Prior to entering foster care, a child and his/her family may receive services through Family Preservation / Family Support in Home Services. These services are described below.
Level A: A child/family who is exhibiting psycho-social issues, mild to moderate behavior problems in the home, school or community to include environmental issues.
Problems may include:
q anxiety
q fear
q withdrawal
q depression
q hyperacivity
q impulsivity
q defiance
q truancy
q pre-delinquent activity
q difficulty getting along with peers and adults
q argumentative
q some verbal and physical aggression
Level B: A child/family who is exhibiting moderate to severe behavior problems in the home, school, family and/or community with a situation requiring intervention by a therapist.
Problems may include:
q extreme acting out behaviors verbally and physically towards siblings, peers and adults
q sexual acting out
q truancy and/or school suspensions
q level of interaction with police and juvenile detention centers
q property destruction
q at risk of hurting themselves and others
q withdrawal
q depression
q hyperactivity
q poor psychosocial skills
q lack of age appropriate developmental behaviors
q impulsivity
Levels of Care
Six different Levels of Care have been developed for assisting both DHR/Department of Family and Children Services staff and private Foster/Child Care provider staff in making appropriate placement and treatment planning decisions for each child in foster care.
Ideally, there should be a joint decision making team designated for making Level of Care decisions. Also a process will need to be agreed upon for allowing children to move up and down the continuum of care.
There are certain general provisions that apply to all levels of care.
§
All levels of care
provide individualized treatment and support services based upon an individual
written service plan that identifies for each child
and family the treatment goals and needed services and resources.
§
Within the levels of care there is a variety of
treatment options and settings to meet each child’s own unique needs for
treatment and support.
§
At all levels there are children for whom psychotropic
medications are prescribed for their mental health conditions. Medication management is more frequent and complex at the
higher levels of care.
§
Each child will participate as fully as possible
according to the child’s own treatment and safety needs in community-based
recreation, services and the local public school.
§
Each child is to be served in the least
restrictive, most family-centered and community-based setting that meets his or
her treatment needs and ensures the safety of the child, the family and the community.
Level 1:
No more than occasional mild emotional and/or
behavioral management problems that interfere with the child’s ability to
function in the family, school and/or community setting.
Family/Peer Relationships:
q
positive relationships can be formed with family
and peers
q
may be unprepared for separation from family
Emotional Functioning:
In most cases child will not have a mental health
diagnosis.
, Mbut may
experience
some :
q anxiety
q fear
q hyperactivity
q moodiness
q withdrawal
q impulsivity
Reaction to separation from family or other life
stressors may warrant mental health intervention or counseling.
Educational
Functioning:
q school behavior
problems are absent or minimal
q child may be behind in
language and/or
learning development which would require specialized services within the school
setting
All education
services are provided in the public school setting.
Behaviors/characteristics:
q no violent or self-destructive
behavior is exhibited
q child does not
present any danger of harm to self, others or property
q no pre-delinquent behaviors
have been exhibited
q restlessness
q no
sexual acting out behaviorwithdrawal
q vverbal hostility
q ccrying spells
q pphysical complaints
q GAF no lower than 71-80 range
q
Reaction to separation from
family or other life stressors may warrant mental health intervention or
counseling.
Medical:
Child/infant has an available medical history that shows no risk factors for ongoing medical concerns.
Child:
q
is is not coming into care from the
hospital
q
and does
not carry any medical diagnoses.
Infant:
q
is full
term,
q
has a birth weight over five and a
half pounds
q
is , is not
drug exposed
q
had and has adequate prenatal care.
q
is Infant is from the normal newborn
nursery and is not a former patient in the special
care nursery.
No specialized medical
needs.
Treatment/Intervention
History:
May have had no other
placement history;
however this is – often first time coming into foster care. Family preservation attempts may have been
tried and failed. Family/caregiver may be experiencing a crisis
necessitating placement of child outside of home.
Exclusions:
Needs which supercede
all of the above from Institutional Foster Care include: MR, autism, medically fragile, IQ
below 70, pervasive developmental disorders.
Rule out:
q
firesetting
q
assault
q
suicidal attempts/intent
q
sexual acting out
q
cruelty to animals
q
absence of a workable school program.
Level 2:
Mild emotional and/or
behavioral management problems that interfere with the child’s ability to
function in the family, school and/or community setting.
Family/Peer
Relationships:
q
Ppositive relationships can be formed with family and
peers
q Mmay be verbally aggressive
toward peers and adults
Emotional Functioning*:
Child is likely to have a mental health
diagnosis,
with:
MMild levels of:
q anxiety
q depression
q hyperactivity
q moodiness
q withdrawal
q impulsivity
q defiance
At this level, children are able to participate and
benefit from individual and/or group therapy.
* Emotional functioning should be determined through
legitimate documentation (ie- psychological / psychiatric evaluation) and/or as
assessed by a licensed professional or master level professional
Educational
Functioning:
q occasional absenses
q detention/ISS
q
infrequent suspensions
q may be placed in classes which meet special learning needs
q other minor school related problems
Education services are
provided in the public school setting.
Behaviors/characteristics:
q Iinfrequent impulsive or deliberate acts which
may result in minor destruction of property
q Nnonviolent,
anti-social acts: - child does not present any danger of harm to self or others
q Ppre-delinquent
behaviors (may
include stealing from peers, rule violations) that are infrequent and
do not indicate an established pattern of behavior – no current juvenile court
involvement
q Iimpulsivity
q Current CAFAS scores
on 8 scales are in 0-50 range
q GAF no lower than 61-70 range
Medical:
Child/infant:
q requires monitoring by specialists
q
diagnosed with failure to thrive, but does
not require a feeding tube to gain weight
q
q
previous diagnosis of lung disease, but does not
require ongoing nebulizer treatments
q has been exposed to drugs or alcohol
q (infant) has a history of poor or no prenatal care
q (infant) mother tests positive for drugs or alcohol, syphilis and/or hepatitis exposure
q neurological
work-up is needed
Treatment/Intervention
History:
Few placements; may have had outpatient
interventions; may be transitioning from emergency care; may be stepping down
from Level
3. Family preservation
attempts may have been tried and failed.
Exclusions:
Needs which supercede all of the above from
Institutional Foster Care include:
MR, autism, medically fragile, IQ below 70, pervasive developmental
disorders.
Also, rRule out:
q
; fire setting
q
, assault
q
or suicidal attempts that
resulted in medical care
q
sexual acting out
q
, cruelty
to animals,
q
and absence of a workable school program.
Level 3:
Mild to moderate emotional and/or behavioral
management problems that interfere with the client’s ability to function in the
family, school and community setting outside of a therapeutic setting. (Emergency
placements – first time coming into care with no assessments available and/or
completed.)
Family/Ppeer Relationships (Social functioning):
q
mMay make Vverbal threats to harm peers/adults
q
occasional mMay
have Iinfrequent outbursts in which
client becomes dangerous to self/others
q
can form positive relationships with others
Emotional functioning*:
Child has a mental health diagnosis, with:
Mild
to moderate levels of:
q anxiety
q depression
q hyperactivity
q moodiness
q withdrawal
q impulsivity
q defiance
Children
Aare generally able to
participate and benefit from individual and/or group therapy.
* Emotional functioning
should be determined through legitimate documentation (ie- psychological / psychiatric evaluation) and/or
as assessed by a licensed professional or master level professional ------- We need to agree upon what the standard is and the
wording
Educational functioning:
q frequent absenses
q frequent detentions / ISS
q school suspensions
q average or below average grades
q repeated grades
q Individual Education Plan --- may receive services in a special education setting
q other school-related problems
Problems can be resolved with appropriate services within the public school setting.
Behaviors/characteristics:
q impulsive or deliberate acts which may result in minor destruction of property
q sexual acting out (that does not harm others)
q
minor
self-injurious behavior and/or suicidal intent (with or without
actual attempt or no
attempt within 90 days)
q infrequent running away with brief absence
q
pre-delinquent behaviors (may include stealing from
peers, rule violations) that are infrequent and do
not indicate an established pattern of behavior ------no more than 8
incidents within the previous 90 days-- may be on probation for minor status offenses
q impulsivity
q drug/alcohol experimentation – no addiction
q current CAFAS scores on 8 scales are in the 40-90 range
q
GAF no lower than 51-60 range
At this level, children may have occasional difficulty showing appropriate behavior in a group setting. They are able to accept feedback on behavior, process feedback and show improvement in behavior over time.
Medical:
*Medically fragile at this level in a therapeutic foster care setting.
Child/infant:
q
hHas
global developmental delay as the primary diagnosis
q
iIs
diagnosed with mild cerebral palsy
q
iIs
diagnosed with fetal alcohol syndrome
q
iIs
recovering from head injury
q
iIs
ordered to have physical, occupational, and/or speech therapy 1-2 times per
week.
q
sSees
2 or more physicians at least on a quarterly basis for medical needs.
Treatment/intervention history:
Few
placements; may have had outpatient interventions, may be transitioning from
emergency placement; stepping down from level 4 or 5; may have had foster home disruption(s);
may have spent brief time in RYDC or other
juvenile justice program; family preservation attempts may have been tried and
failed; may have
had psychiatric
hospitalization.
OtherExclusions:
Needs“Special”
problems which may supercede all of the above from Institutional Foster Care include: MR, Autism,
medically fragile, IQ
below 70; pervasive developmental disorder(s).
Rule out:
q
Rule Out for fire setting,
q
assault that resulted in medical
care or
q
suicidal attempts that resulted in medical care,
q
cruelty to animals,
q
and absence of a workable school
program.
Level 4:
Moderate to serious emotional
and/or behavioral management problems that interfere with the client’s ability
to function in the family, school and community setting outside of a
therapeutic setting.
Family/Ppeer
Relationships (Social functioning):
q threats to harm peers/adults
q occasional outbursts in which client becomes dangerous to self/others – responded to interventions offered (no one was injured)
q frequent arguing
q
inappropriate sexual comments or being sexually
suggestive to peers and/or adults staff
q attempts to form inappropriately close relationships with peers and/or staff (poor boundary issues)
Relationships with family/care-givers are moderately impaired, such that care-givers lack confidence about their ability to meet the child’s needs. Relationships with peers and adults are impaired and conflict is intermittent.
Emotional functioning*:
Child has a mental health diagnosis. Diagnoses would likely indicate the presence of a mood disorder, thought disorder, or cognitive disorder.*
Moderate to high levels of:
q anxiety
q depression
q hyperactivity
q hypoactivity
q moodiness
q withdrawal
q impulsivity
q
defianc
q
defiance
Family/care-givers and school
personnel report that functioning is socially inept; child’s emotional
functioning may be incongruent with chronological age. Children at this level are generally able to
participate and benefit from individual and/or group therapy.
Family/care-givers, and school
personnel report that functioning is socially inept, child’s
emotional functioning may be incongruent with chronological age.
Are generally
able to participate and benefit from group therapy
* Emotional functioning should be determined
through legitimate documentation (ie- psychological / psychiatric evaluation)
and/or as assessed by a licensed professional or master level professional
Educational functioning:
School history includes:
q suspensions and/or possible expulsion
q
possible exclusion from community schools, excessive
absences
q average or below average grades
q having repeated grade(s)
q IEP with possible placement in classes which meet special needs (self-contained, EBD, LD, etc.).
Problems can be resolved with appropriate services at the local school or is stabilized in a psycho-educational program.
Behaviors/characteristics:
q deliberate or impulsive destruction of property -- unlikely a pattern of destructiveness has been identified.
q
sexual acting out reactively without aggression, or
“consensually,” promiscuity ---
q
self-injurious behavior --- which has not warranted medical or
psychiatric treatment----
and/or suicidal intent ideation (with orwithout
actual attempt or no
attempt within 90 days -- with stabilization)
q
running away withbrief absence of several hours or more
q
pre-delinquent / delinquent behaviors (may include
stealing from peers, rule violations) ------ no more than 8 incidents in the previous 3 months (may be on
probation)
q impulsivity
q drug/alcohol experimentation
q current CAFAS scores on 8 scales are in the 80-110 range
q enuretic or encopretic, or have a history of one or both
q inflexible adherence to routines or rituals and/or difficulty with transitions.
q If eating
disorder issues exist, itbut is an exception (not the norm) and does
not pose a medical risk.
q
Ssleeping disturbances may exist intermittently
or consistently.
q
Bbizarre or eccentric behavior is an
exception.may
be present but poses no harm to child
or others.
q inattentive, distractible, or have difficulty concentrating.
q
attends to personal hygiene with occasional
reminders.
q GAF is no lower than
41-50 range
Child is able to attend to
personal hygiene.
At this level, children may have moderate behavioral
outbursts in group settings, creating some difficulty participating in group
therapy. They show limited ability to
accept and
process feedback on behavior , process feedback and
show slow and limited improvement in behavior.
May show inability to accept responsibility for
behavior or show no regret for inappropriate behavior.Acceptance of
responsibility and/or regret for misbehavior may be absent.
These children may have a history of living on the streets, and being involved with street culture with behaviors that could include gang involvement, use and selling of illegal substances, and prostitution.
Must show at least minimal positive response to treatment interventions.
Medical:
If medical needs are present,
child does not need help from medical staff to adequately monitor the
condition. Follow-up care is intermittent, periodic, or routine. Condition does not require access to health
care staff around the clock.
*Medically fragile at this level in a therapeutic
foster care setting.
If medical needs are present,
child does not need help from medical staff to adequately monitor the condition.
Follow-up care is intermittent, periodic, or routine. Condition does not require access to health care staff around the
clock.
Child/infant:
q Requires foster parents to be specially trained by medical personnel
q Foster parents must have CPR training
q (infant) released from hospital with a monitor
q (infant) does not take a bottle well
q reflux that is controlled with 1 or 2 medications
q ordered to have physical, occupational and/or speech therapy 2 or more times per week.
q meets 3 or more medical conditions listed under Level 3
Treatment/intervention history:
It is likely that some interventions have been tried, with limited success. Child has likely had several placements, possibly in various levels of care. Child may be stepping down from Level 5 or 6. Historical information would likely suggest that various medication regimens have been attempted, with moderate or some success noted. In some cases, records will indicate that the child is quite stable on medication(s). Child may have had psychiatric hospitalization and may have a history of having been incarcerated or spent time in a juvenile justice program.
Other:Exclusions:
Problems exist in a couple ofat least two arenas (e.g. with primary support group,
socially, educationally, legally).
Impairment is moderate and persistent.
GAF=41-50
“Special” problemsNeeds which may
supercede all of the above from Institutional Foster Care or Intermediate Group
Homes include: MR, Autism, medically fragile.
Rule Out for:
q
fire
setting,
q
sexual
assault,
q
physical
assault
q
, severe cruelty to animals
q
or suicidal
attempts that resulted in medical care, and
q absence of a workable school program.
Level 5:
Serious to severeemotional
and/or behavioral management problems that interfere with the client’s ability
to function in the family, school and community setting out side of a
therapeutic environment.
Family/Peer relationships:
q
may have a history of hurting
family members
q
may fight with peers
q
outbursts where client
becomes dangerous to self/others but is responsive to immediate interventions
or short term hospitalizations or incarcerations
q
may have ongoing trouble with
all relationships
q
may have trouble attaching to
others
q
may have engaged in sexually
reactive or abusive behaviors (but is involved in on-going treatment to address
this)
q
may have poor boundaries or
violate the rights of others (without deliberate intent)
Relationships with family are
non-existent or very conflictual/chaotic.
Relationships with peers are impaired and conflict is common, but client does not routinely
prey upon or vicitimize others.
Emotional functioning*:
Child has a mental health diagnosis. Diagnoses
would likely indicate the presence of a mood disorder, thought disorder, or
cognitive disorder.*
Moderate to high levels of:
q
anxiety
q
depression
q
hyperactivity
q
hypoactivity
q
moodiness
q
withdrawal
q
impulsivity
q
defiance
Family/care-givers and school personnel report that
functioning is socially inappropriateept;
child’s emotional functioning may be incongruent with chronological age. Children
at this level are generally able to participate and benefit from individual
and/or group therapy.
* Emotional functioning should be determined
through legitimate documentation (ie- psychological / psychiatric evaluation)
and/or as assessed by a licensed professional or master level professional
Educational functioning:
q excessive absences
q
frequent school suspensions
q history of expulsions
q history of disciplinary actions
q failure and/or inability to learn
q
IEP with placement in specialized classes
Client has to be able to have some school program designed
for him/her that is workable in the community.
Behaviors/characteristics:
q
deliberate or impulsive destruction of
property
q
sexual acting out reactively without aggression, or
“consensually,” promiscuity
q
self-injurious behavior and/or suicidal intent which
has not warranted medical or psychiatric treatment within 30 days
q
running away with prolonged absence absence of several
hours or more
q
pre-delinquent / delinquent behaviors (may include
stealing from peers, rule violations, etc) ---no
more than 12 incidents in the previous 3
months
q
impulsivity
q
drug/alcohol experimentation/use
q
current CAFAS scores on 8 scales are in the 110-150 range
q
enuretic or encopretic, or have a history of one or
both
q
flexible adherence to routines or rituals and/or difficulty with transitions
q
eating disorder exists, but is an exception (not the norm) and does not pose a
medical risk
q
sleeping disturbances exist intermittently or
consistently
q
bizarre or eccentric behavior may be present but poses no harm to child or
others.
q
child may be inattentive, distractible, or have
difficulty concentrating.
q
problems with personal hygiene, either on-going or when angry/depressed
q GAF no lower than 41-50 range35
At this level, children may have serious to severe outbursts in group settings,
making it
difficult for them to participate in routines.
They have trouble accepting feedback and/or changing behaviors.
May show marked difficulty
accepting responsibility for behavior and/or show little or no
regret or remorse for inappropriate behavior.
These children may have a history of living on the
streets and being involved with street culture with behaviors that could
include gang involvement, use and selling of illegal substances, and
prostitution.
Must show at least minimal positive response to
treatment interventions.
Medical:
*Medically fragile at this level in a therapeutic
foster care setting.
Child/infant:
q
Hhas a medical condition which requires management
with medications
q
rRequires
foster parents / staff that provide hands-on medical treatment
q
fFoster
parents / staff are required to learn skills that are taught and reviewed over
multiple sessions with medical personnel before taking physical custody of
child
q
Ddiagnosis of asthma or other lung disease
that is controlled with medication
q
sSeizure
disorder that is controlled with medication
q
rRequires
nebulizer treatments
q
rRequires
medications by mouth, feeding tube, injection or suppository
q
rRequires
tube feedings
q
hHas
uncontrolled reflux
q
rRequires
oxygen either continuously or on an as-needed basis
q
Hhas a tracheostomy
q
hHas
HIV infection
q
hHas
diabetes that is controlled with medication
q
hHas
a shunt in the heart
q
iIs
visually impaired
q
Iis hearing impaired
q
Eengages in head-banging or slapping
q
mMeets
3 or more of the medical conditions listed at Level 4
Treatment/intervention history:
Has a history of inconsistent response to
treatment.
It is likely that
multiple interventions have been tried, unsuccessfully. Will likely need intensive and/or specialized
support services to be safe. Child may
be stepping down from Level 6. History would suggest one or more hospitalizations
and may have a history of being incarcerated.
OtherExclusions:
Problems exist in most or all areas of functioning (e.g. with primary support group, socially,
educationally, legally). Impairment is severe
and persistent.
GAF=41-50“Special” problems Needs which may supercede all of
the above from
Intermediate Group Homes include: MR, Autism, medically fragile.
Rule out:
q
firesetting (within the past year)
q
convicted sexual assault
q
killing animals
q
multiple physical assaults or acts of self-injury
q
absence of a workable school program.
DSM-IV:
Axis I: Diagnoses
would likely indicate the presence of some combination of a mood disorder,
thought disorder, and/or cognitive disorder.
In cases where all 3 diagnostic clusters are met, Level 6 LOC might be
indicated.
Axis II: Diagnosis
may exist or evidence may suggest the presence of a personality disorder or
traits.
Axis III: If
present, child may need some help from medical staff to adequately monitor the
condition, followup care is intermittent, periodic, or routine. Condition does not require access to health
care services around the clock.
Axis IV: problems
exist in multiple arenas (e.g. with primary support group, socially,
educationally, legally). Impairment is
major and chronic.
Axis V: GAF=31-40
Additional factors:
1. Child is,
at times (When depressed, child does not bathe.), able to attend to personal
hygiene.
2.
Relationships with family/care-givers are significantly impaired, such
that care-givers are unwilling, or unable to try to meet the child’s
needs. Relationships with peers and
adults are impaired and conflict is common.
3.
Family/care-givers, and school personnel report that functioning is
socially inappropriate, child’s emotional functioning is incongruent with
chronological age.
4. School
history includes frequent suspensions, expulsion, possible exclusion from
community schools, frequent absences, below average or failing grades, having
repeated grades, placement in classes which meet special needs (self-contained,
BD, LD, etc.).
5.
Behavior(s) may include:
Rule and
norm violations
Some
history of use of substances
Verbal and
physical aggression, with physical aggression directed at property and/or
people. Outbursts may be intermittent
or frequent, typically involve intervention by others for child to regain
control. Possible grooming of other
children in preparation for sexual activity.
Possible history of sexually aggressive behavior or sexually reactive
behavior with aggression.
Self-injurious
behavior which has warranted medical or psychiatric treatment. One or more suicide attempts which warranted
professional intervention.
Homicidal
ideation (history of or fleeting)
Sexual
acting out reactively without aggression, or “consensually”, promiscuity.
Destruction
of property such that repairs or replacements are required. May be intentional, impulsive, or pattern
identified.
AWOL
(runaway) with prolonged absence.
Child may
be enuretic or encopretic, or have a history of one or both.
Child may inflexibly adhere
to routines or rituals and likely has difficulty with transitions.
If
disordered eating exists, it is intermittent and does not pose a medical risk.
Disordered
sleeping may exist intermittently or consistently. Nightmares are likely.
Bizarre or
eccentric behavior may be observed occasionally, or minimally.
Boundary
challenges (physical and emotional) may exist.
Child may
be inattentive, distractible, or have difficulty concentrating.
Child may
be hyperactive or hypoactive.
6. It is
likely that multiple interventions have been tried, unsuccessfully. Child has likely been placed, numerous
times, in various levels of care. Child
may be stepping down from Level 6.
Historical information would likely suggest that multiple medication
regimens have been attempted, with variable or short-lived success noted. Child has likely had one or more psychiatric
hospitalizations and may have a history of having been incarcerated.Level 6:Services/Interventions:
Ongoing assessment
Individual therapy
Group therapy
Family therapy
Psycho-educational groups
Educational Services:
self-contained
classrooms
LD, BD
and/or EBD classrooms
GED services
public
school
IEP
Psychiatric services and medication monitoring
prns
I.M.s
mechanical
restraints
crisis
stabilization
Recreational therapy
Art therapy
Occupational therapy
Substance abuse education, and/or treatment
Speech/hearing services
Life skills training
Self-care, personal hygiene
Independent living skills
Aftercare services
Level system
Therapeutic interventions in the milieu
1:1 staff monitoring
Containment (therapeutic holds/physical restraints,
behavior control rooms)
Level 5 would provide a combination of the above
services, based on the child’s needs.
Services might be provided more frequently. At level 5, 24 hour supervision would be available in a
residential setting, with the ability to monitor a child on precautions (for
AWOL, self-harm, suicidal or homicidal ideation). In a therapeutic foster home,
only one therapeutic foster child would be present.
---------------------------------------------------------------------------------------------------------------------
|
|
Level 6:
Severe emotional and/or
behavioral management problems that interfere with the client’s ability to
function in the family, school and community setting out side of a therapeutic
environment.
Family/Peer relationships:
q
ongoing history of aggression towards family members
q
physically aggressive with peers
q
frequent outbursts where client becomes
dangerous to self/others
q
ongoing trouble with all
relationships
q
difficulty attaching to others
q
engaged in sexually reactive
or abusive behaviors
q
poor boundaries or violation of the rights of others
Relationships with family are
non-existent or very conflictual/chaotic.
Relationships with peers are impaired and conflict is common.
Emotional functioning*:
Child has a mental health diagnosis. Diagnoses
would likely indicate the presence of a mood disorder, thought disorder, or
cognitive disorder.*
High levels of:
q
anxiety
q
depression
q
hyperactivity
q
hypoactivity
q
moodiness
q
withdrawal
q
impulsivity
q
defiance
Family/care-givers and school
personnel report that functioning is socially inappropriate; child’s emotional
functioning may be incongruent with chronological age. Children at this level have difficulty participating and benefiting from individual and/or group
therapy.
* Emotional functioning should be determined
through legitimate documentation (ie- psychological / psychiatric evaluation)
and/or as assessed by a licensed professional or master level professional
Educational functioning:
q excessive absences
q
frequent school suspensions
q history of expulsions
q history of disciplinary actions
q failure and/or inability to learn
q IEP with placement in specialized classes
Client has to be able to have some school program designed
for him/her that is workable in the community.
Behaviors/characteristics:
q
deliberate or impulsive destruction of property
q
sexual acting out
q
self-injurious behavior and/or suicidal intent
q
running away with prolonged absence
q
delinquent behaviors
q
impulsivity
q
drug/alcohol experimentation/use
q
current CAFAS scores on 8 scales are 140 or higher
q
enuretic or encopretic, or have a history of one or
both
q
child inflexibly adheres to routines or rituals and has difficulty with transitions
q
eating disorder exists
q
sleeping disturbances may exist intermittently or consistently
q
bizarre or eccentric behavior may be present
q
child may be inattentive, distractible, or have
difficulty concentrating
q
serious problems with personal hygiene, either on-going or
when angry/depressed
q
GAF below 40
At this level, children have frequent severe outbursts in group settings, making it difficult
for them to participate in routines.
They have trouble accepting feedback and/or changing behaviors. Show marked difficulty accepting responsibility for
behavior and/or show little or no regret or remorse for inappropriate behavior.
These children may have a history of living on the
streets and being involved with street culture with behaviors that could
include gang involvement, use and selling of illegal substances, and
prostitution.
May show minimal or no positive response to treatment interventions.
Medical:
Treatment/intervention history:
Has a history of inconsistent response to
treatment. Multiple interventions have
been tried, unsuccessfully. Will need
intensive and/or specialized support services to be safe. History would suggest one or more
hospitalizations and may have a history of being incarcerated.
Exclusions:
Needs which may supercede all of the above include:
MR, Autism.
Services /
Interventions
Services/Interventions:
Following is a list of various
services/interventions that may be offered through Family Foster Care,
Institutional Foster Care (Basic Care Group Homes and Residential
Facilities), Therapeutic
Foster Care, Intermediate Group Homes and Diagnostic Facilities, and Intensive Treatment
Facilities. Many
services may be offered at all levels; however, the level of need for, intensity
of, and duration of certain services may increase at the higher levels.
Levels 1-3
(basic care):
At Level 1, the focus of care is on reassurance, consistency, and regular parenting-type activities with guidance and supervision needed to develop normalized social skills and to ensure emotional and physical well being. Services may be provided in a family foster home or basic care group home.
At level 2, treatment services and supervision are provided in the supportive setting of a therapeutic foster home, basic care group home or residential facility. A mix of services is provided.
At level 3, care, supervision and treatment are provided in an environment in which many activities are therapeutically designed to improve the child’s social, emotional and educational functioning and to teach the child prosocial, adaptive skills. Services may be provided in an emergency shelter, therapeutic foster home, basic care group home or residential facility.
Services at these levels may include:
q
transportation
q
case management
q ongoing assessment
q community based recreational activities & services
q individual therapy
q group therapy
q family therapy
q psycho-educational groups
q
educational Services:
o public school
o GED services
o IEP
o LD, BD and/or EBD classrooms
o self-contained classrooms (Level 3 or higher)
q recreational therapy
q art therapy
q substance abuse education
q life skills training
q oral medication management
q self-care, personal hygiene
q independent living skills
q respite care
q reunification services
q aftercare services
q level system
Level
4 (beginning intermediate):
At this level, services are provided in a
therapeutic setting in which most activities are therapeutically designed to
improve social, emotional, and educational adaptive behavior.
Services
added at this level include:
q occupational therapy
q speech/hearing services
q containment (therapeutic holds/physical restraints; behavior control rooms)
Level 5 (intermediate):
At this level, services and treatment are provided in a therapeutic residential setting or a highly trained and supported therapeutic foster home with only one therapeutic foster child in their home.
Services added at this level include:
q 1:1 staff monitoring available as needed to provide crisis stabilization and treatment
q 24 hour supervision
q specialized respite care
Level 6 (intensive):
At this level, services and treatment are provided within an intense structured setting, with 24 hour treatment, supervision and medical care. Secure programming is available. There are formalized therapeutic interventions. Therapies occur more frequently, and the treatment plan is implemented in all aspects of the child’s daily living routine.
Services added at this level include:
o prns
o i.m.s
o mechanical restraints
o crisis stabilization
q 1:1 staff monitoring
q 24 hour nursing, psychologists and psychiatrists on staff
q substance abuse treatment
q on-site school available