Level 5 Exceptional Treatment Foster Home Guide to Certificationand Placement

Transcript

1 Level 5 Exceptional Treatment Foster Home Guide to Certification and Placement February 2018 Division of Safety and Permanence 02/2018) CF - 5251 (N. - P D

2 DCF is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format, or need it translated to another language, please contact the Wisconsin Relay 711 TTY. Service (WRS) – 711 TTY. For civil rights questions, call (608) 422 - 6889 or Wisconsin Relay Service (WRS) – 1

3 Table of Contents ... ... 3 Guide Overview and Instructions ... ... 3 Level 5 Exceptional Treatment Foster Home Overview ... ... ... ... ... ... 3 History ... - Children’s Long ... ... ... 3 Term Support Waiver Program Collaboration Definition ... ... ... ... ... 4 Intent ... ... ... ... ... ... 4 Population Served ... ... ... ... 5 Getting Started ... ... ... 5 ... Timeline ... ... ... ... ... .. 5 Referral ... ... ... ... ... ... 7 Identification of Agency Roles ... ... ... ... 7 ... ... ... ... ... 9 Budgeting and Rate Setting De veloping a Home ... ... ... ... 10 Licensing ... ... ... ... 10 ... - ... ... ... ... ... 17 Child Specific Planning ... ... Application for Certification or Placement ... 18 ... Managing a Home ... ... ... ... 22 Respite ... ... ... ... ... . 19 Monitoring the License and the Child’s Plan ... ... ... 22 ... Incident Reporting ... ... ... ... ... 23 Restrictive Measures ... ... ... ... ... 25 Appendices ... ... ... ... 30 Appendix A, Important Links ... ... ... ... 30 2

4 Guide Overview and Instructions Foster Homes by outlining This guide provides an overview of Level 5 Exceptional Treatment considerations and agencies looking to license a Level 5 Foster Home or place a child in for an existing home. resources to lease note , this guide summa rizes requirements P Chapter DCF 56 Administrative Code . C itations to Ch. outlined in DCF 56 Admin. Code will be linked throughout the guide . In addition, all requirements out lined in the standards and manuals below must be followed, as applicable;  R equirements outlined in the Wisconsin Ongoing Services Standards must be followed for all children placed in out - - home care, including children in Level 5 Foster Homes; of  For a child enrolled in the Children’s Long Term Support (CLTS) Waiver Program, agencies must comply Wisconsin Department of Health Services Medicaid Home and Community with the requirements in the l Based Services Waivers Manua ;  If the child has an approved restrictive measures plan, that plan must be in compliance with the Guidelines and Requirements for the Use of Restrictive Measures Manual . Agencies all policies specific to other programs in which the child is involved . Examples may must also comply with include Comprehensive Community Services (CCS) or the Children’s Community Options Program (CCOP). Please see Appendix A for links to important web - based materials related to Level 5 Foster Homes. Level 5 Exceptional Treatment Foster Home Overview History The lacement of children in Level 5 Exceptional Treatment Foster Homes requires an exception operation of and p the Department of Children and Families Exceptions Panel. Prior to 2011, the department granted from (DCF) staffed treatment foster homes under DCFS Memo Series 2006 - 15. These exceptions exceptions to operate shift - were granted in order to serve the needs of children who needed overnight awake care and were expected to need care into adulthood in a community setting, often for medical reasons. In 2011, the Levels of Care Foster under Ch Care Licensing Initiative incorporated Level 5 Foster Homes into permanent rule DCF 56 .13(7) Admin. . Code . ( Application for Certification and Child Placement Level 5 Fos An application for an exception DCF - F - ter Home ( 2559 - E ) to Ch. DCF 56 Admin. Code to operate or place a child in a Level 5 Foster Home requires review and approval DCF Exceptions Panel. by the - Children’s Long Term Support Waiver Program Collaboration - Term Support The Children’s Long Waiver P rogram allow s participants to receive Medicaid funding for (CLTS) supports and services necessary to live fully integ rated lives in home and community - based settings. The CLTS Waiver Program is managed by the Department of Health Services (DHS) and is one of Wisconsin’s Home and Community Based S ervices (HCBS) Medicaid Waiver p rograms, which is federally authorized under § 191 5(c) of the Social Security Act. Most children placed in Level 5 Foster Homes are eligible to be enrolled in the Children’s Long Program. Term Support (CLTS) Waiver 3

5 The CLTS Waiver Program provides a structure within which Medicaid funding is availab le to support children who live at home or in the community and have substantial limitations in multiple daily activities as a result of one or more of the following disabilities:  Intellectual/developmental disabilities , Severe emotional disturbances, and /  or  Physical disabilities. The CLTS Waiver Program is not merely a funding source for children to be placed in Leve l 5 Foster Homes, and the CLTS Waiver P rogram requirements must be followed for all children in Level 5 Foster Homes that are also enrolled in the waiver program. Because most children placed in Level 5 Foster Homes are enrolled in the CLTS Waiver Program, it is essential that the Department of Health Services (DHS) and DCF collaborate to ensure that all requirements are being met for children placed in Level 5 Foster Homes, and that adequate plans and services are in pla ce. Definition Level 5 Exceptional Treatment Foster Homes provide care to c hildren whose conditions require a high degree of supervision and overnight awake care that is provided by staff persons in the home 24 hours per day . Licensed foster parents manage the program in the home Level 5 Foster , but do not necessarily also reside in the home. Homes are developed to be child - specific, and function to meet the exceptional needs of the identified child placed in the home. Because children in Level 5 Foster Homes have higher needs than children placed in foster of Care certifications, Level 5 Foster Homes may not provide care for more than 4 children. homes with lower Level Intent - in a community setting . Level 5 Foster Homes are intended to serve children expected to need long term care home and all services provided in that home Each tailored to the identified child’s specific needs and integrate s are the child into the surrounding community. These home s often continue to be the youth’s home as they transition into adulthood continue to need and qualify for y adult services. Because these homes are meant to if the transition youth into adult services, they may be dually licensed as an Adul t Family Home and a foster home. Guides to DCF/DHS Dual Licensure, Certification, and Placement on pages 28 - 29 provide additional information about dually licensing /certifying these homes . 4

6 Population Served A Level 5 Foster Home should only be considered as the last community placement option when all other options have been determined of the child. When considering whether a child to be unavailable or not in the best interest is appropriate to be placed in a Level 5 Foster Home, consider whether the circumstances in Ch. DCF 56.13(7)(a) A dmin. Code exist, and that all of the conditions below are applicable to the child . Child has behaviors or conditions requiring high supervision, • Child requires 24 hour awake care by staff, • - • Child would benefit from a home - like environment, • Child would benefit from fewer children than a group home or residential care center, • The child is expected to need long term care OR • The child has needs agreed to by the department, • All other community placement options have been investigated and determined unavailable or not in the best interest of the child. may be an appropriate placement for that child. If a If the child meets the criteria above, a Level 5 Foster Home child does not meet the typical criteria for a Level 5 Foster Home listed above, DCF may still allow an agency to seek approval from the DCF pursue placement under Ch. DCF 56.13(7)(a)1.c. Admin. Code . Agencies must Chairperson Exceptions Panel Request to Clarify Specific and Limited Circumstances Prior to a by submitting Submitting an Application to Operate a ) E - 5177 to F - DCF Level 5 Exceptional Treatment Foster Home ( - [email protected] before pursuing certification or placement in a Level 5 Foster Home . Getting Started Timeline Agencies should be aware of required to develop or place in a th e length of time timeline Level 5 Foster Home. The ing and preparedness on the agency’s plann Once an agency g varies greatly decides that a Level 5 Foster . dependin to request approval to move Chairperson must contact the DCF Exceptions Panel agency the Home is necessary, a Request to Clarify Specific and Limited Circumstances Prior to Submitting an Application forward by completing 5177 ). Concurrently, counties should be working erate a Level 5 Exceptional Treatm ent Foster Home ( DCF E - - F - to Op pment of a Level 5 home. in collaboration with their local County Waiver Agency in the planning and develo Developing homes take s time due to the need to locate a physical home, hire and train program managers and staff, and develop plans to support the child in the home. After the development stage , an Application for 2559 by the licensing agency ) Certification and Child Placement Level 5 Foster Hom E - must be submitted - F - DCF ( e chedule a site visit application, s to the DCF Exceptions Panel. The DCF Exceptions Panel will review the exception Following receipt of a complete view the physical space, and subsequently approve or deny the application. re to equires the DCF Exceptions Panel to respond within 45 days . application, Ch. DCF 56. 02(2)(b)6.b. Admin. Code r - . is on the following page level overview of the entire process high A 5

7 TIMELINE PROCESS AGENCY specific child or population 5 Foster Home is identified with a A need for a Level in mind county internal will vary Timeline based on processes Placing Agency Licensing Agency and/or determines if The County Waiver Agency from the child is eligible for the CLTS Waiver E - 5177 submits form F to the DCF DCF - - Program and engages the CLTS Support Exceptions Panel Chairperson at in planning. and Service Coordinator [email protected] . The DCF Exceptions Panel Chairperson discusses the proposed home 10 business days or placement with the Exceptions Panel CLTS representative. complete information. Request is denied ; alternate Request is approved ; Placing receipt of Agency Licensing placement option must be identifies a respond within The DCF Exceptions Panel Chairperson will identified Agency (if not already involved) . . , and Placing Agency County Waiver Agency work together to identify a Licensing Agency licensee and (if different than Licensing Agency ) for the foster home. Staffing Agency begins licensing process, ensuring both the identified foster parent and Licensing Agency physical home fulfill r equirements outlined by Chapter DCF 56, Admin. Code. Placing Agency , Licensing Agency County Waiver Agency collaborate to plan for: and Hiring and training staff 1. 2. Making modifications to the physical home 3. Creating policies and procedures specific to the home Child specific planning 4. submitting a complete application. a. Child Welfare : Family Interaction, Permanency Plan, Independent Living, etc. Transitions, Community Involvement, School, etc. Community: b. c. Behavioral Support Plan The lengthiest part of the process, may take several months. Includes significant time and planning prior to d. Restrictive Measures Planning submits an applic Licensing Agency ation The County Waiver Agency completes CLTS 2559 F - - E , to - for exception, form DCF applications, including the Individualized the DCF Exceptions Panel at F - 01715 . Service Plan (ISP) and form . [email protected] DCF Exceptions Panel reviews application and up as necessary . - asks for follow that is submitted. Timeline will vary based on completeness of the application DCF Exceptions Panel schedules and conducts a site visit to the foster home. . denies DCF Exceptions Panel the exception approves or DHS CLTS Representative 45 days for the certification to operate a Level 5 Foster Home. processes CLTS applications. complete application The Panel must within approve or deny from the date of 6 AGENCY Placing /Licensing: CLTS Waiver: KEY: Placing, Licensing, & CLTS : DCF Exceptions Panel:

8 Referral the population of children to be placed in each Level 5 Foster Home is consistent with Ch. In order to ensure that DCF 56 Admin. Code guidelines a Request to Clarify Specific and Limited , licensing agencies are required to submit Circumstances Prior to Submitting an Application t ( DCF - o Operate a Level 5 Exceptional Treatment Foster Home - 5177 - E ) via e - mail to [email protected] once a child has been identified. F a completed referral, may contact the placing agency Once the Exceptions Panel Chairperson has received he/she - up discussion about the home and the placement, which may include the DHS or licensing agency for a follow F ask additional questions regarding Chairperson may Panel representative. : or example, the  The child’s compatibility with other chi ldren in the home . The CLTS Representative from DHS may call with questions regarding:  Coordination with the CLTS Waiver Program and c osts associated with Level 5 Foster Homes . business The Exceptions Panel Chairperson will provide a written approval or denial within ten days of receipt of the completed o Operate Request to Clarify Specific and Limited Circumstances Prior to Submitting an Application t ( DCF - F - 5177 - E ). Per Ch. DCF 56.13(7)(b) Admin. Code , a gencies may a Level 5 Exceptional Treatment Foster Home not proceed in the development of a home without written approval to do so. Identification of Agency Roles The creation and maintenance of a Level 5 Foster Home may involve many different agencies. County agencies - placing agencies (CPA) often work together to license, place, and serve children in Level and licensed private child 5 Foster Homes. There is flex ibility to determine which agencies will be involved to license, place and/or serve the children in the Level 5 Foster Home. County/State Placing Agency Licenses County CPA Licenses County Staffing Agency Staffing Agency Provides CPA Provides Provides Provides Services/Staff Services/Staff Services/Staff Services/Staff Placing Agency county agency or the DCF can be considered the placing with powers and duties under § 48.57 and § 938.57 The y. The placing agency may also be the licensing or supervising agency. agenc 7

9 Children placed in Level 5 Foster Homes are considered placed in out - home care. The placing agency must of - Wisconsin Ongoing Services Standards follow all requirements, including permanency planning requirements. There may be a number of placing agencies involved in any one Level 5 Foster Home due to the number of children placed. It is imp ortant to coordinate with the licensing agency through the application process and maintenance of the home to ensure all requirements are met for every child in the home. CLTS Waiver Agency Most children placed in Level 5 Foster Homes are also involved in the CLTS Waiver Program. Although the CLTS Waiver Program may be involved, they may not act as placing agency. This means, every child placed in a Level 5 Foster Home must be involved with Child Welfare. rogram prior to placement in a Level 5 Foster Home, it is Even if a child is not involved in the CLTS Waiver P important to engage CLTS in planning for placement as soon as a need has been identified. Licensing Agency Both county agencies and licensed private child - placing agencies (CPA) are able to license Level 5 Foster Homes. Level 5 Foster Homes are not licensed by DCF, and if the placing agency does not wish to license the home, they must work with a CPA to develop a home. ons to licensing code are Level 5 Foster Homes require exceptions to Ch. DCF 56 Admin. Code. Because excepti necessary, the licensing agency is the contact for the application to the DCF Exceptions Panel. The licensing agency is responsible for completing and submitting the Application for Certification and Child Placement Level 5 Foster Home ( DCF - F - 2559 - E ). There are many things county agencies should consider when deciding whether to be the licensing agency for a derations for county agencies determining their ability Level 5 Foster Home. The following chart lists some consi to be the licensing agency for a Level 5 Foster Home: • Accepting placement referrals • Understanding treatment level from other counties licensing and supervising agency Licensing a requirements • Manage license/treatment plans Treatment Working Providing/finding training for • • Charging Administrative fee to Level with Other Program Managers and Staff other placing agencies Foster Counties Home Staffing Resources Hire a staffing agency • Cost, contracts, and planning • the Home • Hire individual staff through the Licensor time and resources for • county planning/supervising and • High level of staff turnover application processes Supervising Agency Both county agencies and CPAs are able to supervise a Level 5 Foster Home. The supervising agency is responsible provide all home care. This agency must - of - ng the care and maintenance of the child placed in out for overseei re to focus on the additional qualifications . Be su Code Admin. .15 Ch. DCF 56 services and supervision required in 8

10 for the Level 3 - Ch. DCF 56.15(2) Admin. Code when determining which agency 5 supervising agency caseworker in esponsible for supervising requirements. will be r Staffing Agency Licensing agencies may choose to contract with a separate agency to provide staffing services, or to hire staff and services on their own. Many licensing agencies do not feel they have the capacity to hire, train, and provide direct maintain staff in a Level 5 Foster Home, so contracted services are requested. There are many staffing agencies that already provide direct services to children in Level 5 Foster Homes. When searching for an agency to staf f a new Level 5 Foster Home, licensing agencies may be in contact with these agencies that have experience in Level 5 Foster Homes, an agency they already work closely with, or a new agency that provides direct service to Adults of similar populations. Agr eements and Memorandums of Understanding Due to the number of agencies that may be involved , a memorandum of understanding (MOU) is required as a part of the application process. Some responsibilities are clearly delineated in Code, howe ver , Ch. DCF 56 Admin. Ch. DCF 56.13(7)(n) Admin. Code requires that an MOU determine how agencies will work together to fulfill requirements not otherwise stated . The MOU should address how information will be shared among all agencies. Agencies should consider other components of the MOU based on the specific needs of their agency, and any ng at a minimum: specific circumstances of the home. Many MOUs for Level 5 Foster Homes contain the followi  Communication/notification responsibilities between agencies  Responsibilities for licensing the home  Responsibilities for child/licensee visits and other supervision requirements  Serious and critical incident reporting Payment  Service provisions  The MOU can be specific or general, as needed or requested by the agencies entering the agreement. Budgeting and Rate Setting The Setting Policy applies for all children placed in a Foster Home , including Level 5 Uniform Foster Care Rate Foster Homes. A Basic, Supplemental, and Exceptional Rate shall be established as required under Ch. DCF 56.23 Admin. Code . Level 5 Exceptional Treatment Foster Homes are not subject to rate regulation; t he administrative rate must be negotiated between the licensing, sup ervising, and placing agencies; DCF is not a part of these ons. negotiati maximum allowable cost Level 5 Foster Homes typically exceed the of the foster care rate. CLTS Waiver Program funding may be used to support the additional costs of care and supervision needed in Level 5 Foster Homes or the placing agency must support these additional costs . Agencies must note that CLTS Waiver Program is prohibited from funding costs associated with room and board. County waiver agencies should have a clear der which costs may be CLTS understanding of costs contained within a provider’s budget and carefully consi Waiver Allowable per the waiver manual. If there are questions or concerns about which costs would be considered waiver allowable, County Waiver Agencies should speak with the DHS CLTS Panel Representative as . If counties are seeking additional funding for any reason a written request must be to discuss soon as possible submitted to the CLTS panel representative. 9

11 Developing a Home Licensing Code . . Ch. DCF 56 Admin Level 5 Exceptional Treatment Foster Homes are subject to licensing standards per The , including a licensor for the home must complete all licensing requirements and documentation requirements T here are requirements specific home study certifying Level 5 Foster Homes in addition to licensing standards . . to Home Location and Physical Structure Agencies that are placing children in a Level 5 Foster Home who are or will be enrolled in the CLTS Waiver should ct to the Home and Community - Based Services (HCBS) At requirements . be aware that the setting is subje Settings a minimum, agencies should consider the following when deciding where to open a Level 5 Foster Home: The home must be in a community settin which provides ample opportunities for community g  other facility; , and not on the property of an integration The home should be in an area that allows for a child to access necessary services;   Whether the home is in an area that promotes family interaction and permanency planning; ; f the home in relation to recreation oppor tunities and neighborhood risks  The location o Other considerations specific to the needs of the child .  A licensing agency may choose to rent, buy, or build the physical home. Due to the significant behavioral needs of children placed in Level 5 Foster Homes, these homes cannot be in apartment complexes. Most Level 5 Foster Homes are single family dwellings, or duplexes that have a Level 5 Foster Home on each side of the duplex. When deciding whether to rent, purchase or build a home, agencies should consider the following information:  How long will it take to obtain the home?  Will modifications be required to meet the needs of the child and approved by the landlord? ll the agency use the home for the child?  How long wi Agencies should also consider how the qualities of the home will suit the needs of the child(ren) placed there:  Safety of potential Restrictive Measures plans (stairs, size of rooms/hallways, etc.),  Home - like features, without qualities of an institutional setting, and  All other Ch. DCF 56 Admin . Code requirements. Licensees (Program Managers) Program Managers of Level 5 Foster Homes are considered foster parents and are licensed like any other foster . The licensee, referred to as the program manager, must meet all Ch. DCF 56 Admin. Code requirements parent for licensure. The hiring and training process for a program manager may be lengthy. Beyond the typical hiring process es , agencies should be cognizant of licensing and training requirement s for foster parents that may lengthen the timeline for developing a new Level 5 Foster Home . Licensing agencies should consider havin g multiple licensees . If the program manager must lea ve their position licensed. and no one else is licensed, the home would not have a licensee so it could no longer be considered 10

12 Assessment While Program Managers only provide care for the child less than 50% of the time, they are considered foster and are ultimately responsible for the care of the child. They participate in treatment planning for the parents ’ s policies, procedures, and staff. It is imperative that agencies not only hire child, as well as manage the home them as an employee to work in the ho me, but understand their capacity to care for children and the way that they handle relationships with others. SAFE ) icensing agencies are required to complete a home study using the L Structured Analysis Family Evaluation ( licensees . Licensors Home Study Assessment Tool on all use the home study to understand how the should ir view of their role as a foster parent. licensee will work with and adapt to the child in the home, and assess the For example, the licensor should still ask about marital/intimate relationships, but evaluate this as it pertains to how they navigate relationships for others. should with Home studies the application, but are required to be documented in the file and in not be submitted eWiSACWIS. DCF Exceptions Panel does not review home studies, but may review one if concerns arise. The Qualifications In addition to meeting all licensing requirements, Program Managers must have other qualifications in order to The position description for the Program Manager should reflect the be the licensee for a Level 5 Foster Home. Ch. DCF 56.13(7)(e) Admin. Code and be submitted with the application materials. required qualifications listed in Background Checks The Program Manager is considered a licensed foster parent and must meet all background check requirements. The licensing agency must conduct all required background checks on the licensees. Please see Ch. DCF 56.055 Admin. Code for additional information on background check requirements Training the care of the child must be adequately trained and equipped to Program managers who are responsible for Licensing agencies should be prepared to operate a Level 5 Foster Home and serve children placed in a home. placement, initial licensing, and ongoing trainin g. Ch. DCF 56.13(7)(e) Admin. Code assist licensees in receiving pre - for Program Managers in Level 5 Foster Homes . outlines specific requirements regarding training Ch. DCF 56 Training Type Admi n. Code Program Manager Level 5 Foster Home Citation PRE - 56.13 (7) (e) 5. ‘Pre - placement training.’ A program manager for a Level 5 foster home shall PLACEMENT: placement training under s. DCF 56.14 - complete a minimum of 40 hours of pre 40 hours before or after initial licensure but prior to the placement of any child in (6p) the home. Pre - placement training for Level 5 program managers. The pre 56.14 (6p) placement - training for a foster parent who is a program manager of a Level 5 foster home shall include information on all of the following: (a) The standardized curriculum provided under sub. (6) (a). (b) School advocacy. (c) Cardiopulmonary resuscitation. (d) First aid. (e) Blood - borne pathogens. Medication management. (f) 11

13 (g) Patient’s rights. Positive behavioral supports. (h) Individual service plans. (i) Emergency plans. (j) Four hours of child - specific or population - (k) specific training, orientation, or observation. - placement 56.14 (6) (a) The department shall approve a standardized curriculum for pre operates a foster home with a Level 1 or 2 training for a foster parent who certification that includes information on all of the following: 1. Foster care overview. 2. Expectations of foster parents. 3. Caring for children in foster care. 4. Developing and maintaining family connections. Foster family self - care. 5. INITIAL: 56.13 (7) (e) 6. ‘Initial licensing training.’ A program manager for a Level 5 foster home shall 30 hours complete a minimum of 30 hours of initial licensing training under s. DCF 56.14 (7s) during the initial licensing period. 56.14 (7s) Initial licensing training for Level 5 program managers. The initial licensing training for a foster parent who is a program manager for a Level 5 foster home shall include information on all of the following: (a) The topics listed in sub. (7e). Six hours of child (b) specific or population - - specific training. 56.14 (7e) The initial licensing training shall include information on all of the following: Crisis management. (a) Sexuality and sexual boundaries. (b) Sexual abuse. (c) Effects of maltreatment and trauma on child development. (d) Building life skills. (e) (f) Building birth family and cultural connections. Other topics required by the licensing agency. (g) ONGOING: 56.13 (7) (e) 7. ‘Ongoing training.’ A program manager for a Level 5 foster home shall complete 24 hours a minimum of 24 hours of ongoing training under s. DCF 56.14 (8) in each 12 month period of licensure subsequent to the initial licensing period. 56.14 (8) (a) Individualized training plan. At the time of renewal of a license to operate a foster home, the licensing agency and the foster parent shall evaluate the foster parent’s overall performance and develop an individualized training plan ent based on his or her demonstrated need for training in for the foster par particular topics or in managing specific case situations. (b) Licensing agency approval. The licensing agency shall approve a foster parent’s ongoing training based on the following: 1. The content o f the training shall meet at least one of the purposes of foster parent training under sub. (1) and conform with the foster parent’s individualized training plan, unless a greater training need is demonstrated after the plan was developed. 1r. In additio n to subd. 1., the content of ongoing training for program managers and program staff for a Level 5 foster home shall include all of the following: a. Child maltreatment and reporting requirements. Prompt and adequate treatment. b. 12

14 c. for first aid, blood - borne Any required reauthorizations pathogens, and cardiopulmonary resuscitation. Eight hours of child - specific or population - specific training. d. The format of the training may include any of the following: 2. Face - to - face consultation with professionals with expertise in a. specific identified areas. b. Video, audio, and web - based presentations. c. Support groups. d. Adult education courses. - based resources. e. Books, periodicals, and web f. Television and radio presentations. g. Mentor family consultations. h. Conferences, workshops, seminar s, and webinars. 3. The total credit given for training using books, periodicals, and web based resources under subd. 2.e. and television and radio presentations under subd. 2.f. may not exceed 20% of the required hours. 4. The cost of a particular training opti on and the usefulness of the skills or knowledge that is expected to be gained shall be considered. (c) Dept as training resource. The department shall maintain an inventory of resources for foster parent training and shall coordinate statewide, regional, and local training programs to prevent duplication of effort. Licensing agencies may decide whether to accept any prior training that a licensee has or require them to take additional training to meet any training requirements. Agencies should be aware of the length of time it may take Training verification is required to be submitted as a ed. by the licensing agency to have a program manager train This documentation must entered into the Learning Management System as required by part of the application . 02 , Documentation Requirements for Foster Care Providers in eWiSACWIS. - DCF Memo Series 2015 Home Staff taff in Level 5 Foster Homes are not required to be licensed foster parents. Staff are subject to members S and must meet qualifications and training requirements necessary to care for the needs of the background checks . child Qualifications s outlin es qualification requirements for program staff of Level 5 Foster Home Ch. DCF 56.13(7)(f)4. Admin. Code . The staff members a Level 5 Foster Home are held to high requirements because the children they are hired for The traineeship caring for require a high degree of supervision and care. program option allows for agency flexibility to hire individuals without a background in this field but the ability to learn. T he position description for program staff is also requ ired as part of the application. Hiring and Employment When hiring staff f or a Level 5 Foster Home, program managers must consider additional requirements beyond age and education requirements such as necessary experience with similar populations and ability to meet the high needs of the children in the home . Background checks are required as part of the hiring process under Ch. In DCF 56.13(7)(f)9. Admin. Code and are essential to understanding a staff member’s capacity to care for a c hild. addition to conducting a caregiver background check, the program manager must verify that the potential staff member does not have a criminal history that would substantially relate to the care of children. An individual 13

15 cannot be hired to provid e care for a child in a Level 5 Foster Home if they have had a licensed denied or revoked fewer than two years ago. Licensing agencies should work closely with staffing agencies, to ensure there is clear understanding about the background check requirement s for working in a Level 5 Foster Home. Program managers may make hiring decisions about individuals, but the licensing agency has the ability to request more information to investigate whether an individual has charges that are substantially related to t he care of children. In situations of person work in the home. disagreement, the licensing agency can ultimately make a decision to not have a staff important to understand an employee’s health status . While no condition or diagnosis automatically It is also their disqualifies an individual from being employed, there are conditions that may influence ability to care for . Ch. DCF 56.13(7)(f)7. Admin. Code . children with higher needs Requirements for health exams are listed in Ch. DCF 56.13(7)(f)5. Admin. Code Additionally, requires that program staff in a Level 5 Foster Home must be at least 21 years of age. The DCF Exceptions Panel may consider an exception to the age requirement if appropriate, but may add conditions to the approval that do not allow those under age 21 to work in the home alone. Training Program S pre - placement training and ongoing training per Ch. DCF 56.13(7)(f)10. Admin. taff are required to have . T rai ning provided should be specific to the child and their needs. Code Ch. DCF 56 Training Type Admin. Code Program Staff Level 5 Foster Home Citation TRAINING provides care for ‘Training and orientation.’ Each program staff person who 56.13 (7) (e) 5. AND a child in a Level 5 foster home shall do all of the following before working ORIENTATION: independently with a child: 40 hours (a) Complete a minimum 40 hours of pre - placement training under s. DCF 56.14 (6t) Work with qualified, experience program staff or simil (b) ar professionals for at least the first 80 hours of employment. placement training - 56.14 (6t) - Pre Placement training for Level 5 program staff. The pre for program staff for a Level 5 foster home shall include information on all of the following: (a) standardized curriculum provided under sub. (6) (a). The (b) The topics listed in sub. (6p) (b) to (j) Fifteen hours of child (c) specific or population - specific training, - orientation, or observation. 56.14 (6) (a) The department shall approve a standardized curriculum for pre - placement training for a foster parent who operates a foster home with a Level 1 or 2 certification that includes information on all of the following: 1. Foster care overview. Expectations of foster parents. 2. 3. Caring for children in foster ca re. 4. Developing and maintaining family connections. 5. Foster family self - care. 56.13 (6p) (b) - (j) Pre - placement training for Level 5 program managers. The pre - placement training for a foster parent who is a program manager of a Level 5 foster home shall inc lude information on all of the following: The standardized curriculum provided under sub. (6) (a). (a) 14

16 (b) School advocacy. Cardiopulmonary resuscitation. (c) First aid. (d) (e) Blood - borne pathogens. Medication management. (f) (g) Patient’s rights. (h) Positive behavioral supports. Individual service plans. (i) (j) Emergency plans. ONGOING: 24 ‘Ongoing training.’ A program staff person who provides care for a child in a 56.13 (7) (f) 11. hours Level 5 foster home shall complete a minimum of 24 hours of ongoing (8) in each year of employment subsequent to training under s. DCF 56.14 the initial year of employment. (a) Individualized training plan. At the time of renewal of a license to operate 56.14 (8) a foster home, the licensing agency and the foster parent shall evaluate the foster pa rent’s overall performance and develop an individualized training plan for the foster parent based on his or her demonstrated need for training in particular topics or in managing specific case situations. (b) Licensing agency approval. The licensing agen cy shall approve a foster parent’s ongoing training based on the following: 5. The content of the training shall meet at least one of the purposes of foster parent training under sub. (1) and conform with the foster parent’s individualized training plan, unle ss a greater training need is demonstrated after the plan was developed. 1r. In addition to subd. 1., the content of ongoing training for program managers and program staff for a Level 5 foster home shall include all of the following: Child maltreatment e. and reporting requirements. f. Prompt and adequate treatment. Any required reauthorizations for first aid, blood borne g. - pathogens, and cardiopulmonary resuscitation. h. - specific or population - specific training. Eight hours of child The format of the training may 6. include any of the following: a. Face - to - face consultation with professionals with expertise in specific identified areas. b. Video, audio, and web - based presentations. c. Support groups. d. Adult education courses. based resources. - e. Books, periodicals, and web Televis ion and radio presentations. f. g. Mentor family consultations. h. Conferences, workshops, seminars, and webinars. 7. The total credit given for training using books, periodicals, and web based resources under subd. 2. e. and television and radio presentations under s ubd. 2. f. may not exceed 20% of the required hours. 8. The cost of a particular training option and the usefulness of the skills or knowledge that is expected to be gained shall be considered. 15

17 (c) Department as training resource. The department shall maintai n an inventory of resources for foster parent training and shall coordinate statewide, regional, and local training programs to prevent duplication of effort. as a part of the . by the licensing agency This application Training verification is required to be submitted . documentation must be kept on file should the DCF Exceptions Panel request verification Scheduling/Ratios Ch. DCF 56 Admin . Code .13(7)(f)1. requires minimum staffing ratios of 1 program staff for every 2 children during waking hours and 1 program staff for every 4 children during sleeping hours in Level 5 Foster Homes; however, children placed in Level 5 Foster Homes often need a higher degre e of supervision , including the need for on - call the staff for emergency coverage The child’s treatment team should determine staff ratios that a re appropriate . for each child. If the child needs a restrictive measures plan, agencies must ensure that appro priate staff are scheduled to follow the approved restrictive measures plan. During the application process, staffing ratios and a child’s placement in a Level 5 Foster Home, staffing schedules must be submitted for review. However, during ratios may need to be adjusted. This does not require a formal application, but the DCF Exceptions Panel should be made aware of the change . Responsibilities At a minimum, the staff in Level 5 Foster Homes are responsible for the daily care and supervision of children to ensure their safety and well - This expectation is outlined in Ch. DCF 56.13(7)(f)3. Admin. Code . Staffing being. n place for staff that set forth staff responsibilities, including any agencies should have policies and procedures i communication, incident reporting, or documentation required for their shift. The licensing agency must verify that these policies and procedures are in place at the staffing agency, a nd keep this documentation should the Exceptions Panel request more information. Exceptions Level 5 Foster Homes require a number of exceptions to Ch. DCF 56 Admin. Code. The below exceptions are some of the most common and must be documented on the licen se if applicable to that home. Provision Citation No licensing agency may issue a license to operate a foster home to an employee of the agency or to the relative of an employee of the agency if the employee works in the area of the agency 56.04(2) that issues foster care licenses. This subsection does not apply to a foster parent who receives a payment under s. 48.64 (4) Stats. or to a volunteer for the agency. e in addition to A licensee who applies to any licensing authority for or is issued any other licens the foster home license shall notify the agency that issued the foster home license. No 56.04(8) licensee may hold any other license to operate a foster home under this chapter or a group home under ch. DCF 57. (n) Does not permit a c hild to be mechanically restrained or locked or confined in any 56.09(1)(n) enclosure, room, closet or other part of the house or premises for any reason, except as provided under sub. (5)(i). (a) A foster parent may not use any type of physical restraint on a foster child unless the foster 56.09(1g)(a) child’s behavior presents an imminent danger of harm to self or others and physical restraint is necessary to contain the risk and keep the foster child and others safe. (a) The licensee may not co mbine the care of foster children with regular part - time care of 56.09(2)(a) related children or adults or conduct business or provide services in the foster home - other non 16

18 without the written approval of the licensing agency. The licensing agency shall confer with an y other certifying or licensing agencies involved with the additional activities before granting approval and may approve a request only if the foster parent presents satisfactory evidence that the additional activities will not interfere with the quality or manner of care provided to foster children. The licensing agency may not allow a foster parent who operates a foster home with a Level 3 to 5 certification to also operate a licensed family child care center under ch. DCF 250 or a certified child care h ome under ch. DCF 202 in the foster home. (a) Need for Level 5. An applicant for certification to operate a Level 5 foster home, in conjunction with a licensing agency, may apply to the department exceptions panel if all of the 56.13(7)(a) mstances exist . following circu 5. ‘Age.’ A program staff person who is hired or contracted for on or after January 1, 2011, 56.13(7)(f)(5) shall be at least 21 years old. (c) A child whose level of need is lower than 5 may not be placed in a Level 5 foster home, 56.22(7)(c) except for continuation of an existing placement during planning for the child’s transition to a less restrictive setting following a reassessment under sub. (3) (b). Documentation In addition to information documented through the submission of the Level 5 Application, the exception for the 02 Level 5 Foster Home as required by DCF Memo Series 2015 - must be documented in eWiSACWIS , Documentation Requirements for Fost er Care Providers in eWiSACWIS . The provider record in eWiSACWIS is under the name of the licensee, and all foster home documentation requirements are required for Level 5 Foster Homes. Please see DCF Memo Series 2015 - 02 , Documentation Requirements for Foster Care Providers in eWiSACWIS for provider documentation policy. The background checks conducted for the Leve l 5 Foster Home Program Manager must be entered in eWiSACWIS. These checks may be up loaded under licensing images. Child - Specific Planning Level 5 Foster Homes are intended to be a community setting for the child with services specific to that child’s and the ne eds . Thoughtful planning before placement is required DCF Exceptions Panel reviews these plans wh en considering an application. Some things to consider when developing child specific plans are : Daily Schedules  lanned daily schedule is required to be submitted with the application, o A p The scheduled s hould outline daily routines that are child specific, and o o integrate the child into the community and school. Outline opportunities that  Education o hildren are expected to receive educational services through the school in their community . C o The child’s team should w ork with the school district to ensure timely integration into the school environment and that ic education (FAPE) under the the child receives free and appropriate publ abilities Education Act (IDEA). Individuals with Dis  Permanency Planning o P lacement in a Level 5 Foster Home is not considered legal permanence; t he team must fulfill all § permanency planning requirements in , § 48 and Wisconsin Ongoing Services Standards 938 . o Placing agencies should work with their assigned State Permanency Consultant to be certain every effort has been made to ensure that the child is able to find legal permanence through reunification, adoption, or guardianship. 17

19  Family Interaction/Connections The child’s treatment team work together to identify possible connections for the child and o must and maintaining those connections. work towards developing o C hildren placed in Level 5 Foster Homes are still subject to family interaction policies, and the must develop a plan for family interaction th at fits the child’s needs. child’s team  Independent Living Skills nt living skills may look different for a child placed in a Level 5 Foster Homes , but they o Independe are just as important for the child. still required and are  Behavioral Support Plans o A behavioral support plan is required to be developed for every child placed in a Level 5 Foster Home and submitted for the child’s placement application unless the child’s placement in a Level 5 Foster Home is due to their significant medical needs and not developmental or cognitive needs. specialist behavioral support plan should be devel oped by a qualified o who has met the child The and has assessed the child’s needs in order to create a child specific plan.  Individual Service Plan/Outcomes o I ndividual Service Plan (IS P) and Outcomes document is required for every child enrolled in the CLTS Waiver Program. o The ISP should be an individualized, person - centered document that summarizes the child’s package of formal and informal supports and services.  Transition Planning transition using a trauma informed lens. Below The child’s team should diligently prepare the child for any are some examples of regular transitions: To the Level 5 Foster Home o The child’s treatment team should evaluate whether a slow transition or quick transition  , and will be more appropriate for the child P lan for staff to meet with the child prior to placement in the Level 5 Foster Home.  To s ervices o  Agencies should plan how services such as counseling, physical therapy, etc. will continue once a child moves into a Level 5 Foster Home in order to avoid gaps in service and how to transition services if provider change. To another placement o  lacement move is anticipated, the team should prepare the child for this When p transition. Application for Certification or Placement The Application for Certification an d Chi ld Placement Level 5 Foster Home ( DCF - F - 2559 - E ) can be found on the DCF website. This application is used for initial certification, renewal of certification, and placement requests. Submission of the Application Applications should be submitted to the DCF Exceptions Panel by e - mail to the Level 5 by the licensing agency Foster Home i nbox ( [email protected] ). Only complete applications should be submitted the DCF Exceptions Panel for review. If the application will the application is not complete, be return ed to the lice nsing In order to ensure there is no lapse in licensure, it is important agency with a request for additional information. 18

20 for licensing agencies to submit all application materials for renewal no later than 45 days prior to the expiration of the latest ap See the checklist on the next page for more detail regarding necessary materials. proval. Respite Respite services in a Level 5 Foster Home may only be provided under certain circumstances:  Services for a child who was previously placed in that home Servic es for a child specifically identified and approved by DCF on a planned basis   Services for a child who has needs agreed to by DCF. Approval for respite services to be provided in a Level 5 Foster Home does not require a full application. To request respit e for a specific child, the licensing agency must Request to Clarify Specific and Limited submit a Circumstances Prior to Submitting an Application to Operate a Level 5 Exceptional Treatment Foster Hom e ( DCF - F - 5177 - E ) to [email protected] . The referral should include information regarding the child’s needs, the planned respite schedule y current placements , if applicable. , and how respite may affect an equest for respite in a Level 5 Foster Home through the DCF Exceptions Panel is not the same as requesting the A r a separate approval process, and any agency that intends to use of CLTS Waiver funds for respite services. This is pite services must follow CLTS Waiver procedures for that request. use CLTS Waiver funds for res Panel Review After submitting the application for certification or placement in a Level 5 Foster Home, the DCF Exceptions Panel review s the application and make s a decision regarding the home or placement. If the panel has concerns, those concerns will be addressed with the licensing agency as outlined in the communication graphic below. DCF Exceptions Panel Meetings are held every other week . Materials must be submitted by 4:30 p . m . the Friday prior to the panel meeting in order to be reviewed. This will allow adequate time to review submitted materials. Once the Exceptions Panel has reviewed an application or other information about a Level 5 Foster Home, the Panel may have follow - up questions or request additional information. Panel Composition The children placed in Level 5 Foster Homes are often serv ed by programs through both DCF and DHS, so departmental collaboration is necessary and important. DCF and DHS review all applications for certification or placement in a Level 5 Foster Home together to ensure approval decisions are appropriate under both licensing . The following individuals participate in the DCF Exceptions Panel: and CLTS Waiver Program requirements 1. DCF Exceptions Panel Chairperson, Out - of - Home Care Section Representative 2. DCF Child Welfare Licensing Section Representative 3. DHS CLTS Waiver Program and Restrictive Measures Lead 4. DCF Bureau of Regional Operations Representative Site Visit he application review process also T includes a site visit to the home before the DCF Exceptions Panel is able to reach a decision regarding operation of a Lev el 5 Foster Home. The purpose of a site visit is to provide the Panel with the opportunity to view the home and verify that licensing code is met, as well as pr ovide recommendations for modifications to better support the child in the home. If additional m odifications or follow - up is required, pictures of the issues addressed must be submitted to the DCF Exceptions Panel before approval can be granted. 19

21 The site visit is typically scheduled after a complete application is submitted to the DCF Exceptions Pane l and the initial information has been reviewed. The DCF Exceptions Panel Chairperson will facilitate scheduling a visit with other DCF Exceptions Panel members and contact the licensor to confirm the date of the visit. Decision Timeframe to approve an application for a Level 5 Foster Home varies depending on many factors. The The time required greatest factor in delaying an approval is the completeness of an application and whether the DCF Exceptions - up information or questions from t he licensing agency. Panel requires follow Agencies must also consider the schedule of the DCF Exceptions Panel, the timing of their application submission, and the scheduling of a site visit to the home. If the licensing agency submits materials in time to allow the DCF ions Panel to review an application or follow - up information, the application will continue to move through Except the approval process. Delays in submissions or incomplete information may cause delays of weeks or months. The other members will work together to prioritize scheduling site visits to DCF Exceptions Panel Chairperson and Level 5 Foster Homes, but may be delayed by conflicting schedules. Panel Communication T he licensing agency is responsible for communication with the DCF Exceptions Panel . Assigning one point of contact is meant to ensure that there is one message being communicated about each home and situation. The CLTS Waiver Program has separate requirements, processes, and approvals that happen outside of the Level 5 Foster Home application. Th ese CLTS specific discussions and questions should occur with the DHS representative, the assigned Children’s Services Specialist (CSS), and the Waiver Agency. County The following chart depicts how information should be communicated amongst agencies: Panel Exceptions Exceptions Panel CLTS Chairperson Representative Licensing Agency Information CLTS Specific County Placing Agency Providing Agency/CLTS Care/Services Waiver Agency 20

22 Application Checklist for Certification and Child Placement in a Level 5 Foster Home Request to Clarify Specific and Limited Circumstances Prior to Submitting an Application to the Please email to the DCF Level 5 Foster Home Inbox, - - 5177 - E e ( F Operate a Level 5 Exceptional Treatment Foster Hom DCF ) for prior approval before beginning the application process. [email protected] Application for Certification and Child Placem ent Level 5 Foster Home This checklist mirrors ( DCF - F - 2559 - E ) the verify all needed information is included in application. and should be used to the previously approved placements in the home. Items marked with an asterisk (*) do not apply for relicensure on Program Description: For Each Child: Explanation of other community Physical Plant Description/Floor Plan t opulation p arget Identified placement options* Description of services and t reatment to Explanation of need for Level 5* be provided Transition Plan Process for placement consideration Letters deeming appropriate placement* Home routine and house schedule Crisis Plan Family Interaction Plan Program Manager and Staff: Services to be provided Foster Care license Additional training requirements for staff Permanency Plan Child to staff ratios CLTS Waiver Individual Service Plan verification Training NA Personnel policy verification Position Descriptions Individual Schedule Background Check verification Home Modifications End of Life preparations for terminally ill MOU for involved agencies NA NA (15+ years old) Preparations for adulthood Staff Schedule NA Home Maintenance Plan Restrictive Measures Application (Behavioral) Specific Information: Child/Population NA - Assurance of health, safety, and well being Restrictive Measures Application (Medical) medically for a Emergency Medical protocol NA fragile child Behavioral Support Plan NA 21

23 Approvals When a Level 5 Foster Home or placement is approved, DCF will issue an approval form to the licensing agency. This form will provide timeframes of the approval. Agencies must follow all conditions of the and condition s addition to issuing a form approval for the home In approval. , the DCF Exceptions Panel Chairperson must approve the home in eWiSACWIS. For licensing agencies with access to eWiSACWIS, this oc curs by requesting the through eWiSACWIS . For licensing agencies without access to eWiSACWIS, exception for the Level 5 Foster Home Maximus will enter this request so that the Panel Chairperson may approve the home in eWiSACWIS as required by DCF Memo Series 2015 - 02 , Documentation Requirements for Foster Care Providers in eWiSACWIS . Application for Certification and Child Placement Level 5 Foster Home ( DCF - F - 2559 - E The is also used for home ) renewals and new child placements. For applications for approval renewals, the requirements marked with an equired. Agencies must plan to submit renewal applications no later asterisk on the application checklist are not r than 45 working days prior to the expiration of the latest exception approval. For applications for new child placements in a Level 5 Foster Home that has existing placements, it is not ne cessary to complete application information for existing placements in the home. The licensing agency assembling the application must discuss the other placements in the home in relation to their interactions and compatibility with the new placement. The a pplication should discuss how the new placement will fit in the home with the other child(ren), and the impact that the new home composition will have on the new child and the child(ren) already in the home. An approval from the DCF Exceptions Panel for th e certification or placement in a Level 5 Foster Home is separate LTS Waiver Program approvals for additional funding, home modification from C . s and waiver program enrollment Requests for CLTS Waiver Program funding needs are submitted through DHS and subject to the State are Medicaid Waiver Agency process. Managing a Home Monitoring the License and the Child’s Plan Home and Child Visits A gencies involved must follow requirements for contacts with the foster parent ( Ch. DCF 56.18 Admin. Code ) and with the child ( ). Agencies should note, in addition to their own requirements, the Ch. DCF 56.19 Admin. Code is also required to have weekly face - to - face contact with the child. For children participating in program manager Support and Service Coordinat or the CLTS Waiver Program, requirements must also be met . contact On ly ag encies that meet the definition for licensing, supervising, or placing agencies may complete the required responsibilities of those agencies. Visits by the s taffing agenc y or count y child waiver agencies do not qualify under Ch. DCF 56 Admin. Code as fulfilling contact requirements wi th the licensee or the child . Treatment Team Collaboration After the development of the home and placement of the child , collaboration bet ween all the agencies must continue. This collaboration is to provide oversight and ensure the child’s needs are met in the Level 5 Foster Home. Ch. DCF 56.17(1) Admin . Code outlines expectations for this continued collaboration, and requires development, implementation and maintenance of a treatment team and treatment plan for the child. 22

24 I ncident Reporting Depending on the agencies , different serious or involved DCF Level 5 critical incident reporting requirements exist. In all Level 5 Exceptions Panel Foster Homes, serious incident reporting requirements Chairperson must be followed. CLTS under Ch. DCF 56.06 Admin. Code Waiver Program Incident Reporting requirements must be If the followed for all CLTS Waiver Program participants. DCF Child DHS Child licensing agency is a private child placing agency, the CPA Welfare Waiver ements must also follow all Serious Incident Reporting Requir Licensing Agencies Section , set forth in Child Welfare Licensing Memo Series 2017 - 04L Reporting Serious Incidents . All agencies involved with a Level 5 Foster Home must have a Memorandu m of responsible for incident reporting requirements. outlines who will be Understanding that Present staff member(s) provide a written : Serious Incident Occurs description of the Serious Incident, precipitating - events, and follow up provided Contact is made with the Program Manager to Staff Reporting: inform him/her of the incident Notification is made to the licensing Licensee Reporting: agency Licensing Agency County Licensing Reporting and County CLTS Private CPA OR CLTS Waiver Agency Waiver Reporting: Agency AND AND AND County Placing DCF Child County DCF DCF Agency, if Welfare Placing Exceptions Exceptions not the Licensing Agency Panel Panel DHS same Serious Incident Occurs Immediately following an incident, staff present in the home must document a written description of the serious - up that was provided after the incident. This documentation can incident, the precipitating event, and any follow be done on an agency form, but must include all neces sary information to report to the program manager. Staff 23

25 must contact the program manager immediately following a serious incident, and in some cases, while the serious ation. Staff must be incident is occurring. Agencies must have policy and procedure regarding this document . trained on this documentation procedure to ensure thorough and timely reporting Staff Reporting Staff must contact the program manager immediately following a serious incident, and in some cases, while the ng. If possible, this notification should be at the same time that written documentation serious incident is occurri is provided so that the program manager can report the incident to the licensing agency. Agencies must have program manager. Staff must be trained on this policy and procedure regarding reporting an incident to the documentation procedure to ensure thorough and timely reporting. Licensee ( Program Manager ) Reporting and County W a of the serious v er Agency The program manager must immediately notify the licensing agency i i ncident. This notification may need to occur outside of business hours. It may be necessary to provide the documented preliminary details, and provide additional documentation once more information is received. This notification may be documented on an required information. agency form, but must include all Licensing Agency Reporting The licensing agency has reporting requirements based on the type of agency. County licensing agencies must Chai report the incident immediately to the DCF Exceptions Panel the placing agency . County licensing rperson and agencies can report the serious incident to the DCF Exceptions Panel and county placing agency on an agency form, but must include all information required to be reported to the DCF Exceptions Panel. All li censing agencies are required to report to the DCF Exceptions Panel and the county placing agency immediately after learning of the incident. Private Child Placing Agencies are required to report the serious lfare Licensing Sec incident to the DCF Child We tion on the DCF form, Serious Incident Report ( DCF - F - CFS - 2146 - E ) , within 48 hours of the serious incident . S erious incident report s must be submitted to the DCF Except ions Panel the Level 5 Foster Home In box, [email protected] . through CLTS Waiver Program Incident Reporting The CLTS Support and Service Coordinator is required to follow all incident reporting requirements of the CLTS Waiver Program. Incidents must be reported to DHS in the manner prescribed by the Wisconsin Department of Health Services Medicaid Home and Community Based Services Waiver Manual . Follow up The licensing agency must respond to serious incident reports as appropriate to the situation , including reporting to CPS if necessary . Serio us incident reports should be evaluated for patterns and identification of areas to improve. The serious incident report must be documented in the licensing file, child’s case file, and incorporated into any data collection on incidents. County Waiver Agen cies also have a responsibility to remediate and prevent future incidents to the extent possible. Waiver agencies should partner with the licensing and placing agencies to develop plans that ensure health and safety. The DCF Exceptions Panel will also revi ew reports received and follow - up as necessary. If concerns arise, the DCF . Exceptions Panel may require agencies to meet conditions to address serious or ongoing issues 24

26 Restrictive Measures free movement in response to a medical need or Restrictive measures are methods of interfering with a person’s include physical restraints, medical restraints, dangerous and challenging behaviors . Restrictive Measures M easures may only be used when the child’s behavior poses an isolation and protective equipment. Restrictive as outlined in Ch. DHS 94 Admin. Code imminent risk of serious injury to the child or others always be and must considered a method of last resort. Other behavioral interv entions and preventative measures should be exhausted prior to the use of restrictive measures. All behavior, even challenging and dangerous behavior, has purpose and meaning for the individual, and other interventions are essential to addressing that beha vior. has significant behaviors that warrant the If a child’s team determines that a child placed in a Level 5 Foster Home use of restrictive measures , an application for the use of restrictive measures is required to be submitted to and approved by the DC F Exceptions Panel. Types of Restrictive Measures/Emergency Restrictive Measures Ch. DHS 94 Admin. Code and Ch. DCF 56.09(1g) Admin. Code there are several different types of As defined in restrictive measures, including:  Medical restraint: an apparatus or procedure that restricts the free movement of a patient during a medical or surgical procedure or prior to or subsequent to such a procedure to prevent further harm to the patient or to aid in the patient's or to protect a patient during the time a medical condition recovery exists.  Physical restraint: any physical hold or apparatus, excl uding a medical restraint or mechanical support, which interferes with the free movement of a person’s limbs and body.  Isolation: any process by which a person is physically or socially set apart by staff from others but does not include separation for th e purpose of controlling contagious disease. Seclusion: that form of isolation in which a person is physically set apart by staff from others through  the use of locked doors. Emergency Restrictive Measures: extremely challenging behavior There may be times when a child demonstrates that may require the use of an emergency restraint in order to keep the child or others out of immediate T o be considered an emergency, the danger. pose an immediate threat behavior must be unanticipated, of harm self or others, and not reasonably foreseen; additionally to be considered an emergency, to the child may not have a currently approved behavioral intervention plan to deal with the behavior. If emergency physical restraint is used more than two times in a six month period of time, it is considered a response to an expected challenging behavior. Therefore, it can no longer be classified as an emergency circumstance and a Restrictive Measures application must be submitted. There are ce rtain types of physical restraint that are considered prohibited in Prohibited Restrictive Measures: any circumstances. Agencies must be aware of these prohibited practices and ensure these types of used with any child . These prohibited practices are addressed in Ch. DCF 56 Admin. restraint are never Code and DCTS Memo Series 2017 - 01 Prohibited Restrictive Measures in Community - B ased Programs and Facilities . Ch. DCF 56.09(1g) Admin. Code also has requirements regarding prohibited practices. Application There are separate applications for Medical Restraints and Behavioral Restraints. 25

27  Medical restraints are applicable during a medical procedure, to allow healing of an injury, or as a . protection from injury of a chronic health condition Behavioral restra  ints are used as a part of a behavioral support plan to address a dangerous or challenging behavior. Applications for the use of restrictive measures for a child in a Level 5 Foster Home must be submitted using the required CLTS Waiver Application form and Guidelines and Requirements for the follow all requirements in the . In order to submit the application for behavioral restraints to the DCF Use of Restrictive Measures Manual ons Panel, all components of the applic Excepti , including: ation and plan must be complete  County Waiver Agency Cover Letter,  Physician’s Order/signature/letter of support,  Behavioral Specialist , etc.) All applicable signatures (Child, Guardian, Case Manager, Provider Agency,  Complete personal summary (employment/school, support systems, interests, and likes/dislikes),  Health considerations (diagnoses, health concerns, medications, health care providers), ters/triggers),  Target behaviors (description, frequency/intensity, pat Restrictive measure type,  including example photos,  Review of current and proactive strategies , o Summary information of previous strategies and outcomes , o Description of need for restrictive measures , o Risk and benefits descriptions , o Pictures or literature that outlines proposed restraints , A plan to reduce or eliminate the use of restrictive measures o , and o . A description of training ,  How the plan will be monitored and reviewed by the team o Summary of data collection process, A plan to reduce or eliminate the use of restrictive measures, and o Description of review process for Behavioral Support plan. o .  A copy of the Behavioral Support Plan Applications for Restrictive Measures may be submitted at any time, whenever a child’s team determines there is a need for use of restraint, isolation or seclusion . This application will be reviewed by the DCF Exceptions P anel, and the DHS Restrictive Measures Lead will review to ensure it fulfills requirements in the Guidelines and Requirements for the Use of Restrictive Measures Manual . Decisions regarding Restrictive Measures must also be DCF Memo Series 2015 02 , Documentation Requirements for Foster documented on the license in eWiSACWIS per - . Care Providers in eWiSACWIS While the County Waiver Agency is most likely to complete and assemble the application for restrictive measures, the other agencies work ing with the home and child should be included in planning and must be in agreement with the restrictive measures plan. DCF and DHS Approvals The use of restrictive measures with a child placed in a Level 5 Foster Home must be approved by both DCF and approval T here wil l be conditions of the approval that will be monitored throughout the life of the DHS. . Approval of the use of restrictive meas ures must be documented in eWiSACWIS, if applicable. T he approval for the use of restrictive measures can be rescinded by the DCF Exceptions Panel upon determination staff at the home, or other if there is any injury to the child, that there has been a negative impact on the child, 26

28 persons during the use of a restrictive measure outside of the scope of the approval , or if the provisions of the . If a restrictive measure is used outside the scope of an approval and/or results in a n approval are not fulfilled , agencies must submit an incident report to DCF and DHS within prescribed timelines . injury Renewals determines that there is a continued need for restrictive measures after a prior approval, If the child’s team a must be submitted pr renewal application date . Th e application should be submitted no later ior to the expiration than 45 days before the date of the expiration in order to ensure timely approval of the renewal request. The Panel will review the renewal application and evaluate the progress tow ards the reduction or elimination of the restrictive measures. The Panel will also review the summary data on the use of the . restrictive measure Data regular dat Each approval for a restrictive measures plan will include a condition of approval to submit a to the DCF Exceptions Panel. The child’s placing agency is required to submit monthly reports by the 5th of the subsequent month documenting the use of any restr ictive measure with the child. The monthly reports must include the following information:  The precipitating event,  The number of times the restrictive measures were used,  The duration of the use of restrictive measures,  The staff involved in the restrictive measures,  The type of restrictive measures used,  ctive measures were used, The date and time of the day the restri Changes made to the Behavior Support Plan as a result the use of the restrictive measure, and  A description of the progress the child has made to more effectively communicate his or her needs and  manage his or her emotions withou t the use of restrictive measures. Transitions to Adulthood Children placed in Level 5 Foster Homes often continue to reside in the home into adulthood. The child’s team should initiate early planning to determine next steps in planning a transition to adu lt services.  Initiate early collaboration between the Child Waiver Agency, the provider/program manager of the Level 5 Foster Home, and the Aging and Disability Resource Center (ADRC),  Youth enrolled in the CLTS Waiver Program must be referred to the ADRC for options counseling by the age of 17 years 6 months determine eligibility for the adult long term care system, o If not eligible , the youth may be eligible for extension of out - of - home care under § 48 or Ch. DCF 21 Admin. Code , If the youth remains under an Extension of Out -  - Home Care, he/she may remain of enrolled in the CLTS Waiver Program until discharge from their placement, and  Child’s team should work to prepare that child for aging out of care and transition to other community supports and services. o If eligible , many youth continue to reside in their Level 5 Foster Home into adulthood  Level 5 Foster Homes may be dually lice nsed as Adult Fam ily Homes . Guides on the placement. following pages outline pro cesses for dual licensure and 27

29 LICENSURE AND CERTIFICATION PROCESS DCF/DHS DUAL - 4 Bed Adult Family Homes and 1 Level 5 Exceptional Treatment Foster Homes LICENSING AND CERTIFICATION STANDARDS Chapter DCF Child Foster Home Level 5 Foster Home DCF 1 4 Bed - 56 .13(7) Wisconsin Medicaid Standards for Certified Certified Adult Family Home 2 Bed Adult Family - DHS 1 Home 2 Bed Adult Family Homes - 1 Licensed Adult Family Home Chapter DHS 88 3 Adult Family Home 4 Bed - DHS DUAL LICENSURE/CERTIFICATION PROCESS Prospective licensee contacts a licensing agency 1. (county human services or private Child . Placing Agency) to express interest in developing a Level 5 Foster Home - Licensing agency requests approval from DCF to license home with form DCF - F 2. 5177 E - . 3. After rec a home study and es complet eiving approval from DCF, licensing agency Chapter DCF 56. from fulfill requirements and identified home licensee determines if for exceptions (DCF - F - 2559 - E) to the DCF 4. Licensing agency submits a complete application 4 Bed Level 5 - Exceptions P anel for further consideration of licensure. Panel will schedule a site visit. Foster Home 5. DCF Exceptions Panel completes site visit and verifies compliance with Chapter DCF 56 . DCF LICENSED 6. DCF Exceptions Panel then has 45 days to make a decision regarding the exception. DCF 1 If DCF 7. Exceptions Panel approves the exception, the licensing agency issues the license. Child Foster Home application to the s appropriate 1. Prospective provider submit (Managed certifying agency 2 - in the county of residence. Care Organization) 1 Certifying agency 2. reviews the application . and associated background checks Adult A site visit is conducted . The certifying agency on - site visit and interview are used to 3. determine if requirements for certification are met. 4. Any professional inspections needed prior to decision. (fire, health, etc.) are scheduled as Bed Certified Family Home 5. , certificate is issued . If approved Certifying agency approves or denies the application . OR (F - 60945) , licensing fee, and associated 1. Prospective provider submits application to documents from Section A of form F Division of Quality Assurance (DQA). - 62671 4 - Provider develops a program statement that outlines the number, type and compatibility 2. 3 of ind ividuals to be served, as well as the services provided by the home. Adult 3. DQA reviews the application materials and required background checks . . The DQA After a complete application is received and reviewed, a 4. site visit is scheduled requirements for licensure are met. on - site inspection will de termine if Chapter DHS 88 Bed DHS LICENSED/CERTIFIED Licensed Family Home DQA has 70 days 5. from receipt of completed application to make a licensing decision. , approves or denies the application a license is issued. . And if approved DQA 6. and adults Dually Licensed/Certified Foster and Adult Family Homes may take placement of children consistent with the certification and licenses issued, not to exceed approved capacity. 28

30 DCF/DHS DUAL PLACEMENT PROCESS - Level 5 Exceptional Treatment Foster Homes 4 Bed Adult Family Homes and 1 DEFINITIONS - “CHILD” Wisconsin Chapter DCF 56.03 (5) - Wisconsin Chapter DHS 88.02 (4) “ADULT” age, and under 21 years of   18 years of age or over, and placed under juvenile court  not placed under juvenile court order.  order. nder juvenile court order 21 years old & u - If 18 18 If 21 years old & NOT - court order juvenile nder u jurisdiction ADULT In dividual is considered an Individual is considered a CHILD facility adult DHS Must be placed in home Must be placed in DCF licensed PROCESSES PLACEMENT Agency makes referral for placement [email protected] ) E - 5177 - 1. F - (DCF to . s. 2. DCF Exceptions Panel approves or denies referral to begin placement proces 3. Agency identifies foster parent, home, and begins licensure process (if not licensed) . 4. to the DCF Exceptions E) - 2559 - F - (DCF submits a complete application Licensing agency 4 Bed Level - LICENSED Home Panel for further consideration of placement. 1 DCF Exceptions Panel has . 5. decision regarding application for placement to 45 days make a 5 Foster Home Child Foster DCF DCF 4 1. the Aging and Disability Resource Center (ADRC) in the county of residence to Contact - 1 complete a functional screen and determine eligibility for adult services. the individual will then be connected to a Managed Care 2. If eligible for adult services , Adult Organization (MCO) and an assessment will be completed to connect them to the appropriate home. Bed Licensed or 3. individual’s expressed wants and needs that fits the facility CO will place the adult in the M . Certified Family Home DHS FACILITY If a home is to be licensed as an adult family home and the home is also Wisconsin Chapter DHS 88.03 (2) (d) - licensed as a children’s foster home under ch. DCF 56, the combined licensed bed capacity shall not exceed 4. WHO APPROVES PLACEMENTS? 4 Bed Level 5 Exceptional 1 - (county human services or Every placement must approved by the licensing agency private Child Placing Agency) DCF Exceptions Panel prior to placement. and the Treatment Foster Homes 4 Bed Licensed or Certified - 1 Every placement must approved by the adult placing agency (county human services, , or private agency) M anaged Care Organization (MCO) prior to placement. Adult Family Homes Dually Licensed/Certified and Placement processes for both Level 5 Exceptional Treatment Foster Homes Licensed or Certified Adult Family Homes prior to placement. must be followed Foster & Adult Family Homes 29

31 Appendices Important Links Appendix A, - Important Links Level 5 Foster Homes http://docs.legis.wisconsin.gov/code/admin_code/dcf/021_099 Chapter DCF 56 Administrative Code /56.pdf Ch apter DHS 94 Administrative Code http://docs.legis.wisconsin.gov/code/admin_code/dhs/030/94/ https://dcf.wisconsin.gov/files/cwportal/policy/pdf/ongoing - Wisconsin Ongoing Services Standards - services standards.pdf Wisconsin Department of Health Services https://www.dhs.wisconsin.gov/waivermanual/index.htm Medicaid Home and Community Based S ervices Waivers Manual https://www. dhs.wisconsin.gov/hcbs/faq.htm Home and Community Based Settings Rule Guidelines and Requirements for the Use of https://www.dhs.wisconsin.gov/waivermanual/appndx - r1.pdf Restrictive Measures Manual Uniform Foster Care Ra te Setting Policy https://dcf.wisconsin.gov/files/cwportal/policy/pdf/memos/20 - 12 11.pdf - 02 DSP Numbered Memo Series 2015 https://dcf.wisconsin.gov/files/cwportal/policy/pdf/memos/20 15 - 02.pdf DCF - F - CFS - 2146 - E: Serious Incident Report https://dcf.wisconsin.gov/files/forms/doc/2146.docx DCTS Numbered Memo Series 2017 - 01 https://www.dhs.wisconsin.gov/dcts/memos/201701actionme mo.pdf Level 5 Foster Homes - Forms - E: - F Application for Certification DCF 2559 https://dcf.wisconsin.gov/files/forms/doc/2559.docx - and Child Placement Level 5 Foster Home F - 5177 - E: Request to Clarify Specific and - https://dcf.wisconsin.gov/files/forms/doc/5177.docx DCF Limited Circumstances Prior to Submitting an Application to Operate a Level 5 Exceptional Treatment Foster Home - 00926A: Request for Use of Medical F https://www.dhs.wisconsin.gov/library/f - 00926.htm - CLTSS Restraints F - Request for Use of Restraints, 00926.htm - 00926: https://www.dhs.wisconsin.gov/library/f CLTSS - Isolation, or Protective Equipment F - 01715: Calculating Expenses for a CLTS https://www.dhs.wisconsin.gov/forms/f01715.xlsx Foster Home Using Actual Expenses https://www.dhs.wisconsin.gov/forms/f01721.pdf 01721: Instructions - Calculating CLTS Foster F - Care Room and Board Expenses Licensing Forms and Publications https://dcf.wisconsin.gov/cwportal/fc/forms 30

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