Family Services, Dept. of

Providers of Substitute Care Services, Certification of

Chapter 6: Therapeutic Foster Care

Effective Date: 05/15/2013 to 11/08/2017

Rule Type: Superceded Rules & Regulations

Reference Number: 049.0029.6.05152013

ADMINISTRATIVE RULES FOR CERTIFICATION OF PROVIDERS OF

SUBSTITUTE CARE SERVICES FOR CHILDREN

CHAPTER 6

THERAPEUTIC FOSTER CARE PROGRAMS

Section 1. Program Specific Certification Standards.

(a) All TFC programs must comply with all sections of this Chapter and the following Chapters and Sections:

(i) Chapter 1: All

(ii) Chapter 2: All

(iii) Chapter 3: Sections 1 through 18, Sections 20 through 31, and 33 through 35.

Section 2. Program Description.

(a) Therapeutic Foster Care (TFC) programs (also known by Medicaid as Intensive Child Treatment Services) are operated by any entity that arranges for the placement or temporary care, maintenance, and supervision of children in a place other than the home of the their parents or relatives.

(b) A TFC must be a legal entity eligible to bill Medicaid.

(c) A TFC recruits, trains, approves and provides oversight for its own TFC foster homes.

(d) A TFC is a family-based, intensive treatment foster care program for severely emotionally disturbed (SED) youth.

Section 3. Maximum Capacity.

(a) A TFC home shall not house more than five (5) children, including the TFC foster parents’ own children.

(b) No more than two (2) infants under two (2) years of age shall be placed in one (1) TFC home, including the TFC foster parent’s own children.

(c) A TFC home can have no more than two (2) foster children in their care at one (1) time.

(d) The above guidelines must be observed at all times, including during the provision of respite.

(i) Exceptions (e.g., maintenance of family groupings) shall be approved on a case-by-case basis by the Administrator/Executive Director or designee and certifying authority.

Section 4. Program Personnel.

(a) A TFC program shall have, at a minimum, an Administrator/Executive Director, and sufficient staff to provide for all components of the ITPC, as described in Section 15 of this chapter, to include licensed, provisionally licensed and/or certified therapists (on staff or by contract) to direct the ITPC.

(b) Direct care shall be provided by TFC foster parents.

Section 5. Specialized Staff Training.

(a) TFC staff shall complete a twenty (20)-hour orientation program, as described in Chapter 3, Section 11.

(b) TFC staff shall complete twenty (20) hours of annual training, as described in Chapter 3, Section 11.

(c) TFC foster parents shall complete a twenty (20)-hour orientation program, as described in Chapter 3, Section 11, before they work directly with children in care.

(d) TFC foster parents shall complete twenty (20) hours of annual training, as described in Chapter 3, Section 11.

Section 6. Admissions Criteria.

(a) In order to qualify for placement in a TFC program, a child must have a Diagnostic and Statistical Manual (DSM) diagnosis and exhibit one (1) of the following conditions:

(i) Severe maladaptive or disruptive behavior as expressed in aggressive behavior toward others, aggression toward self through self-inflicting injuries, aggression toward animals or destruction of property. Other aggressive or self-destructive behaviors may include oppositional behavior, incorrigibility, running away behaviors, fire-setting behaviors, suicidal or homicidal gestures, or suicidal or homicidal ideation;

(ii) Severe psychiatric symptoms that affect the ability to perform activities of daily living. The child may be extremely impulsive and demonstrate limited ability to delay gratification. Social and emotional immaturity impairs their decision-making ability and places them at risk in the community. They may evidence psychiatric dysfunction (hallucinations or delusions or bizarre behaviors) that require the constant attention of a caretaker;

(iii) Severe emotional problems associated with medical conditions. Close monitoring and therapy are required due to the child/adolescent not adapting to recommended medical treatment;

(iv) Severe emotional problems associated with sexual and/or physical abuse, which lead the child to avoid adult relationships and be detached from others. The child may be preoccupied with sexual content, act out as a perpetrator or victim; and/or

(v) Severe emotional problems associated with substance abuse. Excessive use of drugs and/or alcohol creating the need for a structured environment, close monitoring, frequent counseling, medical visits, and a well coordinated network of support.

(vi) In addition to meeting the above conditions, children exhibiting the following behaviors may be appropriate for placement in a TFC program:

1. (A) Difficulty following directions;
2. (B) Frequent arguments with persons such as caretakers, siblings, teachers;
3. (C) Mild self-injurious behavior, risk taking, or sexual promiscuity;
4. (D) Frequent fights at home, school or community;
5. (E) Frequent verbally aggressive outbursts;
6. (F) Inability to engage in age appropriate activities without constant supervision (e.g., little league, scouts);
7. (G) Low to moderate risk for sexually victimizing others;
8. (H) Possible involvement with the juvenile justice system; and/or
9. (I) Infrequent school suspensions.

(b) The following are required within 14 days of admission to a TFC program:

(i) Initial diagnostic assessment;

(ii) Medical, psychiatric and substance use history;

(iii) Family and social assessment;

(iv) Child assets and strengths;

(v) Developmental history and current developmental functioning with respect to physical, psychological and social areas, including age appropriate adaptive functioning and social problem-solving;

(vi) Psycho-educational assessment;

(vii) An assessment of the need for psychological testing, neurological evaluation and speech, hearing and language evaluations;

(viii) A problem list, related to the reasons why the child was admitted to this level of care;

(ix) Identification of interventions for the immediate management of the problems identified in 8; and/or

(x) The treatment objectives (desired child responses) expected to be met by the time of the first continued stay review.

Section 7. TFC Foster Parent Requirements.

(a) The TFC program shall develop, adopt, follow and maintain on file written policies and procedures to recruit and approve TFC foster parents capable of providing quality services, while ensuring reasonable and adequate safeguards to children and their families.

(b) TFC foster parents shall be twenty-one (21) years of age or older.

Section 8. Home Study Process.

(a) All TFC programs shall complete and keep on file the following home study process prior to approving a TFC foster home:

(i) Conduct background checks on the prospective TFC foster parent(s) and any other adults residing in the home as set forth in Chapter 3, Section 10.

(ii) Check References. Five (5) positive references must be obtained for each prospective TFC foster parent:

(A) Three (3) non-relative references from persons who have known the applicant for at least two (2) years, and have a general knowledge about the applicant’s ability to care for children; and

(B) Two (2) relative references (e.g., parents, siblings) to assess family relationships and support the appropriateness of the applicant to provide foster care.

(iii) Review physician’s statement verifying prospective TFC foster parent(s) is physically, cognitively, and emotionally capable of providing care for the children;

(iv) TB testing as set forth in Chapter 3, Section 12.

(v) Five (5) or more interviews with the prospective TFC foster parent(s).

(A) Interview each prospective TFC foster parent and household member separately to:

(I) Obtain necessary biographical information; and

(II) Assess each family member’s attitude with regard to becoming a TFC foster family.

(B) Provide sufficient information to acquaint the family with the TFC program and its philosophies and practices; and

(C) Two (2) of the five (5) interviews shall be conducted at the family home with all family members present to assess:

(I) Family functioning; and

(II) How foster children will be included and integrated into the home.

(b) Health and Safety Inspection.

(i) The TFC program shall develop procedures to inspect and monitor every TFC foster home to ensure a safe and healthy environment for children.

(ii) The TFC program shall perform a safety and health inspection of the home addressing all items listed in Section 9 of this Chapter. Documentation of the

(c) Written Home Study.

(i) The written home study shall include documentation of all interviews and information gathered during home study process and shall also include:

(A) Date of interviews and home visits;

(B) Identifying information about all household members including relationship in the family;

(C) Physical and mental health assessment;

(D) Substance use history of family living in the home; and

(E) Motivation for becoming a TFC foster family;

(F) Social history and current functioning;

(G) Family of origin, composition, birth order, parents' marriages, separations, other children of prior relationships;

(H) Parenting;

(I) Family relationships;

(J) Employment and finances; and

(K) Recommendation of approval or disapproval and basis for recommendation.

Section 9. TFC Foster Home Health and Safety.

The TFC program shall develop procedures for the maintenance of a safe, hygienic, and sanitary environment and monitor adherence to procedures in order to protect the health, safety and welfare of the residents.

(a) The TFC program shall conduct and document in the TFC foster home file an annual health and safety inspection of the TFC foster home to ensure that the home meets the following health and safety requirements:

(i) Tobacco, Alcohol and Other Controlled Substances.

(A) The provider and/or TFC foster parent shall prohibit the use of all forms of tobacco, alcohol and other controlled substances by children.

(B) In all TFC foster homes:

(I) The TFC foster home shall maintain a smoke free environment. There shall be no smoking in any space connected to the home environment, to include but not limited to the garage, bathroom, or house;

(II) TFC foster parents shall ensure a smoke-free environment in all motor vehicles while transporting children;

(III) All forms of tobacco and alcohol shall be stored out of reach of children in a locked or inaccessible area;

(IV) TFC foster parents shall not engage in the excessive use of alcohol at any time they are in the presence of a foster children and will not operate a motor vehicle while transporting a foster children if any alcohol has been consumed; and

(V) If a child appears to be addicted to tobacco, alcohol and/or other controlled substances when entering the TFC foster home, the TFC foster parent(s) shall make it known to the TFC program, who shall investigate availability of treatment and offer the treatment to the foster child.

(C) All TFC foster parents shall prohibit all use of illegal drugs by anyone on the premises, in any vehicle used by children and in the presence of children.

(D) The TFC program shall offer referrals to tobacco cessation programs for child(ren), TFC foster parents and staff.

(ii) Animals. All TFC Foster Homes are required to comply with Chapter 3 Section 18 (c) in reference to animals.

(iii) Pest Control. Insect and rodent control measures shall be implemented as needed.

(iv) Indoor Space and Equipment:

(A) Porches, decks and stairs shall have sturdy railings.

(B) Open staircases shall have a child-safe gate if there are young children in the facility/home;

(C) Safeguards must be taken to protect small children from accidental contact with fireplaces, space heaters and other hot surfaces. The TFC foster parent shall ensure the safe disposal of ashes from coal or wood burning fireplace or stoves; and

(D) Unused electrical outlets shall have safety shields if there are young children placed in TFC foster home.

(v) Exterior Conditions.

(A) The overall condition of the buildings and grounds shall be maintained in a clean, uncluttered, sanitary and healthful manner;

(B) House numbers or addresses shall be plainly visible from the street;

(C) Home shall have at least two (2) exits; and

(D) Doors shall be operable from the inside without the use of a key or special effort.

(vi) Emergency Policy and Procedures.

(A) Smoke detectors. Underwriters Laboratory approved smoke detectors shall be installed on all floors of the TFC foster home and centrally located in the hall or area giving access to each sleeping area;

(B) A working fire extinguisher must be available in the TFC foster home;

(C) Every TFC foster home shall have a carbon monoxide detector following manufacturer's recommendations for placement;

(D) Fire exits shall be free of obstructions and accessible at all times;

(E) Windows in rooms designated as sleeping areas must be adequate for emergency escape or rescue; and

(F) Emergency Situations.

(I) Each TFC foster home shall have a written plan for action in case of emergencies (e.g., fire), natural disaster (e.g., earthquakes, floods, tornadoes, and severe weather), and missing children;

(II) The emergency plan of action shall be on file at the TFC Program;

(III) The plan of action shall include:

(1) Specific procedures for responding to the crisis;

(2) The procedure for reporting emergencies to both the TFC PROGRAM and parents and/or legal guardians;

(3) Procedures for relocation and evacuation of children; and

(4) Local, out-of-county and out-of-state emergency contact information, as applicable.

(IV) All household members must be familiar with the escape plan in the event of a fire.

(vii) Storage of Chemicals, Cleaning Solvents, Flammable and Combustible Materials, Poisons, Toxins.

(A) All poisonous and toxic materials shall be stored in a safe location that is inaccessible to young children; and

(B) Combustible and flammable materials and liquids shall be stored outside of main living areas, and shall not create a fire hazard.

(viii) There must be an operable phone available in the TFC foster home.

(ix) Emergency phone numbers and the TFC foster home’s address must be posted and accessible.

(x) The TFC foster parent(s) shall ensure that first aid kits are readily available and accessible in the TFC foster home.

(xi) Weapons/Firearms. All TFC Foster Homes are required to comply with Chapter 3 Section 18 (k) in reference to weapons/firearms.

Section 10. TFC Foster Home Certification and Re-certification.

(a) Approval/disapproval of TFC foster homes is the responsibility of the TFC program.

(b) No TFC foster parent shall be approved to provide care prior to completing the required orientation training.

(c) Careful consideration must be given to all information gathered throughout the application/home study process.

(d) TFC foster homes shall be certified to provide care for a specific number of children, based upon the ability of the TFC foster parents and the size of the TFC foster home, not to exceed two (2) placements and for a period not to exceed two (2) years. A copy of the certificate with the expiration date of the certification must be sent to the regional DFS foster care coordinator with documentation that the background checks have been completed for all of the TFC foster parents.

(e) TFC foster homes shall be reviewed on an annual basis and an in-home inspection must be completed and documented in the TFC foster home file.

(f) The annual review shall include an update of the original home study process and the following:

(i) Ensuring TB testing is current based on Wyoming Department of Health recommendations (http://www.health.wyo.gov/PHSD/tb/index.html);

(ii) Ensuring the TFC foster parents have eighteen (18) hours of annual training, including current in Infant/Child and Adult CPR and First Aid certification;

(iii) Updating the onsite inspection;

(iv) Documenting any changes in the family structure and verifying background checks have been completed prior to any new adult members joining the household; and

(v) Ensuring driver's license(s) and vehicle registration(s) requirements are current.

Section 11. Responsibilities of TFC Foster Parent(s).

(a) Successful fostering requires knowledge and skills beyond those of parenting one's own biological children.

(b) The TFC foster parents' role includes intentional, active involvement in advocating for, planning, and delivering services to meet the individual needs of a child who is not the TFC foster parents' child by birth or adoption, and may include involvement with the child's birth/adoptive parents. Therefore, TFC foster parents are to be considered full, participating members of the family foster care team.

(c) The responsibilities and contributions of the TFC foster parents include:

(i) Acquiring the specialized knowledge and skills to successfully foster a child;

(ii) Actively helping the child and, when appropriate, the child's birth/adoptive parents, to meet case goals;

(iii) Supporting the relationship between foster children and their birth/adoptive families;

(iv) Advocating for additional services needed by the child and, as appropriate, the child's birth/adoptive parents, for attainment of ITPC goals; and

(v) With the TFC treatment team, planning for permanency to connect children to safe and nurturing relationships intended to last a lifetime; and

(d) Required to immediately notify the TFC program as to any new adult proposing to move into the TFC foster home and do required paperwork including but not limited to background checks as cited in Chapter 3 Section 10 and 12.

Section 12. Personal Possessions and Money.

(a) In addition to the requirements listed in Chapter 3, Section 26, the following requirements must be met:

(i) Children in foster care shall be allowed to earn money while in placement, when appropriate and as part of the ITPC:

(A) Employment may be outside the home or work may be performed for the TFC foster parents; and

(B) No child shall be required to participate in uncompensated work assignments unless the work is related to housekeeping, maintenance of the TFC foster home or grounds, personal hygienic needs, or the work is part of an approved vocational or training program.

(ii) Babysitting by foster children.

(A) Foster children may be given permission to baby-sit with the approval of the TFC Administrator/Executive Director or designee and the child's DFS caseworker. Decisions shall be made on a case-by-case basis.

(B) Foster children shall receive compensation for babysitting from the family receiving services. Said compensation shall be based on the current 'market value' paid for babysitting.

(iii) Employment by foster children.

(A) Neither work experience nor the length of time spent on non-paid chores shall interfere with a child's time for school, study periods, play, sleep, community contacts or visits with family, and shall be designed to serve the child's interest;

(B) If work experience is a part of the child's ITPC, it shall be identified in the ITPC;

(C) The TFC foster family shall differentiate between chores children are expected to perform, specific work assignments made as a means of earning money, and jobs performed in or outside of the home to gain vocational training;

(D) The TFC foster family shall limit the length of time children spend on regular non-paid chores to one (1) hour per day during the school year and not more than two (2) hours a day during the summer months; and

(E) The time limits may be extended for the performance of special household projects (e.g., house painting). All time extensions shall be approved on a case-by-case basis by the Administrator/Executive Director or designee.

(F) The TFC foster family shall comply with applicable child labor laws.

(G) Children shall be provided proper supervision when working with or in proximity to power-driven machinery.

(b) The TFC program shall develop policy and procedure describing how each child's personal funds shall be handled, to include where the money is held (e.g., bank account) and how often the account is reviewed by TFC program staff.

(i) A complete record of a child's earnings and dispersals from this fund shall be maintained and made available upon request;

(ii) TFC foster parent(s) shall be actively involved in teaching money management skills appropriate to the child's age; and

(iii) Children shall never be required to use their personal funds for basic and reasonable needs (e.g., hygiene products, food, clothing).

Section 13. Responsibilities of and Services Provided by the TFC Program.

(a) Recruit foster families.

(b) Ensure orientation training and opportunities for annual training requirements of all TFC foster parents.

(c) Develop comprehensive case management services that support the child, the parents and/or legal guardian, and the TFC foster parents.

(d) Facilitate access to the community resources necessary to carry out the ITPC objectives.

(e) Develop, adopt, follow and maintain on file written policies and procedures ensuring:

(i) Children placed in TFC foster homes shall receive guidance and instruction in personal care and good hygienic practices;

(ii) Necessary hygiene supplies, towels, wash clothes and toiletries are provided to children;

(iii) Children are adequately clothed; and

(iv) Children shall not be forced to wear any type of uniform or clothing that is degrading or humiliating.

(f) Maintain ongoing communication with the TFC foster family by visiting in the TFC foster home at least one time each week unless indicated more often based on the circumstances of the case.

(i) At least one (1) home visit each month must occur when the child is present; and

(ii) All visits must be documented in the child’s file.

(g) In addition to home visits, each child shall be seen alone once each month.

(h) Provide outpatient treatment services consistent with an intensive approach to severe emotional disturbances. Specifically:

(i) Individual mental health and/or substance abuse treatment for the child, as needed; and

(ii) Family therapy as required by the ITPC and discharge plan.

(i) Provide or arrange for appropriate consultation and treatment by a psychiatrist if indicated by the assessment.

(j) Put in place a mechanism for the monitoring of service delivery which shall be accomplished at least every thirty (30) days or more as needed and shall meet the following criteria:

(i) Include a random selection of case files not less than ten percent (10%) with a minimum of five (5) case files;

(ii) Documentation must include input from the child. To accomplish this, the child must be interviewed individually; and

(iii) Documentation must include input from the TFC foster parents.

Section 14. Services Provided by TFC Foster Parents.

(a) Room and board;

(b) Supervision;

(c) Meeting the physical, mental health, substance use, vocational, developmental, social, cultural, spiritual and educational needs of children in their care;

(d) Helping the child meet all appointments included in the DFS case plan and ITPC by providing transportation and other pertinent services;

(e) Participating in planning for the child;

(f) Meeting regularly with the TFC case manager, DFS caseworker if in DFS custody and other professionals, as indicated, to review progress; and

(g) Helping the child acquire skills in the following areas:

(i) Socialization;

(ii) Daily living skills;

(iii) Education;

(iv) Job seeking and job placement skills, as appropriate for the child;

(v) Independent living skills; and

(vi) Development of cultural identity.

(h) TFC parents shall, in conjunction with the treatment team, implement the ITPC.

Section 15. Individual Treatment Plan of Care (ITPC).

(a) An ITPC shall be developed for each child within ten (10) days of placement in accordance with the guidelines set forth in Chapter 3, Section 34.

(b) The ITPC shall be developed by the Administrator/Executive Director or designee, TFC therapeutic staff, parent or legal guardian, TFC foster parent(s), DFS caseworker if the child is in DFS custody and the child, if age appropriate.

(c) All ITPCs shall be written, reviewed, and conducted under the supervision of the therapeutic staff. Participants shall sign and date the ITPC. Phone and video participation of any member shall be acknowledged and signed for by someone physically present at the meeting.

Section 16. Respite Care.

(a) Respite is defined as a planned period of relief from direct care.

(b) Respite providers must meet one (1) of the following criteria:

(i) Be an approved TFC foster home; or

(ii) Be approved by the TFC Administrator/Executive Director or designee. Approval of a home, at a minimum, includes a completed application, two (2) or more positive references, home inspection, approved by DFS if the child is in DFS custody and a background check (central registry, DCI prescreen and criminal history).

(c) The respite provider shall be provided with information on how to obtain medical care for the children, instruction on addressing the needs of the children, contact information for the children’s regular caregivers, caseworker, parents, counselors, and other emergency information.