Standards for public agencies

2020 Edition

Residential Treatment Services (PA-RTX) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of residents and their families.


Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
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
  • Table of contents of training curricula
  • Sample job descriptions from across relevant job categories
  • Documentation tracking staff completion of required trainings and/or competencies
  • Training curricula
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files


PA-RTX 2.01

Residential counselors, youth workers, adult care, and child care workers have:
  1. a bachelor’s degree or are actively, continuously pursuing the degree;
  2. the personal characteristics and experience to collaborate with and provide appropriate care to residents, gain their respect, guide their development, and participate in their overall treatment program;
  3. the ability to support constructive resident-family visitation and resident involvement in community activities;
  4. the temperament to work with, and care for, children, youth, adults, or families with special needs, as appropriate; and
  5. the ability to work effectively with the treatment team and other internal and external stakeholders.


The elements of the standard will be considered together to assess implementation. Recruitment of staff with demonstrated competence and with appropriate supervision and specialized training – sometimes available through national certification programs – can compensate for a lack of a bachelor’s degree.
Examples: Experience per element (b) can include lived experience as residential programs can have peer support specialists, youth advocates, mentors, and/or family advocates on staff.


PA-RTX 2.02

Supervisors of direct service personnel are qualified by: 
  1. an advanced degree in social work or a comparable human service field and two years of relevant experience; or
  2. a bachelor’s degree in social work or a comparable human service field and four or more years of relevant experience.

Fundamental Practice

PA-RTX 2.03

A physician or other qualified medical practitioner familiar with the needs of the resident population assumes 24-hour on-call medical oversight to ensure that residents’ health needs are identified and promptly addressed.


The physician can provide services as an employee, contractor, or through another formal arrangement. There may be more than one physician fulfilling the role.


COA recognizes that geographic placement and resources can pose barriers. The use of an emergency room or urgent care facility is acceptable for overnight hours when protocols are established. Agencies can also leverage alternative service delivery methods such as telehealth when regional shortages of certain professional groups make in-person consultation impractical.
NA All residents have private physicians.

Fundamental Practice

PA-RTX 2.04

A licensed psychiatrist with experience appropriate to the level and intensity of service and the population served is responsible for:
  1. developing guidelines for participation in services;
  2. providing psychiatric services, as applicable; and
  3. providing full-time coverage on an on-call basis 24 hours a day, seven days a week.


The psychiatrist can provide services as an employee, contractor, or through another formal arrangement. There may be more than one psychiatrist fulfilling the duties outlined. Residential treatment programs whose primary service is residential substance use treatment are not required to have full-time psychiatric coverage, but may provide psychiatric services though a formal referral arrangement on an as-needed basis.


In situations where a psychiatrist is not available to assume psychiatric responsibility for residents, the agency can receive a rating of 2 if they have an advanced practice registered nurse (APRN) supervised by a physician.


PA-RTX 2.05

Qualified professionals and specialists are available to provide services and support depending on the program model, population served, and specialized care needs.
Examples: Examples of services and providers that may be on staff, or available through a formal arrangement, include:
  1. mental health;
  2. substance use;
  3. crisis intervention;
  4. medicine and dentistry;
  5. psychological services, such as testing and evaluation;
  6. prenatal and postnatal care, and the developmental needs of children;
  7. prenatal and postpartum depression screenings and care;
  8. nursing;
  9. education and vocational skill development;
  10. physical and developmental disabilities;
  11. speech, occupational and physical therapy;
  12. recreation and expressive therapy;
  13. nutrition; and/or
  14. religion and spirituality.

Examples: Examples of populations with specialized care needs include, but are not limited to:
  1. older adults;
  2. children and youth with pervasive developmental disorders;
  3. children and youth who engage in fire setting;
  4. individuals who exhibit sexually reactive behavior;
  5. victims of physical, psychological or sexual abuse;
  6. LGBTQ population, especially those with gender identity issues;
  7. individuals with eating disorders; and
  8. individuals who have trouble communicating or being understood without special assistance.

Fundamental Practice

PA-RTX 2.06

There is at least one person certified in basic first aid and CPR on duty at each program site, at any time the program is in operation.


PA-RTX 2.07

All direct service personnel are trained on, or demonstrate competency in:
  1. assessing needs in crisis situations;
  2. understanding special issues regarding age, gender identity/crisis, substance use and mental health conditions, developmental disabilities, and other needs typically presented by the service population;
  3. understanding the definitions of human trafficking (both labor and sex trafficking) and sexual exploitation, and identifying potential victims;
  4. procedures for responding to residents who run away;
  5. interventions for addressing the acute needs of victims of trauma; and
  6. collaborating with local law enforcement.


PA-RTX 2.08

Caseloads support the achievement of client outcomes, are regularly reviewed, and generally do not exceed 12 residents.


Personnel who carry a caseload include the residential treatment center's milieu counselors, case managers, and/or child, youth, or adult care workers.
Examples: Factors that may be considered when determining caseloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. case complexity and residents’ special circumstances;
  3. age, gender, and population characteristics;
  4. case status and progress toward achievement of desired outcomes;
  5. the work and time required to accomplish assigned tasks and job responsibilities; and
  6. service volume.