Foster Care

Implementation of the Intensive Services Foster Care Program

Posted on by

The California Department of Social Services (CDSS) has issued instructions regarding the implementation of the Intensive Treatment Foster Care (ISFC) program.

The ISFC program is intended to serve children who require intensive treatment and behavioral supports, as well as children with specialized health care needs (including those served under ITFC). The program is designed to ensure that foster youth receive the services they need in a home-based family care setting and that they do not remain or enter a short-term residential program or Group Home.

To achieve this, the ISFC program provides core services and supports, including arranging access to mental health treatment, providing trauma-informed care, and providing transitional support during placement in a permanent home. ISFC program participants who meet the eligibility criteria of other publicly funded programs including mental health, education, and health services will have these services arranged for them by the Foster Family Agency (FFA) or the county.

Children eligible to receive help from the ISFC program are children or nonminor dependents in foster care who require higher level of supervision, as is determined by the Level of Care (LOC) Rate Determination Protocol.

An ISFC resource family includes a licensed foster family home or a certified family home of a licensed Foster Family Agency. An ISFC resource parent is a committed member of the youth’s team who has the ability to meet the individual’s intensive care needs. Non-related legal guardians and Kinship Guardianship Assistance Payment (Kin-GAP) Facilities are not eligible for the ISFC program.

To deliver these services, the ISFC program may either use a licensed FFA or a county licensed to run a FFA, or they may be operated directly by the county as a government program.  In either case, the ISFC program includes Therapeutic Foster Care (TFC) for youth under the age of 21 who are Medi-Cal eligible and meet medical necessity criteria. Each of the involved parties have several responsibilities. FFAs and Counties operating an ISFC must identify and train IFSC foster parents, placement matching, providing core services, and coordination of the appropriate professional and para-professional staff.

TFC parents and caregivers are specially trained and work under the supervision of the TFC agency and in conjunction with the ISFC staff (unless the youth is on probation or child welfare).

ISFC resource parents must complete participate in the development of the child’s plan ensure the well-being of the child, and be in the Resource Family Approval (RFA) program. They must also complete 40 hours of training prior to placement covering topics such as trauma, behavior de-escalation techniques, and cardiopulmonary resuscitation, and is described in depth in ACIN I-28-18.

For child placement, if a child requires immediate placement based on criteria behavioral identifiers, the Social Worker/Probation Officers may make immediate placement at the ISFC level to ensure safety pending an LOC rate determination. If a child has experienced any of the criteria behavioral identifiers within the last twelve (12) months, the placing agency may pay the ISFC rate for up to sixty (60) days, which may be extended pending local county manager approval. This extension should only be granted in the event that an HBFC setting cannot be found.

An ISFC level placement may be made before pre-placement training is completed if certain criteria are met depending on circumstance and those involved.

The ISFC does not allow more than two children in foster care and/or one ISFC eligible child placed in each resource family home, except in sibling group placements where the total number of children in a single resource family home is five (5).

FFA’s that have transitioned or are interested in transitioning to an ISFC program must submit an amended FFA Program Statement Template that is updated to reflect the new ISFC requirements to the Foster Care Rates Bureau. New ISFC programs that were not ITFC providers will receive a rate approval and issued rate letter, as well as a program letter from FCRB with a date effective. Counties not operating as an FFA that intend to opt-in to ISFC public delivery of benefits must submit an ISFC Program Description to the department pending approval.  (ACL 18-25, March 13, 2018.)

 

Medi-Cal for Unaccompanied Refugee Minors (URMs)

Posted on by

DHCS issued a letter with information and guidance to counties regarding cases for Unaccompanied Refugee Minors (URMs)  URMs who are otherwise eligible get no share of cost full scope Medi-Cal benefits, and are to be treated like foster care children for Medi-Cal eligibility purposes.

Three state-designated URM program service providers should submit applications to the county of residence on behalf of URMs placed with the agency.  Social workers will provide verification letters as proof of eligibility for refugees.  County welfare departments must not delay or deny services for failure to provide the SSN or verification of immigration status, though counties should work to verify status in order to maximize federal financial participation.

URM individuals are eligible for full scope Medi-Cal regardless of immigration status.  Those who meet former foster youth (FFY) eligibility requirements are eligible to continue receiving full scope Medi-Cal under the FFY program.  Counties must follow the appropriate rules on annual redetermination and inter-county transfers.

DHCS ACWDL 18-14 (July 3, 2018).

Short Term Residential Therapeutic Programs Placement Criteria, Interagency Placement Committees, Second Level Review for Ongoing Placements

Posted on by

The California Department of Social Services (CDSS) has recently provided guidance and instructions regarding Interagency Placement Committees (IPCs), Short-Term Residential Therapeutic Programs Placement (STRTP) Criteria, Child and Family Teams (CFTs), and Second Level Review requirements for children and nonminor dependents placed in STRTPs and group homes.

Assembly Bill 403 established new licensed children’s residential facilities called STRTPs, which are public agencies or private organizations licensed with CDSS to provide integrated, high-quality, therapeutic programs. The programs are intended for children whose behavioral and therapeutic need are not met by a home-based family setting, even with supportive services. The goal of the program is to provide trauma-informed therapeutic interventions and integrated programming to address barriers to the child’s ability to safely reside and transition into a home-based family setting. The county placing agency, the STRTP, the caregiver, and the child and their support system must work together to identify and coordinate necessary services.

STRTP homes must be cleared by IPCs and a second level of review which takes into account CFT’s opinions.

The IPC is made up of representatives from county placing agencies and the county Mental Health Plan (MHP). The IPC may work together with other jurisdictions to act as a multi-disciplinary committee for child care and treatment. The IPC must also review and approve placements for STRTPs, group homes with a level of care assessed at Rate Classification Level 13/14 and that have been granted extensions (as determined by ACL 16-65), as well as out-of-state residential programs. The IPC decision is to be made by reviewing all available assessments. To support partner agency compliance, county placing agencies must notify and coordinate needed services with the school of origin regarding educational stability and the case plan, the MHP, and the Regional Center currently serving the child immediately upon the child’s placement.

The child may be placed in a STRTP if the child does not require inpatient care in a licensed health facility and the child’s needs have been assessed and can be provided in a STRTP to maintain the health and well-being of the child. One of the following criteria must also be met:

  • the child meets medical necessity criteria as determined by a mental health professional
  • the child is assessed as Seriously Emotionally Disturbed
  • the child is assessed as requiring the level of services provided by the STRTP
  • OR the child meets the criteria for emergency placement into a STRTP.

Emergency placement determinations may be made prior to the IPC determination if:

  • A mental health professional has made a written determination that the child requires the level of care that STRTP services offer
  • The IPC makes a similar determination within thirty days of an emergency placement (or transmits their disapproval to the STRTP)
  • AND the STRTP is not acting as a temporary placement in the event that a home-based family setting cannot be found. The county placing agency must ensure there is commonality of need with the other children in the placement setting.

If counties decide to integrate the CFT and IPC into single meetings, they should do so via an Interagency Memorandum of Understanding.

STRTP providers are not required to accept any specific child for placement, though they are expected to have the capacity to serve individual children with complex needs. The intake process should be coordinated with the IPC to avoid non-admissions and 7-day notices of denial from an STRTP provider, and information should be conveyed to county placing agencies to allow for CFT meetings pending placement. If STRTP providers demonstrate a pattern of not accepting placements, a review may be conducted by CDSS to assess the technical assistance level of the STRTP in order to prevent unnecessary disruption.

Assembly Bill 1997 provided added requirements, and also requires that the Department of Health Care Services and CDSS develop a dispute resolution process in order to track the number of reported and resolved disputes. While this is developed, county placing agencies should inform the CDSS if there is an unresolved IPC dispute by emailing CDSS.

The Continuum of Care Reform (CCR) uses residential care as a short-term, therapeutic intervention until the child is able to transition into a home-based family setting.  The CCR includes additional requirements on case plan documentation and second level review. The former requires that the case plan for a child placed in a STRTP document that the placement is for the purposes of short-term, specialized and intensive treatment, the need for the placement, the plan for transitioning the child, and the projected timeline for future action. If the child is under 12 years of age of younger, prior approval from the director of the child welfare agency is needed.

The Placement Timeframes for Second Level Reviews are age-specific. For children ages 0-6, STRTP placements are extremely rare and not to exceed 120 days. For children ages 6-12, STRTP placements shall not exceed 6 months unless the county made progress toward implementation of the case plan (including the child’s future transition), circumstances beyond the county’s control have impeded the county from obtaining those services, and the need for additional time is documented by a caseworker and approved by the Child Welfare Deputy Director.  For children older than age 13 under the supervision of the dependency court, the placement shall not exceed 6 months unless the Child Welfare Deputy Director or Director has approved the case plan. For children older than age 13 under the supervision of the delinquency court, the placement shall not exceed 12 months unless the Chief Probation Officer of the county has approved the continued placement no less frequently than every 12 months thereafter.

County placing agencies should have established processed to ensure that these processes are followed immediately for children placed in STRTPs or group homes.  (ACL 17-122, January 9, 2018.)

 

Emergency Child Care Bridge Program for Children in Foster Care

Posted on by

The California Department of Social Services (CDSS) has issued guidance for counties participating in the Emergency Child Care Bridge Program for Foster Children in the 2018-19 fiscal year.

The Bridge Program aims to increase the number of stable, sustainable home-based family placements for children in foster care. Because one of the main barriers for placement of foster children is lack of access to child care at the time of placement, resource families, emergency caretakers, approved homes of nonrelative extended family members (NREFM) and parents who have jurisdiction under the juvenile court may be eligible to receive a time-limited voucher for child care and child care services. The program is opt-in at the county level, and funds are to be supplementary to existing funds used to provide child care.

The Resource and Referral (R&R) programs provide information and services to both parents and other potential child care providers. The R&R Programs must enter into a formal agreement with the county welfare agency to facilitate communication and the best use of Title IV-E funding sources. These services are available through Alternative Payment Programs which are funded by states and the federal government, and they are designed to aid parents in creating and accommodating care arrangements for their children.

The Bridge Program has three primary parts. The first establishes an emergency child care voucher or payment which helps eligible families pay for child care costs for foster children until the child turns 12, or 21under some circumstances.  Eligible families may receive a voucher when work or school responsibilities prevent them from being at home to care for the child, or when the family is required to participate in an activity without the child, such as judicial reviews, that are outside the scope of ordinary parental duties. These vouchers may be issued for up to six (6) months until the child is successfully transitioned into long-term, subsidized child care. If this is not possible, eligibility may extend up to, but not beyond, twelve (12) months, at the discretion of the county. If the family secures a subsidized child care placement before their enrollment period in the Bridge Program is set to expire, the family will cease receiving funds from the Bridge Program.

The child care payments may be made to the family or directly to the provider in accordance with Regional Market Rate guidelines.

The second part of the Bridge program is the Child Care Navigator provided by the county R&R Programs to assist families with finding a child care provider, complete program applications, and work with the parents to develop a long-term care plan. The Child Care Navigator is an employee of the local R & R Programs, and works with eligible families, child welfare workers, social workers, and the Child and Family Team (CFT) to assess child care options and provide information about care. Navigator services are available to any child in foster care, any child previously in foster care but in their original home, and any child with parents involved in the child welfare system.

The third part of the Bridge program provides access to trauma-informed care training, which teaches parents and providers about how to work with children in foster care. Also included in the training is information on best care practices and infant/toddler development.

Family eligibility for the Bridge program is determined by the county, which may establish additional criteria depending on local priorities. Eligible parties include resource families and families with a child placed with them for an emergency or compelling reason, licensed foster family homes, certified family homes or NREFM homes, and parents who are under the jurisdiction of juvenile court (such as nonminor dependent parents).

Participating counties must ensure collaboration between the child welfare services program and CalWorks child care program administrators to share information, priorities, and child care plans. They must also develop and agree to plans with the local Resource and Referral Program to ensure that a child care navigator is provided, develop and use eligibility criteria in accordance with local priorities, and distribute payments to eligible families. They must also ensure that the payment or voucher is in the correct amount and in accordance with RMR ceiling payment rates and collect and submit quarterly data and outcomes to CDSS. This data includes information on voucher eligibility and enrollment, type of voucher placements and care settings, and transition information, as well as the number of each type of referral and trauma-informed care training sessions held.  (ACL 18-80, June 14, 2018.)

Presumptive transfer of specialty mental health services for children, youth, and non-minor dependents in foster care

Posted on by

The California Department of Social Services (CDSS) has issued instructions regarding the implementation of AB 1299 regarding presumptive transfer of specialty mental health services (SMHS) for children, youth, and non-minor dependents in foster care.

In the event that a child, youth, or non-minor dependent is taken into foster care and moved to a different county, the responsibility for arranging and paying for adequate SMHS is transferred to the new county of residence.

For expedited transfers, the county must provide, arrange, and pay for SMHS within forty-eight hours of when the child is placed. If the child is in imminent danger or an emergency psychiatric condition arises, SMHS must be provided immediately without prior authorization. If a child is moved and a Child and Family Team (CFT) cannot meet, the county-placing agency is to alert the Mental Health Plan in the new county of residence to the need to provide, arrange, and pay for SMHS.

For foster children or youths who reside in counties other than the county of original jurisdiction after June 30, 2017, who continue to reside outside of the county of original jurisdiction after December 31, 2017, and/or for whom the responsibility to provide, arrange, and pay for SMHS has not been transferred to the new county of residence, placing agencies must complete all duties to notify conditions of presumptive transfer, waiver requests, and waiver decisions ten days before the child’s next status review after December 31, 2017.

Placing agencies must provide information about presumptive transfer requirements, the exceptions, and the right to request a waiver to: the foster child and their attorney, the agency responsible for making mental health care decisions for the foster child, and the social worker and/or juvenile probation officer. These details should also be added to the child’s case file.

Counties must give fourteen days notice of a child’s out-of-county placement to the child’s parent/legal guardian, the child, and their attorney, unless the child’s safety would be endangered by delay or prior notice. In the event that a child is not receiving SMHS, placing agencies are still required to notify the MHP in the new county of residence.

If a child’s placement status changes and the child is moved back into their original county of residence, the placing agency in the original county must notify the MHP in the former county of residence and the county of original jurisdiction.

CDSS also mandates the creation of a Child and Family Team (CFT), which integrates the child with providers, caregivers, and other support structures. Recent instructions encourage that case planning and the CFT process include MHPs and county placing agencies, especially when the case involves an out of county placement. The county of original residence must continue to collaborate with the county of placement to establish and maintain a single CFT for each child.

The presumption of transfer may be waived on a case by case basis, which places a “hold” on the transfer of responsibility. Exceptions are determined by the placing agency in the county of original jurisdiction in coordination with the CFT. A waiver request must be made within seven  days of the placing agency’s decision to move the child out of their original county of residence. If granted, exceptions mandate that responsibility for providing SMHS remains in the county of original jurisdiction if that county can demonstrate the existence of, or ability to establish within thirty (30) days, a contract with SMHS providers.

A Short-Term Residential Therapeutic Program (STRTP) is a congregate care facility, which includes SMHS services. Placement into a STRTP is considered a temporary exception to presumptive transfer, as it is expected to be last less than six months with the child returning home after treatment.

In the event that a waiver request is denied or otherwise contested, the individual who requested the waiver can request judicial review within seven days of the initial denial of the waiver. The court will then have five days to set a hearing on the matter, and during that time, a hold is placed on the presumptive transfer.

Additionally, children who are covered under the Kinship Guardianship Assistance Program (Kin-GAP) are no longer considered dependents of the court so the county of original jurisdiction retains responsibility for SMHS.

Children whose adoptions are finalized and who receive assistance under the Adoption Assistance Program are also not covered by presumptive transfer. The MHP in the county of residence of the youth’s adoptive parents retain responsibility for authorizing and re-authorizing SMHS.

When a foster child is presumptively transferred, it is not intended that the child be covered by multiple MHP’s. Under certain circumstances, however, counties may simultaneous provide SMHS if, for example, the county of original jurisdiction has an established relationship with the child and will continue paying for MHP during the child’s transition. If the county has an established relationship with the child’s substantial support system, and the providers will continue to be involved in the child’s life after the out-of-county placement, the original county of jurisdiction will continue to arrange and provide for the child’s SMHS.

CDSS does not, in existing presumptive transfer law, distinguish between inpatient and outpatient SMHS. Specific conditions apply to psychiatric inpatient services, depending on the circumstance. Because psychiatric inpatient services are not considered foster care placements, children are to be returned to the county of original residence following inpatient hospital stays.

Responsibility for drug Medi-Cal benefits remains with the county of original jurisdiction, even under conditions of presumptive transfer. Counties are expected to collaborate on the provision of necessary substance use disorder services for foster children placed outside the county of original jurisdiction.  (ACL 18-60, June 22, 2018.)

 

 

Assessing child safety and monitoring of safety plans

Posted on by

The California Department of Social Services (CDSS) has issued instructions on assessing child safety when determining if a child can be remain safely in their home. In order to ensure consistency across counties, the CDSS has provided information on safety assessments, safety plans, and risk assessments used during worker visits to the home.

During the initial investigation, caseworkers must determine whether or not the child can safely remain in the home or if immediate removal is necessary. Caseworkers must identify any potential safety threats prior to leaving, and report these threats using the Safety Assessment tool within two (2) days of the visit.

If a caseworker assesses that there is reason to know if the child is an Indian child, the caseworker must take into account the tribe’s social and cultural standards and way of life. In accordance with county procedures, caseworkers must also collaborate with the tribe, and may utilize other tribal or Indian community service agencies.

When child safety has been assessed and the child is allowed to remain in the home, caseworkers must work with caregivers to draft a safety plan. The safety plan, which allows the child(ren) to remain in their current placement, lists specific and immediate steps that can be taken to remedy potential hazards, as well as long-term objectives to ensure the child’s health and safety. Safety plans must also specify all of the involved and their roles and responsibilities. Caseworkers are expected to monitor these safety plans over time through consistent visits (both announced and unannounced), as well as ongoing collaboration with involved parties.

In cases involving substance abuse or withdrawal symptoms, the safety plan must satisfy all requirements established by the Child Abuse Prevention and Treatment Act. This includes specific action steps to mitigate safety threats to both the child and the caregiver, which may involve referrals to external services.

Once a safety plan has been drafted, caseworkers must conduct a risk assessment to determine if the child is in danger of future mistreatment. The risk assessment must be completed within thirty (30) days of the initial visit, and may be used when deciding the status of referrals.

Before a case is closed, a caseworker must conduct a risk reassessment, which evaluates the progress of the safety plan. If the risk is reassessed as low, the caseworker must complete a case closing assessment before the case is closed. If the child has the goal to reunite with their original caregiver, the caseworker must assess whether the child should be returned to the caregivers, maintained in their current placement, or have a permanent placement established.

If a caseworker believes the problems to be too severe to remedy or that the child may be in severe or immediate danger, the case worker may instead draft a case plan, which expedites the removal and re-placement process. (ACL 17-107, February 6, 2018.)