Therapeutic Foster Care

The mission of the Treatment Foster Care Services Program of National Counseling Group is to provide child specific, family centered community based foster care. It is our commitment that services provided by NCG will improve healthy functioning among children and families and will be effective, timely, integrated, comprehensive and compassionate.

It has been demonstrated effective that when out-of-home placement is unavoidable, maintaining the child in the community provides him with the highest likelihood of returning to the most naturalized environment. The therapeutic foster care services provided shall be in the least restrictive environment, a treatment home.  A treatment home provides the most similar experience to that of a naturalized family setting. The continued goal of the Treatment Foster Care Services Program is to support the child in reaching his/her permanency plan; whether that is re-unification, adoption, permanent foster care, independent living or an alternative planned living arrangement (APPLA). 

It is essential that the treatment home be recognized as an integral part of the Treatment Foster Care Services Program. Each child placed in a treatment home, has the right to be in a home that is stable, nurturing, positive and supportive of each client’s permanency plan. The treatment home/parent is the primary conduit for the child to experience appropriate family interactions that may not have been present in his family of origin. The treatment parents will receive on-going training and support from the program that will assist them in caring for each child placed in their home. This specialized training will support the entire family to ensure the child is given the opportunity to develop age appropriate coping mechanisms and esteem that are essential for his success at home, in school and in the community.

Whenever possible (unless prohibited by the courts) the natural/biological family will be included and involved in all aspects of the child’s care.

When re-unification is not possible, NCG will support the permanency plan adopted by the legal guardian.  We support kinship care, adoption, permanent foster care and other long-term living arrangements that maximize the child’s ability to live in the community. A treatment foster home allows the child this opportunity until such permancey plans are finalized.

Program Goals and Anticipated Outcomes

The goals of NCG’s Treatment Foster Care Program include the following:

• Provide comprehensive, coordinated, clinically based services that are client specific in a community based setting;
• Support re-unification when clinically appropriate;
• Support other long-term, family centered placement when re-unification is not possible;
• Provide on-going, clinically based training to treatment parents and program staff thereby enhancing their ability to support the psychological, behavioral, emotional, social and educational needs of children placed in foster homes.

Anticipated Outcomes:

• Continued placement in the least restrictive environment within the community;
• Decreased presentation of maladaptive behaviors;
• Increased development of age-appropriate coping mechanisms;
• Improved school attendance and performance;
• Eliminated use of alcohol and other substances;
• Increased independent living skills;
• Stabilization of the natural family evidenced by successful re-unification;

NCG’s Treatment Foster Care Services Program will provide services to children ranging in age from birth to 21.  The program is open to both males and females without regard to race, color, national origin or sex.  Children with handicapping conditions will be accepted if their needs can be reasonably accommodated. The program recognizes and supports cultural diversity and will ensure that children will be placed in a treatment home that meets their cultural and linguistic needs.

The program will provide services to children who may present with a wide range of emotional, behavioral and psychiatric impairments.  Children admitted to the program may present with the following:

• A history of multiple foster home placements;
• A history of physical, emotional and/or sexual abuse resulting in an out-of-home placement;
• A history of emotional, psychiatric and behavioral impairments;
• A history of inappropriate sexualized behaviors;
• May be transitioning from a higher level of care (residential treatment facility, group home, detention).

All clients placed in the program must be willing to be placed in the home of the family with whom they are matched. The local child welfare agency must have custody of the child, or the birth parent must be willing to sign an “entrustment agreement” with the local referral agency for the duration of the child’s stay in the treatment home.

Admission Criteria

National Counseling Group will work collaboratively with the placing agency to determine what level of care is most clinically appropriate for each child. The assessment process will include a review of social histories, previous treatment plans, individualized education plans, risk assessments, family histories as well as an interview of the client and family when appropriate. NCG ensures that youth placed in the Foster Care Services Program meet one or more of the criteria as outlined in the levels of care below:

Levels of Care:

The Treatment Foster Care Services Program will provide services that are individualized, child specific, strength-based, compassionate and family focused.  The Program has 4 levels of care.

The Emergency Level

The emergency level of care is available to youth that are emergently in need of placement. These children may have been removed from their natural family within the last 24-72 hours or may have been stepped-down from a higher level of care without adequate time for the legal guardian to identify an alternate placement. Clients will be admitted at this level for a period of 30 days. During this time, the treatment team will work collaboratively with the legal guardian to determine the child’s more long-term needs.  Each client will receive a needs assessment within 24 hours of admission. This assessment will be completed by the assigned caseworker and will be the framework for development of the treatment plan. The needs assessment is a comprehensive screening tool that will help identify what, if any, special, child specific services may be indicated. These special services may be related to substance abuse, sexualized behaviors and mental health/dual diagnosis issues. The needs assessment includes areas of assessment to address the need for mentoring and/or independent living or life skills training. During this 30 day assessment phase, the caseworker will provide face-to-face contact with the client at least twice weekly.  The caseworker will coordinate school placement with the legal guardian within three days of placement and will visit the school at least twice during this time. The caseworker will coordinate all indicated appointments addressing medical, dental, psychiatric and educational needs of the client.  Case management crisis intervention is available to the child and treatment parent(s) twenty-four hours a day, seven days a week.

Intensive Level

The intensive level is designed for children who are in need of an out-of-home placement and have severe behavioral, emotional and or psychological impairments that, in the absence of intense supervision and intervention, would require a higher level of care. Children placed at this level may be re-integrating into the community following a residential or correctional stay. Children placed at this level may have experienced multiple failed foster home placements. He/she may have increased difficulty in the educational setting and may require intensive wrap-a-round supports. He/she may require intensive support from the treatment team to include mental health support services, mentoring, individual therapy, substance abuse treatment and/or sex offender treatment. The assigned caseworker will complete a needs assessment within 48 hours of admission and will work with the legal guardian to ensure that any identified special needs and services are addressed. The caseworker will provide face-to-face contact with the client at least twice weekly. The caseworker will coordinate school placement with the legal guardian within three days of placement and will visit the school twice monthly. The caseworker will coordinate all indicated appointments addressing medical, dental, psychiatric and educational needs of the client.  Case management crisis intervention is available to the child and treatment parent(s) twenty-four hours a day, seven days a week.

Moderate Level

The moderate level provides additional structures and supports for children requiring an out of home placement.  Appropriate candidates may present with co-morbid dysfunctions and exhibit maladaptive behaviors frequently. He/she may have been unsuccessful in other placements and may be at risk to be placed in a higher level of care. The moderate level may be appropriate for youth previously placed at the emergency or intensive levels of care that have demonstrated improved functioning and stability.  The client may be in need of additional supports such as mentoring, mental health support services, substance abuse interventions and/or sex offender treatment. The caseworker will provide face-to face contact at least weekly.  Each client will receive a needs assessment within 48 hours of admission, completed by the assigned caseworker and establishing the framework for development of the treatment plan. The needs assessment is a comprehensive screening tool that will help identify what, if any, special, child specific services may be indicated. These special services may be related to substance abuse, sexualized behaviors and mental health/dual diagnosis issues. The needs assessment evaluates the child’s potential need for mentoring and/or independent living or life skills training. A needs assessment will not be required if the youth has been stepped down from a higher level of care within the program. The caseworker will work with the legal guardian to ensure that any identified special needs and services are addressed. The caseworker will coordinate school placement with the legal guardian within three days of placement and will visit the school twice monthly. The caseworker will coordinate all indicated appointments addressing medical, dental, psychiatric and educational needs of the client. Case management crisis intervention is available to the child and treatment parent(s) twenty-four hours a day, seven days a week.

Supportive Level

The supportive level provides structure and support for children needing an out-of-home placement but who do not require intensive supervision and monitoring. Children placed at this level may have demonstrated successes at a higher level of care within the Program. He/she may have emotional, behavioral and psychiatric needs but are able to demonstrate effective coping mechanisms supporting their continued success in the community. Children placed at this level attend school regularly and require little intervention for success in the educational setting. The caseworker will provide face-to face contact twice monthly. A needs assessment will be completed within 48 hours of the admission and will be used in the development of the treatment plan. The caseworker will work with the legal guardian to ensure that any identified special needs and services are addressed. The caseworker will coordinate school placement with the legal guardian within three days of placement and will visit the school twice monthly. The caseworker will coordinate all indicated appointments addressing all medical, dental, psychiatric and educational needs of the client. Case management crisis intervention is available to the child and treatment parent(s) twenty-four hours a day, seven days a week.

When possible, the Needs Assessment will be completed prior to placement.

Additional Services

National Counseling Group offers a wide array of clinical services to support and augment programming within the Treatment Foster Care Services Program. Each client admitted to the program will receive a needs assessment as outlined above. Upon completion of the assessment, the assigned worker will collaborate with the treatment team to determine what additional services are needed to ensure the child’s success in the program. Individual therapy, family therapy, foster family therapy, group therapy and mentoring are available and will be integrated into each client’s treatment plan accordingly. 

Specialized tracts are offered to support clients with specific clinical needs and behaviors. These specialty tracts are:

• Sexualized Behaviors Tract
  • Sexually Reactive/Sexual Offender
  • Sexual Victimization
• Substance Abuse Tract
• Mental Health/Dual Diagnosis Tract
• Criminally Deviant Behavior Tract

Each identified caseworker will complete on-going progress reports and all reports required by the Minimum Standards for Licensed Child Placing Agencies. The caseworker will identify barriers to the client reaching the agreed upon treatment plan goals. He/she will work with the legal guardian, client and treatment team members to support the client and will adjust the treatment plan as indicated. 

Clients placed at the Emergency and Intensive Level of care will be evaluated continually to determine if a decrease in level is therapeutically appropriate. Justification for a decrease in level will be communicated to the placing agency/legal guardian and documented in the progress notes. 

Program Staff

The treatment services program staff composition will minimally be include a Site Director, Case Manager/Parent Trainer and the Treatment Foster Family as well as the Director of Social Services.

Director of Social Services

The Director of Social Services shall supervise directly or through others all child-placing staff and activities; and will assist the executive director and governing body in the formulation and implementation of the agency’s policies and programs related to child-placing. 

He or she shall have a doctor’s or master’s degree in social work from a college or university accredited by the Council on Social Work Education, plus three years of experience in providing casework services to children and their families including one year as an administrator or supervisor of casework services.

Site Director

The Site Director may have a bachelor’s or master’s degree in the field of social work, counseling, psychology, rehabilitation, special education or other human services field and have a minimum of five years experience providing casework services directly with children and families.

The Site Director is responsible for both the administrative and clinical integrity of the program.  He/She ensures the program’s compliance with the minimum standards for Child Placing Agencies, the Code of Virginia as well as National Counseling Group policy.  The Site Director coordinates and oversees all placement activities and ensures approval of foster parents as defined by the minimum standards.

Case Worker/Parent Trainer

The Case worker may have a doctor’s degree or master’s degree in social work from a college or university accredited by the Council on Social Work Education or a field related to social work such as sociology, psychology, education or counseling, with a student placement in providing casework services to children and families. One year of experience in providing casework services to children and families may be substituted for a student placement; or

A baccalaureate degree in social work or a field relate to social work including sociology, psychology, education or counseling and one year of experience in providing casework services to children and families; or

A baccalaureate degree in any field plus two years experience in providing casework services to children and families.

The caseworker is responsible for all aspects of the child’s stay while he/she is in the program.  Responsibilities include coordinating pre-placement and placement activities, discharge planning, preparing reports (i.e.: treatment plans, progress reports, intake and social history, progress notes, contact logs and all other documents required by the Minimum Standards, Code of VA and NCG policy), supervising and monitoring the effectiveness of the foster parent(s), facilitating team meetings and responding to crisis situations twenty four hours a day. He/she ensures the client is linked to all available internal and external resources. The caseworker continually evaluates the child and completes face to face visits as required by the minimum standards and Code of Virginia. He/she collaborates with the legal guardian/social worker to ensure the child’s progress towards his/her permanency plan. The caseworker works collaboratively with the child’s therapist, psychiatrist, social worker and other service providers to coordinate treatment initiatives.

Caseworkers monitor progress towards service plan outcomes and coordinate discharge planning with the legal guardian. He/She provides twenty-four hours per day, seven days a week crisis intervention services.

The caseworker’s maximum caseload may be less than but shall not exceed eight children.

Staff Training and Education

All treatment services program staff will participate in new employee orientation as well as on-going education trainings. Initial training will be at least 40 hours in duration. This comprehensive strength-based training will include the following topics:

• Philosophy and Mission of the program;
• Overview of the History of Therapeutic Foster Care;
• Minimum Standards for Licensed Child Placing Agencies;
• Medicaid Standards;
• Emergency Preparedness;
• Corporal Punishment;
• Crisis Intervention;
• Behavior Management;
• DSM IV and related mental health/psychiatric disorders;
• Sexually Reactive/offender treatment options;
• Substance Abuse treatment options:
• CPR and First Aid training;
• Confidentiality/HIPAA standards/requirements;
• Cultural Diversity;
• Child Abuse and Neglect;
• Grief/Loss issues for children in foster care;
• Permanency Planning/Building Healthy Relationships with Birth Families;
• Documentation Requirements;
• Health Information Management

The treatment services program prohibits the use of corporal punishment. Each employee of the program must agree to not use corporal punishment or other discipline techniques that could be considered abusive.  Documentation of such will be recorded in the employee’s human resource file.

All staff will participate in the first available sequence of the program’s pre-service training for Treatment Foster Parents.

Staff competency with the program requirements will be assessed thru on-going supervision and training. In addition to weekly supervision and bi-monthly staff meetings, program staff will be required to attend specialized trainings throughout the year. Each staff member will receive an annual performance evaluation that will be maintained in his/her employee file.

Treatment Foster Parent

National Counseling Group recognizes that the treatment parent(s) is an integral part of the treatment team that works to ensure a child’s success in the community. We require that each treatment home be a therapeutic, nurturing environment that supports each child in reaching their fullest potential. To this end, NCG requires each treatment parent to:

• Promote and support re-unification if clinically indicated;
• Serve as a positive role model;
• Provide a safe, positive, strength-based environment,
• Be an active part of the treatment team and treatment planning process;
• Support recreational activities;
• Transport clients to the required medical, dental, and mental health appointments;
• Support relationships with siblings and other extended family members when appropriate.

Each treatment parent will fulfill the requirements for certification as a treatment parent with National Counseling Group. Each approved home/parent will meet the Minimum Standards of Licensed Child Placing Agencies. Parents identified for intensive placements will complete additional specialized training to better assist them in caring appropriately for youth placed in their home.Training will include subject matter related to the following:  sex offender specific training (understanding of risk assessments and relapse prevention plans), substance abuse training, and working with mentally handicapped/dually diagnosed individuals as well as training related to criminally deviant behaviors. 

The treatment foster parents are the primary focus of intervention for a child in foster care. It is thru building relationships and maintaining a safe, nurturing and therapeutic environment that the parent(s) is able to assist the child in reaching his/her identified goals.The on-going positive support provided by the foster parent allows the child to develop more positive and socially acceptable behaviors.The treatment services program staff provides on-going support and training for parents to assist them in their roles as treatment parents. The treatment foster parent is an integral member of the multi-disciplinary treatment team. As a result, treatment parents will be actively involved in the treatment planning process.  

Treatment Parents are required to maintain a positive, safe environment. The treatment parent is expected to take the client to all medical and dental appointments, therapy appointments, and medication management appointments with the client’s psychiatrist, attend FAPT and court hearings as well as participate in any other child-centered meetings.

The treatment services program prohibits the use of corporal punishment. Each Treatment Parent must agree to not use corporal punishment or other discipline techniques that could be considered abusive.

Treatment Parents are expected to have tolerance and demonstrate a willingness to allow each child to express his/her own individuality. Treatment Parents will not be permitted to make a child placed in their home practice their religious beliefs. Each child will be allowed to practice his/her own beliefs about religion and spirituality.

The parent is required to successfully attend and complete twenty-four hours of pre-service training.

Pre-service training will include the following topics:

• Mission and Philosophy of the Treatment Services Program;
• Overview of Therapeutic Foster Care;
• Expectations of the Treatment Parent;
• Special Issues related to children in Foster Care;
• Corporal Punishment;
• Discipline and Limit setting;
• Importance of working with biological families;
• Permanency Planning;
• DSM IV and other medical/psychiatric impairments;
• Crisis Intervention;
• Behavior Management;
• Cultural Diversity;
• Communication Skills;
• CPR and First Aid;
• Sexually Reactive/Offender Specific Training;
• Substance Abuse Training;
• Confidentiality and HIPAA training;
• Documentation Requirements (progress notes and financial ledgers)

In addition to meeting all training requirements, each treatment foster parent and home will be fully compliant with the Minimum Standards for Licensed Child Placing Agencies. Parents will be selected in part on the basis of the program’s treatment philosophy and their ability to demonstrate this philosophy on a daily basis. Parents must be willing to accept the level of involvement and supervision provided by the program.

Potential parents will submit to criminal background checks and a search of the central registry for child abuse and neglect as required by the minimum standards within 90 days of the anticipated approval date for the home. Each home must have sufficient financial resources and a working telephone as defined in the Minimum Standards.

The Parent Trainer will complete at least three face-to-face interviews with the potential parent(s). At least two of the interviews will be in the family home. During this home study process, the parent trainer will evaluate the parents’ ability to be a fully licensed home with NCG.The parent must be:

• At least 21 years of age;
• In good physical and mental health and free from communicable disease as evidenced by a health statement signed by a licensed physician;
• Speak the same language as the identified child;
• Have access to reliable transportation;
• Have access to reliable child care that is approved by the agency;
• Must sign a written statement agreeing to not use corporal punishment with children placed in their care;
• Must be willing and able to meet all the requirements of being a treatment foster parent as outlined in the foster parent job description including working with families of origin and adhering to agency policies and procedures;
• Must commit to providing the supervision and support required for children placed in their home.

The program recognizes that on-going training and support are critical to the success of each foster home.  The program requires that each certified treatment parent complete a minimum of twenty four hours of on-going training throughout each certification year.

On-going training topics will include:

• Building resiliency in children and youth;
• Building and Maintaining healthy relationships;
• Crisis Planning and Intervention;
• Substance Abuse specific topics;
• Sexual Offender specific topics;
• Maintaining healthy boundaries with children.

Parents continuing certification, as available, for intensive placements will be required to complete an additional eight hours of training specific to the needs of sexual abusers, substance abuse issues, working with dually diagnosed youth and recognizing the early warning signs of criminally deviant behavior. Clinical Staff specializing in these fields will facilitate and direct these clinically specific trainings.

Family of Origin Services

National Counseling Group will provide services to biological parents and families to the extent that it is possible and appropriate. Services to biological families may include:

• Parent support groups
• Counseling services
• Supervised/unsupervised visitation services
• Inclusion in treatment planning and service delivery(pre-placement and on-going)
• Parent education

Confidentiality

Protected health information, client records and foster parent records are maintained for confidentiality in locked metal cabinets.  Clients, legal guardians and foster parents are made aware of agency policy on confidentiality upon admission to the program and certification as a treatment parent.  Each client and his/her legal guardian are provided with a copy of the NCG Notice of Privacy Statement.  Information regarding a client is not released without a consent form signed by the legal guardian.  Staff and foster parents receive training on HIPAA and the agency’s policy on confidentiality at new employee orientation and pre-service foster parent training.

Quality Assurance

Compliance with the Minimum Standards for Licensed Child Placing Agencies and the Code of Virginia will be monitored internally by quality assurance monitors and corporate oversight. 

Discharge

Discharge planning begins at the time of admission to the program. NCG ensures that the program collaborates with the legal guardian to ensure the client’s progress and success with the defined permanency plan. Discharge from the program will occur when permanency is reached or when requested by the legal guardian or court. 

Successful discharge from the program occurs when permanency is reached and the client has made significant progress towards identified goals. The program will provide aftercare services for children successfully discharged from the program for thirty days from the date of discharge. The aftercare services will be individualized and may include thirty days of case management services, outpatient therapy (individual, family and group) and/or home-based services. The case worker will maintain at least weekly phone contact with the child and will complete one face-to-face visit during the first thirty days post-discharge. The case worker will ensure that the legal guardian has a copy of all recommendations made by the treatment team as well as any required documents. 

Refunds

The policy of NCG is to investigate account credit balances on a monthly basis. Credit balances created by duplicate payments will be refunded within ninety days of receipt. There is no refund policy for services rendered.