Library: Policy

340:75-8-9. Placement procedures in therapeutic foster care homes (TFC) or intensive therapeutic family care (ITFC)

Revised 9-15-22

(a) TFC is the least restrictive, community-based residential care placement setting.  Children in Oklahoma Human Services (OKDHS) custody or tribal custody served in TFC placements are 4 through 17 years of age, and the Oklahoma Health Care Authority (OHCA) authorized reviewer has determined the children meet the medical necessity criteria for TFC services, per Oklahoma Administrative Code (OAC) 317:30-5-741.

(1) The child is diagnosed with any Diagnostic and Statistical Manual of Mental Disorders (DSM) AXIS I primary diagnosis, with the exception of V codes and adjustment disorders, accompanied by a detailed description of the symptoms supporting the diagnosis.

(2) The child's conditions are directly attributed to a mental illness or serious emotional disturbance as the primary need for professional attention.

(3) The inpatient authorization reviewer determines that the child's current disabling symptoms cannot be or were not managed in a less intensive treatment program.

(4) There is evidence that the child's presenting emotional or behavioral problems prohibit full integration in a family or home setting without the availability of 24-hour crisis response, behavior management, and intensive clinical interventions from professional staff.

(5) The child is medically stable and not actively suicidal or homicidal and not in need of substance use or abuse detoxification services.  ■ 1

(6) The parent or the legal guardian of the child in OKDHS custody or tribal custody is afforded the opportunity to actively participate in the child's treatment and planning.

(b) In addition to the above criteria, the following conditions are representative of other factors that may qualify children for ITFC services:

(1) multiple placements in various settings including acute and residential treatment, psychiatric hospitals, group homes, shelter, traditional, and TFC homes;

(2) problematic sexual behavior, a victim of sexual trauma, or both;

(3) extensive physical aggression or causing harm to others, including people and animals;

(4) a variety of self-injurious behaviors including previous suicide attempts;

(5) a history of other difficulties that present a critical risk of harm to self or others;

(6) severely impaired cognitive functioning including hallucinations, affective disorders, and communication deficiencies;

(7) impaired social skills, personal hygiene, and other daily living skills;

(8) a history of substance use, abuse, or exposure;

(9) secondary needs associated with identified developmental or intellectual delays; or

(10) other complex trauma experiences.

(c) The Child Welfare Services (CWS) specialist and supervisor assess each child's treatment needs per OAC 340:75-6-40 and 340:75-6-85.  The CWS specialist seeks TFC or ITFC placement when the:

(1) child's treatment needs can no longer be met in the child's own home, relative home, or traditional foster family setting;

(2) child does not require a group home placement; and

(3) child does not meet the medical necessity criteria for psychiatric treatment.

(d) A child whose behavior requires 24-hour awake supervision or who poses a danger in a family setting is not appropriate for TFC or ITFC placement.

(e) The TFC or ITFC contractor receives child placement referrals from TFC or ITFC placement coordinator, per OAC 340:75-8-12.  ■ 2

(f) The TFC or ITFC contractor requests a TFC or ITFC authorization extension 30-calendar days prior to the expiration of the authorized length of stay.  When the OHCA authorized reviewer denies the service extension, the TFC or ITFC contractor provides written notification within one-business day of the denial to the CWS specialist, or the Indian child welfare worker when the child is in tribal custody only, to initiate transition planning.  ■ 3

(g) TFC or ITFC contractors document in writing, an assessment of the agency's ability to serve a child 5 years of age or younger prior to placement.  The written documentation is maintained for on-site review during program audits and includes:

(1) the assessed diagnosis and proposed treatment plan for the child;

(2) the credentials, experience, and training of the TFC or ITFC contractor's staff documenting the staff's ability to develop an age-appropriate treatment plan and deliver clinical services to children, 5 years of age or younger, with emotional or behavioral problems; and

(3) a description of the proposed TFC or ITFC parent's:

(A) age, availability, experience, and skills;

(B) family structure;

(C) ability to meet the child's needs, including a child 5 years of age or younger; and

(D) parenting responsibilities to other children in the home, children in foster care or TFC or ITFC placement, any adopted children, and any birth children.

(h) The TFC contractor does not place more than two children in a TFC home without prior written approval from the Foster Care and Adoptions Programs deputy director on completed Form 04FT003E, Request for Third Placement.  The TFC contractor submits the written request that includes:

(1) primary treatment needs for the proposed placement of a third child and any subsequent children in the TFC home;

(2) availability, placement history, skills, completed or planned corrective action, and additional contractor supports of the TFC parent identified for proposed third child placement;

(3) risk factors considered and compelling reasons for proposed placement of a third child;

(4) documentation of TFC contractor contact with CWS specialists or supervisors for each child in the home, involved professionals, and each TFC family member regarding the impact of the proposed third child placement;

(5) documentation of TFC contractor's review of any separated siblings placed in the proposed third placement.  Guidance on when siblings may be separated is located in OAC 340:75-6-85; and

(6) other information as requested by the Foster Care and Adoptions Programs deputy director.

(i) An ITFC home serves only one child at a time.  An exception to this limit is reviewed and approved by the Foster Care and Adoptions Programs deputy director.  The ITFC contractor submits the written request on Form 04FT003E that includes:

(1) primary treatment needs for the proposed placement of a second child and any subsequent children in the ITFC home;

(2) availability, placement history, skills, completed or planned corrective action, and additional contractor supports of the ITFC parent identified for proposed placement of a second child;

(3) risk factors considered and compelling reasons for proposed placement of a second child;

(4) documentation of ITFC contractor contact with CWS specialists or supervisors for the child in the home, involved professionals, and each ITFC family member regarding the impact of the proposed placement of a second child;

(5) documentation of ITFC contractor's review of any separated siblings placed in the proposed second placement.  Guidance on when siblings may be separated is located in OAC 340:75-6-85; and

(6) other information as requested by the Foster Care and Adoptions Programs deputy director.

(j) A home serving three or more children without prior written approval is subject to denial of payment above the foster care maintenance rate.  Email approval from the Foster Care deputy director is considered valid written approval.  A child respiting in the home beyond timeframes and processes for extensions, per OAC 340:75-8-11, is considered a placement in the home after 14-calendar days.

(k) Title XIX payments for TFC or ITFC services are not made for TFC or ITFC parents who move out of Oklahoma.  ■ 4

(l) A youth 18 years of age and older may remain in TFC or ITFC placement on a voluntary basis, per OAC 340:75-6-110.  ■ 5

(m) The TFC or ITFC contractor establishes practice modalities to support the placement of all children in OKDHS custody and tribal custody meeting criteria for TFC or ITFC level of care in a fully-certified TFC or ITFC home.  Each child in placement receives services based on his or her individualized service plan to meet mental and behavioral health needs.  Services provided support the child to move to a less restrictive level of care as quickly as possible.

(n) Children in TFC or ITFC are authorized for placement based on meeting specific criteria.  The reimbursement amount paid to the contractor and TFC or ITFC parent are in accordance with Appendix C-20, Child Welfare Services (CWS) Rates Schedule.

(o) Children are supported with TFC or ITFC services to make progressive step downs and maintain stability in placement to reach traditional foster care level or achieve permanency goals.  ■ 3

(p) When the TFC or ITFC placement is not approved by OHCA because the placement need developed outside of OHCA business hours or the business day closed without a return call from OHCA, the contractor may assist with immediate placement of a child OKDHS staff identifies as in need of TFC or ITFC level placement.  These placements are documented and paid through the contractor's resource family partners contract for placement of traditional foster care placements or contracted foster care contract.  OHCA approval is obtained the following business day after placement.  The child is then admitted to TFC or ITFC placement in the same home.  When OHCA denies TFC or ITFC approval, the contractor and CWS specialist immediately coordinate to ensure a new placement referral is initiated for placement in the appropriate level of care.  The child may not remain in a TFC or ITFC home more than three-business days when OHCA denies them for TFC or ITFC placement.  

Revised 9-15-22

1. Oklahoma Health Care Authority (OHCA) authorization for therapeutic foster care (TFC) or intensive therapeutic family care (ITFC).  OHCA inpatient authorization reviewers authorize children in Oklahoma Human Services (OKDHS) custody or tribal custody for TFC or ITFC placement.  Reviewers initially evaluate the child's current treatment needs to determine whether the child likely meets the criteria for TFC or ITFC services.

(1) The child welfare (CW) specialist completes a Child Placement Interview (CPI) by contacting the placement line and requests the information be forwarded to TFC Programs for a TFC or ITFC "sounds like or does not sound like" determination.  After completing the CPI, the CW specialist completes the cover sheet and emails it to TherapeuticFosterCare@okdhs.org.

(2) The CW specialist provides accurate and complete information regarding the child's behaviors to the placement line staff completing the CPI over the phone.

(3) Upon the CPI's completion, TFC program staff sends it to OHCA for approval or denial of the ITFC request.

(4) TFC program staff enters and updates the placement recommendation screens in KIDS according to OHCA approval or denial.

2. TFC or ITFC placement approval or denial.

(1) When the child is approved for TFC or ITFC level of care, TFC program staff emails approval to the child's assigned CW specialist.  TFC program staff emails the CPI and TFC coversheet to all the TFC or ITFC contractors seeking placement.  The TFC or ITFC contractor calls the child's worker when placement is located to schedule the TFC or ITFC intake appointment.  Field staff is not permitted to contact TFC or ITFC contractors directly when seeking placement.

(2) When OHCA denies the child TFC or ITFC, TFC program staff emails the child's assigned CW specialist and the behavioral health consultant for that region requesting assistance in coordinating services at a lower level placement.

3. Lower level placement options.  When the child no longer meets criteria for TFC or ITFC placement and may be placed in a lower level of care, the CW specialist immediately makes plans for the next appropriate placement.  Placement options for a child who no longer meets criteria are:

(1) his or her own home;

(2) a relative home;

(3) an adoptive home;

(4) foster family care including joint approval of the TFC or ITFC home per Oklahoma Administrative Code (OAC) 340:75-8-8, and contracted foster care that is limited to a 90-calendar day stay when pre-approved by the TFC field manager; or

(5) independent living.

4. Out-of-state placements.  CW staff is not authorized to approve TFC or ITFC placement of a child in OKDHS custody with a TFC or ITFC parent who is moving out-of-state.

5. Extended placement services.  The CW specialist and supervisor determine if the youth in TFC or ITFC placement is eligible for voluntary services after he or she becomes 18 years of age.  When the youth is eligible and requests voluntary care, the CW specialist completes requirements, per OAC 340:75-6-110.