FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
WHO WE ARE
Family Services of America are the operators of foster care and outpatient services for children and adults. We not only provide structured treatment settings along with intensive family support, but we offer a diverse program designed to meet the needs of each individual served in our agency. Our agency has a qualified staff who work to accommodate the best interests of our clients. The primary office number is 910-860-9787.
Services are designed to empower persons toward becoming independent and to maximize their quality of life. We believe foster care, in most cases, is not a permanent solution for a child.
Instead, foster care provides for the physical and emotional needs of a child until a more permanent plan can be achieved. We believe each child is an individual and each situation must be weighed individually. We support periodic outside case review of all children in placement to work toward achieving permanent and positive case solutions for the children in our care.
Our Foster Parents are certified and caring individuals selected on a closely screened basis. The agency carries liability insurance, however, the foster parents are not required to have liability insurance unless stipulated by specific state or local mandates.
What is Foster/Therapeutic Foster Care Services?
Therapeutic Family Services (TFS) provides services and supports for a child with a principal diagnosis of mental illness or serious emotional and behavioral disorders or substance-related disorders, and who may also have co-occurring disorders including developmental disabilities.
TFS are not for a child with a sole developmental disability. This service is available for children to age 18, or if eligible for Medicaid to age 21, and to age 19 for Health Choice. TFS must be delivered by a child placing agency licensed (LCPA) by the N.C. Division of Social Services as established in . TFS provides a structured, supervised therapeutic milieu in a family environment with one or two foster parent(s). This TFS family is licensed by the Division of Social Services
(DSS) and provides TFS under the direction of and supervision of a LCPA. The TFS family facilitates and strengthens the development of skill acquisition and use of interventions and supports that address therapeutic treatment, prevention, recovery, and behavior change consistent with age and development for each child served. TFS services are necessary to assist the child in improving and maintaining functioning across life domains. Skill acquisition in this setting will promote permanency placement for the child with his/her parents, relatives, a guardianship arrangement, an adoptive placement with the TFS family or another adoptive family, or an independent living arrangement.
TFS services are strength-based, support developmentally and functionally appropriate positive behavioral interventions, and work to sustain and improve resiliency factors in the child necessary for recovery. This service is built on the TFS family promoting trust by engaging the child and affirming each child’s sense of self and regulation of emotions in relation to self and others.
Services and supports provided by the Therapeutic Family Services family include:
Interventions to build on each child’s strengths for healthy developmental growth across life domains.
071310 1

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
Interventions to increase the child’s knowledge of self in relation to others and improve healthy role development and social skills in order to function successfully within the family setting, the community, and the schools.
On-going structured behavioral interventions that include, but are not limited to, clear and consistent communication; limit setting within the structure of daily living, and opportunity for healthy peer interaction, positive role modeling in all social contexts, problem solving, emotional regulation, anger management and conflict resolution.
Interventions to develop healthy independent living skills.
Interventions to improve and support the child’s understanding of their health, mental health and substance related disorder.
Interventions to improve functioning in life domains and self-management skills in coordination with the child’s medical and behavioral health providers.
071310 2

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
In addition, a child with complex treatment needs may require specialized interventions to remain in the TFS family setting, school and community. Such complex needs may include medical conditions, developmental delays, sexually reactive behaviors, trauma disorders, cooccurring disorders, and/or aggressive and/or violent behaviors. To promote stability of the child in the TFS family setting, additional medically necessary services may be provided as brief interventions in order to maintain the current level of care during periods of disruption or regression that may result in a higher level of restrictive care. Additional services and supports that are determined to be medically necessary may include outpatient behavioral health or other community based services. The licensed child placing agency (LCPA), TFS parent(s) and clinical home provider are responsible for coordinating access to needed additional medically necessary services and supports.
Admission Policy
ADMISSIONS CRITERIA
Eligibility Criteria
A. There is an Axis I or II MH/SA diagnosis (as defined by the DSM-IV-TR or its successors), other than a sole diagnosis of developmental disability.
AND
B. For children with a substance abuse diagnosis, the American Society of Addiction Medicine
Patient Placement Criteria (ASAM-PPC) are met for Level III.1.
AND
C. Moderate to severe difficulty functioning in the naturally available family as evidenced by any four or more of the following:
1. moderate or severe conflict in the current setting, OR
2. pervasive inability to accept age/developmentally appropriate direction and supervision, in significant areas, from caretakers or family members, OR
3. severely limited familial involvement and support, OR
4. impaired ability to form trusting relationships with caretakers, OR
5. limited ability to consider the effect of inappropriate personal conduct in relationship to self and/or others, OR
6. frequent and severely disruptive verbal aggression, OR
7. frequent and moderate property damage and/or occasional, moderate aggression toward self and/or others, OR
8. frequent and disruptive difficulty in maintaining appropriate conduct in community setting, including sexually reactive behaviors.
AND
071310 3

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
D. There is no evidence to support that alternative interventions would be equally or more effective, based on North Carolina community practice standards (Best Practice Guidelines of the American
Academy of Child and Adolescent Psychiatry, American Psychiatric Association, American
Society of Addiction Medicine, Association for Treatment of Sexual Abusers).
Entrance Process
A comprehensive clinical assessment which demonstrates medical necessity must be completed prior to provision of this service. If a substantially equivalent assessment is available, reflects the current level of functioning , and contains all the required elements as outlined in community practice standards as well as in all applicable federal, state, and DHHS requirements, it may be utilized as a part of the current comprehensive clinical assessment. Relevant diagnostic information must be obtained and included in the
Person Centered Plan.
Prior authorization is required on the first date of this service.
For Medicaid-funded Therapeutic Family Services, prior authorization by the Medicaid-approved vendor is required. In order to request the initial authorization, the Person Centered Plan with signatures and the required authorization request form must be submitted to the Medicaid-approved vendor. In addition, a completed LME Consumer Admission and Discharge Form must be submitted to the Local Management
Entity.
For State-funded Therapeutic Family Services, prior authorization by the Local Management Entity is required. In order to request the initial authorization, a Person Centered Plan with signatures, the required authorization request form, and the LME Consumer Admission and Discharge Form must be submitted to the LME.
Medicaid or State funds may cover up to 60 days for the initial authorization period based on medical necessity.
Continued Service Criteria
The desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the child’s Person Centered Plan based on current clinical assessment, history, and the tenuous nature of the functional gains.
AND
One of the following applies:
A.
The child has achieved current Person Centered Plan goals, and additional goals are indicated as evidenced by documented symptoms.
B.
The child is making satisfactory progress toward meeting goals and there is documentation that supports that continuation of this service will be effective in addressing the goals outlined in the Person Centered Plan.
071310 4

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
C.
The child is making some progress, but the specific interventions in the Person Centered Plan need to be modified so that greater gains, which are consistent with the child's pre-morbid level of functioning, are possible.
D.
The child fails to make progress, or demonstrates regression, in meeting goals through the interventions outlined in the Person Centered Plan. The child’s diagnosis should be reassessed to identify any unrecognized co-occurring disorders, and interventions or treatment recommendations should be revised based on the findings. This includes consideration of alternative or additional services.
Discharge Criteria
How do I know I’m ready to leave?
1. Goals have been met
2. You no longer need the medical services involved with treatment
3. Your behaviors can be managed at home
4. You are no longer court ordered for placement
5. Your parents/guardian decide to pull you out of the program
6. Your behavior can not be maintained in this level of care and you need a more supervised structure.
Client Rights Policy
UNDERSTANDING YOUR CLIENT RIGHTS
Foster parents will ensure that each foster child:
(1) has clothing to wear that is appropriate to the weather;
(2) is allowed to have personal property;
(3) is encouraged to express opinions on issues concerning care;
(4) is provided care in a manner that recognizes variations in cultural values and traditions;
(5) is provided the opportunity for spiritual development and is not denied the right to practice religious beliefs;
(6) is not identified in connection with the supervising agency in any way that would bring the child or the child's family embarrassment;
(7) is not forced to acknowledge dependency on or gratitude to the foster parents;
(8) is encouraged to contact and have telephone conversations with family members, when not contraindicated in the child's visitation and contact plan;
(9) is provided training and discipline that is appropriate for the child's age, intelligence, emotional makeup, and past experience;
(10) is not subjected to cruel or abusive punishment;
(11) is not subjected to corporal punishment;
(12) is not deprived of a meal or contacts with family for punishment or placed in isolation timeout except when isolation time-out means the removal of a child to an unlocked room or area from which the child is not physically prevented from leaving. The foster parent may use isolation time-out as a behavioral control measure when the foster parent provides it within hearing distance of a foster parent. The length of time alone will be appropriate to the child's age
071310 5

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK and development;
(13) is not subjected to verbal abuse, threats, or humiliating remarks about himself/herself or his/her families;
(14) is provided a daily routine in the home that promotes a positive mental health environment and provides an opportunity for normal activities with time for rest and play;
(15) is provided training in good health habits, including proper eating, frequent bathing, and good grooming. Each child will be provided food with nutritional content for normal growth and health.
Any diets prescribed by a licensed medical provider will be provided;
(16) is provided medical care in accordance with the treatment prescribed for the child;
(17) of mandatory school age maintains regular school attendance unless the child has been excused by the authorities;
(18) is encouraged to participate in neighborhood and group activities, have friends visit the home and visit in the homes of friends;
(19) assumes responsibility for himself/herself and household duties in accordance with his/her age, health, and ability. Household tasks will not interfere with school, sleep, or study periods;
(20) is provided opportunities to participate in recreational activities;
(21) is not permitted to do any task which is in violation of child labor laws or not appropriate for a child of that age;
(22) is provided supervision in accordance with the child's age, intelligence, emotional makeup, and experience; and
(23) if less than eight years of age and weighs less than 80 pounds is properly secured in a child passenger restraint system that is approved and installed in a manner authorized by the
Commissioner of Motor Vehicles.
Do I have to solicit funds for my foster parent if asked?
NO, Family Services of America, prohibits direct involvement by a child in funds solicitation for Family Services of America
Should I be videoed by my foster parent?
Family Services of America, prohibits the child's participation in any activities involving audio or visual recording and research without the voluntary signed, time- limited consent of the parents, guardian or legal custodian and child, if 12 years of age or older.
Grievance Procedures and Form
What do I do I have a complaint?
071310 6

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
GRIEVANCE RESOLUTION FOR CLIENTS
PURPOSE: To ensure consistent review and disposition of client grievances are reported.
POLICY: It will be the policy of Family Services of America to implement a written grievance policy and procedure.
PROCEDURE: The procedure below will be followed for client grievances.
A. A grievance or a complaint that a client or family would like someone in charge to be aware of and do something about may be reported and handled informally or formally. Below are instructions for a client or family to follow if they have a grievance.
1- Attempt to resolve problem or grievance by first discussing it directly with staff member involved.
2- If the problem or grievance cannot be resolved, you may ask for an a ppointment with the staff member’s supervisor.
3- If the problem or grievance is not resolved, it is the social worker ’s responsibility to inform you of additional steps you may take (which includes meeting with other administrators of Family Services of America or representatives of the referring agency).
4- After meeting with administrators and other representatives you will receive a written response to your grievance within ten working days. The names of the executive director will be included in the response, should you choose to pursue the grievance.
5- You may appeal the response by providing specifics in writing to the executive director who can be contacted at
910-860-9787.
Upon resolution of a grievance, Family Services of America will maintain a copy of the complaint and the resolution in the child's record.
071310 7

071310
FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
GRIEVANCE RESOLUTION REPORT
Name: Date:
RECORD#: PROGRAM:
NATURE OF GRIEVANCE: (include detailed report to include staff involved)
ACTION TAKEN:
RESOLUTION:
COMMENTS:
STAFF SIGNATURE/DATE SUPERVISOR SIGNATURE
8

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
Search Procedures / Policy
I.
REGARDING THE SEARCH OF CLIENTS RECEIVING SERVICES
PURPOSE: To ensure protection of all clients’ treatment environment while protecting
POLICY AND PROCEDURE the privacy and rights of clients suspected of introducing compromising elements into the treatment environment.
II. POLICY: It is the policy of Family Services of America to respond to due cause regarding the possession of weapons and substances of abuse in a systematic approach to provide interventions based on the severity and perceived risk to others and program integrity. It will be the policy of
FSA to intervene based on threats, suspicions, and behavioral observations in a manner which respects the rights and privacy of clients suspected of possession. Each client will be free from unwarranted invasion of privacy.
Every search and seizure will be documented. Documentation will include: scope of search; reason for search; procedures followed in the search; a description of any property seized; and an account of the disposition of seized property.
III. PROCEDURE:
Interventions for “suspicion of possession of weapons and/or substances of abuse will utilize the following procedures; each condition is specified below:
All residents and their parent(s)/guardian(s) will be informed of the search procedure during their admission process.
Foster parents or their social worker supervisor will initiate a request to search the client and/or their belongings when due cause exists. Due cause is defined as a reason to believe that a client has a weapon and/or substances of abuse in their possession while at the group home based on others report, history and the presence of behavioral cues (i.e. boasting, bravado, verbal threats, increased secretive interactions with peers).
Any request for a search will be reviewed by the Social Worker or his/her design the licensed professional prior to implementation if warranted search is uncertain.
Each client will be given the option to empty their own belongings and disclose the possession prior to a search by staff. If clients are suspected of having a weapon, the authorities will be contacted immediately and client will not be allowed into the foster parents home until the authorities determine there is no longer any imminent threat. At that time the foster parent will contact the social worker to inform him/her of the situation.
Parents and the appropriate authorities will be notified of the search or departures of clients from the foster care/therapeutic home, and appropriate incident reports will be completed.
Types of Searches:
Room Search:
071310 9

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
A room search is conducted when a client is suspected of hiding contraband within the treatment environment.
Complete a touch and sight inspection of all possible hiding places in a client’s bedroom to include all articles of clothing, shoes, all personal belongings, dresser/closed shelves and drawers, bed area, pillows, sheets/mattresses, air vents, door/window panels and sills, rugs (lift when possible), light fixtures, and any other opens spaces/cracks which may be possible hiding places.
Room searches should be conducted with a witness, especially a staff witness present whenever possible.
Client should be given the option to witness the search as it is conducted.
A personal search of the client should accompany a room search.
Personal Search:
A personal search is conducted whenever a possibility exists that contraband may be smuggled into the treatment environment of the client’s person.
A personal search involves requesting the client to empty all pockets in order for the foster parent to verify contents. Pants pockets should be turned inside out. Socks are turned down and shoes removed. Hats and hat brims require scrutiny. Purses should be emptied and contents searched. Look inside all containers such as lipstick tubes and other containers.
All clothing articles, suitcases, and other containers should be thoroughly searched when a client is being admitted into the foster care home.
Personal searches should be conducted with a witness whenever possible.
Pat Down Search:
A pat-down search is conducted only when the client is suspected of concealing a weapon or drugs on his/her person. This type of search may also be used if a client has a violent history of a history of carrying weapons on his/her person.
A pat down includes lightly patting the chest (for males), back pants pockets, waistband, legs and ankles with the palm of the hand to discover objects, which may be concealed. All genital areas of males and females will be avoided.
Body Search
Body searches are considered intrusive and are never used at FSA.
071310 10

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
If a client is considered to be so highly dangerous that a strip search is needed to assure safety, he/she should be referred for evaluation at a hospital prior to admission/continuation at FSA.
Each search will be followed by a processing session which will focus on the reason(s) for the search and if indicated, the consequences. For disposal of any weapon or substances found during a search, the local authorities will be contacted.
In the event that a client chooses not to cooperate with a search necessitated at FSA, parents/guardians will be notified. If a client refuses to cooperate with a search necessitated at
FSA, the following directives will be pursued.
Room Search. The foster parent will:
Document that the client was requested to cooperate with a search but refused.
Follow above guidelines for a Room Search, and proceed despite the client’s objections.
Pat Down. The staff will:
1. Keep the client in visual contact until client is transferred from the premises.
2. Refer the client for emergency evaluation for hospital admission to include a body search.
Items confiscated as a result of such searches will be secured until they can be turned over to the parent(s)/guardian(s), destroyed, returned to resident as appropriate, or otherwise disposed of.
A written record of all searches and their results will be maintained in the incident reporting log.
Each search will be documented on a level 1 incident report form. Any seizures of client’s belongings or property possession will be documented on incident level 1 reporting form.
Discipline Policy – including use of physical restraints (if applicable )
PHYSICAL RESTRAINT HOLDS, BEHAVIOR MANAGEMENT AND DISCIPLINE
If you/child is placed in a restraint hold by the foster parent, it will be reported within 72 hours to the state DSS. The parent or guardian will be notified during that time, however, it the hold warrants medical attention, the parent/guardian will be notified immediately.
Why use restraint holds?
1.
To prevent self harm
2.
To prevent harm to others
3.
To prevent damage of property
4.
Imminent/Serious risk of harm
071310 11

FAMILY SERVICES OF AMERICA CLIENT HANDBOOK
Note: If you feel the hold was not needed or intended to hurt, call your case manager immediately.
Medication Administration Information
Medications can only be given unless prescribed by a doctor. The parent/guardian has the right to be notified of any changes/new prescriptions before administering to your child.
The foster parent has the responsibility to follow the doctors order and prescribe the medication as labeled. The child has the right to refuse medications, however, only a doctor to discontinue the medication. When a child goes home on therapeutic leave it is expected that the parent follow the labeled instructions and give the medications on time.
If the parent misses a dosage, they should call the pharmacy for further instructions.
Medications that are over the counter such as Tylenol, advil, etc., must first be authorized by the parent of guardian before they can be administered. Pills must remain in their designated container.
Confidentiality Policy
All information concerning clients of FAMILY SERVICES OF AMERICA, is maintained in a confidential manner. The agency also complies with HIPAA regarding confidentiality of records and privacy of health care information. Information concerning a client may be released only with the express permission of the client, parent or legal guardian, except when required by law or in order to provide services to the client. All information in a client’s record must be protected against loss, destruction, and lack of confidentiality. Access to client records is limited, and records may be duplicated and disseminated only if a signed Authorization to Release
Information is provided.
071310 12