for their contribution to the process of promoting continuous improvement and accountability in juvenile justice programs and services in Florida. Bruce Morton, Daniel May, Harvey Norris, White Foundation Jessica Fansler, Florida Network of Youth and Family Services Patrica Rock, Currie House NOTE: The 2009 quality assurance scoring scale has been revised and will reflect the prevailing practice documented for six months prior to the review. Please be advised that if comparing scores from previous years to this year, the scores will not equate to one another. For more details on the specific changes made for 2009 please reference the Quality Assurance 2008 Workgroup Report found on the QA home page. Revised August

6 STANDARD ONE: MANAGEMENT ACCOUNTABILITY Overview: The program s leadership consisted of the Executive Director, who was newly hired since the last QA visit, a Program Administrator, three Non-Residential counselors, one Outreach Coordinator and a Shelter Manager. The program tracks risk management through many different types of incidents and provides strategies to reduce the identified risk. The program produces a monthly and quarterly report that is circulated to staff and the program's corporate office. There is documentation of testing and inspection of fire prevention and detection equipment. The local fire official has approved the shelter s fire evacuation and prevention plan Staff and volunteers working in direct and continuing contact with youth undergo a criminal history background screening to ensure they are not a danger to youth. P The program did not consistently meet the requirements of the indicator. Frequent and/or significant exceptions occurred or the program was ineffective in completing the items, documentation and/or actions necessary to accomplish the requirements of the indicator, as evidenced by, but not limited to the following: The program failed to submit the Affidavit of Compliance With Good Moral Character Standards to the by January 31, The program demonstrates the importance of monitoring incidents for risk management purposes and develops strategies to limit the risk. P Minimal: The program provides an environment in which youth, staff, and others feel safe, secure, and not threatened by any form of abuse or harassment. P The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: Two CINS/FINS youth were interviewed in the shelter, and both indicated that they were happy with their treatment while in the shelter and the efforts made by the staff to make their time in the shelter as comfortable as possible. Both of the youth stated that the shelter was more safe than their home. One of the two youth was at the shelter for a second time and stated the shelter was a positive factor in her life The program has established outreach activities, written agreements, and informal linkages with other community-based service providers to target youth who are most at-risk to become delinquent. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: There was documentation of over seventeen cooperative agreements between the program and community organizations. There are twenty-seven Safe Place agreements and over fifteen other Revised August

7 collaborative community agreements ranging from educational programs to recreational activities. There is an intensive community outreach program that meets the youth at the rescue missions, homes and alone on the street with food, clothes and shelter. The outreach team has reached over 10,000 youth last year through presentations at schools, churches and street outreach 1.05 All direct care program staff receive eighty (80) hours of training in their first year of employment. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: The staff training files were reviewed for three first year employees. Two of the three had all of the required training and thirty hours over the required eighty hours in the first year of employment. The third employee has only been employed for two months and already had thirty-seven hours of training. There was documentation in the training file of CPR and First Aid training All direct care program staff receive a minimum of twenty-four (24) hours of job-related training annually (after the first year of employment) Management has developed and implemented a comprehensive safety and emergency/disaster preparedness plan The program maintains strict control of flammable, poisonous and toxic items. Minimal: 5 The program did not consistently meet the requirements of the indicator. Frequent and/or significant exceptions occurred or the program was ineffective in completing the items, documentation and/or actions necessary to accomplish the requirements of the indicator, as evidenced by, but not limited to the following: There were inventories and Material Safety Data Sheets (MSDS) for cleaning chemicals, gas and motor oil stored in the shelter. However, there were no inventories or MSDS sheets for approximately twenty gallons of paint stored in the shelter Logbooks document routine daily activities, events, and incidents in the program and are reviewed by direct care and supervisory staff at the beginning of each shift with signature/date on each page. The program did not consistently meet the requirements of the indicator. Frequent and/or significant exceptions occurred or the program was ineffective in completing the items, documentation and/or actions necessary to accomplish the requirements of the indicator, as evidenced by, but not limited to the following: A review of the program logbook for several months found the program's practice of highlighting pertinent issues confusing and inconsistent. There were several blank pages in the back of the logbook. There was no reviews by the oncoming supervisor of the logbook for the two Minimal: 5 Revised August

8 previous shifts that was written into the text of the logbook. Reviews of the logbook by shelter staff was documented in the margin of the logbook by the staff's initials. This prevented a determination of the time and date of the reviews. External Control Factors None STANDARD TWO: SCREENING, INTAKE AND ASSESSMENT Overview: There are three Bachelor level non-residential counselors providing out patient services of the program. The couselors were being supervised by a Licensed Mental Health Counselor (LMHC) who was also the clinical advisor for Anchorage Childrens Home. There are two outreach staff with one supervisor. Screenings are completed twenty-four hours per day. This accomplished by a rotation staffing between the non-residental and shelter staff Initial eligibility screening is begun within seven working days of a youth being referred to the CINS/FINS provider. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: Two of the five files reviewed were initiated by outside referrals and the referral was filed in the record. Each referral was date stamped when the referral was obtained by the agency. The other three appear to have been initiated by the Non-Residential program. All five had a completed screening form filed with the date the form was completed and were signed by the person completing the form. All screening forms were completed within the seventy-two hour time frame of referral. Three forms were completed on the day of the referral. All five reviewed files had a psychosocial assessment completed on the date of first contact. Interview with non-residential counselors indicated it was common practice to complete the Psycho-social assessments on the first visit and in situations where the screening instrument was completed on first visit the psychosocial was also competed at the same time. Two of the psychosocial assessments indicated a need for more intensive services and referrals were made and documented to local crisis stablization unit (CSU) A service plan is developed with the youth and family within seven working days following completion of the psych-social assessment. The program consistently met the requirements of the indicator. The items, documentation and/or actions necessary to accomplish the requirements of the indicator were completed as required, though a few exceptions occurred, as evidenced by, but not limited to the following: Of the five services plans reviewed, all were completed on the day of first visit. However, due to the similarities in all the treatment plans it was difficult to determine the individualization of the plans for specific clients. All five service plans listed the responsibilities of each person involved in each goal on the plan, however, all goals on all plans listed were the exact same for Acceptable: 7 Revised August

9 each person A service plan is implemented, reviewed, and revised, as needed, to address the identified needs of the youth and family. The program did not consistently meet the requirements of the indicator. Frequent and/or significant exceptions occurred or the program was ineffective in completing the items, documentation and/or actions necessary to accomplish the requirements of the indicator, as evidenced by, but not limited to the following: All of the files reviewed maintained the case in an open status for less than 180-days. No six-month reviews were included in any file. There were no service plan revisions made on any of the files, and it did not appear that any revisions were needed. Four of the five files were not reviewed within the initial 30-day time frame. Three of the files required a 60-day review. Of these three, two were not completed within the required time frame while the third one did not contain any evidence that a 60-day review was completed at all The program provides services to youth, their families, legal guardians or others who are considered to be significant in the immediate and follow-up care of the youth. P Minimal: A case staffing committee reviews all cases that cannot be resolved by the CINS/FINS provider. The program consistently met the requirements of the indicator. The items, documentation and/or actions necessary to accomplish the requirements of the indicator were completed as required, though a few exceptions occurred, as evidenced by, but not limited to the following: The program meets all procedural requirements for the indicator; however, there was no practice to evaluate. Acceptable: The program provides substance abuse education as a programmatic activity. External Control Factors None STANDARD THREE: TEMPORARY SHELTER CARE Overview: The program s shelter manager oversees the direct care staff in the functions of the shelter and supervision of the youth. The staff s responsibilities ensure the youth are welcomed to a safe and secure environment, given the opportunity to express matters, learn accountability, life skills, refer and help them to connect with supports and services as they are united with their family or environment The Program demonstrates the goal to protect youth through a classification system that ensures the most appropriate unit assignment and sleeping room assignment. Revised August

10 The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: Shelter and clinical staff use a variety of screenings and assessments to facilitate classification and the youth's placement in a room. The screenings include an admission data sheet, medical consent sheet, childern in needs (CINS) risk factors, the youth's demographics, brief family assessment measures III (FAMII), psychosocial assessment, and assessment of alcohol, tobacco and other drugs ( ATOD) Management takes appropriate action to ensure the shelter s environment is clean, neat, and well maintained. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: A tour of the shelter, non residential offices and grounds found them to be exceptually clean and well taken care of. The youth rooms in the shelter have been fitted with high impact resistant siding to prevent damage and there were no marks or damage to the rooms. The rooms are painted in different colors making them colorfull and individualized. There are fittings in place on the exterior walls to install hurricane resistant siding to make the facility safe up to 150 mile in hour winds. The recreation area and surrounding grounds were clean of debris. There was a small pond in the front of the facility and a observation deck that although showed some age was well taken care of and safe The program provides youth with clear, accessible, and fair avenues for lodging and resolving complaints and grievances, including the opportunity to appeal decisions The program has a behavior management strategy that is designed to not only gain compliance with program rules, but to change the behavior of the youth and increase accountability. This strategy is critical to the program s effectiveness in reducing recidivism. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: The program handbook provides a detailed description of the behavior management system to assist the youth in a successful experience while in the shelter. Interviews with youth and staff indicated that they are well trained on the behavior management system and it was integrated into their daily activities. Youth interviews indicated that it was straight foward system that was easy to follow. Points are awarded for appropriate behaviors and these points can be redeemed for personal items at the point's store. Revised August

11 3.05 Behavioral interventions utilize the least amount of force necessary to address the situation and basic rights of youth are not violated Adequate staffing is provided to ensure the safety and security of youth and staff. P The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: Staff to youth ratios consistantly exceeded the required supervision requirements. A review of fifteen-minute bed checks for three different days found when checked against a clock, the checks were conducted every ten-minutes. Youth stated that they felt safe in the shelter at all times The facility provides a higher level of security for staff secures youth. Strategies should be in place, which work to reduce runaway incidents. The program s policy, procedure, and practice confirm the requirements of the indicator were not applicable for this program. NA 3.08 Special diets are provided to youth as prescribed by appropriate medical or dental personnel or when religious beliefs require the adherence to religious laws Provisions are taken to ensure effective implementation of the National School Lunch and Breakfast Program. The program s policy, procedure, and practice confirm the requirements of the indicator were not applicable for this program. NA External Control Factors None STANDARD FOUR: HEALTH, MENTAL HEALTH, AND SUBSTANCE ABUSE SERVICES Overview: The shelter currently has two full-time residential youth counselors and a licensed mental health counselor (LMHC) who serves as the Clinical Advisor. The Clinical Advisor role is new to the program, as previously supervision was provided via a contract with an external licensed professional. The Clinical Advisor is still in a transition phase with the program, as this role has only been utilized since April The youth counselors provide screening and assessment for youth entering the shelter, and this includes screening for suicide risk, conducting psychosocial assessments, and administering standardized instruments such as the brief Family Assessment Measure III (FAM III). Revised August

12 4.01 Youth Are screened for health related conditions at the time of admission to ensure to the fullest extent possible, the youth has no health or medical conditions that require immediate action. P 4.02 The mental health and substance abuse needs of youth are identified through a comprehensive screening process completed during admission that ensures referrals are made when youth have identified mental health and/or substance abuse needs or are identified as a possible suicide risk. P 4.03 The program has a system in place to safely assess and protect youth with elevated risk of suicide in the least restrictive means possible. An alert system is in place to facilitate information dissemination to staff. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: For one youth who required two additional screenings for level of potential suicidal behaviors using the Evaluation of Imminent Danger of Suicide (EIDS), found in both instances there were not enough risk factors to require further assessment of suicide risk. The licensed professional, however, in both instances for this youth reviewed the EIDS within twenty-four hours. One youth required the need for further assessment due to expression of suicidal ideation. As there was the chance of imminent danger, the program enacted its external referral process and Panama City Police Department was contacted for a possible Baker Act evaluation and commitment. A review of client file, program logbook, and video surveillance, demonstrated that staff responded in a highly efficient manner, and followed all requirements for reporting and placing the youth on constant supervision. Additionally, the on-call counselor arrived at the program to support the youth prior to the police arriving at the shelter and being taken to the mental health facility The program has a written plan, which outlines mental health and substance abuse emergency procedures There is a comprehensive system in place for medication management. This system includes all aspects of medications, including receipt and storage, inventories, administration, documentation and disposal A medical and mental health alert system is in place that ensures that information concerning a youth s medical condition, allergies, common side effects of prescribed medications, foods, and medications that are Revised August

13 P contraindicated, or other pertinent treatment information is communicated to staff. The program consistently met and a majority of the time exceeded the requirements of the indicator with either an innovative approach or an exceptional performance that was efficient, effective, and readily apparent, as evidenced by, but not limited to the following: The program utilizes a dot system for potential alerts. There are three colors that correspond to each alert (red for mental health/suicide risk, yellow for medical alerts, and green for flight risk/history of running). The dots are placed next to the youth name on the staff board, as well as on youth files, and in the cafeteria (for youth with special diet needs). Interviews with staff indicate a comprehensive knowledge of this system and a belief that it is an efficient method of communication. In addition to the dot system, the residential youth counselor, following intake, make a detailed entry into the facility logbook. This entry is exceptionally thorough and includes previous mental health diagnoses, suicide risk (and history of ideation or gestures), relevant issues/reasons for placement, medical concerns and history, medications, and notation of history of inappropriate behaviors or running The facility has a comprehensive process for the provision of emergency care. External Control Factors None PICTURE(S) OF THE FACILITY COMMENTS ON PICTURE(S) Photo of Hidle House. Revised August

14 BUREAU OF QUALITY ASSURANCE DEEMED REVIEW ADDENDUM Program Name: Hidle House QA Program Code: 36 Program Type: CINS/FINS Contract Number: V2021 Provider Name: Anchorage Children's Home Number of Beds/Slots: 20 County/Circuit #: Bay/14 Lead Reviewer Code: 112 Original Review Date(s): September 1-3, 2009 Deemed Review Date: September 2, 2010 Review Team The wishes to thank the following review team members for their participation in this review, and for promoting continuous improvement and accountability in juvenile justice programs and services in Florida: William Hardy, Lead Reviewer, DJJ Bruce Morton, Review Specialist, DJJ Dennis Massey, Circuit 14, Juvenile Probation Officer Summary This deemed review was conducted in accordance with F.A.C. 63L-2.011(4,6) (6/10/10 Hearing Draft). Anchorage Children s Home operates Hidle House, which is a safe haven shelter that provides 24-hour services for runaway, homeless or abused youth ages years old. This facility provides residential, outreach, transitional living, as well as counseling services. Hidle House attempts to provide the flexibility necessary to promote normalcy and independent living through activities that encourage and support, employment, dating, service learning, life skills assessment and planning, extra-curricular activities, etc. A quality assurance review was conducted on September 1-3, 2009, at which time the program received a commendable score placing, the program in Deemed Status with the Department of Juvenile Justice. This Quality Assurance Deemed review was conducted on September 2, 2010, in order to determine if the program is continuing to maintain an acceptable level of performance in nine (9) key areas, which addressed areas such as background screening, training, psychological assessments, case/service plans, counseling services, healthcare admission screening, suicide prevention, medications, and medical/mental health alert process. The (QA) uses a three (3) tier process in order to thoroughly and accurately assess programs. This process includes observations of the youth and staff while at the program, formal and informal surveys/interviews with staff and youth, and review of documentation with candid and open dialog with the program staff. Several staff training files, three youth shelter and other pertinent items that were relevant to the completion of the review were evaluated. A review of several employees for background screenings revealed that two (2) five-year rescreenings were not completed as required. One (1) of which was completed thirteen (13) months and the other three (3) months after the required time frame. The program submitted documentation to explain the tardiness for the re-screening and showed a good faith effort to complete the screenings on time. All other screenings were completed as required. The Florida Deemed Review Addendum Page 1 of 2

15 Annual Affidavit of Good Moral Character was sent to the Department as required within the appropriate timeframe. A review of three (3) staff files for pre-service training and three (3) for annual training revealed that all had completed the required trainings. After reviewing three (3) shelter files, the program completed psychological assessments on all youth. A review of the case/service plans found a lack of youth participation in one (1) of the files, in that, documentation showed no youth signature in three (3) of the service plan followups. Review of another case/service plan found a youth that had been identified with gang affiliation in the initial assessment, but there was no documentation indicating that this issue was ever addressed in the service plan. A review of three (3) shelter files found that all youth received a healthcare screening on the day of arrival. All chronic or acute conditions were identified along with supporting documentation from the parent/guardian. There were no youth identified with any of the chronic medical conditions listed in the DJJ Health Services Manual, however in one (1) file, Attention Deficit Hyperactivity Disorder (ADHD) was listed as a chronic condition. The program is using a colored dot system on the youth s record to identify any medical, mental health or behavioral conditions that staff members need to be aware. A Red dot is used for any youth with a mental health diagnosis, suicidal and/or homicidal ideation or a history of inappropriate behaviors. A Yellow dot is for youth with a medical condition and a Green dot is for a youth with a history of running. Findings As a result of this deemed review, the review team determined that the program: would receive an overall program performance rating of at least Acceptable on a regular review. Accordingly, the program RETAINS DEEMED STATUS. would not receive an overall program performance rating of at least Acceptable on a regular review. Accordingly, DEEMED STATUS IS REVOKED, and a regular review will be conducted within 90 days. Florida Deemed Review Addendum Page 2 of 2