2015 CHILD AND YOUTH SERVICES PROGRAM DESCRIPTIONS

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1 2015 CHILD AND YOUTH SERVICES PROGRAM DESCRIPTIONS 2015 Child and Youth Services Program Descriptions 1

2 Contents Child and Youth Services General Program Standards... 3 Program/Service Structure... 3 Screening and Access to Services... 3 Individualized Plan... 3 Transition/Discharge... 4 Medication Use... 4 Nonviolent Practices... 5 Records of the Person Served... 6 Quality Records Review... 6 Child and Youth Services Specific Program Standards... 8 Adoption... 8 Assessment and Referral... 8 Behavioral Consultation... 8 Case Management/Services Coordination... 9 Child/Youth Day Care... 9 Child/Youth Protection... 9 Community Housing and Shelters Congregate Care Counseling Crisis Programs Crisis and Information Call Centers Crisis Intervention Day Treatment Detoxification Diversion/Intervention Early Childhood Development Foster Care Foster Family and Kinship Care Specialized or Treatment Foster Care Group Home Care Health Home Home and Community Services Intensive Family-Based Services Intensive Outpatient Treatment Promotion/Prevention Residential Treatment Respite Support and Facilitation Youth Services Specific Program Standards Community Transition Community Youth Development Child and Youth Services Specific Population Designation Juvenile Justice Medically Complex Child and Youth Services Program Descriptions 2

3 Child and Youth Services General Program Standards Program/Service Structure A fundamental responsibility of the organization is 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. The organization, where appropriate, provides information to the child/youth served and in collaboration with the parent and/or legal representative. Child- and family-centered care includes the following: Recognition that, when possible, the family is the constant in the child s/youth s life, while the service systems and personnel within those systems fluctuate. Facilitation of family-professional collaboration at all levels of care. Sharing of unbiased and complete information about a child s/youth s care on an ongoing basis, in an appropriate and supportive manner. Implementation of appropriate policies and programs that are comprehensive and provide necessary support to meet the needs of children/youths and families. Recognition of child/youth and family strengths and individuality and respect for different methods of coping. Understanding and incorporating the developmental needs of children/youths and families into service systems. Assurance that the design of health and social service delivery systems is flexible, accessible, and responsive to the needs of children/youth and families. Screening and Access to Services The process of screening and assessment is designed to maximize opportunities for the persons served to 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. Assessment data may be gathered through various means including face-to-face contact, telehealth, or from external resources. 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 Child and Youth Services Program Descriptions 3

4 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 transition process is planned with the active participation of each person served. Transition may include planned discharge, placement on inactive status, movement to a different level of service or intensity of contact, reunification, re-entry in a juvenile justice system, or transition to adulthood. The transition plan is a supportive document that includes information about the person s progress and describes the completion of goals and the efficacy of services provided. It is prepared to ensure a seamless transition to another level of care, another component of care, or an after care program. A discharge summary, identifying reasons for discharge, is completed when the person leaves services for any reason (planned discharge, against medical advice, no show, infringement of program rules, aging out, etc.). Just as the assessment is critical to the success of treatment, transition services are critical for the support of the individual s ongoing well-being. The organization proactively attempts to contact the person served after formal transition or discharge to gather needed information related to his or her postdischarge status. The organization reviews the postdischarge information to determine the effectiveness of its services and whether additional services were needed. The transition plan and/or discharge summary may be included in a combined document or as part of the individualized plan as long as it is clear whether the information relates to a transition or discharge planning. Medication Use Medication use is the practice of handling, prescribing, dispensing, and/or administering medications to persons served in response to specific symptoms, behaviors, and conditions for which the use of medications is indicated and deemed efficacious. Medication use may include self administration, or be provided by personnel of the organization or under contract with a licensed individual. Medication use is directed toward maximizing the functioning of the persons served while reducing their specific symptoms and minimizing the impact of side effects. Medication use includes prescribed or sample medications, and may, when required as part of the treatment regimen, include over-the-counter or alternative medications provided to the person served. Alternative medications can include herbal or mineral supplements, vitamins, homeopathic remedies, hormone therapy, or culturally specific treatments. Medication control is identified as the process of physically controlling, transporting, storing, and disposing of medications, including those self administered by the person served. Self administration for adults is the application of a medication (whether by injection, inhalation, oral ingestion, or any other means) by the person served, to his/her body; and may 2015 Child and Youth Services Program Descriptions 4

5 include the organization storing the medication for the person served, or may include staff handing the bottle or blister-pak to the person served, instructing or verbally prompting the person served to take the medication, coaching the person served through the steps to ensure proper adherence, and closely observing the person served self-administering the medication. Self administration by children or adolescents in a residential setting must be directly supervised by personnel, and standards related to medication use applied. Dispensing is considered the practice of pharmacy; the process of preparing and delivering a prescribed medication (including samples) that has been packaged or re-packaged and labeled by physician or pharmacist or other qualified professional licensed to dispense (for later oral ingestion, injection, inhalation, or other means of administration). Prescribing is evaluating, determining what agent is to be used by and giving direction to a person served (or family/legal guardian), in the preparation and administration of a remedy to be used in the treatment of disease. It includes a verbal or written order, by a qualified professional licensed to prescribe, that details what medication should be given to whom, in what formulation and dose, by what route, when, how frequently, and for what length of time. Nonviolent Practices Programs strive to be learning environments and to support persons served in the development of recovery, resiliency, and wellness. Relationships are central to supporting individuals in recovery and wellness. Programs are challenged to establish quality relationships as a foundation to supporting recovery and wellness. Providers need to be mindful of developing cultures that create healing, healthy and safe environments, and include the following: Engagement Partnership power with, not over Holistic approaches Respect Hope Self direction Programs need to recognize that individuals may require supports to fully benefit from their services. Staff are expected to access or provide those supports wanted and needed by the individual. Supports may include environmental supports, verbal prompts, written expectations, clarity of rules and expectations, or praise and encouragement. Even with supports, there are times when individuals may show signs of fear, anger, or pain, which may lead to aggression or agitation. Staff members are trained to recognize and respond to these signs through de-escalation, changes to the physical environmental, implementation of meaningful and engaging activities, redirection, active listening, etc. On the rare occasions when these interventions are not successful and there is imminent danger of serious harm, seclusion or restraint may be used to ensure safety. Seclusion and restraint are never 2015 Child and Youth Services Program Descriptions 5

6 considered treatment interventions; they are always considered actions of last resort. The use of seclusion and restraint must always be followed by a full review, as part of the process to eliminate the use of these in the future. The goal is to eliminate the use of seclusion and restraint in child and youth services, as the use of seclusion or restraint creates potential physical and psychological dangers to the persons subject to the interventions, to the staff members who administer them, or those who witness the practice. Each organization still utilizing seclusion or restraint should have the elimination thereof as an eventual goal. Restraint is the use of physical force or mechanical means to temporarily limit a person s freedom of movement; chemical restraint is the involuntary emergency administration of medication, in immediate response to a dangerous behavior. Restraints used as an assistive device for persons with physical or medical needs are not considered restraints for purposes of this section. Briefly holding a person served, without undue force, for the purpose of comforting him or her or to prevent self-injurious behavior or injury to self, or holding a person s hand or arm to safely guide him or her from one area to another, is not a restraint. Separating individuals threatening to harm one another, without implementing restraints, is not considered restraint. Seclusion refers to restriction of the person served to a segregated room with the person s freedom to leave physically restricted. Voluntary time out is not considered seclusion, even though the voluntary time out may occur in response to verbal direction; the person served is considered in seclusion if freedom to leave the segregated room is denied. 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. Seclusion or restraint is not used as a means of coercion, discipline, convenience, or retaliation. In a correctional setting, the use of seclusion or restraint for purposes of security is not considered seclusion or restraint under these standards. Security doors designed to prevent elopement or wandering are not considered seclusion or restraint. Security measures for forensic purposes, such as the use of handcuffs instituted by law enforcement personnel, are not subject to these standards. When permissible, consideration is made to removal of physical restraints while the person is receiving services in the behavioral health care setting. Records of the Person 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. 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 2015 Child and Youth Services Program Descriptions 6

7 program in improving the quality of services provided to each person served Child and Youth Services Program Descriptions 7

8 Child and Youth Services Specific Program Standards Adoption Adoption programs are inclusive of open, closed, customary, and international adoptions as well as other permanent custody or care arrangements and provide children/youths with legal and social stability. Customary adoption is a traditional indigenous practice recognized by the community that gives a child/youth a permanent parent-child relationship with someone other than the child s/youth s birth parent(s). Adoption programs ideally provide continuity of lifelong relationships and maintain cultural identity. The adoption program promotes the active participation of all affected by the permanent placement, 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. Programs can be delivered by public or indigenous child/youth welfare authorities, private licensed agencies, or licensed individuals. Signatories to the UN Convention on the Rights of the Child must meet the identified requirements. These organizations must ensure the child s/youth s fundamental right to identity, family, and culture is addressed. When applicable, programs must also conform to the requirements of the 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, as well as all other applicable regulatory requirements. Assessment and Referral Assessment and referral programs provide a variety of activities, including prescreening, screening, assessment, determination of need, and referral to appropriate level of care. 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. Such programs may be separate, freestanding programs; an independent program within a larger organization; or a specifically identified activity within a system of care. Organizations performing assessment and referral as a routine function of entrance into other core programs, such as their case management, counseling, or residential programs, are not required to apply these standards unless they are specifically seeking accreditation for assessment and referral. Behavioral Consultation In behavioral consultation programs emphasis is placed on the reduction or elimination of problematic behaviors. The focus of the program is to replace inappropriate behaviors with 2015 Child and Youth Services Program Descriptions 8

9 positive behaviors or increase the ability of the person served to express more effective and appropriate behaviors. Behavioral strategies are used to teach the person other means to deal with targeted behaviors and the environment to ensure that inappropriate behaviors are discouraged and positive behaviors are learned and maintained. This may include services to persons with eating disorders or those who exhibit self-injurious behaviors. Case Management/Services Coordination Case management/services coordination provides goal-oriented and individualized supports through assessment, planning, linkage, advocacy, coordination, and monitoring activities. It is focused on achieving individualized goals for the persons served. Successful case management/services coordination assists persons served to achieve their goals through communicating and collaborating with other service providers. Programs may provide occasional supportive counseling and crisis intervention services, when allowed by regulatory or funding authorities. Case management/services coordination may be provided by an organization as part of its individual service planning and delivery, by a department or division within the organization that works with individuals who are internal and/or external to the organization, or by an organization with the sole purpose of providing case management/services coordination. Such programs are typically provided by qualified case managers/coordinators or by case management teams. Organizations performing case management/services coordination as a routine function of other services or programs are not required to apply these standards unless they are specifically seeking accreditation for this program. Child/Youth Day Care 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/guardian 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. Child/Youth Protection The primary purpose of child/youth protection programs is to protect the safety and well-being of children/youths as they are entitled to protection from abuse, neglect, and harm or threat of harm. The guiding principles of child/youth protection services include choosing the least intrusive measures while maintaining the child s/youth s safety and well-being; preserving the child s/youth s kinship ties and attachment to the extended family and other persons of importance to the child/youth; involving the family and community in all aspects of services provided, as circumstances allow; and using concurrent planning with all stakeholders. Services provided by this program 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, a family can provide a safe and nurturing 2015 Child and Youth Services Program Descriptions 9

10 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, case management focuses on both the child/youth and the family and demonstrates the importance of establishing permanence for the child/youth as soon as possible. Community Housing and Shelters Community housing or shelters 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 shelters are provided in partnership with individuals and may include housing for family members as well as the child/youth served. These services are designed to assist the persons served to achieve success in and satisfaction with community living. These programs may provide reunification services with the child/youth served and his or her family. They may be temporary or long term in nature. The services are focused on home and community integration and engagement in productive activities. Community housing enhances the independence, dignity, personal choice, and privacy of the persons served. For persons in alcohol and other drug programs, these services are focused on providing sober living environments to increase the likelihood of sobriety and abstinence and to decrease the potential for relapse. 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. These programs may be located in rural or urban settings and in houses, apartments, townhouses, or congregate or other residential facilities. These residences are often physically integrated into the community, and every effort is made to ensure that they approximate other homes in their neighborhoods in terms of size and number of residents. Community housing may include: Temporary shelters or emergency residences. Transitional living that provides interim supports and services for youth aging out of child welfare services, persons who are at risk of institutional placement, persons transitioning from institutional settings, or persons who are homeless. Long-term housing that provides stable, supported community living or assists the persons served to obtain and maintain safe, affordable, accessible, and stable housing. The residences at which community housing services are provided must be identified in the Intent to Survey. These sites will be visited during the survey process and identified in the survey report and accreditation outcome as a site at which the organization provides a community housing program Child and Youth Services Program Descriptions 10

11 Congregate Care Congregate care programs provide shelter, safety, and support outside of their natural homes or placements to children/youths for whom there are documented reports of maltreatment, abandonment, absence without leave, or other identified needs or who are unable to live with their parents or alternative family. Placement is usually made 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. Counseling Counseling programs provide services that include, but are not limited to, individual, group, and family counseling and psychoeducation. These programs offer comprehensive, coordinated, and defined services that may vary in level of intensity. Counseling programs may address a variety of needs, including, but not limited to, problem resolution, situational stressors, family relations, interpersonal relationships, behavior management, mental health issues, life span issues, psychiatric illnesses, addictions (such as alcohol or other drugs, gambling, and internet), eating or sexual disorders, and the needs of victims of abuse/neglect, domestic violence, or other trauma(s). Crisis Programs In this section two distinct programs are available for accreditation. An organization may seek accreditation in either or both of these programs based on the services provided. Crisis and Information Call Centers Standards Crisis Intervention Standards Note: An organization can choose to seek accreditation for any of the crisis programs that it provides, but it is not required to seek accreditation for all of the crisis programs provided. Crisis and Information Call Centers 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. Crisis Intervention 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. Day Treatment Day treatment programs offer person-centered, culturally and linguistically appropriate, comprehensive, coordinated, and structured treatment services and activities. A day treatment 2015 Child and Youth Services Program Descriptions 11

12 program 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. Day treatment programs are offered four or more days per week, typically with support available in the evenings and on weekends. 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. Detoxification Detoxification programs provide support to the persons served during withdrawal from alcohol and/or other drugs. Services may be provided in a unit of a medical facility, in a freestanding residential or community-based setting, or in the home of the person served. The following types of detoxification may be provided: Social detoxification: Social detoxification is provided in an organized, residential, nonmedical setting delivered by an appropriately trained staff that provides safe, 24-hour medication monitoring, observation, and support in a supervised environment for a person served to achieve initial recovery from the effects of alcohol and/or other drugs. Social detoxification is appropriate for individuals who are able to participate in the daily residential activities and is often used as a less restrictive, nonmedical alternative to inpatient detoxification. Outpatient detoxification: Persons served receiving outpatient detoxification treatment usually are expected to travel to a hospital or other treatment facility daily or on a regular basis for detoxification treatment sessions. Sessions may be scheduled for daytime or evening hours. Outpatient detoxification programs may also be combined with a day program. Outpatient detoxification programs may also include provision of medically monitored medications used in the detoxification process. Inpatient detoxification: The inpatient setting offers the advantages of 24-hour medical care and supervision provided by a professional staff and the easy availability of treatment for serious complications. In addition, such a setting prevents persons served access to alcohol and/or other drugs and offers separation from the substance-using environment. Inpatient detoxification is often provided to individuals with co-occurring health conditions that would be impacted by the detoxification process. It is also appropriate for individuals who need extensive medical monitoring during detoxification. Diversion/Intervention Diversion/Intervention programs may include programs traditionally thought of as intervention that focus on changing outcomes for persons served and targeting antecedents of the problem. 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 Child and Youth Services Program Descriptions 12

13 Diversion/Intervention programs may serve persons on a voluntary and/or involuntary basis. Programs that serve persons on an involuntary basis are designed to implement special strategies for engaging this population. Diversion programs may include programs such as juvenile justice/court diversion, substance abuse diversion, truancy diversion, DUI/OWI classes, report centers, home monitoring, afterschool tracking, anger management, and building healthy relationships. Intervention programs target persons who are exhibiting early signs of identified problems and are at risk for continued or increased problems. Early Childhood Development An early childhood development program promotes healthy physical, mental, and emotional development of the child. Early childhood development 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 directed to identified families and children, and 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. These standards are aligned with the implementation of Quality Rating Improvement Systems (QRIS) utilized by many states in the U.S. to assess, improve, and communicate the quality of services in early childhood development programs. Early childhood development programs seeking accreditation are encouraged to use the CARF standards and the identified state QRIS when developing and providing services. Some examples of programs include: Families First Early Intervention (Canada) Supported child development programs Home visitation Family enhancement Looking After Children Building Blocks Healthy Families America Head Start Better Beginnings, Better Futures Child/youth development centers 2015 Child and Youth Services Program Descriptions 13

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