Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule defines Foster Care Services for
Youth with Elevated Needs.
(1) Definitions for the purpose of this
regulation:
(A) Family support team (FST)-The
group of individuals assembled to participate in a family support team meeting,
a meeting convened by the division or children's services provider on behalf of
the family and/or child for the purpose of determining service and treatment
needs, determining the need for placement and developing a plan for
reunification or other permanency options, determining the appropriate
placement of the child, evaluating case progress, and establishing and revising
the case plan;
(B) Foster Youth
with Elevated Needs-A program designed for youth with identifiable and
documented moderate or serious emotional and/or behavioral needs requiring
intensive and individualized intervention to succeed in a community-based
family setting and to achieve their goal of permanency. There are two (2)
levels available to meet the child-specific needs: Level A and Level
B;
(C) Psychiatric hospital-A
hospital which provides diagnostic and treatment services consistent with the
needs of the child. This is the most restrictive placement option utilized by
the Children's Division;
(D)
Medical foster care-A licensed foster home utilized to meet the needs of a
child with extraordinary medical needs. Medical foster parents shall have a
foster parent license and receive training from qualified medical care
providers specific to the unique medical needs of the child;
(E) Residential care facility-A facility
providing twenty-four (24) hour care in a group setting to children who are
unrelated to the person operating the facility and unattended by a parent or
guardian;
(F) Traditional foster
home-A private residence of one (1) or more family members providing
twenty-four (24) hour care to one (1) or more, but less than seven (7),
children who are unattended by a parent or guardian and unrelated to either
foster parent by blood, marriage, or adoption;
(G) Selection/screening team-A team
constituted to evaluate a youth's appropriateness for a higher level placement.
The composition of the team shall be determined by the Children's Division and
shall take into consideration the type of expertise necessary to assess the
unique needs of the youth being assessed. The team shall include the following
individuals: case manager, supervisor, and the circuit or regional specialist
or designated facilitator; and
(H)
"Youth" or "child" A person within the state who is under the age of eighteen
(18), or in the custody of the Children's Division to a maximum age of
twenty-one (21).
(2)
Process for Determining Youth with Elevated Needs.
(A) Children in need of foster care will be
placed in the least restrictive setting in a traditional foster home. In the
event that the child's condition or behaviors indicate that the child requires
a higher level of care, the Children's Division will assess the youth's needs
to determine which is the least restrictive, but most appropriate, placement to
meet the needs of the particular youth based on available resources. The
Children's Division may conduct an elevated needs assessment on the
recommendation of the child's family support team, any member of the family
support team, or at the written request of the child's resource
provider.
(B) The elevated needs
assessment shall be conducted by the selection/screening team which will decide
if the youth is an appropriate candidate for the program by considering the
individual needs of the youth, the presenting behaviors of the youth, and the
impact such behaviors have in the placement setting. Youth eligible for
elevated needs should have more than one (1) presenting problem as listed in
Presenting Problems Displayed By the Youth with Elevated Needs-Level A and
Presenting Problems Displayed By the Youth with Elevated Needs-Level B sections
of this regulation.
(C) Upon
evaluation, the selection/screening team shall conclude-
1. That the youth is not appropriate for the
Youth with Elevated Needs Program;
2. That the youth is appropriate, but a
compatible home is not available in the county of origin or nearby counties;
or
3. The youth is appropriate and
there is a compatible home.
(3) Payment will be made for the least
restrictive level of care found to be appropriate for the youth as determined
by the screening team. The resource provider will only receive payment for one
(1) level of care for the youth. The division will not make multiple payments
for the same level of care to the same provider for the same youth.
(4) Characteristics of a Youth with Elevated
Needs-Level A.
(A) Youth with Level A Elevated
Needs require significantly greater structure and supervision and are
significantly less able to assume responsibility for their daily care than
youth in traditional foster care. These youth typically, but not always, have
experienced multiple out-of-home placements. Youth appropriate for Level A fall
into one (1) of two (2) categories-
1. Youth
presently in a residential setting who may be moved to a less restrictive
setting, but are not reasonably able to effectively function in a traditional
foster home or in their parents' home; or
2. Youth lacking a viable placement in a
traditional foster family home or in their family home, and who, because of
their presenting problems, would be placed in a residential setting unless an
available Level A foster home can be found.
(5) Characteristics of a Youth with Elevated
Needs-Level B.
(A) Youth with Level B Elevated
Needs have significantly serious emotional and/or behavioral problems that
require the twenty-four (24) hour availability of a highly-skilled Level B
resource parent. These youth-
1. Because of
their presenting problems, would be placed in a level III or above residential
treatment facility or psychiatric hospital; and
2. Have been discharged from a residential
treatment facility or psychiatric hospital and are unable to function
effectively in a traditional foster home.
(6) Presenting Problems Displayed By the
Youth with Elevated Needs-Level A. Level A children have a documented history
of presenting behaviors which render the child unable to effectively function
outside of a highly structured setting. Examples of behaviors which the
Children's Division may consider include, but are not limited to:
(A) Significant behaviors which, if not
modified, could result in the youth being designated as a status
offender/juvenile delinquent;
(B)
History of irresponsible or inappropriate sexual behavior, which has resulted
in the need for extraordinary supervision;
(C) Significant, extraordinary, threatening,
intimidating, or destructive behavior which is demonstrated by multiple
incidents over a period of time;
(D) Significant and extraordinary
oppositional and/or defiant behaviors when dealing with authority figures which
pose a significant risk to the health and safety of the child or to
others;
(E) Significant and
extraordinary problems with peer-to-peer interactions which pose a significant
risk to the health and safety of the child and/or his or her peers;
(F) Significant and extraordinary behavioral
and academic problems at school that affect academic achievement or social
adjustment;
(G) Significant and
extraordinary conduct problems with lying, stealing, or manipulating;
(H) Significant and extraordinary problems
with his or her ability to control and/or appropriately express
anger;
(I) Significant problems
with the abuse of alcohol and controlled substances;
(J) Oppositional behavior which contributes
to placement disruptions and the inability to function productively with peers,
parent figures, birth family, etc.;
(K) Any of the above behaviors, coupled with
medical problems; or
(L) Any of the
above behaviors displayed by one (1) or more youth within a sibling group,
qualifying the entire sibling group for placement together, if appropriate.
However, not all of the youth within the sibling group would be eligible for
the Level A maintenance rate.
(7) Presenting Problems Displayed By the
Youth with Elevated Needs-Level B. Level B children have a documented history
of presenting behaviors or diagnoses which render the child unable to
effectively function outside of a highly structured setting. Examples of
behaviors or diagnoses which the Children's Division may consider include, but
are not limited to:
(A) History of suicide or
currently having suicidal thoughts, statements, and/or gestures;
(B) Affective disorders;
(C) Attention Deficit Disorder;
(D) Post-Traumatic Stress Disorder;
(E) Eating disorders;
(F) Panic disorders;
(G) Fears/phobias;
(H) Obsessive/Compulsive Disorders;
(I) Oppositional Defiant Disorders;
(J) Depression/withdrawal;
(K) Dissociative behaviors, black out, pass
out, seizure;
(L)
Anger/rage;
(M) History of fire
setting;
(N) Destruction of
property;
(O) Failure to form
emotional attachments; and
(P)
Multiple short-term placements.
(8) Youth Who May Not be Appropriate for
Level A. Youth who may not be appropriate for Level A may include, but are not
limited to, the following:
(A) Children who
may function successfully in a traditional foster home or adoptive or
guardianship placement;
(B) Youth
who qualify for a higher level of care and meet the criteria for Youth with
Elevated Needs Level B;
(C)
Children under the age of three (3) who cannot be treated effectively through
the behavior modification treatment model;
(D) Youth who exhibit severe psychiatric
behavior, as diagnosed by a psychiatrist/psychologist, such as an obvious lack
of emotional contact, affect disturbances, and/or severe thought
distortions;
(E) Youth with a
recent history of extreme or dangerous physical aggression;
(F) Youth with a recent history of fire
setting;
(G) Youth who have
recently attempted suicide and continue to have suicidal ideations;
(H) Youth with an IQ score below sixty-five
(65);
(I) Youth who are medically
diagnosed as chemically dependent;
(J) Youth with severe medical or physical
handicaps which present barriers that the child cannot or will not
overcome;
(K) Youth whose primary
presenting problem, as diagnosed by a psychiatrist/psychologist, is sexual
addiction and who need extremely structured treatment and unusually close
supervision; or
(L) Youth with
personality disorders, as diagnosed by a psychiatrist/psychologist, who have
severe problems forming attachments with caretakers and significant
others.
(9) Youth Who
May Not be Appropriate for Level B. Youth who may not be appropriate for Level
B may include, but are not limited to, the following:
(A) Children who may function successfully in
a traditional foster home or adoptive or guardianship placement;
(B) Youth who qualify for a lower level of
care and meet the criteria for Youth with Elevated Needs Level A;
(C) Actively suicidal;
(D) Homicidal;
(E) Compulsive fire setter;
(F) Sexual abuse offender which might
endanger other family members;
(G)
Require around-the-clock awake supervision;
(H) Unable to function in school, and
alternative program (day treatment) is not available; and
(I) Youth who have demonstrated behaviors
that pose a significant risk of harm to the youth or others which require
professional treatment in a hospital or institutional or structured residential
care setting.
(10)
Working with Youth with Developmental Delays. Youth with developmental delays
may, or may not, be appropriate for Level B Foster Care. Appropriateness for
Level B Foster Care should be based on the selection/screening team and/or the
family support team (FST) evaluation of all the circumstances surrounding that
particular youth. Youth should not be ruled out for Level B based solely on the
singular characteristic of an IQ score falling below sixty-five (65). Instead,
the team should consider a variety of information including, but not limited
to, the following:
(A) Youth's functioning
level;
(B) Severity of
developmental delays;
(C) Ability
for self-care;
(D) Type of behavior
problems;
(E) Level of physical
aggressions;
(F) Age;
(G) Compliance; and
(H) Need for supervision.
(11) Level A Resource Provider
Training Requirements. In order to qualify as a Level A resource provider, the
resource provider shall complete all required hours of pre-service training in
addition to successful completion of eighteen (18) hours of specialized
training workshops from the following topics:
(A) Team and relationship building;
(B) Communication skills;
(C) Behavior management techniques;
(D) Discipline and punishment
procedure;
(E) Management of
behavior crisis situations;
(F)
Development of an individual treatment plan;
(G) De-escalation skills;
(H) Negotiation;
(I) Positive reinforcement technique;
or
(J) Professional skills for
foster parents.
(12)
Level B Resource Training Requirements. In order to qualify as a Level B
resource provider, the resource provider shall complete all required hours of
pre-service training, complete eighteen (18) hours of Level A specialized
training, and participate in the following nine (9) hours of specialized
training and practicum designed specifically for Level B resource providers:
(A) Crisis Intervention-Two (2)
hours;
(B) Behavior Management-Two
(2) hours;
(C) Suicide
Management-Two (2) hours;
(D)
Medication Management-Two (2) hours; and
(E) Family Orientation-One (1) hour (training
shall include how the severely emotionally disturbed or behavior disordered
child may impact the resource provider's family).
(13) Reviews. The Children's Division will
conduct reviews to ensure that progress is being made toward permanency
throughout the Level A or Level B placement. The division shall conduct reviews
as often as the division determines is necessary to assess the needs of the
child. However, the division shall convene the selection/screening team to
assess the child's placement at least every one hundred eighty (180) days.
Children covered by an adoption subsidy or guardianship subsidy agreement will
be reviewed at least every two (2) years. The division will seek a less
restrictive setting once the youth's presenting problems have been replaced
with appropriate coping behaviors. The decision to terminate the child's
placement in a Level A or B setting shall be made solely by the Children's
Division. In making the decision, the division shall consult with and consider
the recommendation of the FST.
*Original authority: 207.020, RSMo 1945, amended 1961,
1965, 1977, 1981, 1982, 1986, 1993; 210.506, RSMo 1982, amended 1993, 1995;
453.073, RSMo 1973, amended 1978, 1981, 1982, 1985, 1997, 2001, 2005, 2008; and
453.074, RSMo 1985.
