Library: Policy

340:75-14-1. Purpose, definitions, and assessment

Revised 9-15-20

(a) Purpose.

(1) A child's well-being is comprised of four basic domains:

(A) cognitive functioning;

(B) physical health and development;

(D) social functioning.

(2) A child's well-being is dependent upon the caretaker's ability to meet the child's physical health, learning and development, behavioral health, and the child's ongoing opportunities to engage in age- or developmentally-appropriate activities following the reasonable and prudent parent standard.

(3) The child welfare (CW) specialist assesses:

(A) child functioning that includes the specific indicators of child well-being.An assessment of child functioning is the basis for understanding how the caregiver addresses any specific child needs and is a central component of promoting well-being for children who have experienced abuse or neglect; and

(B) a child's needs in these areas throughout the case process and addresses identified needs as part of case planning activities.

(4) Children and families are meaningfully engaged in all aspects of the service process to build and maintain a trusting, supportive working relationship.

(5) A trauma-informed framework of well-being puts together assessments, interventions, actions, and supports that are intentional and inclusive of a deeper understanding of the four basic domains of a child's well-being through a trauma-informed lens.

(6) Children engaged by the CW system, especially those who were removed from their birth families, have likely experienced traumatic events in their lives, thereby impacting their development and overall well-being.

(A) A removal leading to the separation of the family, in and of itself, can cause trauma.

(B) Children's relationships, behaviors, and sense of self may all be impacted.

(D) Not all children who are involved in or witness traumatic events develop traumatic stress responses.Some children are able to adapt and cope with trauma better than others, especially when intervention is early.

(b) Equal access.Children engaged by the CW system have the right to fair and equal access to all available services, placement, care, treatment, and benefits, and to not be subjected to discrimination or harassment on the basis of actual or perceived race, ethnic group identification, ancestry, national origin, color, religion, sex, sexual orientation, gender identity, mental or physical disability, or Human Immunodeficiency Virus(HIV) status.

(c) Definitions. Per Section 1-1-105 of Title 10A of the Oklahoma Statutes (10A O.S. § 1-1-105) the following words and terms, when used in this Subchapter shall have the following meanings, unless the context clearly indicates otherwise:

(1) "Age-appropriate" or "developmentally-appropriate" means:

(A) activities or items that are generally accepted as suitable for children of the same age or level of maturity or that are determined to be developmentally-appropriate for a child, based on the development of cognitive, emotional, physical, and behavioral capacities that are typical for an age or age group; and

(B) in the case of a specific child, activities or items that are suitable for that child based on the developmental stages attained by the child with respect to the cognitive, emotional, physical, and behavioral capacities of the specific child.

(2) "Behavioral health" means mental health, substance use or abuse, or co-occurring mental health and substance use or abuse diagnoses, and the continuum of mental health, substance use or abuse, or co-occurring mental health and substance use or abuse treatment.

(3) "Child behavioral health screener" means a brief measuring tool designed to screen for the presence of behavioral and trauma-related symptoms that may be negatively impacting child function in children ages birth through 17 years old.It additionally has questions geared to track counseling progress and psychotropic medication management.

(4) "Child with disability" means any child who has a physical or mental impairment that substantially limits one or more of the child's major life activities or who is regarded as having such impairment by a competent medical professional.

(5) "Infant" means a child 12 months of age and younger.

(6) "Psychotropic medications" means medications with well-demonstrated efficacy in the treatment of mental disorders through the modification of behavior, mood, and emotions.

(7) "Reasonable and prudent parent standard" means the standard characterized by careful and sensible parental decisions that maintain the child's health, safety, and best interests while at the same time encouraging the emotional and developmental growth of the child.This standard is used by the child's caregiver when determining whether to allow a child to participate in extracurricular, enrichment, cultural, and social activities.For purposes of this definition, the term "caregiver" means a foster parent with whom a child in foster care was placed, a representative of a group home where a child was placed, or a designated official for a residential child care facility where a child in foster care was placed.

(8) "Trauma" means what happens to a child that results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being.

(9) "Successful adulthood program" means a program specifically designed to assist a child in Oklahoma Department of Human Services (DHS) custody or tribal custody in developing and enhancing the skills and abilities necessary for successful adult living, per 10A O.S. § 1-9-107.

(10) "Youth" means a child 13 through 17 years of age.

(d) Child functioning.

(1) Description.Child functioning is concerned with describing the child's general behavior, emotions, temperament, development, academic status, physical capacity, and health status.It addresses how a child functions from day-to-day and their current status rather than focusing on a specific point in time.An assessment of child functioning must take into account the child's age and/or any special needs or developmental delays.

(2) Child functioning indicators.

(A) Emotion/trauma.The degree to which, an adequate pattern of appropriate self-management of emotions is displayed, consistent with the child's age, ability, and developmental level.

(B) Behavior.The degree to which, an appropriate coping and adapting behavior is displayed, consistent with the child's age, ability, and developmental level.

(C) Developmental/early learning.Consistent with age and ability expectations, the child is achieving milestones based on his or her age and developmental capacities.

(D) Academic status.The child, according to age and ability, is:

(i) actively engaged in instructional activities and reading at grade level or an Individualized Education Program (IEP) expectation level; and

(ii) meeting requirements for annual promotion and course completion leading to a high school diploma or equivalent or vocational program.

(E) Positive peer/adult relationships. The child, according to age and ability, demonstrates adequate positive social relationships.

(F) Family relationships. The child demonstrates age and developmentally-appropriate patterns of forming relationships with family members.

(G) Physical health. The child is achieving and maintaining positive health status that includes physical, dental, audio and visual assessments and services.When the child has a serious or chronic health condition, he or she is achieving the best attainable health status given the diagnosis and prognosis.

(H) Cultural identity. Important cultural factors, such as race; class; ethnicity; religion; gender, gender identity, and sexual orientation; and other forms of culture are appropriately considered in the child's life. • 3

(I) Substance awareness.The assessment of substance awareness is multi-dimensional.The assessment:

(i) includes the child/youth's awareness of alcohol and drugs, and his or her own use; and

(ii) for children who have experienced the negative impacts of parent/caregiver substance use or abuse within their home, includes their awareness of alcohol and drugs and treatment/recovery for their parent/legal guardian(s), as age appropriate.

(J) Preparation for adult living skills development.The child, according to age and ability, is gaining skills, education, work experience, long-term relationships and connections, income, housing, and other capacities necessary for functioning upon adulthood; and includes access to age-appropriate, medically-accurate information about reproductive health care, pregnancy prevention, and the prevention and treatment of sexually-transmitted infections at 12 years of age and older.

(e) Screenings and functional assessments.Screening and functional assessment tools are used to inform decisions about appropriateness of evidence-informed services. • 2 All children, birth through 17 years of age, engaged with Child Welfare Services have access to screening and functional assessments for the early and ongoing identification of well-being needs, per 10A O.S. § 1-4-208. • 1

INSTRUCTIONS TO STAFF 340:75-14-1

Revised 9-16-21

1. (a) Child Behavioral Health Screener (CBHS).

(1) CBHS is the standardized screening and functional assessment tool utilized by the child welfare (CW) specialist for all children involved in court intervention and family-centered services cases (FCS), regardless of placement in out-of-home care or in the child's own home for the early and ongoing identification of well-being needs.

(2) The CBHS format assists the CW specialist in gathering and documenting information on a child's development and the presence of behavioral and trauma-related symptoms that may be negatively impacting child function.

(3) The information is used in data-driven decision-making and case planning efforts.

(b) Using CBHS.

(1) The CW specialist:

(A) using age-specific Forms 04TA001E through 04TA011E, Child Behavioral Health Screener and Form 04TA013E, Child Behavioral Health Screener Self-Report, administers the initial CBHS for a child, birth through 17 years of age, to the:

(i) person responsible for the child (PRFC) who remains in his or her own home or is placed in trial reunification for 30-calendar days or longer;

(ii) placement provider, or out-of-home Safety Plan monitor, for a child who is in out-of-home placement for 30-calendar days or longer. Placements in medical or psychiatric facilities, and out-of-state Interstate Compact for the Placement of Children (ICPC) are excluded; or

(iii) youth placed in shelter and residential placement settings for 30-calendar days or longer.

(B) completes the screening process monthly during the required face-to-face child visit with the PRFC, placement provider, or youth placed in shelters and residential placement settings to identify and monitor changes in the child's symptoms and progress in services;

(C) continues to follow Oklahoma Administrative Code (OAC) 340:75-6-48 Instructions to Staff (ITS) # 1-3, on contacts with child, parents, placement providers, and service providers, and is still required to gather and document information obtained during the contact on Forms 04MP007E, Face-to-Face Contact Guide, and 04MP008E, Contact Guide Addendum for Face-to-Face Visit with Youth - Age 16 to 18; and

(D) scores the CBHS responses per instructions provided on the forms and reviews the CBHS results with the PRFC, placement provider, or youth including any referral recommendations.

(c) Scoring CBHS. The "Caseworker Use Only" section on Forms 04TA001E – 04TA012E is provided for scoring and guidance for referral.

(1) The CW specialist completes and submits Form 04TA012E, Referral for Children's Services, to an appropriate evidence-based/evidence-informed behavioral health service provider or SoonerStart as indicated by the CBHS score.

(2) When a referral is made, the CW specialist documents in KIDS using the purpose, "Referral for Services," selects the child and includes the service provider's contact information noting that a referral was made based on CBHS results. The CW specialist:

(A) uploads Form 04TA0012E to the KIDS document management system; and

(B) ensures contact is made with the service provider to obtain treatment status/progression and recommendation regarding whether services are continued, terminated, or additional services are necessary.

(3) The CW specialist utilizes the age-specific CBHS to document a child's development, the presence of behavioral and trauma-related symptoms, behavioral health progress, and psychotropic medication management.

(A) CBHS is entered in the KIDS Client tab, Medical, and Screen. The CBHS is entered in KIDS:

(i) as quickly as possible after the CBHS is completed; and

(ii) no later than the fourth day of the following month.

(B) Detailed instruction for entering the CBHS is available in the KIDS How - To entitled, "OK-TASCC Screeners."

2. Child and Adolescent Needs and Strengths (CANS) assessment.

(1) CANS assessment is a standardized evidence-based functional assessment tool completed by a qualified, trained professional or licensed clinician to assess the strengths and needs of a child placed in foster care to determine the most effective and appropriate level of care for the child in the least restrictive environment and be consistent with the child's short- and long-term goals, as specified in the child's permanency plan.

(2) When a qualified residential treatment program (QRTP) is considered for a child's placement, a CANS assessment is completed by a qualified individual within 30-calendar days of the child's placement in a QRTP, per OAC 340:75-11-233 and 340:75-11-233.1 ITS. The CW specialist:

(A) requests a QRTP placement, per OAC 340:75-11-233 ITS;

(B) assembles a family and permanency team for the child to facilitate completion of the CANS assessment. The team consists of:

(i) all of the child's appropriate biological family members, relatives, and fictive kin;

(ii) all of the appropriate professionals who are a resource to the child's family; and

(iii) when a child attains 14 years of age and at the child's option, no more than two members selected by the child who are not a foster parent of, or caseworker for, the child.

(C) documents in the child's case plan:

(i) the reasonable and good faith efforts to identify and include all the individuals required to be on the child's family and permanency team as described in (B) of this paragraph;

(ii) all current contact information for members of the child's family and permanency team, as well as contact information for other family members and fictive kin who are not part of the family and permanency team;

(iii) evidence that meetings of the family and permanency team are held at a time and place convenient for family;

(iv) when reunification is the child's case plan goal, evidence demonstrating the parent from whom the child was removed provided input on the members of the family and permanency team;

(v) evidence the CANS assessment is determined in conjunction with the family and permanency team;

(vi) the family and permanency team's placement preference recognizes a child is placed with his or her siblings unless there is a finding by the court that such placement is contrary to the child's best interest; and

(vii) when the family and permanency team's and child's placement preferences were not the placement setting recommended by the qualified individual conducting the assessment of the QRTP's appropriateness, the reasons their preferences were not recommended.

(D) obtains the completed CANS assessment and written documentation made by the qualified individual to provide to the court, per OAC 340:75-6-85.

3. Gender identification and sexual orientation.

(a) When a youth discloses self-identification as lesbian, gay, bisexual, transgendered, or questioning (LGBTQ), the CW specialist:

(1) assesses and ensures the child's safety;

(2) assesses and ensures the child's well-being needs are met;

(3) examines personal biases related to self-identification;

(4) affirms the child's self-identification; and

(5) keeps the child's self-identification confidential.

(b) Specific information about LGBTQ Supports is found at:

(1) Oklahoma Human Services Child Welfare Services Guidebook https://cwtraining.oucpm.org/wp-content/uploads/2019/05/LGBTQ-Guidebook-Sept-2018-May-29-2019.pdf; and

(2) Online Training https://www.okdhslearning.org/login/index.php.