Section 4, Chapter 4 (Working with Children), Subsection 5 – Children with Elevated Needs

Effective:  5-1-19


Foster Care for youth with elevated needs is a foster care program designed for the youth who has identifiable and documented moderate or serious emotional and/or behavioral needs. Such a youth requires intensive and individualized intervention to succeed in a community-based family setting and to achieve their goal of permanency. Resource providers of youth with elevated needs have received specific training in addition to Specialized Training Assessment Resources and Support (STARS) pre-service training to enable them to work with youth with elevated needs.

Placements for youth with elevated needs neither are emergency placements nor are they immediate placements. These placements are transitional placement resources to prepare youth to function adequately in a less restrictive environment and or a permanent home. It is not intended to be a long-term or permanent placement resource. A selection/screening team must evaluate the youth’s needs. A pre-placement phase is essential, meaning that the youth should visit the home prior to being placed to determine if the placement is an appropriate fit for the youth. ICPC resource providers are not eligible for elevated needs placements.

The resource licensing worker will notify the elevated needs level B resource parent regarding access to purchase medical, dental, and vision insurance. The worker will inform the resource parent that the insurance company will provide enrollment information.

Characteristics of a Youth with Elevated Needs
Youth with elevated needs require greater structure, supervision, and are less able to assume responsibility for their daily care. These youth have typically experienced multiple out-of-home placements.

Youth appropriate for Level A fall into one of two categories:

  • Youth presently in a residential setting who may be moved to a less intensive setting, but not to a traditional resource home or to their parents’ home; or
  • Youth who lack a viable placement in a traditional resource home and because of their presenting problems would be placed in a residential setting unless an available Level A resource home can be found.

Presenting problems displayed by the Level A candidate may include the following:

  • Behaviors which if not modified could result in the youth being designated as a status offender
  • History of irresponsible or inappropriate sexual behavior, which has resulted in the need for extraordinary supervision
  • Threatening, intimidating, or destructive behavior which is demonstrated by multiple incidents over a period of time
  • Problems of defiance when dealing with authority figures
  • Significant problems with peer relations
  • Significant problems at school that affect academic achievement or social adjustment
  • Significant problems with lying, stealing, or manipulating
  • Significant problems of temper control
  • Mild substance abuse related problems
  • Oppositional behavior which contributes to placement disruptions and inability to function productively with peers, parent figures, birth family, etc.
  • Any of above behaviors, coupled with medical problems
  • Any of above behaviors displayed by one or more youth of a sibling group, qualifying the entire sibling group for placement together, if appropriate. However, not all youth would be eligible for the Level A maintenance rate.

Youth appropriate for Level B have serious emotional and/or behavior problems that require the 24-hour availability of a highly skilled Level B resource parent who is capable of assuming the role of primary change agent. These youth:

  • Because of their presenting problems would be placed in a level III or above residential treatment facility or psychiatric hospital;
  • Have been discharged from a residential treatment facility or psychiatric hospital and who are unable to function in a traditional resource home.

Presenting problems displayed by the Level B candidate may include the following:

  • History of suicide or currently having suicidal thoughts, statements and/or gestures
  • Affective disorders
  • Attention Deficit Disorder
  • Post Traumatic Stress Disorder
  • Eating disorder
  • Panic disorders
  • Fears/phobias
  • Obsessive/Compulsive Disorders
  • Oppositional Defiant Disorders
  • Depression/withdrawal
  • Dissociative behaviors, blank out, pass out, seizure
  • Anger/rage
  • History of fire setting
  • Destructive of property
  • Failure to form emotional attachments
  • Multiple short-term placements

4.5.1 Referral and Placement Process

To initiate the process, the referring Children’s Service Worker should assess the youth’s demonstrated behavior that indicates the need for intensive and individualized intervention. He/she will then prepare and submit a referral packet to the appropriate multidisciplinary foster care selection team. The staffing should occur within 30 days of the referral or resource provider’s request for a staffing.

The worker shall complete (including attachments) the Youth with Elevated Needs referral forms (CD-136 and CD-137) to submit to the review team.

Youth with Elevated Needs (YEN) Review Team
The role of the review team is to evaluate a child’s appropriateness for a higher level placement. The following people should be invited:

  • Case Manager (required to attend)
  • Case Manager’s Supervisor
  • Circuit or Regional Specialist or designated facilitator (required to attend)
  • Current Resource Provider
  • Current therapist
  • School Personnel (with knowledge of the youth’s behaviors and functioning level)
  • Guardian Ad-Litem (GAL)
  • Juvenile officer
  • Court Appointed Special Advocate (CASA)
  • Licensing Worker for the Family (current or potential)
  • Other persons as appropriate for a child specific review including parents.

Placement Process
The YEN Review Team will receive the referral and review the material. The Team will interview, as appropriate, youth, current caregiver, therapist, referring Children’s Service Worker, etc. They will decide if the youth is an appropriate candidate for the program. The Screening Team may recommend:

  • The youth is not appropriate for the program
  • The youth is appropriate, but a compatible home is not available in the county of origin or nearby counties
  • The youth is appropriate, and there is a compatible home

The case manager/Children’s Service Worker will receive a decision from the Screening/Selection Team facilitator indicating the team’s decision. The team can decide the appropriate start date, but this will be back-dated no further than the date of the initial referral.

The Resource worker of potential placement families will share all referral information with the prospective resource parents and assess with them their ability to meet the youth’s needs.

The Children’s Service Worker will then carry out any of the following actions, as appropriate to the youth being placed:

  • Coordinate all planning with the service county, if the county of current placement is different from the case manager county
  • Receive notification when a resource becomes available
  • Notify the licensing worker if the placement is no longer needed

The Children Service Worker will communicate with the potential elevated needs placement regarding pre-placement visits and any other information required.

Level B Resource Parents may be reimbursed via a payment request for transportation costs of pre-placement activities. The actual number of visits is governed by the needs of the youth and the Level B resource family.

The Children’s Service Worker must gain commitment from both the youth and resource family and then proceed with the placement. The worker will assure the youth’s arrival at the resource home when all parties agree the child is ready.

4.5.2 Ongoing Procedures to Maintain Placement
The Children’s Service Worker will assess the youth’s overall treatment needs, including educational and emotional needs and will obtain evaluations if needed. The worker will develop a treatment plan with the Family Support Team (FST) for stabilizing the child’s behavior, to improve their level of functioning at home, school and in the community and to achieve permanency.

Resource parents are the primary change agents for youth placed in their care. Support and guidance should be provided to the resource parents. However, on a case-by-case basis, other therapeutic support may be added for the youth based on the particular situation as recommended by the team working with the youth.

During placement home visits the worker will, if needed:

  • Assess and monitor the youth’s progress toward treatment and permanency goals
  • Assess and monitor the resource parent’s job performance
  • Review and discuss reports maintained by the resource parent
  • Arrange regularly scheduled respite care

The case manager will assess the level of care required by the youth at 90-day intervals and move the youth to a less restrictive environment as appropriate.

The Children’s Service Worker will provide the resource parent with feedback about how the placement and child are doing as needed.

Periodic Reviews

The goal for youth who qualify for the youth with elevated needs program is to stabilize their behavior, to help them function in a less restrictive environment and to achieve permanency. Level A and Level B care is not permanency but is designed to be a stepping stone for the youth to obtain a permanent home. As these youth do have a variety of special needs, the goal of successful permanency can be challenging. Accordingly, resource parents, staff, and other treatment team members must aggressively pursue permanency and use periodic reviews as one of the tools to assure progress toward permanency is occurring.

To assist youth in achieving a permanent home, it is important that the resource parent and the team tailor the level of intensity and intervention to their needs as youth achieve progress and success. Most youth in Level A and Level B care do make substantial improvement in their behavior during the first year of intervention and can function with a reduced level of intensity. Other youth may need the intensity of elevated intervention for longer periods of time to remain out of residential care and/or a more restrictive setting.

The dilemma for the teams may be how to move the youth to the appropriate level of intervention, such as Level A or traditional foster care, without moving the youth from the current resource home. Ideally, youth who improve in Level B care and are ready for less intensive care could move directly to their permanent home. When that is not possible, the next best solution is to keep the youth in the same resource home under the category of Level A, traditional foster care (depending on the youth’s needs) or pre-adoptive home. Youth who are happy in their resource home and are experiencing success should not be moved to a different resource home solely due to no longer needing Level B intervention.

Staff, resource parents and the team members must assess each individual situation carefully and negotiate an outcome that is in that youth’s best interests. Periodic reviews are a critical tool for assuring the youth’s level of intervention is matching their needs and that permanency is on target. As always, the best interest of the youth is the guiding principal with these complex decisions.

Situations where there is disagreement among team members as to continuing need for intervention and/or the appropriate plan for the youth should be referred to the Regional Director or designee for consultation.

Periodic Review schedule:

  • Six (6) months – Multi-disciplinary Selection/Screening team that originally recommended placement with the resource parents and/or the Family Support Team. The team will continue to review youth’s situation every 6 months on an on-going basis.
  • Twelve (12) months reviews – Regional Office Review Team conducts a review based on local team review information. Regional Office Reviews are a critical tool in assuring consistency, accountability and progress with the Level B program. Also, Level B Foster Care status does not exclude youth and families from compliance with ASFA timelines.

4.5.3 Termination of Elevated Needs Classification
Permanency planning shall continue throughout the Level A or Level B placement. The worker shall seek a less restrictive setting once the youth’s presenting problems have been replaced with appropriate coping behaviors. It may be necessary to involve a Children’s Service Specialist for consultation if the team is unable to reach a consensus regarding termination of the youth’s classification.