1. (a) The provider shall comply with sections He-C 6339.01 through He-C 6339.15 for certification compliance.
2. (b) Authorization for payment for child health support services shall be pursuant to a court order, or a non-court ordered or voluntary agreement between DCYF and the family.
3. (c) A provider shall not provide services that exceed 90 days per year without prior approval from the CPSW or JPPO.

4. (d) Service for an additional 90 days per year shall be authorized when the following conditions are met:

   1. (1) The family’s problems have not been resolved and the child remains at risk for out-of-home placement;
   2. (2) The provider has discussed a continuation of services with family members and the CPSW or JPPO; and

   3. (3) The provider submits the following information in writing to the CPSW or JPPO:

      1. a. The reason(s) for continued services;
      2. b. The beginning and ending dates for continued services;
      3. c. The goals for the continued period of services; and
      4. d. The anticipated child and family outcomes.

5. (e) Child health support services shall be provided for the following:

   1. (1) Families at risk of having a child removed from the home due to maltreatment;
   2. (2) Young parents, including teen parents and others who are inexperienced and struggling with their parental responsibilities;
   3. (3) Socially isolated families who lack appropriate parenting role models and access to supportive services;
   4. (4) Families in which ineffective child management techniques are being employed and children who may be withdrawn or depressed, aggressive, delinquent, anxious, or display self-destructive behaviors;
   5. (5) Families where the parents are in the home, but temporarily are unable to effectively carry out parenting functions because of physical or mental illness, disabilities, convalescence, substance abuse, or complications of pregnancy;
   6. (6) Families in which the parents’ ability to effectively parent their children is diminished due to a preoccupation with the care of other family members, such as a spouse, child, or a grandparent who is chronically ill, convalescing, or permanently disabled, or when a parent has a prolonged grief reaction over the death of a spouse, child, or other person;
   7. (7) Families in need of help to learn how to care for children due to lack of knowledge, emotional immaturity, or overwhelming responsibility for many children;
   8. (8) Families headed by grandparents or other relatives who are overwhelmed with the responsibilities of parenting, thereby placing the child at risk of placement in another home;
   9. (9) Families in which the child has been placed out of the home on a temporary basis and the parents need therapeutic intervention to prepare for the return of the child, including help with issues such as appropriate parenting, child management techniques, discipline, communication skills, and anger management, as well as safety of the physical home environment;
   10. (10) Families who need therapeutic intervention to avert future neglect, abuse, delinquency, status offenses, emotional disturbances, and out-of-home placement of a child;
   11. (11) Families who provide foster care who require additional assistance in order to preserve the placement; and
   12. (12) Adoptive families to preserve the family unit.

6. (f) Child health support services shall include:

   1. (1) An initial health and behavioral health assessment, including the following;

      1. a. The health status of each family member;
      2. b. A behavioral health diagnosis and treatment received;
      3. c. The prescription medications of each family member; and
      4. d. The needs of the children and parents;
   2. (2) Addiction recovery support that includes ongoing risk assessment and referral for substance abuse treatment, as well as supportive counseling for those in addiction treatment programs to reduce the effects these addictions have on parenting abilities;
   3. (3) Family-based support that includes education, consultation, and follow-up activities that develop and maintain family support systems to enhance and encourage parental coping and nurturing skills, assessment of parent and child interaction, family counseling and skill building for parents and their children who are in an out-of-home placement, and parenting skills instruction, including role modeling;

   4. (4) Behavior management that includes:

      1. a. An initial behavioral health assessment of the family;
      2. b. Assistance with the development and implementation of behavior strategies for the children and parents in conjunction with child development, including managing the child’s behavior through appropriate discipline;
      3. c. Education and parenting skills to inform and prepare parents for a child’s behaviors and needs, including age appropriate socialization skills of the child;
      4. d. Family support focused on coping skills, stress management, conflict resolution, and impulse control; and
      5. e. Support family and modeling behavioral strategies;
   5. (5) An assessment of the family’s home health care management and education of physical or behavioral illnesses, as well as providing assistance to parents in implementing medical regimes as they relate to their tasks of daily living as prescribed by their medical and behavioral health provider;
   6. (6) Family support with household management that includes safety instruction to eliminate, reduce, or avoid hazards in the home;
   7. (7) Family support with nutritional education that includes safe food handling procedures and dietary needs of children and family;
   8. (8) Connections and facility referrals to community resources and supports that includes instruction, and assistance with accessing community agencies and services; and
   9. (9) Parent education about age appropriate activities, discipline and behavior modification including supervised visitation between parent(s) and children, as ordered by the court.

7. (g) A provider for child health support services shall:

   1. (1) Review the DCYF case plan;
   2. (2) Complete an initial behavioral health needs assessment for the family and using information from the DCYF case plan develop a treatment plan within 30 days of the referral;
   3. (3) Provide a completed treatment plan to the CPSW or JPPO within 30 days of referral;

   4. (4) The agency shall document each family visit, including:

      1. a. The type of service;

      2. b. The date of service;

         c The names of the family members and other individuals who participated;

      3. d. The name of the agency staff who assisted the family;
      4. e. A brief summary of the in-home session;
      5. f. The length of time spent with the family; and
      6. g. The provider’s signature and the signature of a family member and child, as is age appropriate;
   5. (5) Retain a copy of the log of visits and contacts in the family’s file for review during the onsite visits;
   6. (6) Attend case planning or treatment-planning meetings with the family as requested by the CPSW or JPPO;
   7. (7) Discuss discharge planning needs with the family members and the CPSW or JPPO;
   8. (8) Discuss the reason for service termination with the family and CPSW or JPPO;

   9. (9) Immediately notify the CPSW or JPPO of any significant changes in or affecting the family, such as:

      1. a. Changes in employment or income;
      2. b. Housing changes including eviction notice;
      3. c. Death or serious injury or illness of a family member;
      4. d. Separation of the caregivers;
      5. e. Unplanned pregnancy;
      6. f. Changes in patterns of school attendance;
      7. g. Arrests;
      8. h. Police contacts; or
      9. i. Probation or parole violations;
   10. (10) Provide each family with a written description of services, as described in He-C 6339.14 including the cost of the service and potential reimbursement by the family to the DHHS for the services provided;
   11. (11) Employ staff that provides evening, weekend, and holiday coverage to meet the needs of the family;
   12. (12) Employ child health support aides in sufficient number to maintain a 1:6 average aide-to-family caseload ratio; not to exceed 1:9;
   13. (13) Provide child health support aides with agency identification; and
   14. (14) Have an agency policy in place regarding missed appointments by client families.
8. (h) The agency shall employ or contract with a prescribing practitioner.
9. (i) The agency shall employ or contract with a program consultant who is available for consultation with child health support aides.

10. (j) The program consultant referenced in (i) above shall meet one of the following:

    1. (1) For cases when the primary issue is physical health, a physician, physician assistant, advanced registered nurse practitioner (ARNP), registered nurse (RN), or licensed practical nurse (LPN); and
    2. (2) For cases when the primary issue is behavioral health, licensed psychologist, licensed pastoral psychotherapist, licensed clinical social worker, licensed clinical mental health counselor, or licensed marriage and family therapist.

11. (k) The prescribing practitioner servicing as the program consultant shall:

    1. (1) Sign each treatment plan separately as both the prescribing practitioner and program consultant; and
    2. (2) Meet the definition of prescribing practitioner.
12. (l) The program consultant shall review the treatment plan no less than quarterly and document the review by signing and dating the treatment plan.

13. (m) The agency shall employ child health support aides who:

    1. (1) Are at least 22 years of age; and

    2. (2) Possess:

       1. a. A bachelor’s degree from an accredited college or university with a major study in nursing, health, psychology, social work, sociology, education, guidance, or a related field emphasizing human relations, physical, or behavioral health;
       2. b. An associate’s degree from an accredited college or university with a major study in nursing, health, psychology, social work, sociology, education, guidance, or a related field emphasizing human relations, physical, or behavioral health and have 2 years’ experience working with families or other relevant human services experience; or
       3. c. A high school diploma or general equivalency diploma and have 4 years experience working with families or other relevant human services experience.

14. (n) In addition to the requirements in (m) above, all child health support aides shall:

    1. (1) Complete a minimum of 20 hours per year of in-service training, as follows:

       1. a. At least 8 of the 20 hours shall be family systems training; and

       2. b. 12 hours of the overall training hours may be provided in supervision and staff meetings that relate to general therapeutic topics such as:

          1. 1. Substance use disorders:
          2. 2. Child abuse and neglect;
          3. 3. Labor and sex trafficking;
          4. 4. Sexual abuse;
          5. 5. Domestic and family violence;
          6. 6. Behavioral health needs of children and families;
          7. 7. Safety planning for family members;
          8. 8. Crisis intervention techniques;
          9. 9. Early childhood screening and child development;
          10. 10. Trauma informed practice, including screening and evidence-based practices;
          11. 11. Treatment of any co-occurring disorders;
          12. 12. Restorative practices and delinquency prevention;
          13. 13. Behavioral management techniques; and
          14. 14. Infant safe sleeping practices.

15. (o) The agency shall maintain documentation of training that includes:

    1. a. The dates of training;
    2. b. The names of training sessions attended; and
    3. c. The number of hours per training.

16. (p) Child health support aides shall:

    1. (1) Be available for immediate contact so appointments may be scheduled or canceled; and
    2. (2) Carry and present agency identification to the child’s caregiver as necessary.
17. (q) The program supervisor shall provide a minimum of one hour per week of individual clinical supervision for a the child health support aide working full time and pro-rated for part time staff to review the progress and barriers of each case, for which one session per month may be substituted with group supervision.
18. (r) The agency shall complete annual staff evaluations.

19. (s) Within 15 days after service termination, the agency shall forward a report to the CPSW, JPPO or his or her supervisor, that includes:

    1. (1) A summary of visits and contacts with the family, including dates, duration, and locations;
    2. (2) A summary of the progress or lack of progress in meeting the treatment plan, including the tasks accomplished, timeframes, and measurable outcomes achieved;
    3. (3) New information about the family that changes or updates the DCYF case plan, pre-dispositional investigation, or court report;
    4. (4) The community resources and supports available to the family that might be accessed in the future;
    5. (5) Recommendation for ongoing services, including a description of additional progress by parents that is essential to address the needs of each child as specified in the treatment plan and how the provider has worked with the family to assist them in accessing recommended services; and
    6. (6) The dated and signature of the child health support aide and prescribing practitioner;
20. (t) If services are terminated prior to the 15th day of the month, no monthly progress report shall be required for the month. The information for the month in which services are terminated shall be included in a discharge report.

Source. (See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08; ss by #11180, INTERIM, eff 9-19-16, EXPIRES: 3-18-17; ss by #12136, eff 3-18-17