2023 Edition

Respite Care Definition

Purpose

Respite Care reduces caregiver stress, promotes the well-being and safety of care recipients, prevents out-of-home placements, and contributes to stable families.

Definition

Respite Care programs provide temporary relief to caregivers with responsibility for the care and supervision of adults or children who: have physical, emotional, developmental, cognitive, behavioral, or mental health disabilities; are at risk of abuse or neglect; or are in foster care. 


Respite Care provides a supportive, enriching, and therapeutic environment in the caregiver’s home, in the respite care provider’s home, in a program facility, or in the community. Respite care providers can include employees, independent contractors, volunteers, and foster parents. Generally, care is provided for a few hours or days at a time. Services can be provided on a planned or as needed basis, including in response to a crisis. 


Families experiencing medical emergencies and stressful home situations, such as domestic violence or homelessness, may request crisis nursery respite care. Crisis nursery and short-term residential respite services can extend to a few weeks or a month at a time. When services are provided in response to a crisis, the timeframes may be less predictable and dependent upon resolution of the crisis.

Note: When an agency is completing the Child and Family Services Standards (PA-CFS) their respite program is covered under PA-CFS 30: Respite Care for Children in Out-of-Home Care unless they provide respite services for children and families outside of family foster care or kinship care. In this instance, the agency will also need to complete PA-RC to capture all aspects of assessment, service planning, and coordination for these families.


Note: The following definitions apply throughout this section of standards: 


The term “caregiver” refers to the individual with responsibility for caring for an individual with specialized care needs as defined above, such as a parent, guardian, family member, or other responsible party. The term “respite care provider” refers to the paid or unpaid individual who is providing respite care either in a home or facility setting. The term “care recipient” refers to the individual receiving specialized care. 


Note: Please see PA-RC Reference List for the research that informed the development of these standards.


Note: For information about changes made in the 2020 Edition, please see the RC Crosswalk.

2023 Edition

Respite Care (PA-RC) 1: Person-Centered Logic Model

The agency implements a program logic model that describes how resources and program activities will support the achievement of positive outcomes.

Note: Please see the Logic Model Template for additional guidance on this standard.  

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • See program description completed during intake
  • Program logic model that includes a list of desired outcomes being measured
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
 

PA-RC 1.01

A program logic model, or equivalent framework, identifies:

  1. needs the program will address;
  2. available human, financial, agency, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered); 
  5. desired outcomes (i.e. the changes you expect to see in individuals and families); and
  6. expected long-term impact on the agency, community, and/or system.

Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA Accreditation’s PQI Tool Kit for more information on developing and using program logic models.


Examples: Information that may be used to inform the development of the program model includes, but is not limited to: 

  1. characteristics of persons served;
  2. needs assessments and periodic reassessments; 
  3. risks assessments conducted for specific interventions; and
  4. the best available evidence of service effectiveness.
 

PA-RC 1.02

The logic model identifies desired outcomes in at least two of the following areas:

  1. change in clinical status;
  2. change in functional status;
  3. health, welfare, and safety;
  4. permanency of life situation; 
  5. quality of life; 
  6. achievement of individual service goals; and 
  7. other outcomes as appropriate to the program or service population.

Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PA-PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes. 

2023 Edition

Respite Care (PA-RC) 2: Personnel

Respite care providers and program personnel have the competency and support needed to provide temporary care services and meet the needs of individuals and families.

Interpretation: Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Procedures for health evaluations
  • Documentation tracking staff completion of required trainings and/or competencies
  • Sample job descriptions from across relevant job categories
  • Training curricula
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files
 

PA-RC 2.01

Supervisors are qualified by:
  1. an advanced degree in social work or a comparable human service field with one year of relevant experience; or
  2. a bachelor's degree in social work or a comparable human service field with two years of relevant experience.

Interpretation: Demonstrated competence with appropriate experience and training can compensate for a lack of degree.

 

PA-RC 2.02

Respite care providers are trained on or demonstrate competency in the following, as appropriate to the services provided:

  1. assessing the need for additional services;
  2. identification of changes in functioning;
  3. identification of medical needs or problems;
  4. use of adaptive equipment, such as braces and wheelchairs;
  5. providing personal care, including lifting techniques;
  6. promoting positive behavior and implementing appropriate behavior support techniques;
  7. determining if a crisis situation is imminent and intervene using appropriate resources;
  8. providing safe, non-discriminatory, and supportive care to an individual of a different race, ethnicity, culture, religion, sexual orientation, or gender identity; and
  9. any other specialized care needs specific to persons served.
 
Fundamental Practice

PA-RC 2.04

There is at least one person on duty in each respite setting whenever care is being provided that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.

 
Fundamental Practice

PA-RC 2.05

Respite care providers that provide personal care or basic health services receive a health evaluation prior to providing care to determine their ability to perform the essential functions of the job, with or without reasonable accommodation.

Interpretation: While a physical examination is preferred, personnel should receive a general health screening performed by a qualified medical practitioner, provided that the screening addresses communicable diseases.

NA The program is not designed to serve individuals with personal care or health services needs.
 

PA-RC 2.06

Respite care providers sign a statement agreeing to: 

  1. report suspected abuse and neglect;
  2. employ appropriate behavior support techniques; 
  3. refrain from using physical and degrading punishment; and
  4. ensure that others refrain from using physical and degrading punishment.
 
Fundamental Practice

PA-RC 2.07

Screening and selection procedures for respite care providers include:

  1. completing a criminal record and abuse registry check for all adults living in the provider’s home;
  2. contacting references;
  3. ensuring providers have relevant caregiving experience and specific knowledge or skills related to the persons served; and
  4. allowing caregivers and care recipients to identify or select their respite care providers, when appropriate.
Related Standards:

Interpretation: When a finding of child or adult abuse, neglect, or exploitation is indicated, guidelines should be used to determine the appropriateness of provider responsibilities.


Interpretation: Background checks for other adults living in providers home only are required if respite care is delivered in the provider's home.

 

PA-RC 2.08

Employee workloads support the achievement of positive outcomes and are regularly reviewed.

Examples: Examples of factors that may be considered when determining employee workloads include, but are not limited to:

  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.
2023 Edition

Respite Care (PA-RC) 3: Intake and Assessment

The agency ensures that caregivers and care recipients receive prompt and responsive access to appropriate services.

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VIEW THE STANDARDS

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Screening and intake procedures
  • Assessment procedures
  • Copy of assessment tool(s)
  • Outreach strategies and informational materials
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records
 

PA-RC 3.02

Caregivers and respite care providers  are screened and informed about:

  1. how the caregiver’s request and the care recipient’s needs match the agency’s services;
  2. the guidelines for eligibility and availability of services; and
  3. what services will be available and when.

NA Another agency is responsible for screening, as defined in a contract.

 
Fundamental Practice

PA-RC 3.03

Prompt, responsive intake practices:

  1. ensure that individuals who reach out to the agency are treated equitably;
  2. address any concerns and provide emotional support, as needed, regarding the use of respite care;
  3. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
  4. give priority to individuals with urgent needs and emergency situations;
  5. support the timely initiation of services; and
  6. provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.

Interpretation: When a crisis respite program is at full capacity and cannot provide services to a family, the agency should assist the family in developing a plan to provide safe care for the child or adult and refer the family to another appropriate emergency service provider.

 

PA-RC 3.04

Caregivers and, when appropriate, care recipients and/or family members participate in an individualized, trauma-informed, culturally and linguistically responsive assessment that is:

  1. completed within established timeframes; 
  2. updated as needed based on the needs of persons served; 
  3. relationship-focused, allowing time to build rapport, answer questions, and acknowledge concerns; and
  4. focused on information pertinent for meeting service requests and objectives.

Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA Accreditation’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

Examples: In regards to element (d), an assessment may focus on (1) understanding the caregiver’s past experiences and level of satisfaction with respite care, and (2) discussing how caregivers can best utilize their respite time to meet their specific needs. 

2023 Edition

Respite Care (PA-RC) 4: Service Planning and Monitoring

Caregivers and, when appropriate, care recipients and/or family members, participate in the development and ongoing review of an individualized service plan that is the basis for delivery of appropriate services and support.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Service planning and monitoring procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records
 

PA-RC 4.01

An individualized, family-centered, assessment-based service plan is developed in a timely manner with the full participation of the caregiver and care recipient and includes:

  1. agreed upon goals, desired outcomes, and timeframes for achieving them;
  2. services and supports to be provided, and by whom; 
  3. possibilities for maintaining and strengthening family relationships and other informal social networks; 
  4. procedures for expedited service planning when crisis or urgent need is identified; 
  5. guidelines for requesting additional planned or emergency respite care;
  6. fees and payment arrangements, when applicable; and
  7. documentation of the caregiver and care recipient’s participation in service planning.

Interpretation: In regards to element (b), caregiver preferences for the location, hours, activities, and other aspects of respite care delivery should be acknowledged and accommodated to the extent possible. 

Examples: Assisting caregivers in setting specific goals for how they want to spend their respite time may increase caregivers’ satisfaction with respite care. 


 

PA-RC 4.02

The agency works in active partnership with persons served to:
  1. assume a service coordination role, as appropriate, when the need has been identified and no other agency has assumed that responsibility;
  2. ensure that they receive appropriate advocacy support;
  3. assist with access to the full array of services to which they are eligible; and
  4. mediate barriers to services within the service delivery system, including transportation or fees.

Examples: Examples of services referenced in (b) and (c) may include, but are not limited to: (1) support groups and counseling services; (2) physical and behavioral health services; (3) domestic violence services, (4) housing services; (5) financial assistance; (6) social, recreational, and day programs; and (7) mentor services. 

 

PA-RC 4.03

The worker and a supervisor, or a clinical, service, or peer team, review the case to assess:
  1. service plan implementation;
  2. progress toward achieving goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon goals.

Interpretation: Experienced workers may conduct reviews of their own cases. In such cases, the worker's supervisor reviews a sample of the worker's evaluations as per the requirements of the standard.

 

PA-RC 4.04

The worker, caregiver, and care recipients and/or family members when appropriate:

  1. review progress toward achievement of agreed upon service goals; and 
  2. document revisions to service goals and plans.
2023 Edition

Respite Care (PA-RC) 5: Care and Supervision

Care recipients receive individualized care and supervision that promote their safety and well-being.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Procedures for matching care recipients with respite care providers
  • Health and safety procedures
  • Care recipient/provider ratio
  • Most recent safety/risk data, if available
  • Monthly care recipient/provider ratios and coverage schedules for the previous six months, as applicable
  • Interviews may include:
    • Program director
    • Relevant personnel
    • Persons served
  • Review case records
  • Observe ratios and coverage at each unit or group, if applicable
 
Fundamental Practice

PA-RC 5.01

Families are matched with respite care providers who can meet their needs or receive information to enable them to select a suitable respite provider.

Interpretation: Care recipients who require therapeutic or medical treatment should be matched with a provider that has appropriate skills and qualifications.

Examples: Respite care programs can select providers that best meet the needs of caregivers and care recipients by matching families with providers who, for example: (1) speak the same primary language as the care recipients; (2) have personal or professional experience caring for individuals with similar needs as the care recipient; and (3) live in the same community as the family. 

 
Fundamental Practice

PA-RC 5.03

Respite care providers are familiar with the care recipient’s daily routine, preferred foods and activities, and needed therapeutic or medical care.

Examples: Agencies may use smartphone apps and other technologies to help caregivers and respite care providers: (1) share information on the care recipient's history, routines, medical needs, or other pertinent information, (2) monitor the care recipient’s health status, and (3) give feedback, share concerns, or communicate other preferences or needs. 

 
Fundamental Practice

PA-RC 5.05

Crisis respite care provides needed developmentally- and age-appropriate interventions to help the care recipient cope with trauma or stress associated with the crisis.

NA The agency does not provide crisis respite care.

 
Fundamental Practice

PA-RC 5.06

The program provides close supervision of care recipients to ensure safety and service quality, and provider-care recipient ratios do not exceed:

  1. one to eight during waking hours;
  2. one to twelve during sleeping hours; and
  3. one to four during both waking and sleeping hours when children are under school age.

Interpretation: Ratios should be adjusted to meet the special needs of individuals that require therapeutic or medical care, or close monitoring, and include all other children or adults being cared for in the home or facility. Ratios should demonstrate capacity for safe evacuation of care recipients in case of an emergency.

 
Fundamental Practice

PA-RC 5.07

When care recipients experience accidents, health problems, or changes in appearance or behavior, information is promptly recorded and reported to caregivers and administration, and follow-up occurs, as needed.
2023 Edition

Respite Care (PA-RC) 6: Service Environment

Respite care is provided in an environment that ensures the care recipient’s health and safety.

Note: Please see the Facility Observation Checklist for additional guidance on this standard.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Procedures for reviewing and approving respite homes
  • Documentation of licensing/approval
  • Sample of safety plans, if applicable
  • Interviews may include:
    • Program director
    • Relevant personnel
    • Respite care providers
    • Care recipients
  • Review case records
  • Observe facility
2023 Edition

Respite Care (PA-RC) 7: Short-Term Residential Respite and Crisis Nursery Services

Services are designed to meet the needs of care recipients who require a short-term stay in a residential respite or crisis nursery program.

NA The agency does not provide residential respite or crisis nursery services.

Note: Please see the Facility Observation Checklist for additional guidance on this standard.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Rules and behavioral expectations
  • Schedule of social and recreational activities
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Care recipients
  • Review case records
  • Observe facility
2023 Edition

Respite Care (PA-RC) 8: Case Closing

The agency works with caregivers and, when appropriate, care recipients and/or family members to plan for case closing and, when possible, to develop aftercare plans.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
  • Case closing procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Caregivers
  • Review case records
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