Code of Massachusetts Regulations
606 CMR - DEPARTMENT OF EARLY EDUCATION AND CARE
Title 606 CMR 5.00 - Standards for the Licensure or Approval of Agencies Offering Child Placement and Adoption Services
Section 5.07 - Services to Children

Universal Citation: 606 MA Code of Regs 606.5

Current through Register 1531, September 27, 2024

(1) Temporary Placements. The following regulations apply to all children whose out-of-home placement is intended to be temporary, and to all children who have not been surrendered for adoption or the subject of an approved petition for termination of parental rights.

(a) Intake Requirements.
1. History. Upon referral or request for placement services the licensee shall gather a complete developmental, social, educational, medical and mental health history of the child, or review the information that has been documented in the referral or application to determine that it is complete and accurate. The history shall include, but not be limited to the following:
a. the child's full name, citizenship, religion, race and ethnic background;

b. a developmental, social, educational, medical and mental health history of the child, including prenatal factors;

c. complete placement history of the child, including all foster care and residential placements and whether or not the child has ever been adopted;

d. the child's ability to self-preserve;

e. the level of supervision needed by the child;

f. special talents, abilities or interests of the child;

g. full names and ages of the parent(s), siblings, close relatives, and other kinship connections;

h. documentation of the child's legal status, including custody or guardianship, and whether or not the child is free for adoption;

i. a copy of the child's birth certificate; and

j. reasons why any of the information in 606 CMR 5.07(1)(a)1. is not included.

2. Medical Examination at Placement. At the time of placement, the licensee shall determine the date of the child's most recent medical examination. If an examination has occurred within the time period specified in 606 CMR 5.07(1)(e)1, the licensee shall obtain a record of it and enter it in the child's record. If such an examination has not occurred within the specified time period, or a determination is made that an examination is necessary, the licensee shall arrange for the medical examination of the child. Such examination shall be arranged within seven days of placement and shall include:
a. a recording of the child's health history, including prenatal information where available, early developmental history and all immunizations;

b. a recording of the child's present physical condition including growth and development, vision and hearing, nutritional status, and evidence of communicable disease;

c. tuberculosis skin test or chest X-ray, if indicated;

d. for all children between the ages of nine months and six years screening for lead poisoning in accordance with Department of Public Health recommendations;

e. psychiatric assessment or psychological evaluation, if indicated;

f. recommendations concerning restricted activities;

g. recommendations concerning future examinations, care and treatment or immunizations.

3. Dental Examination at Placement. At the time of placement, and as appropriate to the age of the child, the licensee shall determine the date of the child's most recent dental examination. If an examination has occurred within the preceding six months, the licensee shall obtain a record of it and enter it in the child's record. If such an examination has not occurred within the preceding six months, or a determination is made that an examination is necessary, the licensee shall arrange for such an examination to take place as soon as possible.

4. Exceptions to Medical Requirements. The licensee shall not require any child to receive medical treatment or screening when the parent or guardian of such child objects thereto on the basis of his or her sincerely held religious beliefs. However, the program may seek a court order for medical treatment or screening of a child if it believes such medical treatment or screening is in the child's best interest.

(b) Service Planning.
1. Initial Service Plan for the Child. Upon completion of the intake and prior to placement except in cases of emergency, the licensee shall develop a written service plan for each child. In developing the plan, the licensee shall consider the needs of the child for stability and permanency. The service plan shall include:
a. the goals for the child as seen by the licensee;

b. any goals that have been articulated by the child;

c. the services to be provided for the child to support the child's continued growth and development and to achieve reunification or an alternative permanent plan within the shortest possible period of time. Such services may include psychological and psychiatric services, behavior management services, medical, dental and ancillary services, educational and vocational services, including life skills, and post placement services;

d. the level of supervision needed by the child;

e. persons responsible to arrange the services identified;

f. a plan for the nature and frequency of parental, extended family and sibling contacts and visits with the child, if appropriate.

2. Emergency Placement. In emergency situations necessitating immediate foster care or residential placement, the licensee shall initiate the evaluation and development of the service plan within one week of placement. The evaluation and service plan shall be completed within six weeks of placement. Upon completion of the intake and service plan, the licensee shall review the child's current placement and shall transfer the child, if necessary, to a more appropriate placement in accordance with the service plan.

3. Updated Service Plan. Within six weeks of family foster home or residential placement, the social worker responsible for the child shall review the appropriateness of the child's placement. The social worker shall update the child's individual service plan if necessary.

4. Consultation with Appropriate Persons. All service plan reviews and updates shall be completed by the child's social worker following consultation with the worker's supervisor, the child, the child's parents, the foster parents, residential program staff, and any other family and professionals as appropriate.

5. Periodic Review of Service Plan.
a. Periodically and at least every six months from the date of placement, until family reunification or termination of parental rights, the licensee shall review the service plan for each child. The review shall include an assessment of the child's and his family's progress and needs; a review of the services being provided to the child including, but not limited to, medical and dental services provided; services to the child's family; a reconsideration of the child's legal status with the goal of establishing a permanent plan for the child and an examination of alternatives to any temporary placement. The service plan shall be revised if necessary.

b. If after six months of foster care or residential care (or earlier if the licensee deems it to be appropriate), the licensee determines that the child's family has not been interested and involved in maintaining a relationship with their child, or in assuming parental responsibility, or has not made sufficient progress toward the goals in the family service plan, the licensee shall consider adoption as an alternative to foster care and shall make a decision whether to petition for termination of parental rights under Massachusetts General Laws. The licensee shall file such a petition, or document the reasons why that course was not chosen in the child's record. Such a consideration of adoption as an alternative to foster care shall take place at least every six months thereafter.

c. The required reconsideration of the child's legal status and consideration of adoption as an alternative to foster care and any subsequent petitions may be completed by the licensed placement agency having legal custody of the child, in accordance with the provisions of the interagency agreement specified at 606 CMR 5.06(2)(f).

(c) Communication. The licensee shall assure that children in placement have reasonable access to communication through telephone and mail. Such access may be restricted only for therapeutic reasons or court order, documented in the child's service plan.

(d) Health Services - General. The licensee shall assure the availability of a range of medical and dental services to foster children, in order to promote the children's complete physical, mental and social well-being. Such services shall include, but need not be limited to:
1. evaluation and diagnosis;

2. treatment;

3. preventive health services;

4. developmental and rehabilitative services; and

5. consultation in any of the above areas.

(e) Health Services - Specific. Subject to the exception contained in 606 CMR 5.07(1)(a)4., the licensee shall provide or arrange for health services to foster children which include, but need not be limited to:
1. physical examinations at intervals recommended by current Department of Public Health policy, including examination of vision and hearing, screening for lead poisoning as recommended by the Department of Public Health, laboratory tests ordered by the examining physician, and special studies when determined by the physician to be necessary;

2. dental examinations at intervals recommended by the American Academy of Pediatric Dentistry;

3. immunizations as required by the Department of Public Health;

4. tuberculosis control, in accordance with guidelines of the Tuberculosis Prevention and Control program of the Department of Public Health;

5. reporting of communicable diseases and infections in accordance with the law;

6. family planning information, and upon request of the parent or the child (with any required consent of parent or guardian), provision of or referral for family planning devices, medication, and services. Any licensee whose conscience prohibits the provision of such family planning devices, medication or services, may refer such child to a resource which will provide such devices, medication, and services, or shall notify the child or parents that the agency will not provide such referral.

(f) Range of Psychological and Psychiatric Services. The licensee shall provide or arrange for a range of psychological and psychiatric services in order that each child's and family's needs for psychological or psychiatric services will be met. Such services shall include:
1. evaluation and assessment;

2. therapy;

3. consultation with children, parents, foster parents and the staff and administration of the licensee; and

4. counseling to assist the child in understanding his or her placement, the reasons for removal from the family of origin and the goals for the child and family, and to empower the child to contribute to his or her service plan and exercise self-determination, to the extent possible.

(g) Arrangements for Education. The licensee shall arrange for the education of each child in care, in compliance with state and local laws, and shall document the child's educational plan in the child's record.

(h) Representation at Hearings. The licensee shall have a representative present at all judicial and administrative hearings regarding the child, and shall solicit the child's input into the matter, to the extent possible. Alternatively, a representative of the licensed placement agency having legal custody of the child may be present, in accordance with the provisions of the interagency agreement specified at 606 CMR 5.06(2)(f).

(i) Unauthorized Activities. The licensee shall not allow children to participate in any activities unrelated to the service plan of the child or to any agreements with the parent or guardian without the written consent of the parent or guardian and of the child if over 14 years of age. Children of all ages shall be consulted regarding the use of photo listings and other publicity. "Activities" shall mean, but not be limited to the following:
1. research or experimentation which involve the child;

2. fund raising;

3. publicity, including photographs and participation in the mass media, except in cases where such publicity is related to finding adoptive or family foster homes for children.

(j) Transfer of Placement.
1. Any change in a child's placement must be based on a documented assessment of the child's needs.

2. Whenever the licensee determines that a child has been placed in a family foster home or residential facility unsuitable for his needs, the licensee shall evaluate his situation and consider an alternative placement. The licensee shall carry out any transfer in a manner which is sensitive to the needs of the child. Except in an emergency, transfer shall be made only with the consent of the person or agency having legal custody of the child.

3. In the event of transfer of placement, the licensee shall notify the child's foster parents as provided by 606 CMR 5.09(11) or (12), and shall notify in writing the child's parents and any other agency having responsibility for the child.

2. Documentation. The licensee shall document in the child's record the reason for transfer of placement, date of transfer, and the child's new place of residence.

(k) Obligation of Licensee for Expenses. Consistent with the child's service plan and the agreements with parents and foster parents, the licensee shall pay for all expenses incurred on behalf of the child which are not paid for by public funds or third party insurance available to the child.

(l) Reuniting of Child with Family. As soon as the licensee determines that the parent or parents are able to assume parental responsibility for the child, or as provided in the agreement between the parents and the licensee or in a court order, the child and the family shall be reunited.

(m) Development of Discharge Plan.
1. Prior to discharge from foster care or residential care and except in cases of emergency, the licensee shall consult parents, foster parents or the residential program, and other personnel involved in the development and implementation of the child's service plan in order to develop a written discharge plan.

2. The discharge plan shall be explained to the child, the child's parents, foster parents or residential program, and to any agency having custody or guardianship of the child. A copy of the plan shall be made available upon request to such people or agencies.

3. The discharge plan shall include provision for appropriate services in the child's new environment, and shall identify parties responsible for providing after-care services.

(n) Emergency Termination. In cases when discharge from placement is made on an emergency basis, a written discharge summary shall be developed in consultation with the foster parents or residential program and with any other personnel involved in the development and implementation of the child's service plan.

(o) Follow-up Contact. The licensee shall maintain contact with each child for at least three months after termination of foster care or residential care, and shall provide on-going services as necessary to facilitate the child's adjustment to his new environment and to maintain the goals of the service plan, unless such follow-up contact and services are provided by the agency having legal custody of the child in accordance with the interagency agreement specified at 606 CMR 5.06(2)(f). If such contact is not maintained, the licensee shall include in the child's record a clear explanation of the reason.

(p) Requirements in Event of Death.
1. In the event of death of a child in foster care or residential care, the licensee shall immediately notify the child's parents and the agency having custody or guardianship of the child.

2. The licensee shall cooperate in arrangements for investigation, examination, autopsy and burial.

(2) Permanent Placements. Whenever it is determined that reunification with the child's family is not the goal for the referred child, the licensee must assure that:

(a) to the extent that it is available, the intake information required by 606 CMR 5.07(1)(a) is documented, in addition to:
1. a social and health history of the family, and

2. information regarding the talents, interests and abilities of the child's family of origin;

(b) a service plan is developed that documents the responsibilities of the licensee for implementation of a permanent plan for the child. If the plan for the child is adoption, the service plan must outline the responsibilities of the licensee and of prospective adoptive parents necessary to achieve finalization of the adoption.

(c) the service plan must be reviewed and updated, as necessary, every six months until finalization of the adoption.

(d) Licensed Foster Care Prior to and Following Adoption Placement. The licensee shall provide, either directly or through agreement, licensed foster care for any child prior to or following surrender of the child for adoption and until an appropriate adoptive home for the child can be selected. Licensed foster care shall also be provided in the event that a child is removed from a prospective adoptive family.

(e) Post-adoption Services. The licensee shall provide, either directly or by referral, post adoption services that shall include, but need not be limited to:
1. counseling, education, support groups, mentor programs, retreats, camps and organized social activities for adopted children;

2. search, reunion and mediation services to assist, facilitate and support adoptive and birth family members as they locate each other, establish communication and build positive relationships.

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