Child and Youth Services International. All Rights Reserved. 1. Program Standards Sections Overview of Changes

Transcription

1 I was curious whether or not you had any information on ordering of CYS materials, are orders up from last year at this time? If so, do we know how much? Child and Youth Services 2017 Program Standards Sections 2 5 Agenda Program Standards o Section 2 General Program Standards o Section 3 Core Program Standards o Section 4 Core Residential Program Standards o Section 5 Specific Populations Including changes from CARF International. All rights reserved Overview of Changes The Quality Practice Notice on Suicide Prevention released in Sept. 2016, is an addendum at the end of the manual. Modifications to several standards to stress identification of risk factors for suicide. Modifications to language in several standards to ensure SOGIE (sexual orientation, gender identity and expression) are adequately addressed. Typical deletions due to redundancy, changes for clarity and modifications to separate elements. Appearance of numerous changes, but many are similar in just in different locations CARF International. All rights International. All Rights Reserved. 1

2 2017 Overview of Changes Section 2 Applicability Table Diversion/Intervention B now 1 7* (was 1 6*) Promotion/Prevention A now (was 21 30) Respite B now 8 15* (was 8 14*) Com Hsg & Shelters B now 1 11 (was 1 8) H now apply all (was NA) Congregate Care H now apply all (was NA) 2015 CARF International. All rights reserved Overview of Changes Section 3 Remains Core Program Standards Split into two Program Standard sections Section 4 Now Core Residential Program Standards Community Housing and Shelters Congregate Care Crisis Stabilization NEW to CYS (from BH) Foster Family and Kinship Care Group Home Care Residential Treatment Specialized or Treatment Foster Care Added Section 5 for Special Populations 2015 CARF International. All rights reserved. Section 2 General Program Standards Transition / Discharge Medication Use Individualized Plan Nonviolent Practices Screening & Access to Services Records Program Service Structure General Program Standards Quality Records International. All Rights Reserved. 2

3 Section 3 Core Program Standards A. Adoption L. Day Treatment B. Assessment & Referral M. Detoxification / Withdrawal Support C. Behavioral Consultation N. Diversion / Intervention D. Case Man. / Services Coord. O. Early Childhood Development E. Child/Youth Day Care P. Health Home F. Child/Youth Protection R. Intensive Family Based Services G. Community Transition S. Intensive Outpatient Services H. Community Youth Development T. Promotion / Prevention I. Counseling Outpatient U. Respite J. Crisis and Information Call Centers V. Support and Facilitation K. Crisis Intervention Section 4 Core Residential Program Standards A. Community Housing and Shelters E. Group Home Care B. Congregate Care F. Residential Treatment C. Crisis Stabilization G. Specialized or Therapeutic Foster Care D. Foster Family and Kinship Care Section 5 Specific Population Designations A. Juvenile Justice B. Medically International. All Rights Reserved. 3

4 Section 2 General Program Standards The overarching guiding principles include: Child/youth and family driven services. Promotion of resiliency. Cultural and linguistic competence. Strengths based approach. Focus on whole person in context of family and community. Trauma informed, where applicable. CYS Section 2 Applicable Standards Pages A table to identify which Standards and sub sections in Section 2 will be applied to the programs you select for accreditation from Section 3 & 4. 2.A. Program /Service Structure CARF accredited organizations have a responsibility to provide a comprehensive program structure. The staffing is designed to maximize opportunities for the persons served to obtain and participate in the services provided. KEY AREAS ADDRESSED Written plan that guides service delivery Crisis intervention provided Services relevant to diversity Child/youth/family role in decision making Qualifications and competency of personnel Team composition/duties Clinical supervision Effective information sharing Team member responsibilities Arrangement or provision of appropriate Collaborative partnerships P and P that facilitate collaboration Family participation Relevant education Assistance with advocacy and support groups Gathering customer satisfaction International. All Rights Reserved. 4

5 Program / Service Structure Each PROGRAM o Documents Program Scope Description Population Served Settings Hours Days of Services Payer Sources Fees Frequency of Services Referral Sources Specific services whether provided directly o Shares program information with: Person Served Referral Sources Other Relevant Stakeholders Family / Support Systems by choice Payers funders General Public o Reviews the scope at least annually and revises as needed Program / Service Structure Organization provides resources to support overall scope of services for each program/service Based on the scope of services for each program the organization documents its: o Entry criteria o Transition criteria o Exit criteria Program / Service Structure When a child/youth is not eligible for services: o Informed of reasons o In accordance with their choice: The family/support system is informed The referral source is informed o Recommendations are made for alternative services Procedures are implemented to address unanticipated service modification, reductions, or transitions precipitated by funding or other resource International. All Rights Reserved. 5

6 Program / Service Structure Service delivery models/strategies are based on accepted field practice and incorporate current research, evidenced based practice, peer reviewed scientific and health related publications, clinical practice guidelines and/or professional consensus. Program / Service Structure To facilitate integrated service delivery, the program/service implements communication mechanisms regarding the person served that: Address: o Emergent issues o Ongoing issues o Continuity of services: Contingency planning Future planning o Decisions regarding the person served Ensure exchange of information regarding personcentered plan Program / Service Structure The program/service demonstrates: o Knowledge of the legal decision making authority of the person served o The provision of information to the persons served regarding relevant changes in the legal decision making International. All Rights Reserved. 6

7 Program / Service Structure When services are provided from a mobile unit there are written procedures related to: o Responsibilities of drivers and service providers. o Confidentiality of records of persons served and communications. o Privacy related to service delivery. o Accessibility. o Availability of resource information. o Security of medications, equipment and supplies from the mobile unit when not in use. o Safety of records of the person served and personnel. o Maintenance of equipment and vehicle. Program / Service Structure Each Core Program has a written description that guides the delivery of services and includes: o Program description o Philosophy o Goals o Description of service/treatment modalities to achieve the program objectives o Identification or description of special populations served and mechanisms to address their needs Aligns with the first first standard in this section Program / Service Structure Implemented policies and procedures for collaboration in decision making through: o Involving the child/youth and family in all phases of services. o Providing information to facilitate collaboration that is relevant and accessible. o Ensuring the information is understood by the child/youth and family o Setting time lines for the exchange of information. Services are designed and implemented to: Build individual strengths and resilience and also family resilience Support community integration Support recovery, health and well being Promote permanency Restore / Improve functioning Safety Enhance Quality of Life Reflect awareness of individual International. All Rights Reserved. 7

8 Program / Service Structure When the program is identified as a treatment program, it identifies: o Treatment modalities o The credentials of staff qualified to provide treatment Treatment A professionally recognized approach that applies accepted theories, principles, and techniques designed to achieve recovery and rehabilitative outcomes for the persons served. Program / Service Structure The program offers one of more of the following: o Peer support o Family supports o Advocacy o Self help groups o Other avenues of support To meet the needs of the persons served, the program demonstrates how it uses technology to: o Increase access to services o Increase supports o Enhance services Program / Service Structure The program implements written procedures for crisis intervention. Team members, in response to the needs of the c/y served: o Help empower each person served to actively participate with the team to promote recovery, progress, or well being. o Provide services that are consistent with the needs of each person served through direct interaction with that person and/or with individuals identified by that person. o Are culturally and linguistically competent. o Meet as often as necessary to carry out decision making responsibilities. o Document: The attendance of participants at team meetings. The results of team International. All Rights Reserved. 8

9 Program / Service Structure A.18. revised and expanded The organization provides or / arranges for documented competency based training o At: Orientation Regular intervals o To all personnel on suicide prevention. o To direct service personnel on: areas reflecting the specific need of the persons served appropriate clinical skills person centered plan development / implementation interviewing skills program related researched based approaches Trauma informed care practices Clinical risk factors, including: suicide, violence and other risky behavior. Program / Service Structure A designated individual(s) assists in coordinating services by: o Assuming responsibility for the implementation of the plan o Ensuring the person is oriented to services o Promoting participation on an ongoing basis o Identifying and addressing gaps in services o Sharing information on accessing community resources o Advocating o Communicating progress to appropriate others o Facilitating transition including arrangements for follow up o Involving family/support systems o Coordinating services outside the organization Program / Service Structure The organization implements a policy and written procedures for the supervision of all individuals providing direct International. All Rights Reserved. 9

10 Program /Service Structure Documented ongoing supervision of direct service personnel addresses: NEW o Assessment accuracy o Ability to recognize risk factors for suicide and other dangerous behavior o Proficiency of referral skills o Appropriateness of services or supports o Service effectiveness o Feedback on skills o Issues of ethics, legal requirements, boundaries, self care and secondary trauma o Service documentation issues identified through ongoing compliance review o Cultural competency issues o Model fidelity, when implementing evidenced based practices Program / Service Structure Implemented policies and written procedures address positive approaches to behavioral interventions including: o Building positive relationships o Evaluating the environment o Staff interaction to: promote de escalation manage behavior strengthens self regulation o Development of personal safety plan Program / Service Structure The program implements: Written procedures governing the use of: o special treatment interventions o restriction of rights. Methods to ensure intrusive procedures are administered safely in consideration of the c/y s o Physical Developmental Abuse history The program has a process to regularly evaluate: o Restrictions On rights and/or privileges. o Methods to reinstate restrictions or lost rights and/or privileges. On rights and/or privileges. o The purpose or benefit of any International. All Rights Reserved. 10

11 Program / Service Structure The program does not exclude children/youth from services solely based on their juvenile justice status. The program implements p&p that address: o The handling of items brought into the program by: Persons served, Personnel Visitors o Including Legal and Illegal drugs Prescription medications Weapons o The use of tobacco products in all: Locations Vehicles, owned or operated Program / Service Structure Assistive technology is used and reasonable accommodations made in: o Development of services and supports o Ongoing provision of services Training in the use of adaptive devices, toys and equipment is provided to: o Personnel o The child/youth o The family o Caregivers and others Program / Service Structure Program obtains medical consultation regarding medical related policies or procedures. In a medically supervised program, there s a medical director who is a International. All Rights Reserved. 11

12 Program / Service Structure The program implements a policy and procedure for: o Obtaining criminal background checks on all persons providing direct services to children or youths. o Acting on the results of the background checks. Program / Service Structure To elicit input from the children/youths served consumer satisfaction surveys are: o Age appropriate o Developmentally appropriate o Linguistically and culturally appropriate Program / Service Structure Program measures service satisfaction: o Relevance of the information provided o Inclusion and participation of the child/youth in the team process o Inclusion and participation of family in the team process o Service delivery o Outcomes achieved o Transition to home, school or community o Adequate resources and supports needed to maintain International. All Rights Reserved. 12

13 Program / Service Structure For Residential Services: CH/Shelters, Congregate Care, Inpatient Detox, Foster Care Programs, Group Homes, Residential, Overnight Respite Services provided in sites owned, rented or leased by the organization, staff support is available on site 24 /7. C/Y in a residential setting have their own personal space that: * Respects privacy * Promotes personal security and * Safety Separate areas for beds for children/youth according to: * Age, *Gender identity, Developmental and *Other needs. The program provides opportunities for visits with: * Family / Significant Others * Peers Program / Service Structure Peer Support Services (standards A.37 43) Peer and youth support services are designed to have persons with lived experience work directly with persons served. Family support services are designed to have persons who have lived experience through their family member s participation in services directly work with the family of persons served. When an organization employs peer support specialists in any of the core programs seeking accreditation, the following standards must be applied. Mentors Program Service/Structure The organization implements policies and written procedures that are inclusive of a peer workforce. Peer support specialists assist in peer support services: o Design o Development o International. All Rights Reserved. 13

14 Program Service/Structure The organization demonstrates a climate of recovery and/or resilience building by: o Respecting the unique roles of peer support specialists. o Training personnel on the role of the peer support specialists. Program Service/Structure Peer support specialists receive documented competencybased training that: o Is based on a recognized peer support curriculum designed and developed with the input of peer supporters. o Is provided with the involvement of peer supports, as applicable. o Includes: Initial training on the following topics: Personal advocacy. Engagement. Recovery and resiliency principles. Community supports/connections. The effective use of sharing life experiences. Parenting skills, as applicable. Continued Program Service/Structure Peer support specialists receive competency based training that: o Includes: Ongoing training on current practices in peer support services. o Is provided in a manner that is: Understandable. Appropriate to the developmental age of the peer supporter being International. All Rights Reserved. 14

15 Program Service/Structure The organization s written ethical codes of conduct specifically address boundaries related to peer support services. Based on the needs and preferences of the persons served, peer support: o Is consistent with or complementary to the person s identified plan, when applicable. o Includes the following direct service activities performed by peer support specialists, as applicable: Engaging the person served. Supporting personal recovery goals or building on resiliency. Community networking. Advocating with and for the person served. Program Service/Structure Continued Based on the needs and preferences of the persons served, peer support: o Includes the following direct service activities performed by peer supporters, as applicable: Parenting skills. Mentoring. Bridging or navigating. o Includes the following educational activities for the persons served, as applicable: Self advocacy. Wellness. Life skills. Goal setting. Decision making skills Program Service/Structure Peer support services are provided in locations that meet the needs of the persons International. All Rights Reserved. 15

16 2.B. Screening & Access to Services CARF organizations have a process of screening and assessment that is designed to maximize opportunities for the persons served to easily gain access to the organization s programs and services. Each person served is actively involved in, and has a significant role in, the assessment process. Assessments are conducted in a manner that identifies the strengths, needs, abilities, and preferences of each person served. KEY AREAS ADDRESSED Policies and procedures defining access Waiting list criteria Orientation to services Primary assessment Interpretive summary Screening & Access to Services Implemented policies and written procedures: o Define access to services. o Define if/how screening is conducted. o Include: How admissions are prioritized Who makes admission decisions Exclusionary or ineligibility criteria The program demonstrates efforts to minimize the times between first contact, screening and admission, or referral. Screening & Access to Services For persons to make informed choices about services, the program provides information regarding: o Program philosophy o Services and activities program provides o Staff qualifications o Disclosure of potential conflicts of interest o Outcomes performance o Costs of International. All Rights Reserved. 16

17 Screening & Access to Services When screening is conducted it: o Is documented o Reviews each child/youths eligibility information based on: Presenting need(s). Legal criteria, when applicable. o Assesses for appropriateness of services and availability of funding o Identifies whether the program can provide the service needed. o Includes: Interview with child/youth/family or referral source Provides on site pre placement visit, when appropriate o Ensures that screening tools are uniformly administered and staff trained on the use prior to administration Screening & Access to Services If screening identifies an urgent needs and critical need, appropriate action is: o Taken immediately o Documented When a person is found ineligible for services, the program: o Maintains documentation of these actions. o Implements a procedure for redetermining eligibility. Screening & Access to Services Waiting lists: Written procedures Information on: o Severity needs Time on list Remain Current o Continual review Document contact with c/y on list Information and status communicated to child/youth and documented Referral procedures including medical and crisis care Information incorporated into organizations International. All Rights Reserved. 17

18 Screening & Access to Services Children and Youth admitted for services receive an orientation that: o Is appropriate to their needs and services provided o Understandable o Is documented o Identifies person for service coordination o Includes the program s: Expectations Hours of Operation Access to after hours services Legal Requirements Code of Ethics Confidentiality Policy Philosophy of behavioral interventions o Explains: Rights and Responsibilities Ways to provide input Grievance and Appeal Process Administrative discharge criteria How information is used for: Research, Billing, Reporting, and Evaluation cont. Screening & Access to Services o Description of: Purpose and process of assessment Individual plan development C/Y s participation in goal development and achievement. o Copy of the program rules which identify: Restrictions, or behaviors that may lead to loss of rights or privileges Means to regain lost rights or privileges o Applicable policies on: Tobacco Weapons Seclusion and Restraint Drugs (legal / illegal) cont. Screening & Access to Services o Explanation of procedures (when applicable): Court appearances Therapeutic interventions for: sanctions incentives o Transition criteria and procedures o Familiarizes the c/y with the premises, including emergency exits and/or shelters, fire suppression equipment and first aid kits, when International. All Rights Reserved. 18

19 Assessment Screening & Access to Services Assessments are conducted or assessment information is obtained continuously that: o Is respectful o Identifies expectations and needs o That provides for the use of assistive technology o Is responsive to changes o Includes provisions to share results o Provides for legally required notifications o Uses valid and reliable tools Screening & Access to Services Assessments are conducted by qualified personnel that: o Knowledgeable o Trained on the use of the tool Assessments include information from: o Child/Youth o Family o Friends / Peers o Others as permitted Screening & Access to Services The primary assessment gathers sufficient information to develop an individual plan: o Child/youth information includes*: SNAP Fam Hx. Functioning Level Culture / Ethnicity Service Hx Legal Hx Education Info Social Supports Health Hx Environment Spiritual Beliefs Employment Co Occurring Relationships Suicide Risk Immunizations Allergies / Reactions Abuse/Neglect Violence/Trauma Parent / Legal Custodial Status Alcohol, Tobacco, Drugs Legal Involvement Gender ident. / expression and sexual orientation Intellectual Functioning Environmental Surroundings MH status: fire setting/risk taking, animal cruelty/ life stressors Medication Profile / Efficacy Speech, Hearing and Vision Development Hx / Prenatal exposure & International. All Rights Reserved. 19

20 Screening & Access to Services The primary assessment gathers sufficient information to develop an individual plan: o Family information includes: Presenting Problem SNAP Culture Spiritual beliefs Relationships Ethnicity Education Medical hx and status BH hx and status Employment Legal History Hx of abuse, neglect, trauma, violence Financial Status Screening & Access to Services 2.B.13. When assessment results in diagnosis(es), the diagnosis is determined by a practitioner legally qualified to do so in accordance with all applicable laws and regulations. Screening & Access to Services The primary assessment: o Conducted within specific timeframes o Results in an interpretive summary Based on assessment data Used to develop individual plan Identifies co occurring disorders/disabilities Ecological factors that should be addressed in the individual plan o Communicated Reassessments are conducted or obtained within established program International. All Rights Reserved. 20

21 2.C. Individualized Plan Each person served is actively involved in and has a significant role in the individual planning process and has a major role in determining the direction of the individualized plan. The individualized plan contains goals and objectives that incorporate the unique strengths, needs, abilities, and preferences of the persons served, as well as identified challenges and problems. Individualized plans may consider the significance of traumatic events. Participation of child/youth in preparation of individual plan Components of individual plan Coordination of services for child/youth Co occurring disabilities/disorders Content of program notes Individualized Plan The individual plan: o Developed with the active participation of person served o Prepared using info from: Primary Assessment Interpretive summary Based on SNAP Is focused on inclusion and integration into the community, family, natural supports systems, educational setting (as applicable) Involves family (applicable and permitted) Addresses the following needs: Healthcare (meds) Safety Education Cultural Developmental Spiritual Financial Social / Leisure Emotional / Behavioral Legal Other cont. Individualized Plan The individual plan is detailed and: o Identifies needs beyond scope of program. o Specifies the services the program provides. o Specifies referrals for additional services. o Is communicated to the child/youth served in an understandable manner. o Is provided to the International. All Rights Reserved. 21

22 Individualized Plan The individual plan includes: o Goals that are: Appropriate to age Appropriate to culture Based on: SNAP In the words of child/youth/family Reflective of informed choice o Objectives that are: Measurable Appropriate to Achievable Setting Time Specific Understandable Responsive to concerns Reflective of: Expectations, Age, Development, Culture and Ethnicity Individualized Plan.cont The individual plan identifies o Specific services o Frequency o Information about transition o Estimated duration of services o Legal requirements/legally imposed fees (as applicable) As applicable, a safety plan is completed asap and identifies: o Triggers / risk of dangerous behaviors o Coping skills o Preferred interventions o Warning Signs o Advanced Directives (when available) Individualized Plan To determine continued relevance the plan is reviewed with the child/youth: o Based on request for change o According to identified time frame o Modified as needed Based on needs, services include the development of: o Skills for Self Regulation o Cognitive Skills o Social Skills o Social Support o Community living and life skills o Vocational International. All Rights Reserved. 22

23 Individualized Plan When services disrupt education, the program provides or makes arrangements for education continuity. Based on needs or required by law: o Educational Specialist on Team o Consistent with IEP If educational services are provided: o Appropriate o Meet applicable state/federal/provincial law o Include provisions for: Evaluation Group Instruction Individual Instruction Individualized Plan Information is exchanged between program and school system, including: o Reciprocal In services o Authorized release of information o Program participation in o Preparation of school for transition educational planning from program o Assessment of o Preparation of transition from school environment modifications to work / vocational training o Involvement in transition planning for supported living programs When child/youth has co occurring disorders: o The plan addressed them in integrated manner. o Services are provided within organization or by referral by qualified personnel. Individualized Plan 2.C.11. If services are provided to children/youth who have intensive medical needs: o Services are provided in coordination with the person s primary care physician. o Plan addresses how services will be provided to ensure safety. o Services are provided by skilled healthcare providers. o Services are provided in accordance with all International. All Rights Reserved. 23

24 Individualized Plan Progress Notes: o Signed o Dated o Document: Progress toward achieving objectives and goals Significant events or changes Delivery of services and interventions that support the individual plan Movement to other levels of care 2.D. Transition/Discharge Transition, continuing care, or discharge planning assists the persons served to move from one level of care to another within the organization or to obtain services that are needed but are not available within the organization. The process is planned with the active participation of each person served. Two main components in this portion of the standards: the process of planning for the transition/discharge and then the actual event with the corresponding activities and documentation that goes along with each. Transition/discharge planning Components of transition plan Follow up after program participation Transition/Discharge Implemented written procedures for: o Referrals. o Transfer to another level of care or other services. o Inactive status. o Discharge. o Follow up. o Identifying when Trans. Plan to occur and where the Trans. Plan and Discharge Summary are documented. Transition/discharge planning is AS o Initiated at the beginning of services APPROPRIATE o Included in the planning and service delivery International. All Rights Reserved. 24

25 Transition/Discharge Youths leaving services as young adults are engaged in a structured planning process: o At least one year prior to discharge when possible. o That promotes discharge to a safe stable living environment o That includes an identified follow up period, during which aftercare and supports are available directly or through referral. Transition/Discharge The written transition plan is prepared or updated to ensure a seamless transition. The plan: o Developed with input o Identifies current progress and gains o Identifies need for support to assist in well being and community integration o Includes: Housing Plan Education Status and Goals Employment Prep / Career Referral source Information Planning Information about health: medication, physical,behavioral Options available for further services Transition/Discharge Documents provided to external programs/services include the child s/youth s identified: o Strengths o Needs o Abilities o Preferences And the families identified SNAP (as applicable and International. All Rights Reserved. 25

26 Transition/Discharge When transition includes reunification it is: o Initiated as early as possible o Involves: The child/youth Family Out of home provider o Promotes and maintains continuity of life long relationships o Maintains and strengthens connection with extended family and community Transition/Discharge Individuals who participate in the transition plan receive of copy When a child/youth moves to a school or other community service information is provided: o To c/y served o To family/ support system Transition/Discharge When the transition plan indicated need for additional services follow up includes: o Maintaining continuity and coordination o Offering or referring to needed services o Implementing formal protocols for transition of child/youth to adult service according to state/provincial/territorial/ tribal International. All Rights Reserved. 26

27 Transition/Discharge When an unplanned transition / discharge occurs, follow up is conducted as soon as possible: o To provide necessary notifications o Clarify the reasons for the unplanned discharge. o To determine with the child/youth whether further services are needed o To offer or refer to needed services Transition/Discharge For all children/youth leaving services a written discharge summary is prepared: o Extent the goals and objective were o Date of admission met o Presenting condition o Status of child/youth at last contact o Services provided o Recommendations for services o Reason for o Date of discharge discharge o Information on medications prescribed or administered Key Concept 2.E. Medication Use Medication use is directed toward maximizing the functioning of the children/youth served while reducing their specific symptoms and minimizing the impact of side International. All Rights Reserved. 27

28 Medication Use Key Areas Standards include: handling, prescribing, dispensing, and/or administering medications and control. Includes prescribed, samples, OTC, s alternative meds when prescribes for treatment. Training Physician review Policies and procedures *All P&P related to medication use and medication monitoring are implemented consistent with federal, state or provincial laws and licensure requirements. Medication Use Self administration is the application of a medication (whether by injection, inhalation, oral injection, or any other means) by the person served, to his/her body. This also may include staff handing the bottle or blister pack to the individual and instructing, verbally prompting and/or coaching them through the steps to ensure proper adherence, and closely observing them self administer the medication. Self administration by children /youth in a residential setting must be directly supervised by personnel, and standards related to medication use applied. Medication Use Dispensing the practice of pharmacy. Preparing and delivering a medication (including samples) that has been packaged or re packaged and labeled. Prescribing is evaluating, determining what agent is to be used by and giving direction on the use to a child/youth served (or family/legal guardian). It includes a verbal or written order. Medication control providing secure storage and controlled access to medications. Includes transporting, and disposing of medications, including those self International. All Rights Reserved. 28

29 Medication Use Look Closely at Applicable Standards: All organizations must apply standard 1 and 2. Organizations which control medications apply standard 3. Additional aspects of medication use, all standards are applicable to the degree that they define the organization s practice. Medication Use 2.E.1. The organization has a policy that: o Identifies whether or not medication is used in its programs. EACH o The process for children/youth to obtain medications needed to promote recovery and/or desired treatment/service outcomes, including whether or not it directly provides: Medication Control Prescribing Dispensing Administering Medication Use 2.E.2. In response to the needs of persons served and the type of services provided, documented ongoing training and education regarding medications: o Is received by personnel providing direct service to the person served. o When medication services are provided, is received by: Persons served Family members with legal rights or identified by persons served Training includes: (16 elements) LONG LIST of what should be Included * Note: This standard is required for all programs seeking accreditation. even if the program does not control or prescribe, dispense or administer, training may be required for International. All Rights Reserved. 29

30 Medication Use 2.E.3. When the organization physically controls medication (including self admin), written procedures are implemented and include: o Regulatory compliance o Purchase o Selfadministration o Safe Storage o Safe Handling o Packaging / labeling o Biohazards o Safe disposal o Inventory o Off site use o Transportation / Delivery Medication Use When meds are prescribed or provided (inc. self admin) in programs and persons are spending one or more nights: o MAR medication administration record is kept (medication name, dosage, frequency, instructions, prescribing professional) o Access to poison control center to personnel and persons served o Written procedures: For integration into individual plan Process for identifying, responding to, documenting and reporting medication reactions Actions to be followed for emergencies related to medications Medication Use Orgs that provide prescribing, dispensing or administering implement written procedures that include: o Reg. compliance o Person served involvement o 24/7 availability Phys., pharm, or qualif prof. o Doc. And reporting of med reactions and errors o Med use review as part of quality man. system o Identification of ETOH, tobacco or other drug use o Coordination with primary physician o Med use by females of child bearing age o o Med use during pregnancy o AIMS assessments as needed (initiation and 6 months for atypical antipsychotics) Dietary needs and restrictions associated with med use o Lab studies, tests or procedures o Review of past med use : effectiveness, side effects and allergies or adverse reactions o o OTC use Use of a Prescription Drug Monitoring Program (PDMP), when International. All Rights Reserved. 30

31 Medication Use Orgs that provide prescribing implement written procedures that include: Screening for medical comorbidities Evaluation of coexisting medical conditions Identifying potential drug interactions (including otc and alt) Documentation or confirmation of informed consents Continuing a prescribed med if a generic not available Continuity of med use when identified as a need in transition plan Medication Use If prescribing: o The use of guidelines and protocols to reflect state of the art choices and ensure the safety of person served. o A program of medication utilization evaluation, including measures of effectiveness and satisfaction of person served. Medication Use A documented peer review is conducted: o At least annually o By qualified professional with legal prescribing authority, or pharmacist o Representative sample o To assess appropriateness, determined by: Needs and preferences Efficacy o To determine if: Side effects, contraindications were identified and addressed o To identify: Use of multiple meds simultaneously Medication International. All Rights Reserved. 31

32 Medication Use Information from the peer review process is: o Reported to applicable staff. o Used to improve the quality of services provided. o Incorporated into the org. s performance improvement system. Org s that dispense or administer meds implement written procedures to address: o Documentation of medication administration, errors, reactions, use and benefits of prn s and coordination when medication provided by external source. Call CARF if you have any questions. 2.F. Nonviolent Practices Key Concept: The main focus of this section is the training of staff on nonviolent practices, including early recognition of and supportive response to escalating behavior. The standards place an emphasis on an organization s move to eliminate the use of currently existing seclusion or restraint, and include the development of a plan to minimize or eliminate such practices. Nonviolent Practices KEY AREAS ADDRESSED Training and procedures supporting nonviolent practices Policies and procedures for use of seclusion and restraint Patterns of use reviewed Persons trained in use Plans for reduction/elimination of use Pay Close attention to CARF definitions of Seclusion and Restraint could be different other International. All Rights Reserved. 32

33 Nonviolent Practices Definitions: Seclusion refers to restriction of the child/youth to a segregated room with their freedom to leave physically restricted. Voluntary time out is not considered seclusion even though it may occur as a response to verbal direction. Restraint is the use of physical, mechanical, or other means to temporarily limit a child/youth s freedom of movement. It is used when there is an immediate risk of harm to self or others, and it is determined as the only means to de escalate the threatening behavior. RESTRAINT IS NOT Nonviolent Practices Briefly holding a child/youth served, without undue force, for the purpose of comfort or to prevent self injurious behavior, or holding a person s hand or arm to safely escort him or her from one area to another The use of assistive devices for children/youth with physical or medical needs Separating individuals who are threatening to harm one another. Security doors designed to prevent elopement or wandering. Major Points Nonviolent Practices Seclusion or restraint by trained and competent personnel is used only when other less restrictive measures have been found to be ineffective to protect the person served or others from injury or serious harm. Peer restraint is not considered an acceptable alternative to restraint by personnel. In a correctional setting or secure setting, the use of seclusion or restraint for security purposes are not considered seclusion or restraint under these standards. Security measures, such as the use of handcuffs, instituted by law enforcement personnel, are not subjected to these International. All Rights Reserved. 33

34 Nonviolent Practices All organizations must apply standards 1 and 2 2.F.1. The organization has a policy that identifies: o How all personnel will be trained on the prevention of workplace violence. o How it will respond to aggressive or assaultive behaviors. o Whether, and under what circumstances: Seclusion is used within the programs it provides. Restraints are used within the programs it provides. Nonviolent Practices 2.F.2. As applicable to the population served, all direct service or front line personnel receive documented initial and ongoing competency based training in: o Contributing factors or causes of threatening behavior, including training on recovery and trauma informed services and use of personal safety plans. o Recognition of precursors to aggressive behaviors. o Impact of interpersonal interactions. o Medical conditions contributions. o Continuum of alternative interventions. o Prevention of threatening behaviors. o Recovery/wellness oriented relationships and practices. o Crisis management in a supportive, respectful manner, without restraints. 2.F.3. Nonviolent Practices All personnel involved in the direct administration of seclusion or restraint receive documented initial and ongoing competency based training provided by persons or entities qualified to conduct such training, on: o When/how to restrain or seclude while minimizing risk. o Recognizing signs of physical distress in the person being restrained or secluded. o Risks to persons served or personnel, including: Medical and psychological o First aid & CPR. o How to monitor & continually assess for earliest release. o Intervention done by individual and by a International. All Rights Reserved. 34

35 Nonviolent Practices If the org uses S and/or R, a plan is implemented to minimize or eliminate the use of S and/or R that includes: o Identification of the role of leadership. o Use of data to inform practice. o Development of workplace attitudes, skills, and practices that support recovery. o Identification of: Specific strategies to prevent crisis. Timelines to reduce the use of S and/or R. o Identification of roles for persons served and advocates in determining if crisis procedures and practices are implemented in a positive and proactive fashion. o A review of the role of the debriefing process in supporting the reduction of the us of S and/or R. Nonviolent Practices A written status report on the plan for minimization or elimination of the use of seclusion and/or restraint: o Is prepared annually. o Includes: Goals and time lines Progress made in reduction of use. Areas still needing improvement Factors impeding elimination of the use of seclusion and restraint. o Is shared with: Personnel. Persons served. Other stakeholders. Nonviolent Practices If the org uses S and/or R, written procedures for the use of specific interventions are implemented and include protocols for: o Adults. o Children and adolescents. o Persons with special needs. o Team intervention, including: Defining team leadership. Assigning team duties. If a personal safety plan exists for the person served, it is readily available for immediate International. All Rights Reserved. 35

36 Nonviolent Practices An org that uses S and/or R implements policies that specify that: o All attempts will be made to deescalate crisis and use S/R only as a safety intervention of last resort. o S/R is administered by personnel who are trained and competent in proper techniques of administering or applying and monitoring the form of S/R ordered. o S/R is used only for intervention in an emergency situation and to prevent harm to self or others. o S/R is not used as coercion, discipline, convenience, or retaliation by personnel in lieu of adequate programming or staffing. Nonviolent Practices An organization that uses S or R implements written procedures that specify that: o The intake evaluation of the person served: Includes: A review of the medical history to determine whether S or R can be administered without risk to health and safety. An assessment of physical, sexual, and emotional abuse; neglect; trauma; and exposure to violence. o o Identifies contraindication to be considered prior to the use of S or R Appropriate interaction with staff occurs as an effort to deescalate threatening situations. Standing orders are not issued to authorize the use of seclusion or restraint. Nonviolent Practices (cont) written procedures specify o Immediate assessment of contributing environmental factors that may promote maladaptive behaviors are identified and actions taken to minimize those factors. o The simultaneous use of S and R is prohibited unless a staff member has been assigned for a continual fact to face monitoring. o When S or R is used: Documentation confirms that identified contraindications were taken into considerations prior to the use. It is ordered by a physician or designated qualified behavioral health practitioner who has training and competence in the prevention and management of behaviors that are a danger to self or International. All Rights Reserved. 36

37 Nonviolent Practices (cont) o When S or R is used: It is administered in a safe manner, with consideration given to the physical, developmental, and abuse/neglect history of the person served. Personnel are trained to monitor for the unique needs of a person in S or R. As soon as the threat of harm is no longer imminent, the person is removed from S or R. Staff communicate to the person being S or R their intention to keep them and others safe, and how the specific procedure being used will keep do this When S or R is used, a trained staff member must be assigned for continual monitoring. Immediate medical attention is made available for any injury resulting from S or R. Nonviolent Practices Organizations using S or R implement written procedures to require that: o Documentation demonstrates that less restrictive intervention techniques were used prior to the use of seclusion or restraint. o A designated, qualified, and competent physician or QBH practitioner provides face to face evaluation of the person served within one hour of the order for S or R. o An order for S or R is time limited and does not exceed 4 hours for an adult or 1 hour for a child / adolescent. o Orders for S or R may be renewed for a total of up to 24 hrs. Orders for renewal may only occur following a face to face assessment by a QBH. o After 24 hours, a new order is required following a face to face evaluation by a physician or QBH. Nonviolent Practices (cont) Use of S or R implemented written procedures require: o Appropriately trained personnel continually assess, monitor and reevaluate the person to determine if S and R still needed. o All orders are entered into the record as soon as possible, but not longer that two hours after implementation. o The designated and qualified personnel sign the order with the time period mandated by law. o Face to face attention, including: vitals, meals, bathing, use of restroom, is given to a person in S and R at least every 15 minutes by authorized personnel. o Documentation of re evaluations and face to face attention is entered into the record. o As applicable and permitted, documentation that family or significant other(s), legal guardian, advocate and or treating practitioner is notified asap, but at least within 10 hours of International. All Rights Reserved. 37

38 Nonviolent Practices A room designated for the use of S or R has: o A focus on the comfort of the person served, including: Adequate air flow. Comfortable temperature. Safe comfortable seating and/or lying arrangement. o Identified plan for emergency exit. o Access to bathroom facilities, directly or through escort. o Sufficient lighting. o Observation availability. o Call capability when ongoing direct observation is not utilized. o A location that promotes privacy and dignity of the person served. Nonviolent Practices Following the use of S or R, a debriefing is conducted asap (preferably within 24 hours) after the incident, and includes: o The person served, for the purposes of: Hearing about their experience / perspective. Informing them why the R/S was used. Returning control to them. o Involved staff members. o Others observing the incident, when permitted. o Others requested by the person served (family/ guardian/significant other) unless contraindicated. Nonviolent Practices (cont) a debriefing is conducted asap, and includes: o A documented discussion that addresses: The incident. It s antecedents. Assessment of contributing factors on individual, programmatic and organizational basis. Reason for S or R. Specific interventions used. Persons reactions to intervention. Actions possible to make future S or R unnecessary. When applicable, modifications made to the treatment plan to address issues or behaviors that impact the need to use S or International. All Rights Reserved. 38

39 Nonviolent Practices The use of S or R always is documented as a critical incident. The chief executive or designated management or supervisory staff member reviews and signs off on all uses of S or R. o After every occurrence. o Within a designated time frame. o To determine conformance with applicable P & P. Nonviolent Practices The use of S or R always is: o o Recorded in the information system. Reviewed: For: Analysis of patterns of use. History of use by personnel. Environmental contributing factors. Assessment of program design contributing factors. o Used for performance improvement. 2.G. Records of the Persons Served A complete and accurate record is developed to ensure that all appropriate individuals have access to relevant clinical and other information regarding each person served. Content of the record Time frame for record entries Duplicate International. All Rights Reserved. 39

40 Records of the Person Served The record communicates information in a manner that is: o Organized o Clear o Complete o Current o Legible All documents contained in the record that are generated by the organization that require signatures include original or electronic signatures. Records of the Person Served The record includes: o Admission date o Legal guardian info o Emergency contact o Staff primary contact o Release of Information Authorizations o Primary care physician o Healthcare payor o Safety Plan o Reunification Plan o Court Orders/Legal o Health History Status o Current Medications o Pre admit screening o Orientation documentation o Referral documentation o Discharge o Individual Plan Reviews o Transition Plan Summary o Correspondence o Location of other records o Assessments o Services Received o Financial Agreements o Consents o Progress notes Records of the Person Served Entries to the records follow the organization s policy that specifies time frame for entries. If duplicate information or reports from the main record exist or working files are maintained: o They are not substituted for the main record. o Are maintained with same degree of protection. P & P regarding information to be transmitted to others that include: o Identifying what can be shared legally without release o Forms to authorize release of info that comply with all applicable International. All Rights Reserved. 40

41 2.H. Quality Records Review The program has systems and procedures that provide for the ongoing monitoring of the quality, appropriateness, and utilization of the services provided. This is largely accomplished through a systematic review of the records of the persons served. The review assists the program in improving the quality of services provided to each person served. Focus of quarterly review Use of information from quarterly review Quality Records Review The program conducts a documented review of the services provided at least a quarterly that address: o Quality of service delivery o Appropriateness of services o Patterns of service utilization o Model fidelity when EBP The quarterly review is performed: o In accordance with an established review process o By personnel trained and qualified o On a representative sample of : Current records Closed records Quality Records Review The program conducts a documented review of the services provided: o At least quarterly. o That addresses, as evidenced by the record of the person served: The quality of service delivery. Appropriateness of services. Patterns of service utilization. Model fidelity, when an evidence based practice is identified. The quarterly review is performed: o In accordance with an established review process o By personnel trained and qualified o On a representative sample of : Current records Closed International. All Rights Reserved. 41

42 Quality Records Review When records are selected for review the person responsible for providing the service is not: o Solely responsible for the selection of records to be reviewed o A reviewer of his or her records Quality Records Review The review addresses whether: o The person served was: Provided a complete orientation. Involved in making informed choices about services. o Confidential information released appropriately. o Assessments were: Thorough Complete Timely o Risk factors: Were adequately addressed. Resulted in safety plans, when appropriate. Quality Records Review..cont. The review addresses whether.. o Goals and objectives were: Based on: Assessment Results Input from person served Revised when indicated. o Services provided reflect the goals and objectives on the individualized International. All Rights Reserved. 42

43 Quality Records Review..cont. The review addresses whether: o The actual services reflect: Appropriate level of care. Reasonable duration. o When applicable the following have been completed. Transition plan. Discharge summary. o Services were documented according to policy. o The plan was reviewed and updated according to policy. Quality Records Review The program demonstrates that the information collected from the review is: o Reported to applicable personnel o Used to identify training needs o Used to improve service quality Child & Youth Services Core Program Standards Section International. All Rights Reserved. 43

44 Section 3 Core Program Standards 3.A. Adoption Description Adoption programs are inclusive of open, closed, customary*, and international adoptions as well as other permanent custody or care arrangements to provide children/youths with legal and social stability. Programs promote the active participation of all, including the foster family, birth family, extended family, adoptive family, child/youth, advocate, caregivers, members of indigenous or other communities of origin, or other individuals who are significant to the child/youth. Services are based on the best interest of the child/youth. * Customary adoption = indigenous practice of permanent placement with others within the community Programs can be delivered by public or indigenous child/youth welfare authorities, private licensed agencies, or licensed individuals. Various other regulatory requirements may be required by programs: Indian Child Welfare Act, Adoption and Safe Families Act, Multi Ethnic Placement Act, Interethnic Adoption Provisions Act, Fostering Connections, Hague Convention, and the Act to Promote Safe and Stable Families, all other applicable regulatory requirements. 3.A. Adoption Promotion of the active participation of birth, foster, and adoptive families and of the children and youth served Recruitment practices for adoptive families Placement and matching for the child/youth served with adoptive family Assessments for selection of adoptive families Training for adoptive families Post adoption services Modifications to standards 9,10,11 due to consistency of training and education International. All Rights Reserved. 44

45 3.B. Assessment & Referral Description Assessment and referral programs provide a variety of activities, including prescreening, screening, assessment, determination of need, and referral to appropriate services. The provision of information on available resources is not considered a full assessment and referral program. An adequate assessment must be conducted to provide more informed referrals. Assessment and referral may include hotlines, warmlines, or resource referral systems, such as 211 or First Call for Help. Policies and procedures Valid & reliable assessment tools, tests, are utilized. Linkage and follow up as indicated. 3.C. Behavioral Consultation Description In behavioral consultation programs, emphasis is placed on the reduction or elimination of dysfunctional or inappropriate behaviors and to replace them with positive behaviors or increase the ability of the person served to function to at higher gain greater satisfaction in the activity. Services may be provided in a variety of settings; home, educational or clinic. Skill/knowledge of personnel Team meetings Behavioral assessment input Family support Monitoring of strategies 3.C.9. Previous element h. spiritual/cultural separated into two elements. 3.C.16. is NEW and requires written discharge summaries for all persons who leave services. 3.D. Case Management Services Coordination Description Case management/services coordination provides goal oriented and individualized supports through assessment, planning, linkage, advocacy, coordination, and monitoring activities. Successful case management/services coordination assists persons served to achieve their goals through communicating and collaborating with other service providers. Programs may also provide supportive counseling and crisis intervention services, when allowed by regulatory or funding authorities. Personnel qualifications including knowledge of local resources. Services provided at locations convenient for persons served. Services provided based on intensity of need of persons International. All Rights Reserved. 45

46 3.E. Child/Youth Day Care Description A child/youth day care program provides care, development, and supervision for an identified portion of the day. Services are provided to children/youths temporarily entrusted to the program during the parent s/caregiver s involvement at work, school, or other short term activity. Day care programs may be located in a freestanding facility or in a designated area within a school or other community setting. Training of providers Program activities Administration of medication Parent/guardian consent Information provided to parents/guardians Modification to standard 2 for consistency of training standards. F. Child/Youth Protection Description The primary purpose of child/youth protection programs is to protect the safety and well being of children/youths. The guiding principles include choosing the least intrusive measures while maintaining safety and wellbeing; preserving the child s/youth s kinship ties and attachment to the extended family and others important to the child/youth; involving the family and community in all aspects of services, as circumstances allow; and using concurrent planning with all stakeholders. Services reflect the principle that the family, and the family s community, has the primary responsibility for the care, upbringing, and protection of their children/youths. If, with available supports, family can provide a safe and nurturing environment for a child/youth, these services are provided. If removal of the child/youth is necessary to maintain the child s/youth s safety and well being, services focus on both the child/youth and the family and demonstrates the importance of establishing permanence for the child/youth as soon as possible. F. Child/Youth Protection Policies & Procedures that identify roles of the responsible agencies and communication methods. Personnel training Required range of services the program provides. Potential abuse reports and information to be included Arrangements for medical examinations, when applicable. Caseloads framework and specifications Parameters for removal of child from the home. Education of community and other stakeholders concerning maltreatment, abuse and neglect issues. Modifications for consistency and clarity 2,13 & International. All Rights Reserved. 46

47 3.G. Community Transition Description Community transition programs focus on youths transitioning from service systems designed for children and adolescents to adulthood. Recognizing that many of the youths have experienced traumatic events that have impacted their relationships, the program emphasizes the importance of developing and maintaining healthy relationships of all types for successful transition to adulthood. The program provides youth opportunities to explore and understand changes that will occur when they are recognized as legal adults in areas including, but not limited to, access to service systems and funding; living options; and educational, social, and vocational opportunities. Programs may be facility or community based and offered in outpatient or residential settings. They may be comprehensive in scope and provide a wide range of services or specialize in a single or multiple areas of services such as independent living and/or vocational skills. 3.G. Community Transition Relationships with various persons in various stages Personnel competencies and training Inventory of skills and interests Youth voice and involvement Individual service plans include community inclusion A specific range of support services are provided. Modifications to standard 4 for consistency with training standards. Reordered standard previous 19 to H. Community Youth Development Description Community youth development programs are designed to optimize the personal, social, and vocational competencies of youth in order to live successfully in the community. The setting may be informal to reduce barriers between staff members and program participants and may include a drop in center, an activity center, a day program, or a leisure or recreational setting. Community youth development programs provide opportunities for persons served to participate in the community. The program defines the scope of these services based on the identified needs and desires of the persons served. Community activities accessed, chosen by the person served. Relationships with various persons in various stages Participation International. All Rights Reserved. 47

48 3.I. Counseling / Outpatient Description Counseling/outpatient programs provide services that include, but are not limited to, individual, group, and family counseling and education on wellness, recovery, and resiliency. These programs offer comprehensive, coordinated, and defined services that may vary in level of intensity and could be offered in a variety of locations. Counseling/ outpatient programs may address a variety of needs, including, but not limited to, situational stressors, family relations, interpersonal relationships, behavior management, mental health issues, life span issues, psychiatric illnesses, substance use disorders and the needs of victims of abuse, neglect, domestic violence, or other traumas. Service modalities Evidence based practice 3. J. Crisis and Information Call Centers Description Crisis and information call centers respond to a variety of immediate requests identified by the persons served and may include crisis response, information and referral, or response to other identified human service needs. Written procedures for: eligibility, call handling, safety of staff Personnel training and competencies Policy regarding referral expectations Referral procedures 3.J.1. The word policies deleted from the stem. 3.K. Crisis Intervention Description Crisis intervention programs offer services aimed at the assessment and immediate stabilization of acute symptoms of mental illness, alcohol and other drug abuse, emotional distress, acts of domestic violence or abuse/neglect, and persons who are suicidal or identified as runaways. Written emergency procedures Crisis intervention plan Service International. All Rights Reserved. 48

49 3.L. Day Treatment Description Day treatment programs consists of a scheduled series of structured, face to face therapeutic sessions organized at various levels of intensity and frequency in order to assist the persons served in achieving the goals identified in their person centered plans. A day treatment program may prevent or minimize the need for a more intensive level of treatment. It may also function as a step down from inpatient care or partial hospitalization or as transitional care following an inpatient or partial hospitalization stay to facilitate return to the community. Program availability 3 hrs/day, 4 days/wk. Program hours focus on treatment activities Consistency in personnel and scheduled activities Interdisciplinary team involvement, psychiatry available 3.M. Detoxification / Withdrawal Support Description Detox programs provide support to persons during withdrawal from alcohol and/or other drugs. Services may be provided in a unit of a medical facility or a freestanding residential or community based setting or in the home of a person served. Detox Services may be: outpatient, social, or inpatient. Medical evaluation and involvement in services Qualified personnel are available 24 / 7. Description 3.N. Diversion / Intervention Diversion/Intervention programs utilize strategies designed to intervene with at risk or identified individuals to reduce or eliminate identified concerns. Within the child welfare field, examples include alternative response, differential response, or multiple response systems. Diversion/Intervention programs may be voluntary and/or involuntary basis. Programs that serve persons on an involuntary basis are designed to implement special strategies for engaging this population. Intervention programs target persons who are exhibiting early signs of identified problems and are at risk for continued or increased International. All Rights Reserved. 49

50 3.N. Diversion / Intervention Diversion programs may include programs such as juvenile justice/court diversion, substance abuse diversion, truancy diversion, DUI/OWI classes, report centers, home monitoring, after school tracking, anger management, and building healthy relationships. Personnel have skill and knowledge in evidenced informed/evidence based theory and practice of diversionary alternatives. Two or more specified strategies are utilized in services A plan or written logic model exists to guide the programs approach to service delivery. Community collaboration and referral processes 3.O. Early Childhood Development Description An early childhood development program promotes healthy physical, mental, and emotional development of the child. Programs provide services and resources that assist the parent(s)/legal guardian(s) to identify and accept responsibility for the management of their child s health and development. Services may be provided in congregate or community settings or in a home setting and include education, training, and hands on support. Services are designed to optimize development, functioning, and resilience; and prevent developmental delay. Such programs may also engage families, child care providers, and communities in planning for and providing inclusive child care in community settings that support the child s developmental goals. Standards are aligned with the implementation of Quality Rating Improvement Systems (QRIS) in the US. 3.O. Early Childhood Development Some examples of programs include: Families First Early Start First Steps Family enhancement Looking After Children Building Blocks Infant development programs Child/youth development centers Head Start Supported child development programs Early Intervention (Canada) Healthy Families America Better Beginnings, Better Futures Birth to three (0 3) programs Collaborative services Provider training Adequate supervision of children while participating Parent training Modifications to standard 2 for consistency of training standards. Standard 5 previous element f. spiritual/cultural separated into two International. All Rights Reserved. 50

51 Description 3.P. Health Home A health home is a healthcare delivery approach that focuses on the whole person and integrates and coordinates primary care, behavioral health, other healthcare, and community and social support services. A health home is capable of assessing physical and behavioral health needs and demonstrate the capacity to address, either directly or through linkage with or referral to external resources, behavioral health conditions, such as mental illness and substance use disorders, and physical health conditions. Programs may also serve persons who have intellectual or other developmental disabilities and physical health needs or those who are at risk for or exhibiting behavioral disorders. Care is coordinated over time across providers, functions, activities, and sites to maximize the value and effectiveness of services delivered to persons served. 3.P. Health Home Services designed to support overall health and wellness. A recovery focused model of care that respects and promotes independence and responsibility and promotes healthy lifestyles. Ensures access to and coordination of care across prevention, primary care and specialty healthcare services. Monitors critical health indicators. Support individuals in the self management of chronic health conditions. Coordinate/monitor emergency room visits and hospitalizations, including participation in transition/discharge planning and follow up. Collection and analysis of data used to manage and improve outcomes. If the health home is not the actual provider of a particular healthcare service, it remains responsible for supporting and facilitating improved outcomes by providing disease management supports and care coordination with other providers. 3.Q. Home and Community Services Description Home and community services foster a culture that supports autonomy, diversity, and individual choice. Services are referred, funded, and/or directed by a variety of sources. They promote and optimize the activities, function, performance, productivity, participation, and/or quality of life of the individual. The program may be provided in various settings including, but not limited to, private homes, residential settings, schools, workplaces, community settings, and health settings. Services are provided by a variety of personnel, which may include health professionals, direct support staff, educators, drivers, coaches, and volunteers and are delivered using a variety of approaches, supports, and technology. The service providers are knowledgeable of their roles in and contribution to the broader health, community, and social services International. All Rights Reserved. 51

52 3.Q. Home and Community Services Knowledge and identification of appropriate community service options Person centered individualized services Collaboration with the family/support system Personnel competencies Safety and disaster preparedness Education to persons served, family/support system, and other stakeholders 3.R. Intensive Family Based Services Description Intensive family based services are provided in a supportive and interactive manner and directed toward maintaining or restoring a healthy family relationship and building and strengthening the capacity of families to care for their children. The services are time limited and are initially intensive, based on the needs of the family. The services demonstrate a multisystemic approach and have a goal of keeping families together or supporting reunification. The services may include wraparound and family preservation type programs. Services provided Access to professionals Clinical supervision 3.S. Intensive Outpatient Treatment Description The program consists of a scheduled series of sessions connected to the person centered plans of individual. Services may be provided during evenings and on weekends and/or interventions delivered by a variety of service providers in the community. The program may function as a step down program from partial hospitalization, detoxification/withdrawal support, or residential services; may be used to prevent or minimize the need for a more intensive level of treatment; and is considered to be more intensive than traditional outpatient services. Program availability at least 6 hrs/wk (9 for adults) Types of therapy to provide (Individual/family/group) Individual plan review International. All Rights Reserved. 52

53 3.T. Promotion / Prevention Description Promotion/prevention programs are proactive and evidence based/evidenceinformed, striving to reduce individual, family, and environmental risk factors, increase resiliency, enhance protective factors, and achieve individual and comprehensive community wellness through a team or collaborative approach. Programs utilize strategies designed to keep individuals, families, groups, and communities healthy and free from the problems related to alcohol or other drug use, mental health disorders, physical illness, parent/child conflict, abuse/neglect, exposure to and experience of violence in the home and community, and to inform the general public of problems associated with those issues, thereby raising awareness; or to intervene with at risk or identified individuals to reduce or eliminate identified concerns. Programs may be provided in the community, school, home, workplace, or other settings. Programs that offer training to current or future child/youth personnel are also included. 3.T. Promotion / Prevention Organizations may provide one or more of the following types of promotion/prevention programs, categorized according to the population for which they are designed: Universal (Promotion) programs target the general population and seek to increase overall well being and reduce the overall prevalence of problem behaviors. Selected (Prevention) programs target groups that are exposed to factors that place them at a greater than average risk for the problem. These programs are tailored to reduce identified risk factors and strengthen protective factors. Examples of prevention programs include pregnancy prevention, dropout prevention, Strengthening Families, substance abuse prevention, violence prevention, HIV prevention, smoking prevention, child abuse prevention, and suicide prevention. 3.T. Promotion / Prevention Training programs are included under this program category. They provide curriculum based instruction to active or future personnel in child and youth service programs. Examples of training programs include caseworker training, child welfare supervisory training, foster parent training, leadership training, guardian/guardian ad litem training, and childcare assistant International. All Rights Reserved. 53

54 3.U. Respite Description Respite services facilitate access to time limited, temporary relief from the ongoing responsibility of providing for the needs of the person served, families, and/or organizations. Respite services may be provided in the home, in the community, or at other sites, as appropriate. Respite services may be planned or unplanned and may provide services of a short duration, such as respite for medical appointments, or longer duration, such as vacation or emergency coverage. Respite programs are not an alternative for placement. Ongoing communication Time lines Description 3.V. Support and Facilitation Support and facilitation services provide assistance to children/youths and their families and often in conjunction with other programs (e.g. child/youth protection or support programs for foster or adoptive parents). Services can include transporting children/youths served, supervising visitations, individual supports, child minding, safe exchange, homemaking services, parent aides, peer and youth support and family-to-family support, and translation services. Services are primarily delivered in the home or community. A variety of persons other than a program s staff, such as volunteers and subcontractors, may provide these services. Training for personnel Network of professionals Modifications to standards 4,9,13,14,18 for consistency with training and education standard. Child & Youth Services Core Residential Standards Section International. All Rights Reserved. 54

55 4.A. Community Housing & Shelters Community Housing and Shelters Programs address the desires, goals, strengths, abilities, needs, health, safety, and life span issues of the persons served, regardless of the type of housing in which they live and/or the scope, duration, and intensity of the services they receive. The residences in which services are provided may be owned, rented, leased or operated directly by the organization or a third party, such as a governmental entity. Providers exercise control over these sites. Community housing or shelter programs may be referred to as runaway or youth shelters, domestic violence or homeless shelters, safe houses, youth intensive stabilization homes, intake shelters, supervised independent living, maternity homes, halfway houses, or recovery homes. 4.A. Community Housing & Shelters Programs may be located in rural or urban settings and in houses, apartments, townhouses, congregate or other residential facilities. They are often physically integrated into the community, with effort given to approximate other homes in their neighborhoods in terms of size and number of residents. The residences at which community housing services are provided must be identified in the survey application. These sites will be visited during the survey process and identified in the survey report as a site at which the organization provides a community housing program. Partnership with individuals.. Focused on home and community integration May include housing for family members as well as the child/youth May assist with reunification 4.A. Community Housing & Shelters A.1. Modified The program provides. c. Appropriate healthcare linkage (1) Physical health (2) Behavioral health (was Mental/behavioral and (3) addictions) A.4. Modified An individualized service plan is developed that: e. Is reviewed at least quarterly, based on the scope of the program The Intent clarifies in short term programs reviews occur more frequently. Previous standard 11. deleted due to International. All Rights Reserved. 55

56 4.B. Congregate Care Description Congregate care programs provide shelter, safety, and support to children/youths, for whom there are documented reports of maltreatment, abandonment, or have other identified needs and therefore are unable to live with their parents or alternative family. Congregate care programs are often used when smaller more typical homelike settings are unavailable. Although ideally the placement is time limited, longer term placements may be necessary or occur as a youth transitions to independent adulthood. In all situations, integration into the community to the greatest degree possible is achieved. 4.B. Congregate Care Personnel staffing and training Program activities Service Plan 4.B.2. Restructured and Deleted element: Meets weekly Based on the needs of the child/youth served, services are provided by a coordinated team that includes, at a minimum, the following professionals: a. Assigned residential staff members or a plan coordinator. b. A qualified practitioner c. Providers of appropriate medical support services. 4.B.3. Modifications due to consistency of training standard. Previous standard 5. deleted due to redundancy 4.C Crisis Stabilization Description Crisis stabilization programs are organized and staffed to provide the availability of overnight residential services 24 hours a day, 7 days a week for a limited duration to stabilize acute psychiatric or behavioral symptoms, evaluate treatment needs, and develop plans to meet the needs of the persons served. Often crisis stabilization programs are used as a preemptive measure to deter unnecessary inpatient hospitalization. Initial crisis plan Personnel availability Documented daily therapeutic interventions with QBHP Ongoing evaluation for service needs, referrals and linkages prior to International. All Rights Reserved. 56

57 4.D Foster Family and Kinship Care Description Foster/kinship care programs monitor the placement of a child/youth in a family/kin setting outside the birth or adoptive family. The program has agreements or contracts with the foster/kin family which outlines the roles and responsibilities of each. The courts may be involved. The programs assist foster and/or kinship families to recognize the strengths and abilities of the child (and at times family of origin) to effect changes to foster stability in the child s life, with the goal of permanency either through reunification/adoption or other permanent living placement. Some programs may also include recruitment/training of foster families as well as matching/placement of children / youth. 4.D Foster Family and Kinship Care Contracts / agreements Advocacy Child/youth, foster/kin family, family of origin, birth family, caregiver family Training for personnel and foster/kin family 4.D.8. If the program selects foster care providers. element b. deleted due to redundancy. includes a broad selection of families 11. & 12 Modifications due to consistency of training standard. 19. Previous element i. spiritual/cultural separated into two elements. Description 4.E. Group Home Care Group home programs provide placements to children/youths for whom there are documented reports of maltreatment, abandonment, or other identified needs, or treatment services to children/youths with identified behavioral needs. Services are provided in a safe and supportive setting and are time limited. The program goal is to reunite the child/youth with the natural family or other permanent placement when in the best interest of the child/youth. In all situations, integration into the community to the greatest degree possible is International. All Rights Reserved. 57

58 4.E. Group Home Care Access to professionals Community living components Personnel and training requirements Advocacy Permanency plan involvement Supportive program activities Maintenance of family/cultural connections 4.E.1. Restructured and Deleted element: Meets weekly Based on the needs of the persons served, services are provided by a coordinated team that includes, at a minimum, the following professionals: a. Assigned residential staff members or a plan coordinator. b. A qualified practitioner. c. Providers of appropriate healthcare support services. 4.E.3. Modifications due to consistency of training standard Previous standard 11. deleted due to redundancy. Description 4.F. Residential Treatment Programs are organized and staffed to provide both general and specialized nonhospital based interdisciplinary services 24 hours a day, 7 days a week for persons with behavioral health or co occurring needs, including intellectual or developmental disabilities. Services are provided in a safe, trauma informed, recovery focused milieu designed to integrate the person served back into the community and living independently whenever possible. The program involves the family or other supports in services whenever possible. Residential treatment programs may include domestic violence treatment homes, nonhospital addiction treatment centers, intermediate care facilities, psychiatric treatment centers, or other nonmedical settings. 4.F. Residential Treatment Treatment activity requirements Risk assessment Requirements for personnel / treatment team and training Community living components Dietary / nutritional consultation Person centered plan review time frame Previous standards 3, 9 & 14 deleted due to redundancy. 10. Modified to add competency based training. 16. Modifications due to consistency of training International. All Rights Reserved. 58

59 4.G. Specialized or Therapeutic Foster Care Description Programs use a community based treatment approach for children/youth with emotional and/or behavioral issues. This intensive, clinically based treatment is child/youth centered and family focused and offers an alternative to inpatient or residential treatment when a child/youth can no longer live in his or her family home. Treatment is delivered through an integrated team approach that individualizes services for each child/youth. The treatment foster parents are trained, supervised, and supported by the program staff and play a primary role in therapeutic interventions. The program s goal is permanency, either to reunite the child/youth with his or her family or to assist in facilitating an alternative permanent placement. Program staff monitors the child s/youth s progress in services and provide adjunctive services per the individualized plan and program design. The program may also be called intensive foster care, therapeutic family services, or therapeutic foster care. 4.G. Specialized or Therapeutic Foster Care Training of specialized providers and personnel Advocacy Clinical supervision Access to range of professionals Referral network and resources Availability of supervisory staff 24/7 Assists birth/adoptive families promote reunification If placement with siblings is not possible, visits are arranged Contracts / Agreements Access to appropriate activities (community, cultural, recreational, spiritual) 4.G. Specialized or Therapeutic Foster Care 2. Modifications due to consistency of training standard. 9. Added elements: To standard on written agreements... a.(1) What foster care providers can expect from the program Rights of specialized or treatment providers. b.(1) What is expected of the foster care providers. In collaboration with the program, implementation of specific objectives on individual plan. Previous standard 32 has been International. All Rights Reserved. 59

60 Child & Youth Services Specific Population Designations Section 5 5.A. Juvenile Justice If a core program is primarily provided in a correctional facility the Juvenile Justice standards must be applied. Description Programs serve a specific population of adjudicated juveniles referred by the court or from within the justice system. Services can be provided through courts, through probation and parole agencies, or in community based or institutional settings. Institutional settings may include juvenile detention centers, jails, prisons, or other delinquency focused settings. The services are designed to maximize the youth s ability to function effectively in the family, school, and community. 5.A. Juvenile Justice Service team specialized in various JJ theories and approaches services Personnel training Services in a correctional setting, restitution, relationship of staff with corrections Assessment of criminal International. All Rights Reserved. 60

61 5.B. Medically Complex Definition Medically complex (BH, CYS) Persons who have a serious ongoing illness or a chronic condition that meets at least one of the following criteria: Has lasted or is anticipated to last at least twelve months. Has required at least one month of hospitalization. Requires daily ongoing medical treatments and monitoring by appropriately trained personnel, which may include parents or other family members. Requires the routine use of a medical device or the use of assistive technology to compensate for the loss of usefulness of a body function needed to participate in activities of daily living. The medically complex condition of the person served presents an ongoing threat to his or her health status. 5.B. Medically Complex Description These standards consider the individual s overall medical condition, including acuity, stability, impairments, activity limitations, participation restrictions, psychological status, behavioral status, placement, and long term outcomes expectations. Appropriate medical consultation occurs specific to each child/youth in addition to medical consultation related to policies and procedures. Services can be provided in a variety of settings and are not necessarily exclusive programs that serve only this particular population. The services are designed to achieve and maintain an optimal state of health to enhance quality of life. The service plan supports all transitions in the child s/youth s life and is changed as necessary to meet his or her identified needs as well as the needs of the family/caregivers. 5.B. Medically Complex Involvement of medical healthcare professionals Philosophy of health and wellness Inclusion of medical needs in assessments and plan of care End of life planning Personnel competencies Living International. All Rights Reserved. 61

62 Questions Leslie Ellis-Lang LMFT CYS Managing Director ext. International. All Rights Reserved. 62