Therapeutic Family Foster Care 624-05-20-15

(Revised 1/12/09 ML #3170)

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Introduction:

This manual information represents North Dakota’s model of Therapeutic Family Foster Care (TFFC). The North Dakota model was designed to meet the needs of children who would otherwise require a more restrictive setting, such as a group or residential facility. Characteristics of the North Dakota model include the preference for only one child in a therapeutic family foster home (TFFH), with a maximum of two in some situations; small social worker caseloads (8-10); and, intense agency support for the TFFH. This is the model the Department is interested in purchasing for those children who need the TFFH level of care, meet the eligibility requirements for TFFC, and where a TFFH is available to meet the child's needs. TFFC is available statewide; however, due to resource constraints it is limited.

 

Therapeutic family foster care is family care in a specially selected foster home, where the foster parents have participated in intense preparation and training for meeting the needs of children who are at risk of placement in a more restrictive setting. It provides more opportunity for one-on-one work by the TFFH and the child, and a more intense level of support and availability to the TFFH by the social worker who has a limited number of therapeutic family foster care cases. TFFC is intended to be in lieu of a more restrictive setting for children and youth in need of out-of-home care.

 

Licensing & Placement Limits:

Due to the intensity of needs of youth in care, the TFFH license is limited to two children. Preferably, one child will be placed in a TFFC home. Two TFFC children in the home is maximum. If it is determined that the home may be used for more than one child at any time, the license is issued for two. This accommodates brief relief care stays, without the need to amend the foster home license. It is important to keep in mind that licensing and placement are separate and distinct issues. In terms of placement, North Dakota policy states a preference for one child in a TFFH with two (occasional) as the maximum. The maximum of two includes the relief care placement or a mother-infant placement. Licensing requests for more than two in therapeutic family foster homes are handled as exceptions by the regional supervisor in consultation with the Administrator, Foster Care Program, Children and Family Services.

 

Financial County Related to TFFC Placements:

The administrative county for purposes of TFFC is similar to the procedure for children in group/RCCF/PRTF care. The custodian refers the child, ensures that permanency planning takes place, maintains the county case file for purposes of ensuring that custodial duties are carried out, compliance issues met, and that payment is processed on CCWIPS. In other words, the working relationship with the TFFC agency and their financial county is established. The county of financial responsibility maintains all case management responsibility not vested in the custodian.  

 

Referrals to Therapeutic Family Foster Care:

Therapeutic Family Foster Care is a resource for children at risk of a more restrictive placement setting. It is one of the resources available to children in the whole spectrum of out-of-home care (relative care, family foster care, therapeutic family foster care, group care, residential child care, residential treatment). It is intended to address the child's needs at the time, to enable return to a less restrictive setting (family foster care, relative care, or home). TFFC is a very limited resource and is not used for emergency or shelter care, nor is it considered a resource for a planned, long-term foster care placement.  

 

Due to the availability limits of TFFC, only those children who cannot be served in other family foster care homes should be referred to TFFC. The needs of most young children and medically fragile children can most often be met in other foster care homes, sometimes with the addition of excess maintenance payment or other resources. On the other hand, adolescents with behavioral/emotional problems at risk of placement in a more restrictive setting are appropriate referrals to TFFC.

 

Cross Regional Referrals:

Regional supervisors and custodians from the referring and receiving county must be involved in child placement planning decisions. All prospective referrals to the therapeutic family foster care program in a region other than where the custodian is located must be approved by both the referring and receiving regional supervisor(s) before the referral is processed.

 

Multiple Placements in a Therapeutic Family Foster Home:

North Dakota policy states a preference for one child in a therapeutic family foster home with two placements as the maximum. In instances where a second placement is planned, the custodian must review the appropriateness of the placement with the regional supervisor prior to processing the referral. The custodian of the child currently placed in the therapeutic family foster home must be involved in the discussions regarding the possible placement of a second child into the home. It is imperative that all parties involved in utilizing/referring to the same therapeutic family foster home come to an agreement prior to processing the referral.  

 

Eligibility for TFFC:

  1. The child must be in need of the TFFC level of care. Serious consideration must be made to meet needs in a less restrictive setting prior to referral to TFFC. Allow sufficient time to adequately evaluate the child's needs prior to referral to TFFC. The child's referral and entry to TFFC should be planned.
  2. Any child for whom the NDDHS-CFS has a financial responsibility for maintenance payment may receive therapeutic family foster care through the Department’s therapeutic foster care program, as long as other eligibility criteria is met.
  3. Court order with finding (deprived, unruly, delinquent) and appropriate foster care information, i.e. contrary language, prevention and reunification language, independent living language, appropriate custodian, etc.  The court order, with the above information, needs to be in place prior to the referral to TFFC.  
  4. DSM-IV diagnosis.
  5. Medical assistance eligibility.
  6. All of the federal and state requirements for foster care (i.e. case plan, periodic reviews, permanency planning/Foster Care Child & Family team meetings, etc.) also apply.
  7. Regional Supervisor approval (Recommendation Concerning Foster Care Payment in Group Care, RCCF, PRTF, TFFH, now completed on CCWIPS) for a specified period of time.

 

As is the case of any placement planning, the situation must be discussed in the permanency planning/Foster Care Child & Family team meeting setting. Questions regarding appropriateness of referral for TFFC should be directed to the regional supervisor before the referral is processed.

 

Length of stay in TFFC varies according to the child's needs and progress. TFFC is not intended to be used as emergency or shelter care, nor is it intended to develop into a long-term placement. Current projected length of stay in TFFC is estimated at 9-18 months. Because TFFC is a limited resource, a dual approach is required to maximizing the availability of this resource for children in need of care, namely:

  1. Ensure that TFFC is used only for children in need of the TFFC level of care, and
  2. When the child is ready for a less restrictive environment, transition the child and make the TFFC bed available to serve another child.

 

One way to ensure that all parties are fully aware of the intended purpose and use of TFFC is to commence discharge planning at the onset of TFFC placement, and involve all parties pertinent to the child's foster care situation, i.e. TFFH, TFFC social worker, child and parents, custodian, etc.

 

EXCEPTION: TFFC Accelerated Referral/Intake:

The regional supervisor may make an exception to the above policy for TFFC/referral/intake in a situation where the child has a temporary foster care order; a court hearing has been scheduled; the child is eligible for medical assistance; and the custodian has evaluative information on the child sufficient to determine that TFFC is appropriate.

 

This exception to the TFFC referral and intake policy is intended to accelerate the youth’s TFFC intake when absolutely necessary. The exception does not apply to situations where the child's need is shelter care. This policy exception provides quicker access to TFFC when it is clearly the service needed by the child, a temporary foster care order is in place; a longer foster care order is forthcoming; and the custodial agency has not had the opportunity for a planned entry to TFFC. The expectation then, is the child will remain in TFFC for treatment after the order is issued.

 

TFFC Accelerated Intake Eligibility:

  1. Temporary foster care court order.
  2. DSM-IV diagnosis.
  3. Permanency planning committee/Foster Care Child & Family team review.
  4. Medical assistance eligibility.
  5. NDDHS-CFS has financial responsibility for the child's maintenance payment.
  6. Regional supervisor approval (Recommendation Concerning Foster Care Payment in Group Care, RCCF, PRTF, TFFH, on CCWIPS) for TFFC for a period not to exceed 40 days: The regional supervisor notes on the approval that the situation is a TFFC Accelerated Intake-Exception.

 

40-day approval provides ample time for the 30-day hearing and securing the foster care court order.

  1. At this point, the TFFC case must meet all of the qualifications for TFFC.  If all requirements for TFFC are not met, the youth’s eligibility for TFFC ceases.

Please note that the accelerated intake provision is a policy exception, and it is expected that it will be used infrequently. It does not change the policy regarding TFFC intake.

 

Rate for Therapeutic Foster Care - PATH-ND:

Refer to NDDHS 623-05 and NDDHS 447-10 for Therapeutic Family Foster Care rate information and billing procedure.