13 CSR 35-60.070 - Foster Care Services for Youth with Elevated Needs

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.

Notes

13 CSR 35-60.070

AUTHORITY: section 453.073, RSMo Supp. 2009, sections 207.020, 210.506, and 453.074, RSMo 2000, and Young v. Children's Division, State of Missouri Department of Social Services, 284 S.W.3d 553 (Mo. 2009).* Original rule filed Feb. 23, 2010, effective Oct. 30, 2010.

*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.