Treatment Foster Care - Family Setting 624-05-20-15

(Revised 4/1/2025 ML #3905)

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Treatment Foster Care (TFC) is an alternative to institutional and residential facilities intended to meet the complex mental and behavioral health needs of children in a least restrictive family setting. This level of care is for children who experience frequent, co-occurring symptoms and behaviors that result in the need for increased services, supports and provider training to address complex trauma. Custodial agencies seeking placement in a TFC home must make a referral through the Children's Treatment Services Level of Care Determination assessment process. For more information on symptoms and behaviors of eligible children, see the Level of Care Chart for reference.

 

Licensing Limits:

A Licensed Child Placing Agency (LCPA) is granted authority by HHS as an authorized licensing agency to recruit and retain foster care providers to offer treatment foster care (TFC).

 

HHS grants authority to the authorized licensing agency to assess and determine the number of placements a TFC provider can best accommodate at one time. It is recommended by the department, no greater than two TFC placements are in a treatment provider home at one time. However, the authorized licensing agency may request to amend the license for additional placements. An amendment to allow for additional beds must be submitted to the CFS Licensing Unit. The license amendment request must be done in advance of a placement.

 

Ongoing assessment of the family is completed by the authorized licensing agency to determine appropriateness of the placements, and the ability of the foster care providers to engage in the necessary treatment interventions to meet the mental and behavioral health needs of children.

 

Adoptive Placement: If a treatment provider has been approved for adoptive-placement, the family shall be assessed to determine if they are able to accommodate an additional treatment placement. If appropriate, an amendment to the license may be requested to increase bed capacity in the home. When the adoption is finalized, the adopted child becomes a member of the household and does not count against licensed bed capacity.

 

Placement Approvals into Treatment Foster Care:

A child who has been approved at TFC will be granted an approval for a 180-period beginning at the date of placement.

  1. Initial 30-day window: The approval to be placed at the TFC level of care is valid up to 30 days; meaning a child must be placed at the TFC level of care within 30 days of receiving the approval from the Qualified Individual, unless otherwise approved by the department. The effective date of placement into the TFC home starts the 180-day approval timeframe. If the TFC placement is not available for more than 30 days or pre-approved by the department, a new Children’s Treatment Services Level of Care Determination cannot be completed for a period of 60 days from the date of determination.

  2. Bed Hold: If a child's situation meets the “absence from placement” policy in 623-05-20-30, a TFC bed hold is allowable. A new assessment is not required, so long as the approval has not expired.

  3. Transition: A child may be transitioned from one treatment home to another if it is determined in the best interest for their treatment. The child will not require a new assessment. The placement maximums and approval timeframes remain.

  4. Post-Discharge: A child who discharges from TFC but still has a period of time allowed within their 180-day approval timeframe may be re-admitted without a new Children’s Treatment Services Level of Care Determination, if determined necessary for treatment, so long as the approval has not expired.

  5. Denial: A child who is placed in the TFC level of care and who is denied during a continued stay review must discharge within the approval timeframes.

  6. "Back-to-Back" assessments are prohibited. The child may not be reassessed for 60 days from the date of determination unless otherwise approved by the department.

  7. Turning 18: A child who has current TFC approval that extends beyond their 18th birthday, must discharge TFC placement on their 18th birthday.

  8. Secondary placements are allowable and used when a child is transitioning from a facility or participating in an overnight visit from a primary placement (Ex: QRTP or State home) to a secondary placement (Ex: TFC Home) and will return to the primary placement. If the child does not return to the primary placement, the date the child was placed into the TFC home is considered primary. Overnights visits are allowable for 4 calendar days per visitation in a licensed provider home. If a child is going on a home pass with an unlicensed caregiver (parent/guardian/relative), the visit is entered as a secondary placement (relative placement) and limited to 14 days.

 

Service Requirements for Treatment Foster Care:

The Treatment Foster Care agency must work in conjunction with the custodial agency to ensure discharge planning starts the date of admission and assist in achieving the permanency plan. The custodial agency is responsible to identify and submit parent, relative or permanency planning contact information to the treatment foster care agency including but not limited, names, addresses, phone numbers and emails. The Treatment Foster Care agency must ensure the minimum service requirements noted in the contract with the department are met for each child placed at the TFC Level of Care. Services include but are not limited to:

  1. Complete a Diagnostic Assessment upon intake and no greater than 30 days after placement, if one has not been completed in the past year. If one has been completed in the past year the agency must complete a Diagnostic Assessment Recognition, with updates to the Diagnostic Assessment happening annually thereafter.

  2. Complete Treatment Plans and review monthly with the clinical treatment team to update the plan to meet the child’s needs.

  3. Completed weekly individual therapy or more often if the frequency and intensity of child behaviors require more intervention.

  4. Complete weekly family therapy in the home of the foster care provider and with the biological family or identified permanency plan, if applicable.

  5. Complete twice weekly in-home skills work with the child and no less than once per week with the foster care provider, biological family and identified permanency plan, if applicable.

  6. Complete parent partner weekly coaching to the biological family and identified permanency plan, if applicable.

  7. Coordinate other services as needed, such as psychiatric oversight, medication management, school supports, speech, occupational therapy, respite care etc.

 

Referrals to Treatment Family Foster Care:

It is the responsibility of the custodial agency worker to submit the Universal Application (SFN 824) and relevant supporting documentation to the treatment agency and upload documentation to Assessment Pro, to initiate an Children’s Treatment Service’s Level of Care Determination. Referrals for TFC must take into consideration the purchase of service agreement parameters the agency has with the Department. TFC referrals must adhere to:

  1. Age Parameters = Children age 6 thru 17

    1. Children under the age of 6 or 18+ are not eligible for TFC.

  2. Sibling Placements

    1. Children who are not eligible for TFC may be placed simultaneously with a sibling who is TFC eligible.

    2. In order to maintain sibling connections, siblings must be placed in the same provider home for the same timeframe.

 

Out of State Placements

North Dakota foster children in need of out-of-state placement must follow the North Dakota Children’s Treatment Services- LOC before seeking an out of state placement setting.

 

The Department does not prohibit children from being placed outside of the state of North Dakota, however it is highly discouraged to place a child away from their connections and reunification or permanency plan options. If seeking an out of state placement, Interstate Compact for the Placement of Children (ICPC) must be followed. Before seeking out of state TFC or equivalent placement, all in-state options must be exhausted and documented.

 

For children under the custody of another state, seeking placement in a ND TFC, the sending state must complete the ICPC, payment paperwork and Children’s Treatment Services- LOC before placement can occur.

 

Treatment Foster Care Reimbursement

The Department will authorize all eligible TFC reimbursement directly to the TFC agency based on billing. Foster Care Maintenance payment policy, 623-05, directs custodial agencies on allowable expenses.

 

A child is prohibited from receiving the TFC daily rate without an approval for the TFC level of care or agency approval for a secondary placement. If the child is placed in a TFC home and their approval expires, the child is no longer eligible for the TFC reimbursement effective the date of expiration. It is imperative that custodial agency workers monitor the approval timeframes.