OKDHS.org - OAC 340:75-8-9. Placement procedures in therapeutic foster care homes

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340:75-8-9. Placement procedures in therapeutic foster care homes

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Revised 6-1-07

(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 18, 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 request written approval from the Children and Family Services (CFSD) programs manager for TFC prior to the placement of a child five years of age or younger. The written request 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 340:75-6-115.9. • 5

INSTRUCTIONS TO STAFF 340:75-8-9

Revised 6-1-07

1.   Authorization for TFC.

(1) APS Healthcare. A child in Oklahoma Department of Human Services (OKDHS) custody is authorized for TFC placement by inpatient authorization reviewers of APS Healthcare. Reviewers initially evaluate the child's current treatment needs to determine whether the child likely meets the criteria for TFC services.

(A) The CW county of jurisdiction worker requests APS evaluation for admission to TFC by calling 1-800-762-1560, selecting the Inpatient Prior Authorization option, and requesting a TFC evaluation.

(B) The CW county of jurisdiction worker provides to the APS reviewer accurate and complete information regarding the child's behavior. The information provided is documented in Form 04KI010E, Placement Worksheet.

(C) When the reviewer determines the child likely meets criteria for TFC, the reviewer faxes the "sounds like" designation to the area resource coordinator (ARC).

(D) The CW county of jurisdiction worker makes the placement request on the child's KIDS Placement Recommendation screen, and the supervisor approves the placement request immediately following the TFC approval by the reviewer. The CW supervisor's approval of the placement request indicates that Form 04KI010E has been reviewed for completion and accuracy.

(E) To appeal a TFC denial, the child's CW county of jurisdiction or county of placement worker contacts the CFSD programs manager for TFC.

(2) Contractor listing. TFC contractors are found in the KIDS Resource Directory, resource category - Residential-State Office Authorized, resource type - Therapeutic Foster Care Contractor.

2.   ARC assignment. The CW supervisor's approval of the recommendation for TFC placement initiates the secondary case assignment to the ARC. Refer to OAC 340:75-8-12 ITS for the ARC's role and responsibilities.

3.   Lower level placement options. When the child no longer meets criteria for TFC placement and can be placed in a lower level of care, the CW county of jurisdiction worker immediately makes plans for the next appropriate placement. Placement options for a child who no longer meets criteria are:

(1) own home;

(2) relative home;

(3) adoptive home;

(4) foster family care, including joint approval of the TFC home per OAC 340:75-8-8; or

(5) independent living.

4.   Out-of-state placements. CW staff are not authorized to approve TFC placement of a child in OKDHS custody with a TFC parent who is moving out‑of-state.

5. Extended placement services. The CW county of jurisdiction worker and supervisor determine whether the child in TFC placement is eligible for voluntary services after age 18. If the child is eligible and requests voluntary care, the CW county of jurisdiction worker completes requirements per OAC 340:75-6-115.9.

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