Standards for public agencies

2020 Edition

Residential Treatment Services (PA-RTX) 18: Care and Supervision

The agency provides 24-hour-a-day care and supervision that is respectful, supportive, and tailored to each resident’s developmental, educational, clinical, and safety needs and attentive to effects of congregate living.
2020 Edition




Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behavior, improve functioning and well-being, and return to a stable living arrangement in the community.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Resident/personnel care and supervision ratios
  • Supervision and scheduling criteria
  • Procedures for preventing and responding to missing and runaway children
  • Educational or training materials provided to residents for skills development
  • Resident/personnel care and supervision coverage schedules for the previous six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

Fundamental Practice

PA-RTX 18.01

Adults that provide direct care and supervision offer residents:
  1. nurturance, structure, support, respect, and active involvement;
  2. services provided in a safe, secure environment that prohibits weapons and gang activity;
  3. consistent limit-setting;
  4. flexibility, when appropriate and in the resident’s best interest;
  5. guided practice to learn effective communication, positive social interaction, and problem solving skills; and
  6. education and skills training specific to risk-taking behaviors, including practice with decision making and anger management.
Examples: This approach can help to anticipate, prevent, and reduce the occurrence of bullying and other unsafe or negative peer interactions.

Examples: Regarding element (d), being flexible with codified rules that contradict a resident’s best interest can allow the agency to provide individualized care that is tailored to the resident’s needs. For example, being flexible with bedtimes for a resident who may have experienced nighttime trauma rather than strictly enforcing a lights out time allows the agency to be responsive to the needs of residents.

Fundamental Practice

PA-RTX 18.02

Resident care and supervision is provided by:
  1. personnel-to-participant ratios for day time and overnight hours that are appropriate to the program model, length of treatment, population served, and their age, developmental and clinical needs;
  2. a sufficient number of qualified personnel on-site that can respond to emergency/crisis situations and meet the special needs of residents during busy or more stressful periods;
  3. an on-call, professional clinical staff member available on a 24-hour basis;
  4. rotating after-hours and holiday coverage when needed; and
  5. same-gender and cross-gender supervision when indicated by individual treatment needs.


The agency must demonstrate that based on their program model and the population served their staffing ratios for day time and overnight coverage are addressing potential risks and meeting the needs of their clients. 


Regarding element (c) the professional clinical staff person is permitted to sleep during sleeping hours.


The agency may use direct care workers or counselors to provide supervision to residents. Personnel must be awake at all times unless convincing evidence demonstrates the resident group does not need awake supervision during sleeping hours. Examples of reasons certain homes or programs might not have awake personnel are: care for a long-term, stable population; majority of unit residents are ready to move to a less restrictive setting; low runaway rates; and low rates of night-time incidents. Electronic supervision is not an acceptable alternative to supervision by personnel.
Examples: National recommendations for the supervision of children in residential care is that there are no more than four children per worker during waking hours and no more than eight children per worker during overnight hours. Smaller ratios are recommended for intensive residential treatment programs and short-term diagnostic centers. Additionally, several sources indicate that improved outcomes, including better engagement and retention, are found in addiction treatment programs with low staffing ratios. For example, low staff to client ratios contribute to a high level of service and keeping clients involved in rehabilitation for longer periods which helps individuals reach their ultimate goal of overcoming addiction.
Note: Agencies must also meet state licensing requirements for care ratios.


PA-RTX 18.03

The agency establishes procedures for preventing and responding to missing and runaway children that address:
  1. creating an environment that provides a sense of safety, support, and community;
  2. identifying risks or triggers that may indicate likeliness to run away from programs;
  3. communication and reporting to relevant staff, authorities, and parents or legal guardians; and
  4. welcoming, screening, and debriefing when children return to the program.
NA The agency does not serve children or families with children.