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122 <br />• <br />e <br />• <br />R Du RI IAM <br />Durham SOC Care Review <br />LEVELS OF RESIDENTIAL CARE <br />Appendix 3 <br />LEVEL IV <br />Children who are appropriate for this service may have the following behaviors: <br />1. Refusal to follow directions and conform to structure of school, home or community <br />2. Constant, and frequently violent arguments with caretakers, peers, siblings and/or <br />teachers <br />3. Severe level of self-injurious behavior, risk taking, sexual promiscuity <br />4. Frequent suicidal actions/history of multiple, serious suicidal actions <br />5. Daily physical altercations in school, home or community <br />6. Constant verbally aggressive and provocative language <br />7. Frequent and severe property damage <br />8. Probable legal system involvement <br />9. Frequent school suspensions or expulsion <br />10. High risk for sexually victimizing others <br />11. May be related to the presence of severe affective, cognitive or developmental <br />delays/ disabilities <br />Child is in need of: <br />A higher level of supervision and structure than can be provided in a level 3 facility. <br />Supervision by awake staff during times when the child is sleeping in order to maintain <br />the child. <br />- A facility that is "physically secure". There are locks and the child needs a high level of <br />constant supervision to be maintained within the treatment facility A higher level of clinical <br />intervention than in a level III facility. <br />- The use of a time out room. <br />- The possible use of seclusion and/or restraint to control aggressive or self-injurious <br />behaviors. <br />The child is not at all accepting of the treatment process and requires the security of a <br />locked facility to begin the treatment process. The Child may have a history of elopement <br />from treatment facilities. The child's educational needs must also be met in a secure setting <br />provided by the residential provider. <br />Typically, the treatment (psychiatric, psychological, medical, vocational, recreational, <br />educational) needs of consumers at this level are so extreme that these activities can only be <br />undertaken in a therapeutic context. These services are conducted in a manner that is fully <br />integrated into ongoing treatment. <br />Page 3 <br />