Alliance Standards Section 6: Residential Section 12: Program (overall) Foster Family Services Section 13: Foster Family Agency Foster Family

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1 Residential Services and Foster Care Crosswalk of Alliance and s This document provides a general crosswalk of the 2012 CARF and Alliance standards for accreditation of residential and foster care services. s Section 6: Residential Section 12: Program (overall) Foster Family Services Section 13: Foster Family Agency Foster Family The following table lists the Alliance residential and foster care standards (in the left column) and the relevant CARF standards (in the right column) that align to each s Section 1. ASPIRE to Excellence Assess the Environment 1.A. Leadership Set Strategy Persons Served and Other Stakeholders Obtain Input Implement the Plan 1.E. Legal Requirements 1.F. Financial Planning and Management 1.H. Health and Safety 1.I. Human Resources 1.K. Rights of the Persons Served Review Results Effect Change Section 2. Child and Youth Services General Program Standards 2.A. Program/Service Structure 2.B. Screening and Access 2.C. Individual Plan 2.D. Transition/Discharge 2.E. Medication Use 2.F. Nonviolent Practices 2.G. Records of the Child/Youth Served Section 3. Child and Youth Services Specific Program Standards 3.O. Foster Family and Kinship Care 3.V. Residential Treatment 3.X. Specialized or Treatment Foster Care

2 Residential Standards 6.1: There shall be a written policy for the safeguarding of money, personal property or valuables held on behalf of a child. 1.A.6. Corporate responsibility efforts include, at a minimum, the following: a. Written ethical codes of conduct in at least the following areas: (4) Service delivery, including: (d) Personal property. 1.F.9. If the organization takes responsibility for the funds of persons served, it implements written procedures that define: a. How the persons served will give informed consent for the expenditure of funds. b. How the persons served will access the records of their funds. c. How funds will be segregated for accounting purposes. d. Safeguards in place to ensure that funds are used for the designated and appropriate purposes. e. How interest will be credited to the accounts of the persons served, unless the organization is subject to guidelines that prohibit interest-bearing accounts. f. How monthly account reconciliation is provided to the persons served. 1.K.2. The organization implements policies promoting the following rights of the persons served: c. Freedom from: (2) Financial or other exploitation. 2.A.33. Each person served in a residential setting has his or her own personal space that: a. Respects privacy. b. Promotes personal security. c. Promotes personal safety. 3.V.4. The program provides the following community living components, in accordance with all applicable regulations: e. Security of property. Residential and Foster Care Crosswalk Alliance and CARF standards 1

3 Residential Standards 6.2: A child s funds shall not be commingled with Agency funds or petty cash. There shall be accurate accounting records and client signed receipts for such funds. 1.A.6. Corporate responsibility efforts include, at a minimum, the following: a. Written ethical codes of conduct in at least the following areas: (1) Business. (d) Personal property. (e) Setting boundaries. (f) Witnessing of documents. (7) Prohibition of: (a) Waste. (b) Fraud. (c) Abuse. (d) Other wrongdoing. 1.F.9. If the organization takes responsibility for the funds of persons served, it implements written procedures that define: a. How the persons served will give informed consent for the expenditure of funds. b. How the persons served will access the records of their funds. c. How funds will be segregated for accounting purposes. d. Safeguards in place to ensure that funds are used for the designated and appropriate purposes. e. How interest will be credited to the accounts of the persons served, unless the organization is subject to guidelines that prohibit interest-bearing accounts. f. How monthly account reconciliation is provided to the persons served. Residential and Foster Care Crosswalk Alliance and CARF standards 2

4 Residential Standards 6.3: There shall be a written policy describing the circumstances under which a fine can be levied against a child. Fines levied against a child shall be recorded and explained in the child s file. All fines shall be maintained in a separate account for the benefit of the child or all children in placement. 6.4: Clients shall receive a reasonable and age appropriate allowance weekly. 6.5: The Agency shall have a written Emergency Intervention Plan and Runaway Plan, approved by its Board of Directors and Licensing. All staff shall have been trained on the contents and interventions in these Plans. 2.A.21. The program s policies promoting the rights of the person served addresses: b. Written procedures governing the use of: (1) Special treatment interventions (2) Restriction of rights. c. Methods to ensure that intrusive procedures are addressed in a safe manner, with consideration given to the: (1) Physical history of the person served. (2) Developmental history of the person served. (3) Abuse history of the person served. 2.B.7. Each person admitted to services receives an orientation that: e. Includes: (6) An explanation of the program s procedures, when applicable, regarding: (a) Expectations for court appearances. (b) Identification of therapeutic interventions for: (i) Sanctions. (ii) Incentives. CARF standards do not require a program to provide an allowance. 1.A.3. The identified leadership guides the following: f. Risk management. 1.E.1. The organization demonstrates a process to comply with the following obligations: e. Licensing. 1.H.4. Personnel receive competency-based training: a. Both: (1) Upon hire. (2) Annually. Residential and Foster Care Crosswalk Alliance and CARF standards 3

5 Residential Standards b. In the following areas: (1) Health and safety practices. (2) Identification of unsafe environmental factors. (3) Emergency procedures. (5) Identification of critical incidents. (6) Reporting of critical incidents. (8) Reducing physical risks. c. That is documented. 1.H.8. The organization has written procedures regarding critical incidents that include: e. The following incidents, if appropriate: (10) Elopement. 1.H.9. A written analysis of all critical incidents is provided to or conducted by the leadership: a. At least annually. b. That addresses: (1) Causes. (2) Trends. (3) Actions for improvement. (4) Results of performance improvement plans. (5) Necessary education and training of personnel. (6) Prevention of recurrence. (7) Internal reporting requirements. (8) External reporting requirements. 2.A.13. The program implements written procedures for the provision of crisis intervention services. 2.A.20. The program implements policies and written procedures that address positive approaches to behavioral interventions, including: a. An emphasis on building positive relationships with the persons served. b. Evaluation of the environment. Residential and Foster Care Crosswalk Alliance and CARF standards 4

6 Residential Standards 6.6: There shall be a termination report for all children discharged or removed from the Agency that is prepared within 30 days of discharge and contains: 1. The name, address and relationship to the child of the person to whom the child was released, 2. The reason for the discharge/removal, and, 3. A brief summary of the care or treatment provided during the placement. 6.7: There shall be quarterly reports summarizing care/services provided and evaluating progress in relation to the Plan. c. Staff interaction with the persons served that: (1) Promotes de-escalation. (2) Manages behavior. (3) Strengthens self-regulation. d. Development of a personal safety plan for each person served on an individual basis, when indicated. 2.D.11. For all persons leaving services, a written discharge summary is prepared that: a. Includes the date of admission. b. Identifies the presenting condition. c. Describes the services provided. d. Describes the extent to which established goals and objectives were achieved. e. Describes the reasons for discharge. f. Identifies the status of the person at last contact. g. Lists recommendations for services or supports. h. Includes the date of discharge from the program. 2.C.12. Progress notes or recordings: a. Are: (1) Signed. (2) Dated. b. Document: (1) Progress toward achievement of identified: (a) Objectives. (b) Goals. (2) Significant events or changes in the life of the person served. (3) The delivery of services and specific interventions that support the individualized plan. (4) Movement to other levels of care. 2.G.3. The individual record includes: h. As applicable, the person s: (9) Individualized plan, including reviews. Residential and Foster Care Crosswalk Alliance and CARF standards 5

7 Residential Standards 6.8: There shall be a structured, consistent and well established service/treatment program including: A daily routine and schedule. An activity schedule that indicates recreation planning, a variety of program activities, and community integration that reflects each child s needs. Services (therapeutic, educational, etc.) offered to or provided for each child. 3.V.8. There is at least a quarterly review of each person s: a. Plan of services. b. Goals. c. Progress toward goals. 2.A.1. Each program/service: a. Documents the following parameters regarding its scope of services: (1) Population(s) served. (2) Settings. (3) Hours of services. (4) Days of services. (5) Frequency of services. (9) The specific services offered, including whether the services are provided directly or by referral. b. Shares information about the scope of services with: (1) The persons served. (2) Families/support systems, in accordance with the choices of the persons served. 2.A.6. Service delivery models and strategies are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and/or expert professional consensus. 2.A.8. Each core program for which the organization is seeking accreditation has a written program description that: a. Guides the delivery of services. b. Includes: (1) The philosophy of the program. (2) Program goals. (3) A description of the service modalities to be provided to achieve the program objectives that: (a) Is relevant to the specific culture of the population served. (b) Includes: (i) Broad strategies to be used to achieve objectives. Residential and Foster Care Crosswalk Alliance and CARF standards 6

8 Residential Standards (ii) The rationale for the choice of service modality(ies). (4) Identification or a description of: (a) Special populations served. (b) Mechanisms to: (i) Address needs. (ii) Cultivate strengths. 3.V.1. The program provides treatment with integrated therapies, activities, and experiences throughout the day, seven days per week, which consists of three or more of the following: a. Therapeutic activities such as individual, family, and group counseling. b. Educational activities. c. Training activities. d. Crisis intervention. e. Development of community living skills. f. Family support, with the approval of the person served. g. Linkages to community resources. h. Advocacy. i. Development of social skills. j. Development of a social support network. k. Development of vocational skills. l. Assistance in securing housing that is safe, decent, affordable, and accessible. m. Medical care and/or therapies. n. Development of recreational and leisure skills. o. Education on wellness and recovery. 3.V.4. The program provides the following community living components, in accordance with all applicable regulations: a. A written daily schedule of activities. b. Regular meetings between the persons served and program personnel. c. Opportunities to participate in activities that would be found in a home. d. Adequate personal space for privacy. e. Security of property. f. A homelike and comfortable setting. g. Individual possessions and decorations. h. Daily access to nutritious: Residential and Foster Care Crosswalk Alliance and CARF standards 7

9 Residential Standards (1) Meals. (2) Snacks. i. Opportunities for unstructured private time. 6.9(a): There shall be clear written procedures governing the controls on, usage, storage, monitoring, and disposal of all prescription and over-the-counter medications, including PRN medications. Policies and procedures shall incorporate the following: A statement of overall philosophy. Prohibition against the use of medication for discipline. Information regarding the medication and its potential side effects shall be available to the child, staff and to the parent/guardian, if applicable. Undesirable side effects shall be documented in the client file, reported and followed up. All medications administered shall be documented in the client s file. 6.9(b): For Over the Counter (OTC) medications to be administered to clients, there shall be: a. An OTC PRN Authorization/prescription listing the medications to be used and signed by a physician; b. A statement authorizing when the client may request the medication by name or by symptom, signed by a physician; 3.V.9. Persons served are given opportunities to participate in: a. Community activities. b. Cultural activities. c. Recreational activities. d. Spiritual activities. 1.K.2. The organization implements policies promoting the following rights of the persons served: c. Freedom from: (1) Abuse. 2.A.8. Each core program for which the organization is seeking accreditation has a written program description that: b. Includes: (1) The philosophy of the program. (3) A description of the service modalities to be provided to achieve the program objectives that: (a) Is relevant to the specific culture of the population served. (b) Includes: (i) Broad strategies to be used to achieve objectives. (ii) The rationale for the choice of service modality(ies). 2.E.1. The organization has a policy that identifies: a. Whether or not medications are used in its programs. b. The process for persons served to obtain medications needed to promote recovery and/or desired treatment/service outcomes, including whether or not it directly provides: (1) Prescribing. (2) Dispensing. (3) Administering. Residential and Foster Care Crosswalk Alliance and CARF standards 8

10 Residential Standards c. If generic medications are being administered, they must be specifically listed on the Authorization/prescription, OR there must be a may substitute generic statement signed by a physician; d. A reason for and response to the medication documented on a medication on administration form; e. Locked as any other medication. 2.E.2. In response to the needs of the persons served and the type of service provided, documented ongoing training and education regarding medications: a. Is received by: (1) The persons served. (2) When applicable, individuals and family members with legal right or identified by the persons served. (3) Personnel providing direct service to the person served. b. Includes: (1) How the medication works. (2) The risks associated with each medicine. (3) The intended benefits, as related to the behavior or symptom targeted by this medication. (4) Side effects. (5) Contraindications. (6) Potential implications between medications and diet/exercise. (7) Risks associated with pregnancy. (8) The importance of taking medications as prescribed, including, when applicable, the identification of potential obstacles to adherence. (9) The need for laboratory monitoring. (10) The rationale for each medication. (11) Early signs of relapse related to medication efficacy. (12) Signs of nonadherence to medication prescriptions. (13) Potential drug reactions when combining prescription and nonprescription medications, including alcohol, tobacco, caffeine, illegal drugs, and alternative medications. (14) Instructions on self-administration, when applicable. (15) Wellness management and recovery planning. (16) The availability of financial supports and resources to assist the persons served with handling the costs associated with medications. 2.E.3. When the organization physically controls medications (including medications selfadministered by the person served or the use of samples), written procedures are implemented and include: a. Compliance with all applicable local, state or provincial, and federal laws and Residential and Foster Care Crosswalk Alliance and CARF standards 9

11 Residential Standards regulations pertaining to medications and controlled substances, including onsite pharmacy services and dispensing. b. Purchase, when applicable. c. Transportation and delivery, when applicable. d. Safe storage. e. Safe handling. f. Packaging and labeling, when applicable. g. Management of biohazards associated with the use of medications. h. Safe disposal. i. Inventory. j. Self-administration. k. Off-site use. 2.E.5. An organization that provides prescribing, dispensing, or administering of medications implements written procedures that include: d. Documentation and reporting of: (1) Observed and/or reported medication reactions. (2) Medication errors. g. Use of over-the-counter medications. 2.E.6. An organization that provides prescribing of medications has written procedures that include: a. Screening for common medical co-morbidities using evidence- or consensusbased protocols. b. Evaluation of co-existing medical conditions for potential medication impact. c. Identifying potential drug interactions, including the use of over-the-counter or homeopathic supplements. d. Documentation or confirmation of informed consent for each medication prescribed, when possible. e. Continuing a prescribed medication if a generic medication is not available. f. Continuity of medication use when identified as a need in a transition plan for a person served. 2.E.10. An organization that provides dispensing or administering of medications implements Residential and Foster Care Crosswalk Alliance and CARF standards 10

12 Residential Standards 6.10: All medications shall be stored in a double locked method and keys to medication storage shall be strictly controlled to insure security. 6.11: The use of psychotropic medication shall be highly controlled and shall be used only after medical evaluation and diagnosis by an appropriate specialist indicates that it would be of value. written procedures that address: a. Documentation of medication administration, errors, and reactions. 2.E.3. When the organization physically controls medications (including medications selfadministered by the person served or the use of samples), written procedures are implemented and include: a. Compliance with all applicable local, state or provincial, and federal laws and regulations pertaining to medications and controlled substances, including onsite pharmacy services and dispensing. d. Safe storage. 2.E.5. An organization that provides prescribing, dispensing, or administering of medications implements written procedures that include: a. Compliance with all applicable local, state or provincial, and federal laws and regulations pertaining to medications and controlled substances, including onsite pharmacy services and dispensing. b. Active involvement of the persons served, when able, or their parents or guardians, when appropriate, in making decisions related to the use of medications. c. Availability of a physician, pharmacist, or qualified professional licensed to prescribe for consultation 24 hours a day, 7 days a week. d. Documentation and reporting of: (1) Observed and/or reported medication reactions. (2) Medication errors. e. Review of past medication use, including: (1) Effectiveness. (2) Side effects. (3) Allergies or adverse reactions. f. Identification of alcohol, tobacco, and other drug use. g. Use of over-the-counter medications. h. Use of medications by women of child bearing age. i. Use of medications during pregnancy. j. Special dietary needs and restrictions associated with medication use. k. Necessary laboratory studies, tests, or other procedures. l. When applicable, documented assessment of abnormal involuntary movements at the initiation of treatment and every six months thereafter for persons served receiving typical antipsychotic medications. Residential and Foster Care Crosswalk Alliance and CARF standards 11

13 Residential Standards m. When possible, coordination with the physician(s) providing primary care needs. n. Review of medication use activities, including medication errors and drug reactions, as part of the quality monitoring and improvement system. 6.12: If psychotropic medication is administered, there shall be a physician s prescription and a medication consent signed by the parent/guardian or a court authorization for the medication in the client file. All of the following shall be documented at least monthly in the client s file and signed by a physician: Continued justification for the use the medication. The time frame for follow-up appointment(s) with the physician. Anticipated results and significant potential side effects. 2.E.6. An organization that provides prescribing of medications has written procedures that include: a. Screening for common medical co-morbidities using evidence- or consensusbased protocols. b. Evaluation of co-existing medical conditions for potential medication impact. c. Identifying potential drug interactions, including the use of over-the-counter or homeopathic supplements. d. Documentation or confirmation of informed consent for each medication prescribed, when possible. e. Continuing a prescribed medication if a generic medication is not available. f. Continuity of medication use when identified as a need in a transition plan for a person served. 2.E.5. An organization that provides prescribing, dispensing, or administering of medications implements written procedures that include: a. Compliance with all applicable local, state or provincial, and federal laws and regulations pertaining to medications and controlled substances, including on-site pharmacy services and dispensing. b. Active involvement of the persons served, when able, or their parents or guardians, when appropriate, in making decisions related to the use of medications. c. Availability of a physician, pharmacist, or qualified professional licensed to prescribe for consultation 24 hours a day, 7 days a week. d. Documentation and reporting of: (1) Observed and/or reported medication reactions. (2) Medication errors. i. Use of medications during pregnancy. 2.E.10. An organization that provides dispensing or administering of medications implements written procedures that address: b. Documentation of medication administration, errors, and reactions. Residential and Foster Care Crosswalk Alliance and CARF standards 12

14 Residential Standards 6.13: Restricting children to their rooms, other than at bedtime, shall be used only if: The child is not in danger of hurting self or others. The room is not locked. The child is aware of the duration of room time. The maximum duration of room time shall be one (1) hour, unless specifically reviewed and approved by the person in charge of the program or their designee. There is a detailed written report of each incident in the child s file. A log is maintained with every instance documenting the name of the child, the name of the person (s) placing the child in room time, the reason for the intervention, the length of time the intervention lasted, and the outcome/result of the intervention. 6.14: Physical restraint and/or protective separation shall be used only if: There are written policies and procedures governing their use. They are employed only to protect the child from injury to self, others, or the community. They are not used as punishment. Protective separation does not occur in a locked room. Protective separation and/or physical restraint beyond thirty minutes are prior approved by the person in charge or their designee. All of Section 2.F. addresses specific to restricting children to their room; CARF calls this seclusion if the child is prevented from leaving their room (even if unlocked) 2.A.20. The program implements policies and written procedures that address positive approaches to behavioral interventions, including: a. An emphasis on building positive relationships with the persons served. b. Evaluation of the environment. c. Staff interaction with the persons served that: (1) Promotes de-escalation. (2) Manages behavior. (3) Strengthens self-regulation. d. Development of a personal safety plan for each person served on an individual basis, when indicated. 2.F.1. The organization has a policy that identifies: a. How all personnel employed by the organization will be trained on the prevention of workplace violence. b. How it will respond to aggressive or assaultive behaviors. c. Whether, and under what circumstances: (1) Seclusion is used within the programs it provides. (2) Restraints are used within the programs it provides. 2.F.6. If the organization uses seclusion or restraint, written procedures for the use of specific interventions include protocols for: b. Children and adolescents. c. Persons with special needs. Residential and Foster Care Crosswalk Alliance and CARF standards 13

15 Residential Standards A log is maintained for every instance documenting the name of the child, the name of the person (s) placing the child in physical restraint or protective separation, the reason for the intervention, the length of time the intervention lasted, and the outcome/result of the intervention. There is a detailed written report of each incident in the child s file. d. Team interventions, including: (1) Defining team leadership. (2) Assigning team duties. 2.F.8. An organization that uses seclusion or restraint has policies that specify that: c. Seclusion or restraint is used only for intervention in an individual's emergency situation and to prevent harm to him/herself or others. d. Seclusion or restraint is not used as coercion, discipline, convenience, or retaliation by personnel in lieu of adequate programming or staffing. 2.F.10. Organizations using seclusion or restraint implement written procedures to require that: a. Documentation demonstrates that less restrictive intervention techniques were used prior to the use of seclusion or restraint. b. A designated, qualified, and competent physician or licensed independent practitioner provides face-to-face evaluation of the person served within one hour of the order for seclusion or restraint being given. c. An order for seclusion or restraint is time limited and does not exceed four hours for an adult. For a child or adolescent, the order does not exceed one hour. d. Orders for seclusion or restraint may be renewed for a total of up to 24 hours. Orders for renewal may only occur following a face-to-face assessment by a designated, trained, and competent qualified behavioral health practitioner. e. After 24 hours, a new order is required following a face-to-face evaluation by a designated, qualified, and competent physician or licensed independent practitioner. f. Appropriately trained personnel continually assess, monitor, and re-evaluate the person served to determine whether seclusion or restraint is still needed. g. All orders are entered into the record of the person served as soon as possible but not more than two hours after implementation. h. The designated and qualified personnel sign the order within the time period mandated by law. i. Face-to-face attention, including attention to vital signs and the need for meals, liquids, bathing, and use of the restroom, is given to a person in seclusion or restraint at least every 15 minutes by authorized personnel. Residential and Foster Care Crosswalk Alliance and CARF standards 14

16 Residential Standards j. Documentation of re-evaluations and face-to-face attention is entered into the record. k. As applicable and permitted, there is documentation that the family or significant other(s), legal guardian, advocate, and/or treating practitioner of the person served is notified as soon as possible but at least within ten hours of the initial use of seclusion or restraint. 6.15: Only staff specifically trained by certified trainers shall use physical restraint, protective separation, or any containment procedure. 6.16: Case records shall be complete and current. 2.F.13. The use of seclusion or restraint always is documented as a critical incident. 2.F.3. 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: a. When and how to restrain or seclude while minimizing risk. b. Recognizing signs of physical distress in the person who is being restrained or secluded. c. The risks of seclusion or restraint to the persons served or personnel, including: (1) Medical risks. (2) Psychological risks. d. First aid and CPR. e. How to monitor and continually assess for the earliest release. f. The practice of intervention done by an individual. g. The practice of intervention done by a team. 2.G.1. The individual record communicates information in a manner that is: a. Organized. b. Clear. c. Complete. d. Current. e. Legible. Residential and Foster Care Crosswalk Alliance and CARF standards 15

17 8.1: All licensed foster family agencies shall accept applications from adult applicants, evaluate applicants for certification, or decertify homes, on a nondiscriminatory basis without regard to age, sex, race, religion, color, political affiliation, national origin, disability, marital status, gender identity, actual or perceived sexual orientation, or ancestry. 8.2: All home study, certification, intake, discharge and direct supervision of foster families shall be the responsibility of staff with a master's degree in social work or social welfare, marriage, family and child counseling (MFT), child counseling, child psychology, child development, counseling psychology or social psychology, and course work and field practice as required by law or appropriate exception. 1.A.5. The organization implements a cultural competency and diversity plan that: a. Addresses: (1) Persons served. (2) Personnel. (3) Other stakeholders. b. Is based on the consideration of the following areas: (1) Culture. (2) Age. (3) Gender. (4) Sexual orientation. (5) Spiritual beliefs. (6) Socioeconomic status. (7) Language. c. Is reviewed at least annually for relevance. d. Is updated as needed. 3.X.7. If the program selects specialized or treatment foster care providers, it has a comprehensive plan for recruitment, selection, and maintenance that: a. Is reflective of the larger community that the program serves. b. Includes a broad selection of families to ensure that the needs of the children/youths served are met. c. Meets the expressed criteria set in all applicable jurisdictional guidelines. d. Includes procedures for the monitoring of each home. 1.I.4. The organization: a. Identifies the competencies needed by personnel to: (1) Assist the persons served in the accomplishment of their established outcomes. (2) Support the organization in the accomplishment of its mission and goals. b. Assesses the current competencies of personnel at least annually. c. Provides resources to personnel for professional development. 1.I.9. As applicable, the organization demonstrates a process that addresses the provision of services by personnel that are consistent with relevant: a. Legislation governing practices. Residential and Foster Care Crosswalk Alliance and CARF standards 16

18 b. Licensure requirements. c. Registration requirements. d. Certification requirements. e. Professional degrees. f. Professional training to maintain established competency levels. g. On-the-job training requirements. h. Professional standards of practice. 2.A.6. Service delivery models and strategies are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and/or expert professional consensus. 2.A.17. For personnel providing direct services, the organization: a. Provides or arranges for: (1) Assessment of competency. (2) Competency-based training. b. Includes the following in its assessment of competency and competency-based training: (1) Areas that reflect the specific needs of the persons served. (2) Clinical skills that are appropriate to the position. (3) Person-centered plan development. (4) Interviewing skills. (5) Program-related research-based approaches. 2.A.19. Documented ongoing supervision of direct service personnel addresses: a. Accuracy of assessment skills, when applicable. b. Proficiency of referral skills, when applicable. c. The appropriateness of the services or supports selected relative to the specific needs of each person served. d. Service effectiveness as reflected by the persons served meeting their individual goals. e. The provision of feedback that enhances the skills of direct service personnel. f. Issues of: (1) Ethics. Residential and Foster Care Crosswalk Alliance and CARF standards 17

19 8.3: There shall be one social worker for every fifteen (15) children or fraction thereof in placement or as required. Supervisors who supervise less than six social workers shall be allowed to carry a caseload of three children in place of supervising one social worker. 8.4: There shall be written procedures for accepting, responding to, and resolving foster parent complaints. 8.5: The FFA shall not actively recruit homes licensed by a county or certified by another FFA. The FFA shall not certify any foster family currently licensed or certified. (2) Legal requirements. (3) Boundaries. (4) Self care. (5) Secondary trauma. g. Service documentation issues identified through ongoing compliance review. h. Cultural competency issues. i. Model fidelity, when implementing evidence-based practices. 2.A.2. The organization provides the resources needed to support the overall scope of each program/service. 1.K.4. The organization: a. Implements a policy and written procedure by which persons served may formally complain to the organization that specifies: (1) That the action will not result in retaliation or barriers to services. (2) How efforts will be made to resolve the complaint. (3) Levels of review, which include availability of external review. (4) Time frames that: (a) Are adequate for prompt consideration. (b) Result in timely decisions for the person served. (5) Procedures for written notification regarding the actions to be taken to address the complaint. (6) The rights of each party. (7) The responsibilities of each party. (8) The availability of advocates or other assistance. b. Makes complaint procedures and, if applicable, forms: (1) Readily available to the persons served. (2) Understandable to the persons served. 1.A.6. Corporate responsibility efforts include, at a minimum, the following: a. Written ethical codes of conduct in at least the following areas: (1) Business. (2) Marketing. (3) Contractual relationships. Residential and Foster Care Crosswalk Alliance and CARF standards 18

20 8.6: FFA has signed Alliance Foster Family Agency MOU and staff are familiar with requirements. (4) Service delivery, including: (a) Conflicts of interest. (e) Setting boundaries. 3.X.9. The program utilizes written agreements that clearly define: a. What the foster care providers can expect from the program, including: (1) On-call support 24 hours a day, 7 days a week. (2) Initial and ongoing training. (3) Communication about appropriate and known information about the child/youth and his or her family. (4) Available support for managing issues that arise in the placement. (5) Supervision and monitoring. b. What is expected of the foster care providers, including: (1) Providing support to the child/youth in maintaining meaningful contact with his or her family, when appropriate. (2) Providing a high standard of daily care to the child/youth, including: (a) Nutritious meals and snacks. (b) A safe living environment. (c) A comfortable living environment. (d) Emotional support. (e) Boundaries consistent with the needs of the child/youth served. (f) Physical needs. (3) Encouraging the child/youth to personalize his or her living space with individual possessions. (4) Recognition and attention to any special needs of the child/youth, including: (a) Dietary needs. (b) Religious needs. (c) Other identified needs. (5) Providing a home that is safe and free from hazards. (6) Refraining from the use of corporal punishment and other inappropriate means of discipline. (7) Ensuring that the child s/youth s health-related needs are met. (8) Providing a supportive learning environment to build the skill levels of the child/youth. (9) Facilitating the child s/youth s engagement in developmentally appropriate peer and leisure activities. (10) Clearly communicating what is expected of the child/youth in terms of household rules. Residential and Foster Care Crosswalk Alliance and CARF standards 19

21 8.7: The written Need and Services Plan shall be completed within thirty (30) days of admission and the Plan shall be updated at least semi-annually. Documentation of team reviews of client progress shall be ongoing. 3.X.12. The program uses a plan to regularly monitor each foster home placement. 2.C.4. To determine continued relevance, the individualized plan is: a. Reviewed with the person served: (1) Based on his or her request for a modification. (2) In accordance with identified time frames. b. Modified as needed. 2.C.12. Progress notes or recordings: a. Are: (1) Signed. (2) Dated. b. Document: (1) Progress toward achievement of identified: (a) Objectives. (b) Goals. (2) Significant events or changes in the life of the person served. (3) The delivery of services and specific interventions that support the individualized plan. (4) Movement to other levels of care. 8.8: The written Needs and Services Plan shall identify: Involvement by the child's parent(s) or guardian(s) and who retains responsibility for dealing with the child's parent(s) or guardian(s); Participation by the foster parents in the formulation and implementation of the plan; Participation by the child if developmentally appropriate in the formulation of the plan; 2.G.4. Entries to the records of the person served follow the organization s policy that specifies time frames for entries. 2.A.10. Services are designed and implemented to: a. Build on: (1) Individual strengths. (2) Family strengths. b. Build resilience. c. Support the recovery, health, or well-being of the persons served. d. Ensure safety of the persons served. e. Enhance the quality of life of the persons served. Residential and Foster Care Crosswalk Alliance and CARF standards 20

22 Permanency goals; Identified positive traits and strengths; presenting problems; Treatment goals; Objectives; Interventions; and Discharge plan. f. Restore and/or improve functioning. g. Support the integration of the persons served into the community. h. Promote permanency, as applicable. i. Reflect awareness of the following characteristics of each person served: (1) Physical. (2) Developmental. (3) Cultural. (4) Spiritual. (5) Behavioral. (6) Emotional. 2.C.1. The individualized plan: a. Is developed with the active participation of the person served. b. Is prepared using the information from: (1) The primary assessment. (2) The interpretive summary. c. Is based on the person s: (1) Strengths. (2) Needs. (3) Desires. d. Is focused on the person s inclusion and integration into: (1) The community. (2) His or her family, when appropriate. (3) Natural support systems. (4) An educational setting, when applicable. (5) Other needed services. e. Is inclusive of family/support system participation, when applicable and permitted. f. Addresses the following needs, as identified: (1) Healthcare. (2) Medications. (3) Safety. (4) Educational. (5) Emotional/behavioral. (6) Developmental. (7) Social and leisure. (8) Spiritual. (9) Cultural. Residential and Foster Care Crosswalk Alliance and CARF standards 21

23 (10) Financial. (11) Legal. (12) Others. g. Is detailed and: (1) Specifies the services to be provided by the program. (2) Identifies any needs beyond the scope of the program. (3) Specifies referrals for additional services. h. Communicated to the person served in a manner that is understandable. i. Provided to the person served, when possible. 2.C.2. The individualized plan includes the following components: a. Goals that are: (1) Expressed in the words of the person(s) served. (2) Reflective of the informed choice of the: (a) Child/youth served. (b) Parent(s)/legal guardian, if applicable. (3) Appropriate to the person s culture. (4) Appropriate to the person s age. (5) Based upon the person s: (a) Strengths. (b) Needs. (c) Abilities. (d) Preferences. b. Specific service objectives that are: (1) Reflective of the expectations of: (a) The person served. (b) The service team. (2) Reflective of the person s: (a) Age. (b) Development. (c) Culture. (d) Ethnicity. (3) Responsive to the person s disabilities/disorders or concerns. (4) Understandable to the person served. (5) Measurable. (6) Achievable. (7) Time specific. Residential and Foster Care Crosswalk Alliance and CARF standards 22

24 8.9: The social worker s visits with foster parents and foster child(ren) shall be of sufficient length, and appropriate frequency to meet the needs of the foster family and child(ren), but not less than twice monthly in the home. (8) Appropriate to the service setting. c. Identification of: (1) Specific service interventions to be used. (2) Frequency of using specific interventions. d. The estimated duration of services. e. Information on, or conditions for, transition to other services. f. When applicable, identification of: (1) Legal requirements. (2) Legally imposed fees. 2.A.6. Service delivery models and strategies are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and/or expert professional consensus. 2.A.10. Services are designed and implemented to: a. Build on: (1) Individual strengths. (2) Family strengths. b. Build resilience. c. Support the recovery, health, or well-being of the persons served. d. Ensure safety of the persons served. e. Enhance the quality of life of the persons served. f. Restore and/or improve functioning. g. Support the integration of the persons served into the community. h. Promote permanency, as applicable. i. Reflect awareness of the following characteristics of each person served: (1) Physical. (2) Developmental. (3) Cultural. (4) Spiritual. (5) Behavioral. (6) Emotional. 2.A.15. Team members, in response to the needs of the persons served: Residential and Foster Care Crosswalk Alliance and CARF standards 23

25 a. Provide services that are responsive to the needs of each person served through direct interaction. b. Meet as often as necessary to carry out decision-making responsibilities. c. Document: (1) The attendance of participants at team meetings. (2) The results of team meetings. 2.C.2. The individualized plan includes the following components: b. Specific service objectives that are: (1) Reflective of the expectations of: (a) The person served. (b) The service team. (2) Reflective of the person s: (a) Age. (b) Development. (c) Culture. (d) Ethnicity. (3) Responsive to the person s disabilities/disorders or concerns. (4) Understandable to the person served. (5) Measurable. (6) Achievable. (7) Time specific. (8) Appropriate to the service setting. c. Identification of: (1) Specific service interventions to be used. (2) Frequency of using specific interventions. d. The estimated duration of services. 3.X.12. The program uses a plan to regularly monitor each foster home placement. Residential and Foster Care Crosswalk Alliance and CARF standards 24

26 8.10 Case management shall be provided no less than two (2) hours per month. 2.A.6. Service delivery models and strategies are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and/or expert professional consensus. 2.A.10. Services are designed and implemented to: a. Build on: (1) Individual strengths. (2) Family strengths. b. Build resilience. c. Support the recovery, health, or well-being of the persons served. d. Ensure safety of the persons served. e. Enhance the quality of life of the persons served. f. Restore and/or improve functioning. g. Support the integration of the persons served into the community. h. Promote permanency, as applicable. i. Reflect awareness of the following characteristics of each person served: (1) Physical. (2) Developmental. (3) Cultural. (4) Spiritual. (5) Behavioral. (6) Emotional. 2.A.15. Team members, in response to the needs of the persons served: a. Provide services that are responsive to the needs of each person served through direct interaction. b. Meet as often as necessary to carry out decision-making responsibilities. c. Document: (1) The attendance of participants at team meetings. (2) The results of team meetings. 3.X.12. The program uses a plan to regularly monitor each foster home placement. Residential and Foster Care Crosswalk Alliance and CARF standards 25

27 8.11: There shall be provisions for social work support to be available to each foster home on a 24-hour basis, seven days a week. 8.12: The agency shall have written policies and procedures for recognizing and responding to foster family respite needs. 8.13: No child shall be locked in a room at any time for any reason. 3.X.15. The program has on-call availability of supervisory staff members to respond to urgent situations 24 hours a day, 7 days a week. 3.X.17. The program has a plan for access to qualified practitioners 24 hours a day, 7 days a week. 2.A.8. Each core program for which the organization is seeking accreditation has a written program description that: a. Guides the delivery of services. b. Includes: (1) The philosophy of the program. (2) Program goals. (3) A description of the service modalities to be provided to achieve the program objectives that: (a) Is relevant to the specific culture of the population served. (b) Includes: (i) Broad strategies to be used to achieve objectives. (ii) The rationale for the choice of service modality(ies). (4) Identification or a description of: (a) Special populations served. (b) Mechanisms to: (i) Address needs. (ii) Cultivate strengths. 3.X.5. A referral network is established for the following: a. Emergency care. b. Respite care. c. Medical care. d. Other services to meet the needs of the children/youths served. 2.A.20. The program implements policies and written procedures that address positive approaches to behavioral interventions, including: a. An emphasis on building positive relationships with the persons served. b. Evaluation of the environment. Residential and Foster Care Crosswalk Alliance and CARF standards 26

28 c. Staff interaction with the persons served that: (1) Promotes de-escalation. (2) Manages behavior. (3) Strengthens self-regulation. d. Development of a personal safety plan for each person served on an individual basis, when indicated. 2.A.21. The program s policies promoting the rights of the persons served address: a. The use of crisis intervention procedures, including the use of seclusion or restraint. b. Written procedures governing the use of: (1) Special treatment interventions. (2) Restrictions of rights. c. Methods to ensure that intrusive procedures are administered in a safe manner, with consideration given to the: (1) Physical history of the persons served. (2) Developmental history of the persons served. (3) Abuse history of the persons served. 3.X.2. The program provides competency-based training to meet the identified needs of the children/youths served: a. To: (2) Specialized or treatment foster care providers. b. That covers: (4) Behavior management skills. (12) Specialized training as needed. CARF considers a locked room to be seclusion. Standards in 2.F. would apply. 8.14: Restricting children to their rooms, other than at bedtime, shall be used only if: The child is not in danger of hurting self or others. 1.K.2. The organization implements policies promoting the following rights of the persons served: c. Freedom from: (1) Abuse. (3) Retaliation. Residential and Foster Care Crosswalk Alliance and CARF standards 27

29 The room is not locked. The child is aware of the duration of room time. (4) Humiliation. (5) Neglect. e. Informed consent or refusal or expression of choice regarding: (1) Service delivery. 2.A.6. Service delivery models and strategies are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and/or expert professional consensus. 2.A.8. Each core program for which the organization is seeking accreditation has a written program description that: a. Guides the delivery of services. b. Includes: (1) The philosophy of the program. (3) A description of the service modalities to be provided to achieve the program objectives that: (b) Includes: (i) Broad strategies to be used to achieve objectives. (ii) The rationale for the choice of service modality(ies). (4) Identification or a description of: (a) Special populations served. (b) Mechanisms to: (i) Address needs. 2.A.20. The program implements policies and written procedures that address positive approaches to behavioral interventions, including: a. An emphasis on building positive relationships with the persons served. b. Evaluation of the environment. c. Staff interaction with the persons served that: (1) Promotes de-escalation. (2) Manages behavior. (3) Strengthens self-regulation. d. Development of a personal safety plan for each person served on an individual basis, when indicated. Residential and Foster Care Crosswalk Alliance and CARF standards 28

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