Standards for private organizations

2020 Edition

Residential Treatment Services (RTX) 10: Healthcare Services

Residents receive comprehensive healthcare services to promote optimal physical, emotional, and developmental health.
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.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Initial health screening procedures
  • Procedures for the coordination and provision of healthcare and dental examinations and services
  • Informational health and wellness materials
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

Fundamental Practice

RTX 10.01

An initial health screening is conducted by a qualified medical practitioner for all residents within 24 hours of admission to identify the need for immediate medical care and assess for communicable disease.


Qualified medical practitioner refers to a licensed physician, registered nurse, nurse practitioner, physician’s assistant, or other healthcare professional that is permitted by law and the organization to provide medical care and services without direction or supervision. For the purposes of this standard, qualified medical practitioners are distinct from other clinicians who are not permitted by law to provide medical care and services without direction or supervision (e.g., clinical social workers, licensed vocational/practical nurses, and medical assistants). To meet the standard, the initial medical screening must be administered by a qualified medical practitioner.

If the organization does not have a qualified medical practitioner on staff, it should research community resources and consider creating a formal arrangement or a memorandum of understanding (MOU) with a local physicians group, local health department, federally-qualified health center, urgent care clinic, community-based health clinic, or telehealth providers.

When possible, the screening should be performed by the resident’s primary care physician who has knowledge of the resident’s medical history or a physician that can serve as the resident’s medical home while in care. For children in care, the local child welfare agency may be responsible for ensuring the initial health screening is completed or may assist the organization to identify possible medical resources.


When a resident returns following a runaway episode, a health screen should be conducted within 24 hours of entry back into care to identify whether he or she was victimized or otherwise hurt or injured while on the run.


In situations where the resident is unable to receive an initial health screening by a qualified medical practitioner within 24 hours, the organization can receive a rating of 2 if it has procedures in place for accommodating exceptional circumstances and is able to provide evidence that the screening occurred within 72 hours of admission. Examples of exceptional circumstances include, but are not limited to:
  1. weekend placements; and
  2. when a client is transferring from the care of a public agency that has arranged for an initial health screening to be conducted within 72 hours of admission to the program.
Examples: Conditions that require immediate or prompt medical attention include, but are not limited to: signs of abuse or neglect, serious or accidental injury, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances.

Fundamental Practice

RTX 10.02

Every resident receives:
  1. a comprehensive medical examination within five days after admission, unless the resident has received a medical exam within the last year, and annually thereafter; and
  2. a dental examination within six months prior to or one month after admission, with appropriate follow-up thereafter.


When records from the most recent medical and dental examinations are unavailable, or examinations are incomplete, the organization must ensure that examinations are completed within the required timeframes.


The purpose of the medical examination is to identify and assess medical, developmental, and mental health conditions that require treatment, additional evaluation, and/or referrals to other healthcare professionals or specialists. The examination must be comprehensive, build on history gathered during the initial medical screening, and focus on specific assessments that are appropriate to the individual’s age and developmental level. Findings from the exam should be used to develop individualized treatment plans, as well as inform follow-up assessments and services.


In situations where resources are not available for preventive dental care to occur every six months, the organization can receive a rating of 2 if there is an annual preventive exam and evidence that recommendations from the dental practitioner indicate the child is not in need of more frequent care. Children with dental issues or at high risk of dental problems must be receiving the care they need. Families should be engaged in the process and solution for getting their child the needed dental care.
NA The organization only operates a crisis stabilization unit or a short-term diagnostic center.

Fundamental Practice

RTX 10.03

The organization provides needed health services directly or by referral, and:
  1. retains documentation of the resident’s and his or her family’s known medical history, including immunizations, operations, medications, and medical conditions and illnesses; and
  2. provides the information to the resident and/or his or her legal guardian upon request.

Fundamental Practice

RTX 10.04

To promote their ability to maintain positive health practices, youth receive appropriate support and education regarding:
  1. proper nutrition and exercise;
  2. personal hygiene;
  3. substance use and smoking;
  4. sexual development;
  5. safe and healthy relationships;
  6. family planning and pregnancy options;
  7. pregnancy, prenatal care, and effective parenting; and
  8. prevention and treatment of diseases, including sexually transmitted infections/diseases and HIV/AIDS.
NA The organization only operates a crisis stabilization unit, short-term diagnostic center, or detoxification program.


RTX 10.05

The organization provides or arranges specialized health services to meet the needs of the service population, as appropriate.
Examples: Specialized health services may be needed by older adults, pregnant and parenting individuals, individuals with eating disorders, individuals with substance-use related conditions, or children with autism and pervasive developmental disorders. These services may include, for example:
  1. tobacco cessation programs;
  2. fetal alcohol syndrome screening;
  3. speech, language, and occupational therapy;
  4. prenatal care, well-baby care, and accessing child and infant health insurance programs;
  5. gender identity counseling; and
  6. screening for the onset of or existence of common cancers.