2022 Edition

Family Foster Care and Kinship Care (CA-FKC) 13: Treatment Foster Care

Children with significant emotional, behavioural, medical, or developmental needs receive structured treatment within a therapeutic family setting that promotes well-being, family connections, and community integration.
NA The organization does not provide treatment foster care services.

Currently viewing: FAMILY FOSTER CARE AND KINSHIP CARE (CA-FKC)

VIEW THE STANDARDS

Purpose

Children in Family Foster Care and Kinship Care live in safe, stable, nurturing, and often temporary family settings that best provide the continuity of care to preserve relationships, promote well-being, and ensure permanency.

Note: Organizations providing Foster Care Home Services only will complete CA-FKC 13.07- CA-FKC 13.09 only. 

1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Treatment planning and review procedures
  • Criteria for selection of treatment foster parents
  • Worker contact procedures
  • Table of contents of treatment model training for staff and treatment foster parents
  • Discharge procedures
  • Formal agreements with therapeutic facilities and/or providers that serve children and families in the program
  • On-call schedule for treatment foster care programs for previous six months
  • Documentation tracking treatment foster parent completion of required training
  • Training curricula for treatment foster parents

  • Interviews may include:
    1. Program director
    2. Parents
    3. Treatment team members
    4. Treatment foster parents
    5. Children and youth
  • Review case records
  • Review treatment foster parent records

 

CA-FKC 13.01

Treatment foster services are delivered by individualized treatment teams that include: 

  1. family members; 
  2. treatment foster parents or kinship caregivers; 
  3. local child welfare agency workers;
  4. treatment foster care program personnel, including the program supervisor, case managers, and clinicians or clinical consultants;
  5. educators or school administrators; and
  6. a range of specialized providers, as appropriate to children's emotional, behavioural, medical, and/or developmental needs.

Interpretation

The treatment team should include at least one worker or contract employee, in addition to the supervisor, who has an advanced degree in social work or a related field and at least two years of professional experience working with children with specialized treatment needs.
 
NA The organization provides Family Foster Care Home Services only.

Examples: Depending on the needs of children, specialized providers may include, but are not limited to: behaviour support specialists; nurses; primary care physicians and specialist physicians; psychiatric nurses and psychiatrists; and occupational, physical, and speech rehabilitation therapists. 


The team may also include the child’s guardian ad litem or legal representative.


 

CA-FKC 13.02

Preliminary treatment plans developed prior to placement identify:
  1. diagnoses;
  2. strategies to ensure children’s adjustment to treatment families; and
  3. short-term goals for the first 30 days of out-of-home care.
NA The organization provides Family Foster Care Home Services only.

 

CA-FKC 13.03

Within 30 days of placement, treatment teams develop individualized, comprehensive treatment plans that: 

  1. identify, incorporate, and build on children’s strengths and assets;
  2. specify diagnoses and presenting problems that prompted the referral to treatment foster care or were identified during assessment;
  3. address needs in major developmental areas; 
  4. specify short- and long-term therapeutic interventions; 
  5. review any psychotropic medication use, including dosages, side effects, and contraindications;
  6. address stressors in the children's environment that are trauma reminders or contribute to their emotional or behavioural issues;
  7. establish an emergency response plan for medical emergencies or behavioural health crises related to the child's conditions; and
  8. establish initial plans for respite care, discharge, and aftercare.

Interpretation

When children are prescribed psychotropic medications, the treatment team must collaborate to ensure the treatment parent understands the specified medication’s intended use, relevant precautions, protocols for monitoring efficacy and side effects, and what to do in the event of negative reaction or improper administration.

NA The organization provides Family Foster Care Home Services only.

 

CA-FKC 13.04

Treatment plans are:
  1. discussed weekly by the treatment team to coordinate an effective response to current issues or behaviours;
  2. reviewed monthly to evaluate progress towards treatment goals; and 
  3. officially updated every 90 days to evaluate progress and the continued need for treatment foster care.

Interpretation

 Intervals for discussing treatment plans for medically fragile children should be established based on the intensity of the child’s ongoing needs. 


When children transition to a lower intensity level of care, such as traditional foster care, but are able to remain in the care of the same resource family, treatment foster parents should be helped to prepare for any resulting changes in supports and services, including reduced worker contact or reimbursement rates. 


Interpretation

Treatment planning and review should also address the use of restrictive interventions, when authorized, including an evaluation of the frequency of use and effectiveness of prevention strategies. 

NA The organization provides Family Foster Care Home Services only.

 

CA-FKC 13.05

The organization coordinates and ensures the provision of needed therapeutic, rehabilitative, and support services, including specialized treatment services. 
NA The organization provides Family Foster Care Home Services only.

Examples: Needed services may include, but are not limited to:

  1. individual, family, and/or group therapy, 
  2. social skills groups, and 
  3. medical treatment. 

 
Fundamental Practice

CA-FKC 13.06

Formal relationships are established with: 

  1. mental health facilities, medical institutions including neonatal and pediatric facilities, and other rehabilitation service providers to ensure the availability of requisite medical and mental health services; and 
  2. a board-certified physician with experience appropriate to the level and intensity of service, and the needs of the population served, who assumes responsibility for medical elements of a program when it serves children with acute medical needs.
NA The organization provides Family Foster Care Home Services only.
Examples: The board-certified physician can provide service as an employee, contractor, or through formal agreement. 

 
Fundamental Practice

CA-FKC 13.07

The organization selects treatment parents based on established criteria that are determined based on the characteristics of children who need treatment foster care, and include: 

  1. an assessment of the family's capacity to provide therapeutic care for children with significant needs; 
  2. three non-relative references; and 
  3. attainment of at least 21 years of age.

Interpretation

Regarding element (a), the selection process for treatment families must also meet the resource family assessment standards outlined in CA-FKC 18.

Examples: Regarding element (a), demonstrated capacity may include previous experience as a resource parent or work experience in a therapeutic setting, such as a residential treatment center, or as a healthcare provider, if being selected to care for children with acute medical needs or physical disabilities. 


Organizations can foster recruitment of existing resource families to become treatment families by facilitating opportunities to connect with experienced treatment parents to learn about the treatment parent experience.


 

CA-FKC 13.08

Treatment foster parents receive specialized pre-service treatment foster care training to prepare for their professional and parenting roles and to assume primary responsibility for:

  1. implementing in-home treatment strategies;
  2. assisting children to understand treatment goals and interventions; 
  3. documenting children’s behaviours and progress in targeted areas and responses to services and interventions received; and
  4. acting as liaisons with clinical personnel.

Interpretation

Pre-service training should include learning opportunities that incorporate the experience of veteran treatment parents, such as peer mentoring, coaching, situational role-play, or other training activities that illustrate real life scenarios.

Examples: Treatment foster care programs can provide joint trainings for workers and treatment parents in certain areas, such as trauma informed care, to facilitate mutual learning, foster positive relationships between workers and treatment parents, and reinforce treatment parents’ professional role.


 

CA-FKC 13.09

Treatment parents receive initial and ongoing training that addresses:
  1. managing the needs and diagnoses specific to each child; 
  2. crisis prevention and de-escalation;
  3. navigating the child welfare, behavioural health, and healthcare systems;
  4. educational advocacy skills and the special education system;
  5. incorporating other providers and medical equipment, as necessary, into the home; and
  6. engaging with birth families, including when appropriate, discussing and/or demonstrating interventions, advocacy skills, and other competencies related to the child’s conditions. 

Interpretation

Regarding element (a), the organization should provide treatment parents with enhanced training or other relevant learning opportunities when placing children with treatment parents who do not have experience with the child’s specific needs or conditions.
Depending on children’s needs, enhanced training should address:
  1. adjusting parenting and communication styles to the child’s emotional or developmental needs;
  2. teaching basic life skills;
  3. engagement strategies for youth;
  4. verbal de-escalation techniques;
  5. recognizing the child’s triggers, antecedents, and crisis cycle;
  6. strategies for preventing retraumatization, including adjusting rules or disciplinary practices that can be triggering; 
  7. responding to aggression or assaultive behaviour; and
  8. repairing the treatment parent-child relationship after conflict or crisis. 

Examples: Educational advocacy skills may include: 

  1. maintaining relationships with teachers and administrators; 
  2. monitoring attendance and academic performance; 
  3. participating in collaborative planning around academic goals, behaviour support, and extracurricular activities; 
  4. advocating for additional social and educational supports; 
  5. staying up-to-date on school policies and programs that could affect the child; and
  6. ensuring prompt response to harassment or discrimination. 

     
    Fundamental Practice

    CA-FKC 13.10

    Treatment foster parents receive the support they need to carry out their role, including: 
    1. weekly contact by the assigned worker; 
    2. in-person contact every two weeks and more frequently when indicated; 
    3. on-call crisis intervention 24-hours a day, seven days a week;
    4. routine follow-up on training topics and competencies;
    5. respite care;
    6. resources for recognizing and coping with secondary trauma and stress; and 
    7. the availability of additional personnel and technical assistance, as needed.

    Interpretation

    Additional personnel should be available during critical or stressful periods, such as the time from the end of the school day until bedtime.

    Examples: More frequent in-person contact may be indicated during periods of transition, such as in the initial six weeks of placement, and when changes occur to the child’s level of care or treatment team, which can be triggering for children and stressful for treatment parents.


     

    CA-FKC 13.11

    Discharge reports are tailored to support the transition to the next care setting, and document:

    1. the course of treatment and treatment recommendations;
    2. the transfer of records and appointment information; and
    3. the nature, frequency and duration of aftercare services, when applicable.

    NA The organization provides Foster Care Home Services only.