(a) Therapeutic foster care (TFC) is the least restrictive community-based residential care placement setting.  Children in Oklahoma Department of Human Services (OKDHS) custody served in TFC placements are ages three through 17 years of age male or female, and determined by the Oklahoma Health Care Authority (OHCA) authorized reviewer to meet the medical necessity criteria for TFC services, per OAC 317:30-5-741.

• (1) The child has been diagnosed with any DSM-IV AXIS I primary diagnosis, with the exception of V codes and adjustment disorders, accompanied by a detailed description of the symptoms supporting the diagnosis.
• (2) The child's conditions are directly attributed to a mental illness or serious emotional disturbance as the primary need for professional attention.
• (3) It has been determined by the reviewer that the child's current disabling symptoms cannot be or have not been managed in a less intensive treatment program.
• (4) There is evidence that the child's presenting emotional or behavioral problems prohibit full integration in a family or home setting without the availability of 24-hour crisis response, behavior management, and intensive clinical interventions from professional staff, preventing the child from living in a traditional family home.
• (5) The child is medically stable and not actively suicidal or homicidal and not in need of substance abuse detoxification services.  • 1

(b) The Child Welfare (CW) county of jurisdiction worker and supervisor assess each child's treatment needs per OAC 340:75-6-40 and 340:75-6-85.  The CW worker seeks TFC placement when the:

• (1) child's treatment needs can no longer be met in the child's own home, relative home, or traditional foster family setting;
• (2) child does not require a group home placement; and
• (3) child does not meet the medical necessity criteria for psychiatric treatment.

(c) A child whose behavior requires 24-hour awake supervision or who poses a danger in a family setting is not appropriate for TFC placement.

(d) The TFC contractor receives referrals for the placement of children from the area resource coordinator (ARC), per OAC 340:75-8-12.  • 2

(e) The TFC contractor requests a TFC authorization extension 30 days prior to the expiration of the authorized length of stay.  If the OHCA authorized reviewer denies the extension of services, the TFC contractor provides written notification within one working day of the denial to the CW county of jurisdiction and county of placement workers, if different.  • 3

(f) TFC contractors document in writing an assessment of the agency's ability to serve a child age five and under prior to placement.  The written documentation is maintained for onsite review during program audits and includes:

• (1) the assessed diagnosis and proposed treatment plan for the child;
• (2) the credentials, experience, and training of the TFC contractor's staff documenting the staff's ability to develop an age appropriate treatment plan and deliver clinical services to children, five years of age or younger, with emotional disturbances or behavioral disorders;
• (3) other information as requested by the CFSD programs manager for TFC; and
• (4) a description of the proposed TFC parent's:
  • (A) age, availability, experience, and skills;
  • (B) family structure;
  • (C) ability to meet the needs of a child, including a child age five or younger; and
  • (D) parenting responsibilities to other children in the home, children in foster care or therapeutic foster care placement, any adopted children, and any birth children.

(g) The TFC contractor does not place more than two children in a TFC home without prior written approval from the CFSD programs manager for TFC.  The TFC contractor submits the written request that includes:

• (1) primary treatment needs for the proposed placement of a third child and any subsequent children in the TFC home;
• (2) availability, placement history, skills, completed or planned corrective action, and additional contractor supports of the TFC parent identified for proposed placement of a third child;
• (3) risk factors considered and compelling reasons for proposed placement of a third child;
• (4) documentation of TFC contractor contact with CW workers or supervisors for each child in the home, involved professionals, and each TFC family member, regarding the impact of the proposed placement of a third child;
• (5) documentation of TFC contractor's review of any separated siblings placed in the proposed third placement; and
• (6) other information as requested by the CFSD programs manager for TFC.

(h) Title XIX payments for TFC services are not made for TFC parents who move out of Oklahoma.  TFC placements are made only in Oklahoma.  • 4

(i) A child may remain in TFC placement on a voluntary basis after age 18, per OAC  340:75-6-110.  • 5