Standards for public agencies

2020 Edition

Residential Treatment Services (PA-RTX) 8: Coordinated, Individualized Team Approach

Team members are aligned in implementing a structured, individualized therapeutic program in collaboration with residents and families to ensure that residents’ daily living experiences are well integrated and promote the development of positive skills and behaviors.
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
  • Care coordination procedures
  • Case assignment procedures
  • Procedures for involving residents in decision making
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents and their families
  • Review case records


PA-RTX 8.01

In collaboration with the resident and their family, an interdisciplinary team:
  1. coordinates, monitors, and, when necessary, advocates for services tailored to the needs of individual residents; and
  2. makes decisions regarding service planning and delivery.
Examples: For example, service decisions made in partnership with the resident may include:
  1. the need for additional assessments;
  2. determining the appropriate level of care;
  3. obtaining access to the full array of services to which they are eligible;
  4. mediating barriers in the service delivery system;
  5. the need for family services to resolve concerns that will otherwise extend the resident’s stay;
  6. planning for transition and case closing; and
  7. necessary follow-up services.
Note: Interdisciplinary program elements are discussed in PA-RTX 9.01.


PA-RTX 8.02

Interdisciplinary teamwork:
  1. encourages resident participation in treatment team meetings;
  2. specifies the intended result of daily living experiences, activities, and interventions in the service plan;
  3. engages residents in developmentally-appropriate, trauma-informed, culturally sensitive activities and interactions designed to alter or improve behavior, provide support, and promote healthy development and return to their community;
  4. provides opportunities for participation by one or more consistent caring adults, taking into account the resident’s strengths and interests; and
  5. coordinates therapeutic and educational and/or vocational activities with individual service and skill development plans.


PA-RTX 8.03

A coordinated team approach promotes a stable, ongoing, goal-directed caseworker-resident relationship and minimizes the need for multiple case managers assigned to the individual or family.


Central coordination of services is one of the most important aspects of care for victims of human trafficking. It provides the opportunity to develop an important, consistent connection with the staff person while the complex myriad of needed services are accessed and coordinated.
Examples: Agencies can streamline and coordinate services and goals by:
  1. assigning a worker at intake or early in the contact;
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel;
  3. identifying overlapping responsibilities and tasks;
  4. clarifying roles; and
  5. establishing guidelines and procedures that ensure collaboration across systems.


PA-RTX 8.04

Residents are given the opportunity for voice and choice relating to their treatment and program activities, as well as to share feedback including dissatisfaction with aspects of care.
Examples: The establishment of resident councils is one way to involve residents in all aspects of care and ensure that they have an opportunity to provide feedback on staff, activities, rules, food, their overall experience, sense of safety and support, and the living environment. This type of activity can also provide opportunities for peer advocacy, self-advocacy, and leadership. For programs serving for youth, family advisory councils can be established to involve families in the governance of the program.