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Table of Contents
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
Mission and Vision
Objectives
Organizational Chart
Charts for Service Population
Services and Resources
 Kentucky, New Mexico, North Carolina, Ohio, Oklahoma,
Pennsylvania, South Carolina, Texas, Virginia
Policies
 Children’s Rights and Responsibilities
 Code of Ethics
 Confidentiality
 Duty to Warn
 National Reporting Policy
 Prohibition of Corporal Punishment
 Access to Case Records
Staff Training Requirements
Dealing with children who are at risk.
Basic Medical Needs & problems of service population
 List of potential problems of service population
 Poison Information
Medication Administration
Legal and Judicial Issues that could Influence Service Delivery
Emergency and Safety Plan
Bloodborne Pathogens Exposure Control Plan
Infection Control Plan
Indian Child Welfare Act 1978
New Mexico Orientation Manual Addendum
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OUR VISION
The Bair Foundation will be
The most sought after, Christ-centered,
social services ministry for children,
youth and families in North America.
OUR MISSION
The Bair Foundation will provide
Christ-centered quality care
and services dedicated to the
treatment, restoration and empowerment
of children, youth and families.
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The Bair Foundation Objectives
(Areas of Focus)
I. Quality of Care: It is extremely important to The Bair Foundation
organization that we provide quality of care for all recipients of services. This
quality of care is measured and monitored through our outcome measurements.
Outcome measurements are systems of measuring progress in areas such as
self-care, behavior and social skills, to name a few. In additional training (for
program employees), you will be educated on the specifics of outcome measures
testing and reporting for your job responsibilities.
II.
Growth: As in all organisms in life, if it is not growing it
is diminishing. The Bair Foundation works toward expanding
our service to additional towns, counties and states. Our
desire is to bring Christian Foster Care services to all those in need. We
monitor our growth goals through a variety of documentation methods. A
weekly census is tabulated with information from each office. It assists the
directors in knowing if they are above or below their growth goals for that time
period. In addition, each office has a new family development plan that assists
them in setting goals for the recruitment and training of new foster parents.
III. Compliance: The Bair Foundation’s goal is to have zero licensing
citations. The process of licensing is a review completed by external
organizations whose purpose is to ensure quality and ethical practices of care to
those we serve. Each state has their own licensing requirements that each
office must meet annually.
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THE BAIR FOUNDATION
KENTUCKY
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Regional
Vice President
Kentucky State
Director
Program Director
Treatment Director
Childcare Secretary
Therapists
Social Service
Workers
Recruiter/Intake
Coordinator
Foster Home
Secretary
Foster Families
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THE BAIR FOUNDATION
NEW MEXICO
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Executive Vice President
State Director
Director of Social Services
Intake Director
Foster Home Secretary
Child Care Secretary
Treatment Coordinators
Foster Parents
In all offices where there is a case manager supervisor, he/she reports
to the DSS and the assigned case managers report to the case
manager supervisor.
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THE BAIR FOUNDATION
NORTH CAROLINA
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Southeast Regional Director
NC Director of Social Services
Intake Director/ Recruiter
Social Service Workers
Secretary
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THE BAIR FOUNDATION
OHIO
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Executive Vice President
State Director
Administrative Assistant
Director of Social Services
Director of In-Home
Services
Intake Director/Foster
Home Coordinator
Placement Coordinator
Foster Home Secretary
Child Care Secretary
Case Managers
Foster Parents
Driver
Trainer
In all offices where there is a case manager supervisor, he/she reports
to the DSS and the assigned case managers report to the case
manager supervisor.
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THE BAIR FOUNDATION
OKLAHOMA
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Executive Vice President
State Director
Director of Social Services
Intake Director
Foster Home Secretary
Placement Coordinator
Child Care Secretary
Case Managers
Foster Parents
Drivers & Volunteers
In all offices where there is a case manager supervisor, he/she reports
to the DSS and the assigned case managers report to the case
manager supervisor.
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THE BAIR FOUNDATION
PENNSYLVANIA
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Executive Vice President
State Director
Program Director
Foster Home
Coordinator/ Director
of Intake
PA Director of
Adoption &
Permanency Services
Placement Coordinator
Adoption & Permanency
Supervisor
Foster Home Secretary
Transportation
Coordinator
Drivers & Volunteers
Adoption Workers
Child Care Secretary
Foster Care Specialists
Foster Parents
Receptionist/File Clerk
In all offices where there is a case manager supervisor, he/she reports to the DSS
and the assigned case managers report to the case manager supervisor.
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THE BAIR FOUNDATION
TEXAS
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Executive Vice President
TX State Director
Regional Directors
Directors of Social Servies
Director of Intake
Foster Home Secretary
Case Manager Supervisor
Case Managers
Child Care Secretary
Case Managers
Foster Parents
In all offices where there is a case manager supervisor, he/she reports
to the DSS and the assigned case managers report to the case
manager supervisor.
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THE BAIR FOUNDATION
SOUTHEAST ORGANIZATIONAL CHART
Board of Directors
Executive Director
Southeast Regional
Director
SC Director of
Social Services
VA Directors of
Social Services
Intake Director/
Recruiter
Intake Director/
Recruiter
Casemanagers
Casemanagers
Secretary
Secretary
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FISCAL DEPARTMENT
ORGANIZATIONAL CHART
Board of Directors
Executive Director
Chief Financial Officer
A/R Supervisor
A/R Clerks
A/P Supervisor
A/P Clerks
Staff Accountant
Payroll
Staff Accountant
Secretary
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Chart for Service Population
52.7%
47%
69.0%
31%
44.4%
56%
54.4%
45%
50.0%
50%
48.0%
52%
51.6%
48%
47.8%
52%
46.1%
53%
45.0%
55%
62.2%
38%
57.7%
42%
35%
32%
54.0%
46%
65.1%
68.2%
58%
53.8%
46%
41.9%
54.6%
45%
44.7%
55%
40%
Ab
ile
n
Al e
to
on
Am a
ar
illo
Au
st
in
D
al
la
H
s
ar
lin
g
H en
ou
st
o
Lu n
bb
M
oc
id
dl k
e
M
id tow
we
n
N
ew
st
C
W
ilm ity
in
gt
P
o
Ke itts n
bu
nt
rg
/C
h
ol
um
Sa
bu
n
s
An
Sa
ge
n
l
An o
to
ni
o
Tu
ls
a
Ty
le
Vi r
ct
or
ia
W
ac
N
o
at
io
na
lly
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
60.5%
Percentage of Males and Females in Care
Males
Females
84.80%
75.60%
73.90%
78.60%
76.70%
67.20%
65.10%
63.40%
62.90%
57.70%
50%
49.40%
43.40%
26%
lly
o
N
Caucasian
Hispanic
African American
Other
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at
io
na
or
ia
Vi
ct
le
r
Ty
ls
a
io
An
to
n
ge
l
o
1.70%
16.70% 17.40%
9.80%
7.10% 9.40%
n
Ab
Offices
10.70%9.90%
4.40%
2.60%
0%
An
5.70%
12.10%
10.60%
7.50%
6.30%
4.70% 2.70%
0.50% 0.40%
n
7.60%
6.10%
0%
W
ac
19.10%
Sa
2.30%
11.30%
7.60%
4.80%
21.90%
21.90%
14.10%
nt
0%
19.50%
34.50%
24.10%
22.80%
Ke
14%
36%
36%
Tu
31.50%
22.10%
16%
47.50%
40.50%
35.80%
30%
Sa
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
ile
ne
Al
to
on
Am a
ar
illo
Au
st
in
D
al
la
H
s
ar
lin
ge
n
H
ou
st
o
Lu n
bb
oc
M
k
id
dl
et
M
o
w
id
n
w
N
ew est
C
W
i
ilm ty
in
gt
o
Pi
tts n
bu
rg
h
Percentages
Nationality of Children in Care
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Services and Resources
The Bair Foundation serves a variety of children with varying needs. To best
assist each child, The Bair Foundation has developed numerous programs that
utilize professional staff and community resources to meet individual treatment
needs.
The Bair Foundation philosophy encompasses the desire that all children
deserve a family. The Bair Foundation further believes that a child’s
therapeutic needs can frequently be served effectively within a well-trained
foster family setting.
We as an organization believe that children do not have to conform to our
system of services, but that we will conform to the needs of that child.
Combining our programs and services with community resources, the child is
afforded the family environment he/she needs and deserves.
Each office has access to and utilizes mental health (psychological, psychiatric),
medical, dental, vision, speech, hearing services, educational services, parent
advocate groups, CASA (Court Appointed Special Advocate) and churches in
their communities to provide the treatment and stimulation necessary for
meeting the needs of each child.
The following list delineates programs that are offered in the various states in
which we do service. For further information concerning program specifics,
refer to the National Administrative Manual, State Sections.
KENTUCKY
NEW MEXICO
NORTH CAROLINA
OHIO
Foster Care, Therapeutic Foster Care Program
Therapeutic Foster Care Program
Therapeutic Foster Care Program, Kinship Coordination Program
Adoption Program, Intensive In Home Services
Adoption Program
Columbus Exceptional Foster Care Program
Columbus Intensive Foster Care Program
Columbus Specialized Foster Care Program
Columbus Traditional Foster Care Program
Columbus/Kent Supervised Independent Living
In-Home Services Plan Program
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OKLAHOMA
PENNSYLVANIA
SOUTH CAROLINA
TEXAS
VIRGINIA
Kent Exceptional Foster Program
Kent Specialized Foster Care Program
Kent Therapeutic Foster Care Program
Ohio Medically Needy Foster Care Program
Oklahoma Therapeutic Foster Care Program
Oklahoma Emergency Foster Care Program
Oklahoma Outpatient Services
Adoption Program
Allegheny Therapeutic Foster Care Program
Diagnostic Program
In-Home Program
Kinship Care Program
Medical Foster Care Program
Reunification Program
Therapeutic Foster Care Program
Therapeutic Foster Care Program
Special Needs Adoption Program
Therapeutic Foster Care Program
Habilitative Foster Care Program
Primary Medical Needs Foster Care Program
Assessment Home
Therapeutic Foster Care Program
In-Home Program (Richmond)
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Policies
THE BAIR FOUNDATION
Children’s Rights & Responsibilities
National
Children’s Rights while in Care:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Foster parents shall not subject children to exploitation in any form
(employment-related training or gainful employment).
All children shall be provided an opportunity to participate in religious
services.
Each child shall be supplied with facilities and supplies for personal care,
hygiene and grooming.
The home or agency shall see that each child is supplied with his or her own
clothing and shoes appropriate to the season, age, activities and individual
needs which are comparable to that of other children in the community.
Except for infants, individual space in the foster home must be provided for
the child’s personal possessions and for a reasonable degree of privacy.
Foster parents shall allow the child to bring, possess and acquire personal
belongings subject only to reasonable household rules and the child’s service
plan.
Personal belongings shall be sent with the child when he/she leaves the
home.
Foster parents shall only expect a child to perform household tasks which
are within the child’s abilities, reasonable for the child’s age and similar to
those expected of other household members of comparable age ability.
Children shall be given guidance in managing their own money.
Money earned by a child or received as a gift or allowance shall be his
personal property.
A child shall not be required to use earned money to pay for room and board
unless it is part of the treatment plan and approved by the parent or
guardian and the agency.
Children shall not be denied their right to privacy in writing, sending or
receiving correspondence, in accordance with the service plan.
Children shall not be denied food, mail or visits with their families as
punishment.
Children shall not be subjected to remarks that belittle or ridicule them or
their families.
Children shall not be threatened with the loss of foster home placement.
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16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Children shall have the right to visit family in the home, receive phone calls
from family members and friends unless contra indicated in the child’s ISP.
Children have a right to reasonable access to writing materials, stamps,
envelopes and telephone calls, including reasonable funds or means by which
to use telephones must be provided.
Children shall not be publicly identified to their embarrassment as wards of
the agency.
Children shall not be exploited or embarrassed by any publicity or
promotional materials.
Children shall not be forced to acknowledge their dependency on the child
placing agency or their gratitude to it.
Children shall have opportunity for private conversation with the agency’s
staff member responsible for their supervision, either at the child’s or the
agency’s request.
Education opportunities shall be provided for each child in foster care in
accordance with his/her education plan of care.
Children have the right to attend all court hearings pertinent to themselves
unless contraindicated.
Children have a right to request an in-house review of their case, treatment
and service plan.
Children have a right to refuse any service, treatment or medication, unless
mandated by law or court order. (If services, treatment or medication are
refused, children will be informed about the consequences of such refusal
which could include discharge.)
Children have the right to participate in an Independent Living Skills
Program if the child is 16 years of age or older.
Children have the right to file a grievance about concerns they have about
care and treatment.
Children have the opportunity to participate in decisions regarding services
provided to them.
Children have the right to receive services in a non-coercive manner.
Children have a right to social interaction and to participate in community
activities.
Children have a right to daily physical activities.
Children will receive humane discipline, and shall not be subject to adverse
interventions without the following: a physicians approval; informed consent
of the client or his/her representative; documentation of less restrictive
methods that have failed which are in the client’s record and approved by
the interdisciplinary team.
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Children’s Responsibilities While in Care:
1.
2.
3.
4.
5.
6.
To participate in the planning and implementation of their treatment plan.
To cooperate within the foster home by obeying the house rules.
To follow agency policies and procedures which directly affect them. Ie.
Smoking, hunting, driving a vehicle, alcohol & drug use etc.
Attend school and academically work to the best of their ability.
To work respectfully with their case manager.
To contact their case manager regarding any questions or concerns, Monday
through Friday from 8:30 AM – 4:30 PM at the local office, or in the event
of an emergency on off hours, the on call case manager.
Discharge or Termination:
1.
2.
3.
Children shall be discharged from The Bair Foundation as a result of careful
planning.
Arrangements for discharge shall be made mutually between The Bair
Foundation and the placing agency.
The Bair Foundation is limited by its resources. If the child’s needs exceed
The Bair Foundations resources, discharge planning and referrals will be
made in concurrence with the referring agency.
Code of Ethics
National
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The Bair Foundation believes in gaining the participation of clients served in
decisions about their care and treatment and therefore provides opportunity for
each person served to be in attendance and participate in the development of his
or her individual service plan. The client’s signature on the service plan, as
developmentally appropriate, indicates participation in the plan’s development.
The Bair Foundation utilizes research for the purposes of monitoring service
outcomes for clients in the Foster Care and In-Home Services programs. If The
Bair Foundation should seek client participation in clinical research for purposes
other than outcome monitoring, and the client chooses not to participate in such a
proposed research study, he/she is still eligible for continued services from the
agency, provided he/she continues to meet the eligibility requirements of the
program in which he/she desires to participate.
The Bair Foundation is committed to protecting the privacy and confidentiality of
persons served. Extensive policies exist regarding employee access and
responsibility in regard to confidential client information. Violations of The Bair
Foundation National Confidentiality policy may result in disciplinary action.
The Bair Foundation is committed to assessing client need and basing treatment
planning and referrals on identified needs.
The Bair Foundation is committed to resolving differences with the client or any
member of the client’s treatment team through structured procedures. Both
client and biological parent grievance procedures are maintained to adequately
investigate complaints filed by a person served and/or his or her family members.
The Bair Foundation adheres to the right of persons to receive treatment as
needed. If a conflict arises between the need for service and financial
arrangements, a plan will be developed to meet the client’s needs by the Director
of Social Services for the office in which the child will be placed. The plan will
include alternative resources to services the client needs and must be approved by
the Executive Director.
The Bair Foundation requires its professional staff to know and follow the social
work code of ethics. (You can obtain a copy by contacting the National office or
NASW 750 First St., NE, Washington DC, Washington 20002-4241) If you are
licensed in another related profession, The Bair Foundation requires you to know
and follow the code of ethics for that profession. The employee is responsible for
obtaining their respective code of ethics.
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THE BAIR FOUNDATION CONFIDENTIALITY POLICY
NATIONAL
The Bair Foundation requires that information that may identify a child or the
foster family, as well as other information contained in the client record, is kept
confidential. The Bair Foundation also requires that no staff/foster family
disclose or make use of information, directly or indirectly, concerning the foster
child, or the family, or any of other clients other than in the course of the
performance of his or her duties.
Client information will only be released to organizations or individuals outside of
The Bair Foundation when a release of information (form I-07) is signed by parent
or legal guardian that specifically documents what information is to be given, the
time period that such permission remains in affect, and to whom and for what
purpose the information is to be released.
If any client is unable to understand the Consent to Release of Information
Agreement, due to developmental or physical disability, and if that client has no
biological parent or guardian able to sign such an agreement for him or her, then
the following procedure is to be followed:
A request for release of information will be made in writing to the Director of
Social Services in the office where the child or family is being served. The client’s
Case manager will review the release of information request with the client and
explain all applicable rights to that person and his or her family. The Director of
Social Services will then sign the release of information form, signifying that the
above process has taken place and that the client is in agreement with such
information being disclosed.
PERSONNEL POLICIES
1. Employees are required to sign a confidentiality/non-compete agreement
prior to beginning employment.
2. All employees are required to sign a job description that includes
requirements for maintaining confidentiality.
3. State and County representatives seeking to review a client file for
purposes of determining compliance by The Bair Foundation with state or
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local regulations must sign a Contract Monitoring and Audit Confidentiality
Agreement form.
CLIENT POLICIES
The fact that a child is in foster care will not be a matter for public promotion by
The Bair Foundation.
1.
No child will be required to make statements regarding his or her
background.
2.
No child will be required to make statements regarding his or her
dependence on the state, The Bair Foundation, or the foster family.
3.
No child will be required to make public statements acknowledging
gratitude.
4.
Pictures, reports, or identification of a foster child are expressly
prohibited without written consent by the biological parent, the county
with custody, or the child if he/she is 18 years of age or older and will be
limited for a specific purpose that will be explained to the youth and/or
the biological parent.
5.
The Bair Foundation requires that no staff or foster family disclose or
make use of information, directly or indirectly, concerning a foster child,
or the family, or any other clients other than in the course of the
performance of his duty.
6.
The Bair Foundation shall not involve a child in any activity such as fund
raising, publicity, or human research projects without prior written
consent of the parent/guardian or legal custodian and the child. Written
consent shall be contained in the child’s file.
______________________________________________________________
Signature (Child)
Date
______________________________________________________________________________
Signature (Parent/Legal guardian)
Date
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DUTY TO WARN THIRD PARTY VICTIMS POLICY
NATIONAL
In situations when a member of The Bair Foundation staff becomes aware that a
client has made a threat to harm another person, under certain circumstances that
staff member has the duty to warn the person against whom the threat has been
made.
The following circumstances must exist before a TBF staff member may break
confidentiality in order to warn a potential victim:
 A client has communicated to The Bair Foundation professional a specific
and immediate threat of serious bodily injury against a specifically
identified or readily identifiable third party
AND
 The professional determines that the client presents a serious danger of
violence to the third party.
The Bair Foundation professional must consult with The Director of Social
Services or Supervisor before any interventions can be implemented.
The TBF staff and supervisor will consider one or more of the following
interventions:
 Notifying the intended victim.
 Notifying someone who will notify the victim.
 Notifying the police.
 Initiating a voluntary or involuntary hospitalization.
__________________________________________
Signature
Date
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Mandated Reporting
Policy and Procedure
NATIONAL
As a contract agent for government child protective services, The Bair Foundation
personnel are mandated to report any suspected incidents of abuse or neglect
perpetrated against a child. Such abuse or neglect indicators may include but are
not limited to unexplained injuries or direct allegations. In addition, The Bair
Foundation personnel are mandated to report any criminal behavior committed by
or against a child.
Personnel mandated reporting requirements are defined in the following policies
and procedures. Review the appropriate policy and procedures with your supervisor
so that you fully understand the reporting requirements for your state.
Reporting Suspected Abuse or Neglect
Kentucky
Kentucky (877) 597-2331
http://chfs.ky.gov/dcbs/dpp/childsafety.htm
Professionals Required to Report Rev. Stat. § 620.030
All persons are required to report, including, but not limited to:
Physicians, osteopathic physicians, nurses, coroners, medical examiners, residents,
interns, chiropractors, dentists, optometrists, emergency medical technicians,
paramedics, or health professionals
Teachers, school personnel, or child care personnel
Social workers or mental health professionals
Peace officers
Reporting by Other Persons Rev. Stat. § 620.030
Any person who knows or has reasonable cause to believe that a child is dependent,
neglected, or abused shall immediately report.
Standards for Making a Report Rev. Stat. § 620.030
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A report is required when a person knows or has reasonable cause to believe that a
child is dependent, neglected, or abused.
Privileged Communications Rev. Stat. § 620.030(3)
Neither the husband-wife nor any professional-client/patient privilege, except the
attorney-client and clergy-penitent privilege, shall be a ground for refusing to
report.
Inclusion of Reporter’s Name in Report
The reporter is not specifically required by statute to provide his or her name in
the report.
Disclosure of Reporter Identity Rev. Stat. § 620.050
The identity of the reporter shall not be disclosed except:
To law enforcement officials, the agency investigating the report, or to a
multidisciplinary team
Under court order, after a court has found reason to believe the reporter
knowingly made a false report
Reporting Suspected Abuse or Neglect
New Mexico
New Mexico (855) 333-7233
http://www.cyfd.org/content/reporting-abuse-or-neglect
N.M. Stat. Ann. § 32A-4-3
Standard for Report:
- To know or have reasonable suspicion that a child has been abused or
neglected.
Persons Required to Report:
- Every person, Any licensed physicians, resident or an intern examining, attending
or treating a child, Any law enforcement officer, Any judge presiding during a
proceeding, any registered nurse, any visiting nurse, any schoolteacher, any school
official, any social worker acting in an official capacity, any member of the clergy
who has information that is not privileged as a matter of law
Failure to Report: § 32A-4-3
- Any person that is required and fails to make a report is guilty of a
misdemeanor.
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Reporting Suspected Abuse or Neglect
North Carolina
North Carolina 800-422-4453
http://www.dhhs.state.nc.us/dss/cps/index.htm
Professionals Required to Report Gen. Stat. § 7B-301
Any person or institution that has cause to suspect abuse or neglect shall report.
Reporting by Other Persons Gen. Stat. § 7B-301
All persons who have cause to suspect that any juvenile is abused, neglected, or
dependent, or has died as the result of maltreatment, shall report.
Standards for Making a Report Gen. Stat. § 7B-301
A report is required when a reporter has cause to suspect that any juvenile is
abused, neglected, or dependent, or has died as the result of maltreatment.
Privileged Communications Gen. Stat. § 7B-310
No privilege shall be grounds for failing to report, even if the knowledge or
suspicion is acquired in an official professional capacity, except when the
knowledge or suspicion is gained by an attorney from that attorney’s client during
representation only in the abuse, neglect, or dependency case. No privilege, except
the attorney-client privilege, shall be grounds for excluding evidence of abuse,
neglect, or dependency.
Inclusion of Reporter’s Name in Report Gen. Stat. § 7B-301
The report must include the name, address, and telephone number of the reporter.
Disclosure of Reporter Identity Gen. Stat. § 7B-302
The Department of Social Services shall hold the identity of the reporter in
strictest confidence.
Reporting Suspected Abuse or Neglect
Ohio
Ohio (855) 642-4453
http://jfs.ohio.gov/ocf/reportchildabuseandneglect.stm
Professionals Required to Report Rev. Code § 2151.421
Mandatory reporters include:
Attorneys
Physicians, interns, residents, dentists, podiatrists, nurses, or other healthcare professionals
Licensed psychologists, school psychologists, or marriage and family
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therapists
Speech pathologists or audiologists
Coroners
Administrators or employees of child daycare centers, residential camps,
child day camps, certified child care agencies, or other public or private
children services agencies
Teachers, school employees, or school authorities
Persons engaged in social work or the practice of professional counseling
Agents of county humane societies
Persons, other than clerics, rendering spiritual treatment through prayer in
accordance with the tenets of a well-recognized religion
Superintendents, board members, or employees of county boards of mental
retardation; investigative agents contracted with by a county board of
mental retardation; employees of the Department of Mental Retardation and
Developmental Disabilities; employees of a facility or home that provides
respite care; employees of a home health agency; employees of an entity
that provides homemaker services
Persons performing the duties of an assessor or third party employed by a
public children services agency to assist in providing child or family-related
services
Reporting by Other Persons Rev. Code § 2151.421
Any other person who suspects that a child has suffered or faces a threat of
suffering from abuse or neglect may report.
Standards for Making a Report Rev. Code § 2151.421
A report is required when a mandated person is acting in an official or professional
capacity and knows or suspects that a child has suffered or faces a threat of
suffering any physical or mental wound, injury, disability, or condition of a nature
that reasonably indicates abuse or neglect of the child.
Privileged Communications Rev. Code § 2151.421
An attorney, physician, or cleric is not required to make a report concerning any
communication the attorney, physician, or cleric receives from a client, patient, or
penitent in a professional relationship, if, in accordance with § 2317.02, the
attorney, physician, or cleric could not testify with respect to that communication
in a civil or criminal proceeding.
The client, patient, or penitent in the relationship is deemed to have waived any
testimonial privilege with respect to any communication the attorney, physician, or
cleric receives, and the attorney, physician, or cleric shall make a report with
respect to that communication if all of the following apply:
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The client, patient, or penitent, at the time of the communication, is either a child
under age 18 or a mentally retarded, developmentally disabled, or physically
impaired person under age 21.
The attorney, physician, or cleric knows, or has reasonable cause to suspect based
on facts that would cause a reasonable person in similar position to suspect, as a
result of the communication or any observations made during that communication,
that the client, patient, or penitent has suffered or faces a threat of suffering
any physical or mental wound, injury, disability, or condition of a nature that
reasonably indicates abuse or neglect of the person.
The abuse or neglect does not arise out of the person’s attempt to have an
abortion without the notification of her parents, guardian, or custodian in
accordance with § 2151.85.
Inclusion of Reporter’s Name in Report Rev. Code § 2151.421
The reporter is not required to provide his or her name in the report, but if he or
she wants to receive information on the outcome of the investigation, he or she
must provide his or her name, address, and telephone number to the person who
receives the report.
Disclosure of Reporter Identity Rev. Code § 2151.421
The information provided in a report made pursuant to this section and the name
of the person who made the report shall not be released for use and shall not be
used as evidence in any civil action or proceeding brought against the person who
made the report.
Reporting Suspected Abuse or Neglect
Oklahoma
Oklahoma (800) 522-3511
http://www.okdhs.org/programsandservices/cps/default.htm
Professionals Required to Report Ann. Stat. Tit. 10A, § 1-2-101; Tit. 21, §
1021.4
Mandatory reporters include:
All persons
Commercial film and photographic print processors or computer technicians
Reporting by Other Persons Ann. Stat. Tit. 10A, § 1-2-101
Every person who has reason to believe that a child is a victim of abuse or neglect
must report.
Standards for Making a Report Ann. Stat. Tit. 10A, § 1-2-101; Tit. 21, §
1021.4
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A report is required when:
Any person has reason to believe that a child under age 18 is a victim of
abuse or neglect.
A physician, surgeon, or other health-care professional, including doctors of
medicine, licensed osteopathic physicians, residents, and interns, attends
the birth of a child who tests positive for alcohol or a controlled dangerous
substance.
A commercial film and photographic print processor or computer technician
has knowledge of or observes any film, photograph, video-tape, negative, or
slide depicting a child engaged in an act of sexual conduct
Privileged Communications Ann. Stat. Tit. 10A, § 1-2-101
No privilege shall relieve any person from the requirement to report.
Inclusion of Reporter’s Name in Report
This issue is not addressed in the statutes reviewed.
Disclosure of Reporter Identity
This issue is not addressed in the statutes reviewed.
Reporting Suspected Abuse or Neglect
Pennsylvania
Pennsylvania (800) 932-0313
http://www.dpw.state.pa.us/forchildren/childwelfareservices/calltoreportchildabu
se!/index.htm
Professionals Required to Report Cons. Stat. Tit. 23, § 6311
Persons required to report include, but are not limited to:
Licensed physicians, osteopaths, medical examiners, coroners, funeral
directors, dentists, optometrists, chiropractors, podiatrists, interns, nurses, or
hospital personnel
Christian Science practitioners or members of the clergy
School administrators, teachers, school nurses, social services workers,
daycare center workers, or any other child care or foster care workers
Mental health professionals
Peace officers or law enforcement officials
Reporting by Other Persons Cons. Stat. Tit. 23, § 6312
Any person who has reason to suspect that a child is abused or neglected may
report.
Standards for Making a Report Cons. Stat. Tit. 23, § 6311
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A report is required when a person, who in the course of employment, occupation,
or practice of a profession, comes into contact with children, has reasonable cause
to suspect, on the basis of medical, professional, or other training and experience,
that a child is a victim of child abuse.
Privileged Communications Cons. Stat. Tit. 23, § 6311
Except with respect to confidential communications made to a member of the
clergy that are protected under 42 Pa.C.S. § 5943 (relating to confidential
communications to clergymen), and except with respect to confidential
communications made to an attorney that are protected by 42 Pa.C.S. §§ 5916 or
5928 (relating to confidential communications to an attorney), the privileged
communication between any professional person required to report and the patient
or client of that person shall not apply to situations involving child abuse and shall
not constitute grounds for failure to report as required by this chapter.
Inclusion of Reporter’s Name in Report Cons. Stat. Tit. 23, § 6313
Mandated reporters must make a written report that includes their name and
contact information.
Disclosure of Reporter Identity Cons. Stat. Tit. 23, § 6340
The release of the identity of the mandated reporter is prohibited unless the
secretary finds that the release will not be detrimental to the safety of the
reporter.
Reporting Suspected Abuse or Neglect
South Carolina
South Carolina (803) 898-7318
http://dss.sc.gov/content/customers/protection/cps/index.aspx
Professionals Required to Report Ann. Code § 63-7-310
The following professionals are required to report:
Physicians, nurses, dentists, optometrists, medical examiners, or coroners
Employees of county medical examiner’s or coroner’s offices
Any other medical, emergency medical services, mental health, or allied
health professionals
Members of the clergy, including Christian Science practitioners or religious
healers
School teachers, counselors, principals, assistant principals, or school
attendance officers
Social or public assistance workers, substance abuse treatment staff, or
child care worker in a child care center or foster care facility
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Foster parents
Police or law enforcement officers or juvenile justice workers
Undertakers, funeral home directors, or employees of a funeral home
Persons responsible for processing films or computer technicians
Judges
Volunteer nonattorney guardians ad litem serving on behalf of the South
Carolina Guardian Ad Litem Program or the Richland County CASA
Reporting by Other Persons Ann. Code § 63-7-310
Except as provided above, a person, including, but not limited to, a volunteer
nonattorney guardian ad litem serving on behalf of the South Carolina Guardian Ad
Litem Program or the Richland County CASA, who has reason to believe that a
child’s physical or mental health or welfare has been or may be adversely affected
by abuse and neglect may report, and is encouraged to report, in accordance with
this section.
Standards for Making a Report Ann. Code § 63-7-310
A report is required when a reporter, in his or her professional capacity, receives
information that gives him or her reason to believe that a child has been or may be
abused or neglected.
Privileged Communications Ann. Code § 63-7-420
The privileged quality of communication between husband and wife and any
professional person and his or her patient or client, except that between attorney
and client or clergy member, including a Christian Science practitioner or religious
healer, and penitent, does not constitute grounds for failure to report. However, a
clergy member, including a Christian Science practitioner or religious healer, must
report in accordance with this subarticle except when information is received from
the alleged perpetrator of the abuse and neglect during a communication that is
protected by the clergy and penitent privilege as provided for in § 19-11-90.
Inclusion of Reporter’s Name in Report
The reporter is not specifically required by statute to provide his or her name in
the report.
Disclosure of Reporter Identity Ann. Code § 63-7-330
The identity of the person making a report pursuant to this section must be kept
confidential by the agency or department receiving the report and must not be
disclosed, except as specifically provided for in statute.
Reporting Suspected Abuse or Neglect
Texas
Texas (TX) (800) 252-5400
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https://www.dfps.state.tx.us/Contact_Us/report_abuse.asp
Professionals Required to Report Fam. Code § 261.101
Persons required to report include:
A professional, for purposes of the reporting laws, who is licensed or certified by
the State or who is an employee of a facility licensed, certified, or operated by
the State and who, in the normal course of official duties or duties for which a
license or certification is required, has direct contact with children.
Professionals include: Teachers or daycare employees
Nurses, doctors, or employees of a clinic or health-care facility that provides
reproductive services
Juvenile probation officers or juvenile detention or correctional officers
Reporting by Other Persons Fam. Code § 261.101
A person who has cause to believe that a child has been adversely affected by
abuse or neglect shall immediately make a report.
Standards for Making a Report Fam. Code § 261.101
A report is required when a person has cause to believe that a child has been
adversely affected by abuse or neglect.
Privileged Communications Fam. Code §§ 261.101; 261.202
The requirement to report applies without exception to an individual whose
personal communications may otherwise be privileged, including an attorney, a
member of the clergy, a medical practitioner, a social worker, a mental health
professional, and an employee of a clinic or health-care facility that provides
reproductive services.
In a proceeding regarding the abuse or neglect of a child, evidence may not be
excluded on the ground of privileged communication except in the case of
communication between an attorney and client.
Inclusion of Reporter’s Name in Report
The reporter is not specifically required by statute to provide his or her name in
the report.
Disclosure of Reporter Identity Fam. Code §§ 261.101; 261.201
Unless waived in writing by the person making the report, the identity of an
individual making a report is confidential and may be disclosed only:
As provided by § 261.201
To a law enforcement officer for the purposes of conducting a criminal
investigation of the report
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A report of alleged or suspected abuse or neglect and the identity of the person
making the report are confidential. A court may order the disclosure of such
confidential information, if after a hearing and an in camera review of the
requested information, the court determines that the disclosure is:
Essential to the administration of justice
Not likely to endanger the life or safety of a child who is the subject of the
report, a person who made the report, or any other person who participates in an
investigation of reported abuse or neglect or who provides care for the child
The Texas Youth Commission shall release a report of alleged or suspected abuse
if the report relates to abuse or neglect involving a child committed to the
commission. The commission shall edit any report disclosed under this section to
protect the identity of:
A child who is the subject of the report
The person who made the report
Any other person whose life or safety may be endangered by the disclosure
Reporting Suspected Abuse or Neglect
Virginia
Virginia (804) 786-8536
http://www.dss.virginia.gov/family/cps/index.html
Professionals Required to Report Ann. Code § 63.2-1509
The following professionals are required to report:
Persons licensed to practice medicine or any of the healing arts
Hospital residents or interns, and nurses
Social workers or probation officers
Teachers or other employees at public or private schools, kindergartens, or
nursery schools
Persons providing full-time or part-time child care for pay on a regular basis
Mental health professionals
Law enforcement officers, animal control officers, or mediators
Professional staff employed by private or State-operated hospitals,
institutions, or facilities to which children have been placed for care and
treatment
Persons age 18 or older associated with or employed by any public or private
organization responsible for the care, custody, or control of children
Court-appointed special advocates
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Persons age 18 or older who have received training approved by the
Department of Social Services for the purposes of recognizing and reporting child
abuse and neglect
Persons employed by a local department who determine eligibility for public
assistance
Emergency medical services personnel, unless such personnel immediately
reports the matter directly to the attending physician at the hospital to
which the child is transported
Person employed by public or private institutions of higher education, other
than an attorney who is employed by a public or private institution of higher
education as it relates to information gained in the course of providing legal
representation to a client
Athletic coaches, directors, or other persons age 18 or older employed by or
volunteering with private sports organizations or teams
Administrators or employees age 18 or older of public or private day camps,
youth centers, and youth recreation programs
Reporting by Other Persons Ann. Code § 63.2-1510
Any person who suspects that a child is abused or neglected may report.
Standards for Making a Report Ann. Code § 63.2-1509
A report is required when, in his or her professional or official capacity, a reporter
has reason to suspect that a child is abused or neglected. For purposes of this
section, ‘reason to suspect that a child is abused or neglected’ shall include:
A finding made by a health-care provider within 6 weeks of the birth of a child
that the results of toxicology studies of the child indicate the presence of a
controlled substance not prescribed for the mother by a physician
A finding made by a health-care provider within 6 weeks of the birth of a child
that the child was born dependent on a controlled substance that was not
prescribed by a physician for the mother and has demonstrated withdrawal
symptoms
A diagnosis made by a health-care provider at any time following a child’s birth
that the child has an illness, disease, or condition that, to a reasonable degree of
medical certainty, is attributable to in utero exposure to a controlled substance
that was not prescribed by a physician for the mother or the child
• A diagnosis made by a health-care provider at any time following a child’s birth
that the child has a fetal alcohol spectrum disorder attributable to in utero
exposure to alcohol
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When ‘reason to suspect’ is based upon this subsection, that fact shall be included
in the report along with the facts relied upon by the person making the report.
Privileged Communications Ann. Code §§ 63.2-1509; 63.2-1519
The requirement to report shall not apply to any regular minister, priest, rabbi,
imam, or duly accredited practitioner of any religious organization or denomination
usually referred to as a church as it relates to information required by the
doctrine of the religious organization or denomination to be kept in a confidential
manner.
The physician-patient or husband-wife privilege is not permitted.
Inclusion of Reporter’s Name in Report
The reporter is not specifically required by statute to provide his or her name in
the report.
Disclosure of Reporter Identity Ann. Code § 63.2-1514
Any person who is the subject of an unfounded report who believes that the report
was made in bad faith or with malicious intent may petition the court for the
release of the records of the investigation or family assessment. If the court
determines that there is a reasonable question of fact as to whether the report
was made in bad faith or with malicious intent and that disclosure of the identity
of the reporter would not be likely to endanger the life or safety of the reporter,
it shall provide to the petitioner a copy of the records of the investigation or
family assessment
If a number is not listed, or if you need to report suspected abuse in a State other
than your own, please call:
Child help USA National Child Abuse Hotline
1-800-4-A-CHILD
(1-800-422-4453)
TDD: 1-800-2-A-CHILD
Child help USA is a non-profit agency which can provide reporting numbers, and has
Hotline counselors who can provide referrals.
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The Bair Foundation
Prohibition of Corporal and Degrading Punishment
National
“Corporal punishment” means the willful infliction of, or willfully causing the
infliction of, physical pain on a child.
No person employed by, contracted with or volunteering at The Bair Foundation
shall inflict, or cause to be inflicted, corporal punishment upon a child.
In addition, Bair Foundation shall tolerate no act of degrading (humiliating,
demeaning) punishment. (Refer to State Policies concerning Punishment and
Discipline)
ACCESS TO CASE RECORDS
NATIONAL
CLIENT ACCESS AND CONTRIBUTION
The Bair Foundation recognizes that clients have a right to access their case
records. If a client (child or designated legal representative) wishes to review
their personal or family’s record, a request must be made to the case manager
stating the specific portion of the case record that he or she wishes to view. The
case manager will then copy the pertinent section(s) of the file and depersonalize
any identifying information that would breach confidentiality of persons involved in
the client’s case. The client’s review of file information must be conducted in the
presence of a casemanager or administrative staff and on The Bair Foundation’s
premises.
Clients are also permitted to contribute to the record. If the client wishes to add
a statement to the record regarding a problem or services received he or she may
do so. If an employee of The Bair Foundation adds any responses to the client’s
statement in the case record the client must be notified of this action.
Once a client has been discharged from care, he or she may still gain access to
case records by following the above procedure and presenting valid identification.
Entire case records are kept on file after discharge for a minimum period of seven
(7) years.
REFUSAL TO SHARE INFORMATION
The Bair Foundation may refuse to share information with a client, or with a
client’s guardian, on the basis of perceived harm to the client, information
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considered harmful to the client, must be documented as such by the child’s
therapist or legal guardian. Such refusals of information must be reviewed and
approved in writing by the Chief Executive Officer, National Director of
Operations or State Director.
Under extreme circumstances when a child is denied access to his or her case
record because information contained therein has been deemed harmful to the
child. The child may implement the chain of command as outlined in the grievance
procedure. At any point during the grievance procedure, or following the
exhaustion of the grievance procedure, The Bair Foundation may choose to appoint
a qualified professional, with the child’s consent, to access the record on behalf of
the child. This professional must sign a statement that information previously
deemed harmful to the client will not be shared with the client.
STAFF AND OTHER ACCESS
The Bair Foundation personnel are authorized to see specific case record
information on a “need to know” basis. Others outside the organization may have
access to case record information if permitted by law and a release of information
is obtained according to The Bair Foundation policy.
Staff Training Requirements
These Training requirements pertain to all program personnel including local
directors, casemanagers, intake staff, (secretaries must take 4 hours of BI
training) and Caseaides/Drivers (employees or volunteers):
All States Training
Initial Training
Renewal
CPR
First Aid and Medication
Reactions
Behavior Intervention
Medication monitoring and
administration including
psychotropics
Orientation manual
Annual Training Manual
Indian Child Welfare Act
1978
Within 6 months
Within 6 months
Every 2 years
Every 2 years
Within specified timeframe
At orientation
Annually thereafter
Annually thereafter
Kentucky Training
Initial Training
Renewal
Sexual Harassment Training
Psychotropic Medications
Crisis Prevention Techniques
At Orientation
At Orientation
Within specified timeframe
Annually thereafter
Annually thereafter
At orientation
Annually each January
At orientation
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Cultural competence
Group Study Process
Together Facing the
Challenge
CPR/1st aid
Annual Training Manual
At Orientation
At Orientation
At Orientation
Within specified timeframe
Every two years
Annually each January
New Mexico Training
Initial Training
Renewal
New Hires:
Group Study Process
Treatment Coordiantor
Training Manual
Cultural Diversity
Disorders of Childhood
Psychotropic Medications
Foster Parent Handbook
Within specified timeframe
Within specified timeframe
At Orientation
At Orientation
At Orientation
At Orientation
North Carolina
Training
Initial Training
Renewal
New Hires:
Group Study Process
Case Management Training
Manual
ITP Training
Medicaid Training
New Hires:
Within specified timeframe
Within specified timeframe
Within specified timeframe
At orientation
Annual refreshers
Pennsylvania Training
Initial Training
Renewal
(case managers, supervisors and local directors)
New Hires:
Sexual Harassment Training At orientation
Child Abuse recognition and
At orientation
staff responsibilities
Basic safety practices
At orientation
Principles of childcare
At orientation
Casemanager Training
Within specified timeframe
ISP Training
At orientation
Annual Training:
40 hours annually
Refreshers of All States training * should it be needed to keep current.
20 of the 40 hours must be provided through one of the following: formal inservice
training, academic programs, participation in conferences, institutes or workshops.
Up to 20 hours may be provided through supervisory conferences
Oklahoma Training
Initial Training
Renewal
(case managers, supervisors and local directors)
Refreshers of All States training * should it be needed to keep current.
New Hires:
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Sexual Harassment Training
Foster Parent Training
Casemanager Training
Annual Training:
Within specified timeframe
40 hours annually
Refreshers of All States training * should it be needed to keep current.
12 hours of training related to the following topics:
1. Casemanagement
2. Assessment and treatment planning
3. Normal childhood development
4. Treatment of children with attachment disorders
5. Treatment of children and families with substance abuse
6. Chemical dependency disorders
7. Treatment methodologies for emotionally disturbed children
8. Child in Need of Mental Health Treatment Act
9. Gatekeeping Procedures
10. Anger management
CAFAS Refresher
Annually
Ohio Training
Initial Training
Renewal
New Hires:
Refreshers of All States training * should it be needed to keep current.
Sexual Harassment Training At Orientation
Casemanager Training
Within specified timeframe
Manual
ISP Training Manual
Within specified timeframe
For Licensed Professional Counselors (Including Clinical Counselors)
License renewal 30 clock hours of approved continuing professional education in:
1. Human growth and development
2. Counseling Theory
3. Counseling Training
4. Group Dynamics, processing and counseling
5. Appraisal of Individuals
6. Research and Evaluation
7. Professional, Legal and Ethical Responsibilities
8. Social and Cultural Foundations
9. Lifestyle and Career Development
For Social Work assistants, Licensed Social Workers or Licensed Independent Social
Workers
License renewal 30 clock hours of continuing education in social work
Additional Tier training required for Ohio employees (Casemanagers and Directors)
Tier I AA Workshops (completed within 6
Tier II AA Workshops (Completed within 3
months of hire)
years of completion of Tier I)
Family and Child Assessment (12 hours)
Achieving Permanency Through Interagency
Collaboration (6 hours)
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Birth parent Services (6 hours)
Cultural Issues in Permanency Planning (12
hours)
Openness in Adoption (12 hours)
Post Finalization Adoption Services (6
hours)
Adoption Assistance ( 3 hours)
Gathering and Documenting Background
Information (12 hours)
Placement Strategies (3 hours)
Pre-finalization Adoption Services (6 hours)
In-Home Service/Outpatient Counseling Training
New Hires:
Initial Training
Renewal
Ethnic /Cultural Sensitivity
Within 7 days of Hire
Sexual harassment training
At Orientation
Casemanager Training
Manual
Confidentiality
Community Support Provider
(CSP) Job Description
Consent/Release of
Information
Identification, Sociodemographic and
Assessment
CGAS Youth Rating Scale,
GAF (Adults)
Youth Rights / Grievance
Procedure
Admission Criteria
Diagnostic Assessment
Health History / Health
Checklist
Genogram /Ecomap
Individual Client Service
plan Procedures
Productivity
Mandatory Reporting
Duty To Warn
Home visit with staff prior
to working independently
Within specified timeframe
Consent for Treatment
CSP Interventions
Records Control / Case File
Procedures
Complete Within 30 days of
Hire
Complete Within 14 days of
Hire
Must be completed before
working independently
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Resource Agencies
Receipt of Forms
Acknowledgement
Intake / Referral Process
Incident Reporting / Major
Unusual Incident Policy
Employee Performance
rating
Respite Care / Check
Requisition
Accessibility, Availability,
Appropriateness and
Acceptability of Services
Interagency Referral Process &
Community Resource Book
Quality Assurance Policy /
Utilization Reviews
Facilities and Safety Policy
Occupational / Safety and
Health Policy
Infection Control Program
Safety: Report, Fire and
Tornado Drills
Recognition of Need for
Additional Services
Assessing for Increased Level
of Care
Agency Service Plan
Abbreviations
Counseling and
Psychotherapy Job
Description
Client Transfer
Termination of Services
Closing Summary
Check Requisitions
Accounting (Action Sheets)
Drug Theft Policy
Involuntary Termination
Policy
Ethnic / Cultural Sensitivity
Family Practitioner’s Guide
to Home-Based Services
Parent Training Manual
Family Preservation Service
Article
Complete Within 60 days
of Hire
Complete Within 90 days of
Hire
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Child Development Article
Risk Factors Article
Juvenile Delinquency
Handout
Anger management Handout
South Carolina
Training
New Hires:
Group Study Process
Case Management Training
Manual
ITP Training
Medicaid Training
Texas Training
Initial Training
Renewal
Within specified timeframe
Within specified timeframe
Within specified timeframe
At orientation
Annual refreshers
Initial Training
Renewal
New Hires: (Required to obtain 30 hours during their first year of employment)
Group Study Process
Within specified timeframe
Casemanagement Training
Within specified timeframe
Manual
CAFAS Training
Within specified timeframe
Annual refreshers
ISP Training
Within specified timeframe
Annual refreshers
Annual Training:
20 hours annually
Child Placing Staff
Refreshers of All States training * should it be needed to keep current.
20 hours of Training related directly to child-placing responsibilities.
At lease 75% of the 20 hours must consist of:
1. Course work from an accredited educational institution
2. Workshops
3. Seminars
4. Other direct training provided by qualified agencies
5. Inservice training or self-instruction programs must include stated learning
objectives, curriculum and learning activities and an evaluation component.
Level I Staff
20 hours of training, 10 of which must be related to child-placing responsibilities
Virginia Training
New Hires:
Group Study Process
Case Management Training
Manual
ITP Training
Medicaid Training
Initial Training
Renewal
Within specified timeframe
Within specified timeframe
Within specified timeframe
At orientation
Annual refreshers
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Dealing with Children who are at risk
Often the children who come into care at The Bair Foundation have varying needs
that at times may manifest themselves where they are a risk to themselves and
others. The following procedures can be helpful in dealing with a child who
potentially is at risk.
A. If the foster child’s behavior presents a serious threat (potential for
serious physical harm) to him/herself or others, staff should take immediate
action in assisting foster parents in dealing with the child to de-escalate the
behavior that is putting the child at risk.
B. When the TBF case manager becomes aware of a foster child in his/her
care presenting a threat of physical harm or suicide risk, the case manager
must notify his/her supervisor and the custodial agency immediately.
C. The case manger will instruct the foster parent to take immediate steps to
continuously observe the child or transport the child to a hospital or
psychiatric unit for a complete assessment.
D. The Bair Foundation case manager will provide a detailed description of the
event precipitating the need for continuous observation, including time
observation started, the individual observing, and any actions taken to
prevent the child from self-inflicted injury. The case manager will work with
the foster parent to complete the documentation.
E. The case manager will work with the child’s counselor or other professional
staff to properly assess the child’s need of continued observation.
F. If a psychiatric episode occurs and the foster parent did not contact The
Bair Foundation, the case manager will document the reason why and develop
a plan of action to ensure contact.
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Basic Medical Needs and Problems of
Service Population
The Bair Foundation staff and foster parents shall ensure that each child receives
a physician’s examination, including a screening for communicable diseases, within
30 days prior to admission, or medical or nurse’s screening within two working days
of entry into care, with a full examination by a physician within 30 days (unless
specified earlier by state regulations), a dental assessment within 30 days before
or after entering care for children ages 3 and older(un less specified earlier by
state regulgations), identification of medical needs and referral for services, an
assessment of the need for age-appropriate immunizations within 30 days and
hearing, vision, and lead-exposure screenings within 30 days.
The examination must include:
 A review of the child’s health history
 Comprehensive physical examination of the child
 Laboratory or diagnostic tests as indicated by examining physician,
including those required to detect communicable diseases
 Completion of the Medical Examination form
Ensure that each child receives a dental examination by a licensed dentist within
30 days of admission unless the child has had an examination within the previous 6
months and the results of the examination are available.
Arrange for immediate medical attention when a medical problem is recognized.
Ensure that each child has a medical examination every year and a dental
examination every 6 months, after initial appraisals. An Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) exam will count as an annual medical
examination.
EPSDT is a special health care program for persons under 21 years of age. EPSDT
physical examinations are a state regulation in PA, OH, OK and TX and must be
completed for children in care. Examinations are to be completed according to the
age of the child as follows:
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EPSDT Checkup Schedule for All States
Kentucky
Ohio
Oklahoma
Pennsylvania
New Mexico
Medical
1 month
2 months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
24 Months
3-6, 8 Every
year
10-20
annually
Medical
1 month
2 months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
24 Months
30 months
Annually after
age 3 through
20
Medical
Birth
2 months
4 months
6 months
9 months
12 months
15 months(opt)
18 months
24 months
3 – 5 Every
year
6 – 21 Every
other year
Medical
New Born
1 month
2-3 months
4-5 months
6-8 months
9-11 months
12 months
15 months
18 months
24 months
30 months
3-21 Every
year
Medical
Birth
2-4 days
1 month
2 months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
24 Months
30 months
Annually after
age 3 through
20
Dental
Start at age 3,
every six
months
thereafter
Dental
Start at age 3,
every six
months
thereafter
Dental
Start at age 3,
after that,
annually.
Dental
Start at age 3,
every six
months
thereafter
Dental
Start at age 3,
every six
months
thereafter
North
Carolina
Medical
Within 1
month
2 months
4 months
6 months
9 or 15
months
12 months
18 months
2-20 Every
Year
South
Carolina
Medical
Newborn
2-5 days
1 month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
3-21 annually
Texas
Virginia
Medical
New born
5 days
2 weeks
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
3 – 20
Annually
Medical
Newborn
1 month
2 month
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
3 – 20
annually
Dental
Start at age 3,
every six
months
thereafter
Dental
Start at age 3,
every six
months
thereafter
Dental
Start at 6
months, every
3-6 months as
recommended
Dental
Start at age 3,
every 6
months
thereafter
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The following is a list of problems that could be incurred during childhood or
adolescence. This list is not intended to be used in diagnosis of an illness but is to
be used to inform of potential problems with the service population we deal with.
For further information on medical needs or problems of children and adolescent
contact your case manager or primary care physician.
I.
What is Asthma?
It's a chronic disease that makes it hard to get air in and out of lungs during
asthma attacks. These attacks can be prevented, but not cured and sometimes
they can be fatal if they are very severe and not treated. More kids miss school
because of this disease than any other chronic one.
What are some warning signs of an asthma attack?
• coughing
• tightness in the chest
• feeling tired
• restlessness
• wheezing
What causes an attack?
Common triggers are:
Smoking
Aspirin and other medications
Dust and dust mites
Strong emotional responses (laughing, crying, etc.)
Pollen
Pets (the "dandruff' from their skin)
Stress
Roaches (their feces and dried body parts)
Breathing cold air/weather changes
Colds, respiratory infections
Mold, mildew
Playing sports, running
Perfumes, deodorants
Air pollution
Strong chemical smells (paint, cleaning fluids, etc.)
Second hand smoke is a BIG trigger (especially for kids)!
Signs/Symptoms of asthma:
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Coughing with or without a cold (This is often the first symptom that asthma isn't
under control)
Whistling, hissing or wheezing sounds in the chest
Feeling short of breath (easily winded)
A heavy or tight feeling in the chest
Waking up often during the night
Feeling tired
Trouble exhaling (breathing out used air trapped in lungs)
NOTE: Infants and children may not show the usual symptoms and instead you may
notice:
noisy breathing and congestion, or mucus, in the chest
constant or repeated coughing spells
they get tired more easily than other kids during playtime
they may stop their activities to prevent coughing or wheezing
II. Upper Respiratory Infections in Children
Upper respiratory infections, generally known as common colds, are very common in
young children. They are usually caused by viruses. Symptoms may include runny or
stuffy nose, sneezing, watery eyes, sore throat, cough and slight fever. Colds are
contagious, especially during the first 3 or 4 days. Since colds are caused by
viruses, they are not cured by antibiotics. Usually the symptoms clear up in a few
days but some children may be sick for a week or have a cough that lasts several
weeks.
To take care of your child's cold, remember:
Do not give aspirin to children under 16 years of age. The use of aspirin in children
during viral illness has been linked to a potentially fatal disease, Reyes Syndrome
Do not give over the counter cold medicines to infants without first talking to your
doctor. Many over the counter cold medicines are not that helpful.
Removing the mucus from your child's nose may make sleep and feedings easier.
Use a soft rubber bulb syringe to remove mucus. To loosen the mucus and make it
easier to suction, you can try either warm water or salt drops from the pharmacy.
Place three drops in each nostril before suctioning. Do one nostril at a time.
Use a cool mist humidifier to increase moisture in your child's environment. Do not
use steam humidifiers.
Give extra clear fluids.
Try to get your child to rest or do quiet activities.
Keep your child home from day care or school until the fever is gone, usually 2 or 3
days.
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Call your doctor if your child's fever lasts more than 36 hours, your child complains
of earaches or sore throat, develops rashes or if nasal discharge lasts more than
two weeks.
Come to the emergency room if your child has refused to drink fluids and has signs
of dehydration such as listlessness, no urination, no tears or if your child has
difficult, labored breathing.
III. What causes ear infections?
Ear infections are a common problem for many babies and young children. Most ear
infections occur when the child develops a cold and infection from the nose travels
up through the Eustachian tube, which is a direct passage from the nose to the
middle ear.
What are the symptoms?
If your child is old enough to talk, he or she will probably be irritable and complain
of an earache. Babies may keep pulling or rubbing their ears and cry in pain for long
periods of time. Fever is also a symptom of ear infection. If your child has these
symptoms, you should contact your doctor as quickly as possible.
How is it treated?
Typically, doctors prescribe antibiotic to battle the infection and aspirin
substitutes to reduce pain and fever. Aspirin should not be given to children under
the age of 16 without a doctor's recommendation due to the risk of Reye’s
Syndrome. In some children, the fluid in the middle ear does not drain away even
after the infection is gone. This can interfere with the child's hearing and lead to
recurring ear infections that can be severe. In these instances, doctors often
recommend an operation in which tiny, plastic tubes are inserted through the
eardrums to alleviate the pressure and allow the fluid to drain away. This simple
surgical procedure is performed by an ear specialist.
IV. What are learning disabilities (LD)?
If your child is not doing as well in school as they have the potential to, they may
have a learning disability. Having a learning disability means having a normal
intelligence but a problem in one or more areas of learning.
People with LD have brains that work and learn differently. Some people with LD
also have attention deficit hyperactivity disorder or ADHD. When LDs are not
found and treated early on, they tend to “snowball.” As kids get more and more
behind in school, they may become more and more frustrated, feeling like a failure.
Often self-esteem problems lead to bad behavior and other problems. It’s really
key to diagnose LD early, so kids can get the help they need to learn as well as they
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can. According to experts, about 6-10 percent of school-aged kids in the United
States has a learning disablility.
V.
What are the "early warning signs" of learning disabilities?
Children with learning disabilities exhibit a wide range of symptoms. These include
problems with reading, mathematics, comprehension, writing, spoken language, or
reasoning abilities. Hyperactivity, inattention and perceptual coordination may also
be associated with learning disabilities but are not learning disabilities themselves.
The primary characteristic of a learning disability is a significant difference
between a child's achievement in some areas and his or her overall intelligence.
Learning disabilities typically affect five general areas:
1. Spoken language: delays, disorders, and deviations in listening and speaking.
2. Written language: difficulties with reading, writing and spelling.
3. Arithmetic: difficulty in performing arithmetic operations or in
understanding basic concepts.
4. Reasoning: difficulty in organizing and integrating thoughts.
5. Memory: difficulty in remembering information and instructions.
What causes learning disabilities?
Because there are lots of kinds of learning disabilities, it is hard to diagnose them
and pinpoint the causes. LDs seem to be caused by the brain, but the exact causes
are not known. Some risk factors are:
Heredity
Low birth weight, prematurity, birth trauma or distress
Stress before or after birth
Treatment for cancer or leukemia
Central nervous system infections
Severe head injuries
Chronic medical illnesses, like diabetes or asthma
Poor nutrition
LDs are not caused by environmental factors, like cultural differences, or bad
teaching.
When your child is diagnosed with a LD, the most important thing is not to look
back and try to figure out if something went wrong. Instead, think about moving
forward and finding help.
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VI. What is Measles?
Measles is a highly contagious viral disease that mainly affects children, but can
occur at any age. Thanks to immunization, the illness occurs much less often than in
the past when epidemics were common.
What are the symptoms of measles?
The early symptoms may resemble a bad cold. A child with measles may run a fever,
feel weak, and develop a dry cough, sore throat, and runny nose. The eyes may
become red, itchy and sensitive to light, and little white spots appear inside the
mouth and eyelids. Then within three or four days, a red rash appears, occurring
first behind the ears, on the hairline, neck, and face, then spreads to the trunk
and limbs, affecting the entire body within about 24 hours. It usually takes eight
to 12 days to come down with symptoms after being exposed to measles. Call a
physician at the first sign of measles, and again if complications develop such as an
ear or chest infection, lethargy, headache, vomiting, breathing difficulties, a
convulsion, or bleeding from the nose, mouth, rectum or under the skin.
When should a child be immunized against measles?
It is important to be immunized against measles. The first vaccination should be
given at around 15 months of age. A second shot to boost immunity should be given
between the ages of 11 and 12 to those who have not had measles.
VII. What is mumps?
Mumps is primarily a childhood illness that is caused by a virus. The chief sign of
mumps is swollen, painful salivary glands, especially directly behind and below the
ears.
What are the symptoms of mumps?
Symptoms usually start out resembling the flu with a fever, headache and muscle
aches. Then within a couple of days the swelling typically appears. It often begins
on one side, but can spread to the other side or to other salivary glands. It takes a
week or 10 days for the swelling to recede. To help relieve the discomfort, an
aspirin substitute can be used for pain and fever and plenty of liquids should be
given. Mumps is contagious from about two days before the symptoms appear until
the swelling is gone.
When should a child be immunized for the mumps?
The mumps vaccine, which is effective at preventing mumps in most children, is
given at the age of 15 months, followed by a booster between the ages of 11 and 12
in those who have not yet had mumps. Be sure to call the doctor if a person with
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mumps is lethargic or if they have convulsions, develop a stiff neck, swollen
testicles, abdominal pain, vomiting, dizziness or difficulty hearing.
VIII. What causes a viral infection?
Consider these symptoms: runny noses, headaches, muscle aches, fever, cough,
croup, nausea, vomiting and abdominal cramps. What do they have in common? They
are all usually caused by a virus. Virus germs are behind virtually all colds and most
run-of-the-mill cases of flu. But occasionally, there can be a bacteria-based
infection like an ear infection, sinus infection, tonsillitis or bacterial pneumonia.
Sometimes a bacterial infection develops after a child's resistance has been
lowered by a viral infection, and sometimes they occur on their own.
Why is it important to understand the difference between a viral and
bacterial infection?
Because giving a child penicillin or another antibiotic for a viral infection is a
potentially-harmful waste of time and money. On the other hand, bacterial
infections can, and should, be treated with antibiotics. So here are some clues: In a
child with a cold or cough, suspect a bacterial infection if a fever recurs after the
first few days or the runny nose or coughed-up matter is yellow or green. If a child
has an earache, suspect a bacteria-based ear infection. In a child with a sore
throat, it takes a throat culture to determine if it is bacterial - to determine if it
is strep throat. In all these cases, consult with the child's physician the same day.
But if a sick child starts breathing rapidly, drools, has swallowing difficulties, or is
markedly irritable or lethargic, you should call the physician right away.
IX. What is whooping cough?
Pertussis (pur-TUSS-iss), or whooping cough, is a contagious respiratory disease
that primarily affects infants and young children and can be fatal if it is not
diagnosed and treated.
What are the symptoms of whooping cough?
Symptoms usually resemble a cold including fever, sneezing, runny nose, watery
eyes, fatigue, loss of appetite and a mild cough. After one to three weeks, the
cough usually becomes more severe. It is after these long coughing spells that the
child makes a high-pitched "whooping" sound as they gasp for air. These spells may
also cause the child to vomit. If you think your child may have whooping cough, it is
important to have your doctor examine them because complications can include
dehydration and pneumonia.
How is whooping cough treated?
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You will be advised of the proper treatment and medication may be prescribed. The
disease can last up to 10 weeks. During this time, your child should drink plenty of
fluids, eat frequent, small meals, rest and stay warm and avoid irritants that make
them cough such as cigarette smoke.
X.
When do children outgrow wetting the bed?
Bed wetting is something almost all children outgrow by the time they reach
puberty. However, the rate at which they outgrow it varies greatly with boys
usually being a little behind girls. Sometimes stress such as the arrival of new
sibling or a divorce can cause a child to begin wetting the bed again. In children
who mature slower than other children their age, bed wetting can be very
frustrating and humiliating.
What should a parent do if a child wets the bed?
If your child wets the bed, never scold or embarrass them. If they feel anxious or
nervous, the problem may take longer to outgrow. Try to handle the situation as
inconspicuously as possible. Cover their mattress with a waterproof material and
use bedding that is washable. Once your child is six years old, some experts
recommend withholding drinking fluids around three hours before bedtime and
making sure the bathroom is used just before going to bed. Some professionals
also advise using a special alarm that is placed over the mattress and rings as soon
as it senses moisture. This wakes the child and serves as a reminder to use the
bathroom. If these methods fail, consult your doctor to make sure there is nothing
medically wrong. Remember, what your child needs most is your patience and
reassurance.
XI. What are Head Lice?
Head lice are tiny, light brown insects that have claws at the end of their legs.
They bite the scalp and lay their eggs, called nits, in the hair. Anyone can get lice
even with good health habits and frequent hair washing.
Is it contagious?
Lice can spread quickly by close contact with someone who has lice or by sharing
hats, scarves, combs, brushes, towels or bedding with an infected person.
Outbreaks of head lice sometimes occur in schools and day care centers.
What are the symptoms?
You may notice that the scalp itches and has a rash. Lice are difficult to see, but
the nits are white, very numerous and look like dandruff. Unlike dandruff, nits are
attached so tightly to the hair, that they cannot be shaken off or removed with
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normal washing. They are most easily seen above the ears and at the back of the
neck.
How is it treated?
If you suspect a member of your family has lice, please call your health care
provider for treatment. Your doctor will prescribe an anti-lice shampoo or creme
rinse for home treatment. With treatment, all lice and nits will be killed. Notify
the school or day care of the lice infection so other children and items that
children share can be checked. Children can usually return to school after one
treatment with the shampoo.
Check the heads of everyone else living in your home. All household members over
the age of two, who are not pregnant, should be treated with the anti-lice shampoo
or rinse even if lice and nits are not seen. Wash clothing, toys, bed linens, combs,
brushes and towels in hot water. Items that cannot be washed in hot water should
be placed in a plastic bag for seven days or at a freezing temperature for 24
hours. Furniture and rugs, where an infected person usually rests his head and
which cannot be washed in hot water, bagged or frozen, may be sprayed with RID
spray and then vacuumed once daily for a week.
If, after initial treatment, the itching interferes with sleep, the rash is not clear
by one week, the rash clears and then returns, new eggs appear in the hair, or if
the sores start to spread or look infected, call your health care provider.
XII. What is Acne?
Acne is a skin condition that can cause pimples, blackheads and cysts to develop on
the face, chest, neck, shoulders or back. When dirt and oil accumulates in a hair
follicle or oil gland, it clogs the pore. This is a perfect environment for bacteria to
grow, irritating the surrounding skin and causing the area to break-out.
How common is it?
Most teenagers have problems with acne. For some, the problem quickly clears up
on its own but for most it lasts about 10 years. It is not unusual however, for
women in their mid-20's or mid-30's to experience acne for the first time.
What causes Acne?
No one knows what causes acne, but certain things seem to aggravate it, including
stress. Diet has not been proven as a factor, but some people are affected by
certain foods.
How is it treated?
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If you have a problem with acne, avoid oil-based cosmetics. Wash your face gently
with a warm wash cloth using a mild soap and keep your hair clean. Do not pick at
your face. It can cause scarring. There are many over-the-counter products that
can help prevent and clear-up acne. Products with benzoyl peroxide help keep the
pores from clogging and kill some bacteria that cause pimples. It may take 4-8
weeks to see an improvement so do not get discouraged. If you still are not
satisfied with the results, talk with your doctor.
XIII. Anorexia: What is It?
Anorexia nervosa is an eating disorder, typically affecting adolescent girls, in
which the desire for thinness leads to voluntary starvation. People with this
disorder believe themselves to be overweight, even though they may be extremely
thin. They find food repulsive and refuse to eat, losing excessive amounts of
weight and endangering their health. If untreated, the condition can lead to death.
There are many factors that contribute to the development of anorexia. Experts
say that they key issue in anorexia nervosa is not food, but is more directly related
to the person's desire for attention or approval. It is usually associated with some
type of emotional stress or conflict, such as poor self-esteem or family problems.
Anorexics may develop rituals for eating and exercising, their hands and feet may
be cold and females may have irregular menstrual periods. As their bodies weaken,
anorexics increasingly deny that a problem exists. If signs of this condition are
noticed, a physician should be consulted. Treatment is most effective shortly
after the symptoms appear.
XIV. Bulimia: What is It?
Bulimia nervosa, sometimes called the binge/purge syndrome, is an eating disorder
in which a person eats compulsively and then eliminates the food by self-induced
vomiting. Sometimes bulimics purge by abusing laxatives, fasting or exercising to
quickly burn calories. The condition most often affects adolescent girls and young
women, and usually starts with a diet, which leads to cravings for sweet, starchy,
and fatty foods. If the person gives in, an eating rampage may result, followed by
purging to avoid weight gain. People who develop this binge/purge pattern tend to
be perfectionists who strive to please others. They may have low self-esteem and
be embarrassed about their food behaviors and terrified of discovery. If
untreated, bulimia can cause serious health problems and, in some cases, may be
life-threatening. Anyone with symptoms of bulimia should see a doctor. With
therapy, the condition can be cured.
XV.
What is depression?
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Everybody gets the blues now and then - but for millions of Americans, depressive
illnesses are more serious than that. They are persistent, recurring conditions that
can interfere with a person's ability to sleep, eat, and hold a job and can last for
weeks or months at a time. Major depression is a very common and serious medical
illness. Often, depression run in families. Depressed people have unusual brain
chemistry patterns. Major depression is often precipitated by a major life event
(divorce, stressful job, death of a loved one). Serious depression may however
occur even in the absence of any significant life stress. Depression is very
responsive to treatment. Most people will feel markedly improved within 6-8 weeks
of treatment.
Another form of the disorder is manic-depression in which a person swings
between excessive euphoria and depression.
What causes depression?
The exact cause of depression is not known. Changes in mood characterized by
feelings of sadness, hopelessness, and worthlessness may be associated with:
a major depressive disorder or a chronic, milder depressive disorder
a complication of another psychiatric disease or medical illness
a reaction to a medication or drug
use of alcohol, amphetamines, cocaine, or LSD.
Some people have a greater risk of depression, such as those who:
have obsessive-compulsive or have a family history of anxiety or depression.
What are the symptoms?
The symptoms of major depression include a significant degree of one of the two
following symptoms for more than 2 weeks:
feeling sad or blue (may include crying spells, anxiety, agitation, irritability) every
day.
loss of interest or pleasure in usual activities.
In addition, major depression involves a significant degree of at least four of the
following symptoms:
poor appetite and significant weight loss, or increased appetite and significant
weight gain
inability to sleep (insomnia), increase in time spent sleeping (hypersomnia), or
difficulty sleeping soundly
fatigue, loss of energy
increased physical activity (agitation) and restlessness
decreased sex drive
feelings of self-reproach or inappropriate guilt/feelings of hopelessness or
helplessness
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difficulty in thinking clearly or concentrating
memory difficulties
thoughts of death or suicide.
People suffering from depression may have recurring, unexplained pain in certain
parts of their bodies. Depressed people have difficulty in maintaining normal
relationships with other people.
Poison Information
HOUSEHOLD POISON SAFETY
Kitchen
Keep all products in their original containers and out of reach of children.
Install child safety latches on all drawers or cabinets containing harmful
products. Store harmful products away from food.
Keep emergency phone numbers near the phone. Place the Poison Center
sticker on your phone. Also, make your name, address and phone number
available in case a babysitter or friend has to call.
Bathroom
Keep medicines in original containers with child-resistant caps.
Regularly clean out the medicine chest.
Keep medicines, sprays, cosmetics, fingernail preparations, hair care
products, etc., out of reach of children.
Install child safety latches on all drawers or cabinets containing harmful
products.
Garage
Keep all products in their original containers.
Lock up all harmful products and keep out of reach of children.
Keep original labels on all containers.
OCCUPATIONAL HAZARDS
Be aware of any chemicals around your workplace and safety precautions
needed when working with them.
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Make sure you know the safety procedures for your work site and what to do
in the event of an emergency. Also, know the location of the MSDS (Material
Safety Data Sheets).
Always wear the proper safety equipment when necessary on the job site
and follow instructions for wash-up.
MEDICATIONS
Always read labels.
Do not borrow or loan prescribed medicines.
Throw out old or expired medications by flushing medicines down the toilet.
Keep your doctor informed of prescription and non-prescription medicines
you are taking.
Check with your pharmacist or physician if you are taking two or more
medications at the same time. Call the poison center if you still have
questions.
Never take more than the prescribed amount of any medication.
Use child-resistant containers in your purse and keep medicines in locked
cabinets at home.
Always store medicines in their original containers.
Never refer to medicine as candy and avoid taking medicine in the presence
of children.
PESTICIDES
Use gloves, protective clothing and eyeware to prevent skin and eye
exposures.
Store pesticides in their original containers and away from food or drinks.
Read and follow directions and warnings before using a product.
Never mix different products or chemicals.
Remember that using twice the amount of chemical needed does not mean
that you will gain twice the benefit.
Dispose of toxic chemicals properly by contacting the Department of Health
in your state.
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Emergency Actions for Pesticide Poisoning:
Poison on the Skin: Remove contaminated clothing and flood skin with water
for 10 minutes. Then gently wash with soap and water and rinse. If at all
possible, have the container or label with the ingredients listed while making
the call.
Chemical Burns on the Skin: Remove contaminated clothing and flood skin
with water. Avoid using ointments, greases, powders, and other drugs in first
aid treatment of burns. Keep area as clean as possible.
Poison in the Eye: Flood eye with lukewarm (not hot) water poured from a
large, clean glass 2 or 3 inches from the eye. Repeat for 15 minutes. Have
patient blink as much as possible while flooding the eye.
Inhaled Poisons (dusts, vapors, gases): Immediately get the person to
fresh air. Avoid breathing fumes. Open doors and windows wide. If victim is
not breathing, begin artificial respiration and call 911.
Swallowed Poisons:
MEDICINES: Do not give anything by mouth until you have called for
professional advice.
CHEMICALS or HOUSEHOLD PRODUCTS: Unless the patient is unconscious,
having convulsions, or cannot swallow, give milk or water immediately, then
call for professional advice.
Insect Bites/Stings: Remove stinger. Apply meat tenderizer or baking soda
paste to site. Use ice packs as needed for swelling. If patient develops
breathing problems, itching, nasal congestion, wheezing or swelling around
the lips or tongue, go to the nearest emergency room or call 911.
After following the above emergency actions, immediately call the Poison
Center.
PLANTS
Know the plants in your area, yard and home. Label pots with the common and
botanical names.
Keep plants, seeds, fruits and bulbs stored safely away from children and
pets. Remember Christmas plants such as mistletoe and holly may be
dangerous.
Teach children at an early age to keep plants out of their mouths. Make
them aware of poisonous plants.
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Do not allow children to suck on flowers or make "tea" from leaves.
Do not eat wild plants, especially mushrooms. Heating and cooking do not
always destroy the toxic components.
Do not make homemade medicines, shampoos, lotions or teas from plants. Be
careful of herbal health store remedies.
Avoid smoke from burning plants. Do not smoke health store "non-tobacco"
cigarettes.
Remember, a leaf can block an infant's airway. Do not allow small children to
play in areas where plants and grasses are high.
Never chew on jewelry made from seeds, beans, or grasses from plants.
Learn to identify plants that may cause a rash, such as poison ivy or poison
oak.
Do not make toys or whistles from unknown flowers or trees.
Emergency Actions for Plant Poisoning:
Mouth: Remove any remaining portion of the plant, berry, or mushroom. Save
and preserve a piece of the plant or mushroom, in a dry container (jar or
box) to bring in for identification. Have the patient wash mouth out with
water. Check for any irritation, swelling or discoloration.
Skin: A few plants may cause irritation, itching and/or a rash to the skin. To
prevent further irritation, remove contaminated clothing. Wash skin gently
with soap and water and rinse.
Eyes: Wash hands with soap and water to avoid further irritation to the eye.
Rinse eye well with lukewarm (not hot) water for 10-15 minutes. Standing in a
cool shower to wash eyes out is an easy way to rinse the eye.
All direct service providers will receive additional training in poisons when
you complete First Aid Training.
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Medication Administration
I.
Introduction
II.
Medication related issues
III.
Categories of medications and effects of medications
IV.
Observing and reporting
V.
Obtaining medications
VI.
Administering medications
VII.
Documentation, storage and disposal
I.
Introduction:
Medication administration is a serious responsibility for those who care
for foster children requiring ongoing medication therapy. The intention
of this training is to give the foster parents and staff the basic
knowledge of medications, reactions, principles of administration, storage
and disposal of medications.
II.
Medication Related Issues;
In 1970 the Comprehensive Drug Abuse Prevention and Control Act
established rules for narcotic, depressants, stimulants and hallucinogens
(controlled substances). You as an employee or foster parent for The
Bair Foundation are responsible to adhere to the policies and procedures
governing the administration of medications. You are authorized to
administer medications only under the direction of a licensed physician.
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All medications must be securely locked and only those authorized
individuals should have access to those substances.
There are criminal penalties for the misuse of controlled substances.
When a child receives medication at two different sites (home and
school), a separate labeled prescription bottle will be obtained from the
pharmacy for use at each site.
When medications are taken to school, document on the backside of the
medication log form, the date, the number of pills and to whom they were
given. On the medication log, put an S in the box when the child is at
school receiving the medication.
When medication is prescribed and administered to by staff or foster
parents, informed consent is received at time of admission and
throughout the ISP process where medications are reviewed quarterly.
III.
Categories of Medications and Effects of Medications:
Categories of Medications:
There a two types of categories of medications; prescription and over
the counter medications. It is important to note that when dealing with
children on multiple medications that not all over the counter medications
are recommended to be given to individuals on certain meds. When
individuals are receiving prescription medication, administration of overthe-counter medications should be done in consultation with a qualified
medical professional to identify possible adverse interaction of
medications.
Consult with the child’s physician on which over the counter medications
are recommended for your foster child.
Effects of Medications:
As with any medication given, there could be side effects or interactions
that could occur. When obtaining the prescription, familiarize yourself
with the information given by the pharmacist. It will be important to
note as you observe the child as to the effect the medication is having on
them.
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There are three types of effects of medications, desired effect,
adverse effect or no effect.
Desired effect: The medication accomplished what it was designed
for. The child got better.
Adverse effect: This would be what we would classify as a side
effect. That the medication affected the individual in an adverse or
opposite way.
No effect: The medication had no effect on the condition of the
child. The child stayed the same.
Some common psychotropic medications given to child are:
- Methylphenidate (Ritalin)- side effect- nervousness, agitation,
anxiety, insomnia, loss of appetite, nausea, vomiting, dizziness,
palpitations, headache, increased heart rate, increased blood
pressure, and psychosis
- Sertraline (Zoloft)- side effect- dizzy or drowsy, anxiety, panic
attacks, trouble sleeping, skin rash or hives; difficulty breathing;
swelling of your face, lips, tongue, or throat.
- Amphetamine Salts (Adderall)- side effects- fast, pounding, or
uneven heartbeats;feeling light-headed, fainting;increased blood
pressure (severe headache, blurred vision, trouble concentrating,
chest pain, numbness, seizure)
- Geodon- side effects- hives; difficulty breathing; swelling of your
face, lips, tongue, or throat, dizziness, feeling light-headed, fainting,
fast or pounding heartbeat; fever, stiff muscles, confusion, sweating,
fast or uneven heartbeats; fever, chills, body aches, flu symptoms;
white patches or sores inside your mouth or on your lips; tremor
(uncontrolled shaking), restless muscle.
- Straterra- side effects-chest pain, shortness of breath, fast or
uneven heartbeats;feeling like you might pass out; unusual thoughts or
behavior, aggression, hallucinations (seeing things that are not there);
nausea, pain in your upper stomach, itching, loss of appetite, dark
urine, clay-colored stools, jaundice
- Vyvnase- side effects- fast, pounding, or uneven heartbeats;
decreased blood pressure (feeling light-headed, fainting); tremor,
restlessness, hallucinations, unusual behavior, or motor tics (muscle
twitches); or dangerously high blood pressure (severe headache,
blurred vision, buzzing in your ears, anxiety,...
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- Concerta- side effects- fast, pounding, or uneven heartbeats;
feeling like you might pass out; fever, sore throat, and headache with
a severe blistering, peeling, and red skin rash; aggression,
restlessness, hallucinations, unusual behavior, or motor tics (muscle
twitches); easy bruising
- Risperidone (Risperdal)- side effects-fever, stiff muscles, confusion,
sweating, fast or uneven heartbeats; restless muscle movements in
your eyes, tongue, jaw, or neck; drooling, tremor (uncontrolled
shaking); seizure (convulsions); fever, chills, body aches, flu
- Olanzapine (Zyprexa)- side effects-very stiff (rigid) muscles, high
fever, tremors, sweating, confusion, fast or uneven heartbeats, slow
heart rate, feeling like you might pass out; twitching or uncontrollable
movements of your eyes, lips, tongue, face, arms, or legs; trouble
speaking or swallowing; dry mouth
- Fluoxitine (Prozac)- side effects- mood or behavior changes, anxiety,
panic attacks, trouble sleeping, or if you feel impulsive, irritable,
agitated, hostile, aggressive, restless, hyperactive (mentally or
physically), more depressed, or have thoughts about suicide or hurting
yourself. skin rash or hives; difficulty breathing; swelling of your face,
lips, tongue, or throat
- Oxcarbazine (Trileptal)- side effects- Oxcarbazepine can reduce
the sodium in your body to dangerously low levels, which can cause a
life-threatening electrolyte imbalance. Contact your doctor right away
if you have headache, trouble concentrating, memory problems,
weakness, loss of appetite, feeling unsteady, confusion, hallucinations,
fainting, shallow breathing, and/or increased or more severe seizures.
hives; difficulty breathing; swelling of your face, lips, tongue, or
throat.
- Abilify- side effects- fever, stiff muscles, confusion, sweating, fast
or uneven heartbeats; jerky muscle movements you cannot control;
sudden numbness or weakness, headache, confusion, or problems with
vision, speech, or balance; fever, chills, body aches, flu symptoms,
sores in your mouth, hives; difficulty breathing; swelling of your face,
lips, tongue, or throat.
IV.
Observing and reporting:
As with all medications given, the intent is to have a desired effect from
taking the drug. In all cases, this does not happen. At times, there is no
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change or the individual may even have an adverse reaction to the
medication. It is up to the foster parent or staff who administered the
medication, to observe the child for signs how the medication has
affected them. If there is no change or an adverse reaction, the child’s
physician needs to be notified, the instructions followed and the incident
documented on the medication log.
Foster parents or staff are required to make every effort to notify all
medical personnel about any medications the child is currently taking and
any changes in medication.
V.
Obtaining Medications:
Should the physician dispense medication samples to the foster child, a
prescription must accompany the samples. It is prohibited to administer
sample medications without a prescription.
When returning from the pharmacy with a prescription, fill in the
medication log with all the information taken from the prescription
bottle. Count the number of pills to ensure accuracy. If there is a
discrepancy in the number of pills in the bottle, note on the medication
log and notify the pharmacy.
VI.
Administering Medications:
Children in your care may be required to take medications. At times it
may only be one medication for an occasional illness or for many, multiple
types of medications for chronic conditions. It is imperative that foster
parents and staff be aware of following the physician’s instructions.
All medications must be administered by an adult.
All medications are to be given according to the instructions on the label.
Prescriptions must be in original container with pharmacy label.
Hand washing is the most important and basic technique in preventing and
controlling the transmission of germs. It is very important that prior to
administering any medications that proper hand washing take place.
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Should medication be accidentally dropped or contaminated, make a note
on the back of the medication log.
When administering medication use the bottle cap or paper cup to shake
out pills and return the excess to the bottle should there be any.
The Five Rights of Medication Administration:
Make sure you have the right person. The one the prescription was
ordered for. It is illegal to give one child’s prescription medication to
someone else.
Make sure you have the right medication. Check the medication bottle
label against the medication log to ensure accuracy. Be sure they match.
Make sure you have the right dose. Double-check the amount of
medication before administering. Be sure it is the right dosage the
doctor prescribed.
Make sure it is the right time. Medication is to be given in compliance
with the physicians order. If the prescription says to be given at noon,
then it is to be given at noon or within one half hour before or after the
scheduled time.
Make sure it is the right route. Is it the proper way to give the
medication.
In regard to insulin dependent diabetics or those requiring medications
that are injected, each foster parent or staff that is required to give
injections will receive additional training by a certified medical
professional. Administration of injection medications (insulin, vitamins)
will be under the authorization and close supervision of the physician
prescribing the medication to the child.
Regulations in some states require the destruction of used insulin
syringes and needles. Recapping, bending or breaking a needle increases
the risk of needle-stick injury so it is not recommended. Unless the
syringe will be reused, it should be placed in a puncture-resistant disposal
container or needle-clipping device, which retains the clipped needle in an
inaccessible compartment. In areas with container-recycling programs,
placement of containers of used syringes, needles, and lancets with
materials to be recycled is prohibited. Local trash-disposal authorities
should be consulted to determine the appropriate disposition of such
containers. The likelihood of reuse of a syringe by another person is
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decreased if the plunger is separated from the barrel at the time of
disposal.
If you have any questions regarding the disposal of injection supplies
contact your physician for further instruction.
VII.
Documentation, Storage and Disposal of Medications:
When administering medication the individual who has given the
medication must sign off on the medication log, by initialing in the box
that corresponds to the medication and time, immediately after giving
the medication. All medication must be kept locked and out of reach of
children.
Refrigerated medications must be kept in a locked container separate
from food.
Every prescription medication must be written on the medication log with
times the med is to be given, date, dosage and person administering
medicine.
When medications are taken to school, document on the backside of the
medication log form, the date, the number of pills and to whom they were
given. On the medication log, put an S in the box when the child is at
school receiving the medication.
When a medication is contaminated or discontinued, the foster parent
along with the casemanager on the next home visit will dispose of in a
safe manner, i.e. flushing down toilet or sink. The name of the medication
and number destroyed will then is documented on the back of the
medication log sheet with both foster parent and casemanager initials.
When completing the medication log, make sure that it is completed in its
entirety.
Make sure that who ever administers medications signs the back of the
log along with their initials. Document any alterations in medication
regime on the backside giving an explanation as to why it occurred.
VIII.
Protocols for the administration and storage of prescribed and
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over the counter medications includes:
a. The Bair Foundation utilizes medications for children that are prescribed
by a licensed physician or psychiatrist and are FDA approved.
Medications that have abuse potential are identified in the child’s service
plan.
b. All states must have and utilize medication logs, which record the child’s
name, the time and what medication was received.
c. Any alterations from the child’s medication administration schedule as
prescribed by the physician will be documented on the medication log.
d. Medications are stored in a locked storage container. In South Carolina,
medications are to be stored in a doubled locked location.
e. The Bair Foundation Foster parents will adhere to all prescription
recommendations provided by the pharmacist as it pertains to over the
counter medications.
New Mexico Medication Training Addendum
Medications are administered only by qualified, licensed medical staff, or are selfadministered by the client with supervision of staff/foster parents who have been
trained in assisting with self-administration.
Policies and procedure support self-administration of medication. Staff/foster
parents trained in these procedures provide supervision of self-administration of
medications and document the time the medications are taken, the side effect
observed, and client response, as well as any medication refused or held. When
medications are self-administered by clients, a staff member/foster parent may
hold the container for the client and/or assist with opening the container, but may
not place the medication in the client’s hand or mouth. Put the medication in a cup
or on a plate for the client to take. Do not give them the bottle itself.
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Legal and Judicial Issues that Could Influence Service Delivery
Class action suits have been used to bring about reform in state and local child
welfare systems. As of 1996, class actions suites were filed in 31 states. Most of
the grounds for the lawsuits were noncompliance with family preservation
requirements.
Consent decrees outline the necessary changes that need to be made, who was
responsible and on what time schedule it was to be done. Although the consent
decrees were intended to produce positive effects often it resulted in lower staff
morale due to increased paperwork.
We as a child welfare agency are governed by these laws. We adhere to the
regulations of the Multiethnic Placement Act which mandates:
1.
It prohibits states and other entities that are involved in foster care or
adoption placement and that receive federal financial assistance under title IV-E,
title IV-B , or any other federal program, from delaying or denying a child’s foster
care or adoptive placement on the basis of the child’s or the prospective parent’s
race, color or national origin;
2.
It prohibits these states and entities from denying to any individual the
opportunity to become a foster or adoptive parent on the basis of the prospective
parent’s or the child’s race, color, or national origin;
3.
It requires that, to remain eligible for federal assistance for their child
welfare programs, states must diligently recruit foster and adoptive parents who
reflect the racial and ethnic diversity of the child in the state who need foster
and adoptive homes.
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TBF
Emergency and Safety Plan
1.
INTRODUCTION
Purpose
Levels of Emergencies
Plan Implementation
2.
PLANNING
Staff Orientation and Training
Drills
Evacuations
Supplies and Equipment
Emergency Lists
3.
COMMUNICATIONS
Off-site personnel safety
4.
EMERGENCY PREPAREDNESS PROCEDURES
Fire
Loss of Utilities
Medical Emergencies
Severe Thunderstorms
Severe Winter Storms
Tornadoes
Dealing with a potentially violent situation
 Telephone Threat
 For an angry or hostile visitor or coworker
 For a person shouting, swearing, and threatening
 For someone threatening you with a gun, knife or other weapon
5.
RESPONSIBILITIES
Employees
Caregivers
Consumers
6.
SAFETY
General
Department
Facility
7.
PERSONAL PREPAREDNESS
8.
REPORTING FORMS
 Attachment 1
 Attachment 2
Safety Report
Safety Checklist
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I. INTRODUCTION:
A. PURPOSE: This plan is designed to assist you in knowing some
preliminary information necessary in dealing with an emergency
situation as well as describe the responsibilities of staff members and
caregivers for a wide range of emergency and disaster situations. It
is prepared with input from disaster relief services and American Red
Cross instructions for emergency situations.
B. LEVELS OF EMERGENCIES: There are various levels of
emergencies: Local emergencies that TBF personnel can handle by
following procedures on their own emergency plan. Examples: power
outage, minor earthquake. A moderate to severe emergency requires
mutual aid assistance from the fire department, police, emergency
care services. Example: fire, tornado, hurricane, flood. The next is a
major disaster, which encompasses the response capabilities of large
amounts of aid, recovery time is extensive and the response time from
major support agencies may be seriously delayed or impaired.
C. PLAN IMPLEMENTATION: The Emergency and Safety Plan will be
implemented by all staff and caregivers at the time of the emergency.
It will be reviewed annually to encompass the necessary components
for education and training. The Disaster Preparedness Plan will be
implemented by all staff at the time of a disaster and will be reviewed
annually. Foster Parent Disaster Preparedness Plan will be reviewed at
recertification or when major changes have occurred such as
residential move or change in occupants(those having responsibilities
identified in the plan).
II.
PLANNING
STAFF ORIENTATION AND TRAINING
All agency staff and caregivers will be oriented to the Emergency and
Safety Plan, which includes the Disaster Preparedness Plan and will be
updated when revisions are made.
DRILLS:
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Fire Drills will be conducted according to COA and/or licensing
regulations of each state/program, and will occur biannually or more
often as indicated by licensing.
EVACUATIONS:
Evacuations will take place every fire drill. Evacuation routes will be
posted in all TBF buildings and offices.
SUPPLIES AND EQUIPMENT:
Emergency First Aid Kits are kept in all offices and foster homes.
EMERGENCY LISTS:
Numbers of emergency personnel in the community are available at
each office. There is also numbers available for cell phones and
pagers should the communication system be temporarily altered.
III. COMMUNICATIONS:
During an emergency, telephones and cell phones will only be used to
report emergency conditions or to request emergency assistance.
A. Off-site personnel safety:
All personnel that work off-site (in the field) have cell phone access
for emergency purposes. Case managers are required to sign out at
the main office prior to their out of office meeting and document
where they will be able to be reached.
Each employee is trained in areas of emergency response practices
including the ability to assess risk and safety of persons served and
techniques for handling emergencies and appropriate coordination with
mental health, law enforcement and other professionals. Training is
also received in risk management strategies to protect themselves,
persons served and the organization.
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All program personnel are trained on the following techniques:
techniques for deescalating conflict; personnel safety measures;
management of aggressive or out of control behavior and protocols for
notifying family members or other contacts in case of emergencies.
IV.
DISASTER PREPAREDNESS PROCEDURES:
A. Fires:
In the event a fire, all employees, caregivers, consumers, families
within the building will evacuate to a predetermined location, which is
far enough away from the building to ensure safety. Emergency
personnel will be contacted via calling 911 or the emergency number
for local fire department in your area. Procedures will be followed
according to your Disaster Preparedness Plan.
B. Loss of Utilities:
Should there be a loss of utility within The Bair Foundation facilities,
the utility company will be notified to determine the length of outage
for that office. The supervisor/director will notify the national
office with this information and the CEO or their representative will
determine the course of action.
C. Medical Emergencies:
All program staff and caregivers are trained in CPR
and First Aid procedures as part of post hire
requirements. In the event of a medical emergency, the ABC’s of CPR
will be instituted and all efforts will be made to give immediate
medical attention until trained emergency response personnel arrive.
In the event of serious injuries, accidents or illness, do not move the
seriously injured or ill person unless it is a life-threatening situation.
Call 911 or your local emergency number giving your name, location and
telephone number. Give as much information as possible regarding the
nature of the injury or illness, whether or not the victim is conscious,
etc.
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Return to the victim and attempt to keep him/her calm and as
comfortable as possible. Do not move the victim unless necessary to
prevent further injury. Be alert to any jewelry with an inscription
indicating a medical condition…(for example: epilepsy, diabetes, heart
condition, allergies) or other medical conditions. Notify the EMS
personnel if you find any identification of this sort. First aid should
only be given to the victim by a trained person.
D. Severe Thunder Storms:
Some helpful information:
Before Lightning strikes…..
 Keep an eye on the sky. Look for darkening skies, flashes of
light, or increasing wind, Listen for the sound of thunder.
 If you can hear thunder, you are close enough to the storm to
be struck by lightning. Go to safe shelter immediately.
 Listen to your local station on the radio for latest weather
forecasts.
When the storm approaches…
 Find shelter in a building or car.
 Telephone lines and mental pipes can conduct electricity.
Unplug appliances. Avoid using the telephone or any electrical
appliances.
 Avoid taking a bath or shower, or running water for any other
purposes.
 Turn off the air conditioner. Power surges from lightning can
overload the compressor, resulting in a costly repair.
 Draw blinds or shades over windows. If windows break due to
objects blown by the wind, the shades will prevent the glass
from shattering into your home or building.
E. Severe Winter Storms:
Prepare a Winter Storm Plan…
 Have extra blankets on hand
 Ensure that each member of your household has a warm coat,
gloves or mittens, hat, and water resistant boots.
Assemble a Disaster Supply Kit containing…
 First aid materials
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Battery-powered radio, flashlight and extra batteries
Canned food and opener
Bottled water (at least one gallon per person per day to last at
least 3 days)
 Extra warm clothing, including boots, mittens and hat.
 Assemble a Disaster Supply Kit for your car.
 Have your car winterized before the winter storm season.
Know what winter storm watches and warnings mean…
 A winter storm watch means a winter storm is possible in your
area.
 A winter storm warning means a winter storm is headed for
your area.
 A blizzard warning means strong winds, blinding wind-driven
snow, and dangerous wind chill is expected. Seek shelter
immediately.
When a winter storm watch is issued…
 Listen to your local radio and TV stations for further updates.
 Be alert to changing weather conditions.
 Avoid unnecessary travel.
When a winter warning is issued…
 Stay indoors during the storm.
 If you do go outside, several layers of lightweight clothing will
keep you warmer than a single heavy coat. Gloves or mittens
and a hat will prevent loss of body heat. Cover your mouth to
protect your lungs.
 Understand the hazards of wind chill, which combines the
cooling effect of the wind and cold temperatures on exposed
skin.
 As the wind increases, heat is carried away from a person’s
body at an accelerated rate, driving down the body
temperature.
 Walk carefully on snowy, icy, sidewalks.
 After the storm, if you shovel snow, be extremely careful. It is
physically strenuous work, so take frequent breaks, Avoid
overexertion.
 Avoid traveling by car in a storm, but if you must…
Carry a disaster supply kit, keep your gas tank full of gas for
emergency use and to keep the fuel line from freezing. Let
someone know your destination, your route and when you expect



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to arrive. If your car gets stuck along the way, help will be sent
along your predetermined route.
If you do get stuck…
 Stay with your car. Do not try to walk to safety.
 Tie a brightly colored cloth (preferable red) to the antenna for
rescuers to see.
 Start the car and use the heater for about 10 minutes every
hour. Keep the exhaust pipe clear so fumes won’t back up in the
car.
 Leave the overhead light on when the engine is running so that
you can be seen.
 As you sit, keep moving your arms and legs to keep the blood
circulating and to stay warm.
 Keep one window away from the blowing snow slightly open to let
in air.
F. Tornados:
Prior to Tornado Season make sure your Disaster Preparedness Plan is
accurate
 Ensure the safety of all occupants of the office/home. Locate
occupants to a safe place. It could be a basement or if there is
no basement, a center hallway, bathroom, or closet on the
lowest floor. Keep this place uncluttered.
 Have a copy of your disaster Preparedness Plan.
 Stay turned for storm warnings…
 Listen to your local radio and TV stations for further updates.
 Know what a tornado watch and warning means
A tornado watch means a tornado is possible in your area.
A tornado warning means a tornado has been sighted and
may be headed for your area. Go to safety immediately.
When a tornado watch is issued…
 Listen to your local radio and TV stations for further updates.
 Be alert to changing weather conditions. Blowing debris or the
sound of an approaching tornado may alert you.
When a tornado warning is issued…
 If you are inside, go to the safe place you picked to protect
yourself from glass or other flying objects. The tornado may
be approaching your area.
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If you are outside, hurry to the basement of a nearby sturdy
building or lie flat in a ditch or low-lying area.
 If you are in a car or mobile home, get out immediately and
head for safety.
After the tornado passes:
Office: Notify Your State Director or Regional Director of
your situation/location.
Foster Home: Contact Your local TBF office or SSW to inform
them of your situation and location.
Follow the instructions of your disaster Preparedness Plan in
the event that your office/home was damaged and is
uninhabitable.

G. Dealing with a potentially violent situation/terroristic threats:
1.





Dealing with telephone threats:
Keep calm. Keep talking
Don’t hang up
Signal a coworker
Ask caller to repeat the message and write it down.
For a bomb threat, ask where the bomb is and when it is set to go
off.
 Listen for background noises and write down the description.
 Write down whether it is a man or a woman; pitch of voice, accent;
anything else you hear.
 Try to get the person’s name, exact location, telephone number.
 Signal a coworker to immediately call the local police.
 Notify your immediate supervisor.
 Follow instructions for evacuating the building.
2. For an angry or hostile visitor or coworker:
 Stay calm. Listen attentively
 Maintain eye contact
 Be courteous. Be patient
 Keep the situation in your control
3. For a person shouting, swearing, and threatening:
 Signal a coworker, or supervisor, that you need help (using
prearranged code words)
 Do not make any calls yourself
 Have someone call the local police
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4. For someone threatening you with a gun, knife, or other
weapon:
 Stay calm. Quietly signal for help. (using prearranged code words)
 Maintain eye contact.
 Stall for time
 Keep talking – but following instructions from the person who has
the weapon.
 Don’t risk harm to yourself or others
 Never try to grab a weapon
 Watch for a possible chance to escape to a safe area
 If you see someone being threatened, immediately call your local
police and notify your immediate supervisor.
 Follow the lines of command identified in the disaster
preparedness plan to notify authorities of the situation.
H. Hurricane:
Know what Hurricane WATCH and WARNING Mean: A watch is when
conditions are possible in the specific area of the WATCH within 36
hours. A WARNING is when conditions are expected in the specified
area of the WARNING within 24 hours.
All personnel that work off-site (in the field) are given agency calling
cards for emergency purposes. Some TBF workers carry pagers
enhancing the organization’s ability to contact them in a timely manner,
but all TBF workers are required to sign out at the main office prior to
their out of office meeting and document where they will be able to be
reached. Social Services Workers are responsible for knowing where the
children on their care load are located. It is imperative that during time
of weather emergencies that workers keep in close contact with foster
families, knowing where they are and where they will be going. In
addition, SSW’s need to keep the county worker informed of any location
changes for children referred by them to The Bair Foundation.
Communication is of utmost importance in ensuring the safety of children
in care. Refer to the Disaster preparedness Plan for your Local office.
Foster Parent: It is important to know ahead of time where you could go
if you are told to evacuate. Follow your Disaster Preparedness Plan.
Remember you need to notify your TBF worker prior to any re-location of
foster children in your care along with address and phone number. Keep
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handy the telephone numbers of these places as well as a road map of
your locality. You may need to take alternative or unfamiliar routes if
major roads are closed or clogged. Listen to a local radio or TV stations
for evacuation instructions. If advised to evacuate, do so immediately.
If possible take these items with you when evacuating:
o
Prescription medications and medical supplies;
o
Bedding and clothing, including sleeping bags and pillows
o
Bottled water, battery-operated radio and extra batteries, first aid
kit, flashlight
o
Car keys and maps
o
Documents, including driver’s license, Social Security card, proof of
residence, insurance policies, wills, deeds, birth and marriage
certificates, tax records, etc.
Know What to Do When a Hurricane WATCH Is Issued

Listen to a local radio or TV stations for up-to-date storm
information.

Prepare to bring inside any lawn furniture, outdoor decorations or
ornaments, trash cans, hanging plants, and anything else that can be
picked up by the wind.

Prepare to cover all windows of your home. If shutters have not been
installed, use precut plywood as described above. Note: Tape does not
prevent windows from breaking, so taping windows is not
recommended.

Fill your car's gas tank.

Recheck manufactured home tie-downs.

Check batteries and stock up on canned food, first aid supplies,
drinking water, and medications.
Know What to Do When a Hurricane WARNING Is Issued
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Listen to the advice of local officials, and leave if they tell you to do
so.

Complete preparation activities.
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
If you are not advised to evacuate, stay indoors, away from windows.

Be aware that the calm "eye" is deceptive; the storm is not over. The
worst part of the storm will happen once the eye passes over and the
winds blow from the opposite direction. Trees, shrubs, buildings, and
other objects damaged by the first winds can be broken or destroyed
by the second winds.

Be alert for tornadoes. Tornadoes can happen during a hurricane and
after it passes over. Remain indoors, in the center of your home, in a
closet or bathroom without windows.

Stay away from flood waters. If you come upon a flooded road, turn
around and go another way. If you are caught on a flooded road and
waters are rising rapidly around you, get out of the car and climb to
higher ground.
Remember, to keep your TBF worker informed of any changes in location
as a result of the hurricane.
(Information retrieved from American Red Cross Disaster
http://www.redcross.org/services/disaster/0,1082,0_587_,00.html#Plan
)
I. Pandemic: A global outbreak of disease that occurs when a new virus
appears in the human population causing serious illness, spreading from
person to person worldwide.
A. To plan if a pandemic occurs:
 Have two week's worth of water and supplies. If a pandemic
occurs stores may not have enough supplies or you may not be
able to get to the store for them, it will be important to have
extra supplies. These can also be useful in other
emergencies.
 Have medical supplies and prescription drugs and other health
supplies on hand.
 Get involved with local community as it works to prepare for
an influenza pandemic.
B. To limit the spread of germs and infection:
 Wash hands frequently with soap and water.
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 Stay away from one another as much as possible if they are
sick. If you are sick stay home so you do not spread your germs
to others.
C. MRSA ( Methicillin-reisitant Staphylococcus aureus) - type of
staph that is resistant to some Antibiotics. The Department of
Health highlights the following Centers for Disease Control
and Prevention recommended precautions:
 Keep hands clean by washing thoroughly with soap and water or
use alcohol based hand sanitizer.
 Keep cuts and scrapes clean and covered with bandage until
healed.
 Avoid contact with other people's wounds or bandages.
For more information:
 Visit www.pandemicflu.gov
 The Centers for Disease Control and Prevention (CDC)
hotline, 1-800-232-4636, is available
in English and Spanish, 24 hours a day, 7 days a week. TTY: 1888-232-6348. Questions can be e-mailed to cdcinfo@cdc.gov.
 Links to state departments of public health can be found at
http://www.cdc.gov/other.htm#states.
V.
Responsibilities:
Employee: As with any natural disaster, safety is the key element, your
safety and the safety of the client with whom you are working. As an
employee of the Bair Foundation it is important that you are familiar with
responding in various situations. Know your emergency numbers and
procedures to follow when emergencies happen. Notify your immediate
supervisor of your location and condition as soon as possible. Know your
Disaster Preparedness Plan and where a copy is located.
Know the locations of all exits in the building you are working and where
the fire extinguishers are.
Caregivers: As caregivers of foster children in the Bair Foundation it is
important for you to be prepared should an emergency arise. Be familiar
with procedures in the Disaster preparedness Plan for your home. Ensure
the safety of your family and foster child (ren) by knowing what to do in
the event of an emergency. Notify your caseworker as soon as possible
after the emergency has occurred.
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Consumers: Follow the instruction of your foster parents or staff when
involved in an emergency. Familiarize yourself with the Disaster
Preparedness Plan for your home especially events that occur or have
occurred in your local area.
VI.
Safety
General: The Bair Foundation complies with all applicable OSHA, labor
department and life safety requirements. As part of orientation, new
employees and caregivers are educated on the emergency and safety plan
along with the Disaster Preparedness Plan for their office.
Local Office: Local office directors will provide additional training in the
use of specialized equipment, materials handling and safety requirements
for their area.
Facility: In keeping with the need for operating with properly maintained
office surroundings, each office will have an assigned employee as the
safety officer. The safety officer for each office will complete a
monthly check of the office surroundings and equipment utilizing the
Monthly Safety Office Checklist (Attachment 2). Any identification of
problematic areas will be immediately brought to the attention of the
building landlord (Attachment 1). Review of monthly safety office checks
and monitoring of completed work to ensure a safety environment will
occur during the quarterly PQI meeting held in each office. Storage
areas, attics and stairwells will be maintained in an uncluttered state.
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The Bair Foundation
Safety Report
Name:______________________________________ Date___________
Occurred/Discovered:_______________________________
Type of Problem:
 Staff Injury
 Facility Repair
 Fire Safety
 Other:________________________________
1. Please describe the nature of the problem (when occurred/discovered, what
happened, who was involved, if applicable).
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
2. Please describe what action(s) you took, include the names of other persons
contacted:
______________________________________________________________
______________________________________________________________
______________________________________________________________
3. Please indicate any follow-up actions that need to be
taken:_________________________________________________________
______________________________________________________________
______________________________________________________________
Reported By:_________________________ Date:_____________________
Administrative/Safety Review and Action Taken:
______________________________________________________________
______________________________________________________________
______________________________________________________________
Reviewed by:_______________________________Date:_________________
Attachment 1
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Office Safety Inspection Checklist
Inspection Date:________________
Location (office):______________________
Person Performing Inspection:____________________________________________
Yes
Are fire extinguishers charged?
Are fire extinguisher tags up to date?
Are exits marked?
Are electrical outlets and switches covered?
Are electrical cords properly placed as not to be a trip hazard?
Are power strips being used in the correct fashion?
One power cord per receptacle (no daisy chains)
Are floors, aisles, and work areas free of slipping and hazards?
Is the Emergency Evacuation Route posted?
Is staff trained in the event of an emergency evacuation?
Are emergency phone numbers posted?
Are stairways clear of obstructions?
Is a first aid kit readily available?
Is there a usable flashlight available for emergencies?
Have staff been free from injuries, the office free of safety
repairs or safety incidents in the last month?
If any line items are checked no than a safety report needs to be completed and
attached.
*File in PQI notebook under Scorecard Data section.
Fax this report to Carrie Hogue at (724) 946-8711 or e-mail at cahogue@bair.org
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No
BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN
I.
Introduction
 Purpose
 Responsibility
 Terms and Definitions
II.
Exposure Control Plan
 Universal Precautions
 Safe Practice Controls
 Housekeeping
 Equipment
 Hazard Communication
III.
Standard Precaution
 Personal Protective Equipment
 Removing PPE’s
IV.
Work Practice Controls
 Hand washing
 First Aid Supplies
V.
Lead poisoning
VI.
Asthma
VII.
Management of Infectious Wastes, Blood Spills, Contaminated Surfaces and
Contaminated Laundry
 Sharps
 Handling Contaminated Laundry
 Feminine Hygiene Products
 Blood Spills
VIII. Hepatitis B Immunization
IX.
Blood/Body Fluid Post Exposure Protocol
X.
Information and Training
XI.
Record Keeping
XII.
Review of Exposure Control Plan
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I.
Introduction

Purpose: The Bair Foundation ensures that all employees with
occupational exposure to human bloodborne pathogens are
protected from contracting bloodborne disease through the
implementation of a bloodborne pathogens exposure control
plan. The elements of the plan are adopted from rules issued
by the Occupational Safety and Health Administration (OSHA)

Exposure Control is the responsibility of all employees who have
contact with consumers and other staff. It is imperative that
all employees use universal precautions when dealing with blood
and bodily fluids and that safe practice controls are exercised
for all exposure incidents, including airborne pathogens.

Terms and Definitions:
Bloodborne Pathogens: a pathogenic microorganism present in
human blood that can cause disease in humans.
Airborne pathogens: pathogenic microorganisms present in the
air that can cause disease in humans.
Contaminated: the presence of blood or other potentially
infectious materials on an item or surface.
Exposure incident: means a specific eye, mouth, other mucous
membrane, non-intact skin or parental contact with blood or
other potentially infectious materials that result in the
performance of an employee’s duties.
Other potentially infectious materials: Includes, semen, vaginal
secretions, saliva in dental procedures, and any body fluid that
is visibly contaminated with blood.
Sharps and contaminated sharps: A sharp is any object that
can readily penetrate the skin, i.e. Needles, broken glass,
scalpels, exposed ends of dental wires. The definition of
contaminated sharps is limited to those contaminated with
blood or other potentially infectious materials.
Universal precautions: The term “Universal Precautions” refers
to a system of infectious disease control that assumes that
every direct contact with body fluid is infectious and requires
every employee exposed to direct contact is to be protected.
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II.
Exposure Control Plan

The term “universal precautions” refers to a system of
infectious disease control that assumes that every direct
contact with body fluid is infectious and requires every
employee exposed to direct contact with body fluids to be
protected. Therefore, universal precautions are intended to
prevent health care workers from mucus membrane, and nonintact skin exposures to blood-borne pathogens. Bodily fluids
recognized by The Center for Disease Control as directly linked
to the transmission of HIV and or HBV to which universal
precautions apply: blood, semen, blood products, vaginal
secretions, cerebrospinal fluids, synovial fluid, pericardial fluid,
amniotic fluid and concentrated HIV or HBV viruses. Although
the risk of HIV or HBV infections is extremely low in feces,
nasal secretions, sputum, sweat, tears, urine and vomitus unless
they contain visible blood, it is recommended to use universal
precautions for all bodily secretions to eliminate any risk of
infection transmission.

Airborne pathogens - TB is primarily an airborne disease.
The disease is not likely to be transmitted through
personal items belonging to those with TB, such as
clothing, bedding, or other items they have touched.
Adequate ventilation is the most important measure to
prevent the transmission of TB.
Anthrax is a spore-forming bacterium. The spores have
protective coats and can withstand extreme heat,
drought, and other harsh conditions. They can live for
centuries in soil. Anthrax spores also have the potential
for use in biological warfare because of their ability to
survive and because they spread easily in air and can be
inhaled.

Safety Practice Controls will be stressed to employees dealing
with the potential situations within their job specifications.
The Bair Foundation will make available the necessary equipment
to protect and guard its employees from potential exposure to
bloodborne pathogens. Hand washing facilities that are readily
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



III.
accessible with the necessary antiseptic hand cleansers and
paper towels will be available at all office sites.
Housekeeping: Antibacterial cleansers will be utilized in
cleaning any areas of contamination. Universal precautions will
be used when cleaning any contaminate areas.
Transporting : Should an exposure incident happen when
transporting a consumer, the employee should isolate the
contaminated area. As a precaution, staff should carry tissues
or paper towels in their vehicle for such incidents. Transport
the consumer to the closest TBF office and use universal
precaution to clean the individual and vehicle.
Equipment: Any equipment used i.e. Diabetic needles, lancets,
where blood is evident, will be cleansed or discarded using
universal precautions.
All sharps items will be disposed of in an appropriate sharps
container.
Hazard Communication: Warning labels will be fixed to any
containers with bio-hazardous materials.
Standard Precautions


Personal Protective Equipment: Protective Barriers reduce the
risk of exposure to health care workers and caregivers’ skin or
mucous membranes to potentially infectious materials. When
using universal precautions, protective barriers such as gloves,
masks and protective eyewear, reduce the risk of exposure to
blood, body fluids containing visible blood and other fluids to
which universal precautions apply. Universal precautions are
intended to supplement rather than replace recommendations
for routine infection control, such as proper hand washing and
use of gloves to protect contamination of the hands.
Removing PPE’s: When removing personal protective equipment
caution is needed as to not contaminate other areas. When
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removing latex gloves, pull the wrist potion of the glove toward
the finger so that the contaminated portion of the glove goes
inside while holding that glove with the gloved hand. With the
hand that is free from the glove, pull the wrist portion of the
glove toward the finger so that the contaminated part and the
other glove are both on the inside of the glove. Dispose of the
gloves in an approved receptacle. Wash hands thoroughly using
the recommended method.
IV.
Lead Poisoning
Why is lead so toxic? The body mistakes lead for calcium when
ingested. The lead then attaches to and disrupts enzymes essential to
the functioning of the brain and other cells. The body never
decomposes the lead into another, more easily tolerated substance,
because lead is an element.
The process of chelation can remove lead from the bloodstream, but
most of the lead that is absorbed into a child's brain remains there
forever. The U.S. Public Health Service estimates one out of six
children under age 6 has enough lead in his blood to place him in what
scientists now consider high risk.
Although adults are susceptible to the toxic effects of lead, children
are at high risk due to the nature of a child's activities that involve
the introduction of non-food items into their bodies. Lead poisoning is
entirely preventable, yet it is the most common and societal
devastating environmental disease of young children.
The only cure for lead poisoning is prevention. One way to prevent lead
poisoning is to first test for lead presence. Secondly, if lead is
present in your home, take steps to remove the source of lead.
SYMPTOMS OF LEAD POISONING
 Headaches
 Irritability
 Abdominal Pain
 Vomiting
 Anemia
 Weight Loss
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 Poor Attention Span
 Noticeable Learning Difficulty
 Slowed Speech Development
 Hyperactivity
EFFECTS OF LEAD POISONING
 Reading and Learning Disabilities
 Speech and Language Handicaps
 Lowered I.Q.
 Neurological Deficits
 Behavior Problems
 Mental Retardation
 Kidney Disease
 Heart Disease
 Stroke
 Death
Long term exposure to small amounts of lead may cause brain damage
in children who do not show any symptoms.
How can we protect our children against lead poisoning.
 Get your child tested.
 Keep play areas, toys, floors and hands clean.
 Reduce the risk by preventing your child from chewing on anything
covered with lead paint, such as window sills, furniture, toys, cribs,
or playpens.
 Don't remove lead paint yourself.
 Don't bring lead dust into your home.
 Get the lead out of your drinking water or at least have it tested
by your water supplier or health department and know if it contains
lead.
 Eat right by eating foods rich in iron and calcium.
Places in your home where lead may be found:
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V.
Asthma
What is Asthma?
It's a chronic disease that makes it hard to get air in and out of lungs
during asthma attacks. These attacks can be prevented, but not cured
and sometimes they can be fatal if they are very severe and not
treated. More kids miss school because of this disease than any other
chronic one.
What are some warning signs of an asthma attack?
• coughing
• tightness in the chest
• feeling tired
• restlessness
• wheezing
What causes an attack?
Common triggers are:
Smoking
Aspirin and other medications
Dust and dust mites
Strong emotional responses (laughing, crying, etc.)
Pollen
Pets (the "dandruff' from their skin)
Stress
Roaches (their feces and dried body parts)
Breathing cold air/weather changes
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Colds, respiratory infections
Mold, mildew
Playing sports, running
Perfumes, deodorants
Air pollution
Strong chemical smells (paint, cleaning fluids, etc.)
Second hand smoke is a BIG trigger (especially for kids)!
Signs/Symptoms of asthma:
Coughing with or without a cold (This is often the first symptom that
asthma isn't under control)
Whistling, hissing or wheezing sounds in the chest
Feeling short of breath (easily winded)
A heavy or tight feeling in the chest
Waking up often during the night
Feeling tired
Trouble exhaling (breathing out used air trapped in lungs)
NOTE: Infants and children may not show the usual symptoms and
instead you may notice:
noisy breathing and congestion, or mucus, in the chest
constant or repeated coughing spells
they get tired more easily than other kids during playtime
they may stop their activities to prevent coughing or wheezing
VI.
Work Practice Controls

Hand washing:
Proper hand washing is the cornerstone of infection control.
The following technique is recommended to minimize the spread
of pathogens:

Avoid wearing rings other than a plain band. Remove
wristwatch or push it to the middle of your forearm.

Stand in front of the sink, keeping your hands and
clothing away from the sink surface.

Turn on the water and adjust the temperature to warm.
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
Wet your hands and wrists thoroughly under the running
water.

Keep hands and forearms lower than your elbows to
prevent water from flowing from the most to the least
contaminated area.

Apply enough soap to produce a good lather. (If you use
bar soap, rinse it before and after you use it) Lather vigorously.

Using plenty of lather and friction, wash your hands for
10 to 15 seconds. Vigorously wash the palms and backs of your
hands, each finger, the areas between your fingers, and your
knuckles, wrists and forearms. Wash at least one inch above
any area of contamination. Washing loosens the germs.

Keeping your hands down, rinse your hands, wrists and
forearms thoroughly.

With a clean paper towel, blot your hands from the
fingers toward your wrists and forearms.

Turn water off by using the paper towel to avoid
contaminating your hands.


VII.
Dispose of paper towel in a proper receptacle.
First Aid Supplies: All offices will have basic first aid supplies
available to employees and their guests.
Management of Infectious Wastes, Blood Spills, Contaminated Spills
and Contaminated Laundry
 Sharps: Contaminated needles or other
contaminated sharps must not be bent or recapped.
Immediately after use, contaminated sharps will be placed in an
appropriate container. Disposable sharps will be discarded in
containers that are closable, puncture resistant, leak proof on
all sides and bottom and labeled “Biohazard”.
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


VIII.
Hepatitis B Immunization

IX.
Hepatitis B is a type of viral hepatitis acquired from exposure
to human blood and body fluids that result in liver inflammation.
While the use of universal precautions helps protect from this
disease, the Hepatitis B vaccination is an additional measure.
Blood/Bodily Fluid Post Exposure Protocol

X.
Handling contaminated laundry: Use universal precautions when
handling contaminated laundry. Double bagging is necessary to
ensure containment of the contamination.
Feminine Hygiene Products: Use universal precaution when
discarding refuse with feminine hygiene products.
Blood Spills: Blood on non-porous surfaces can be handled by
diluting the spill with an equal volume of 1:10 household bleach
solution and then absorbing it with disposable paper towels.
Remember to use disposable gloves to protect any
contamination on yourself. There are also available a number of
products which absorb and solidify blood spills and chemically
treat them. These methods are often expensive compared to
bleach and many are not time tested as to their effectiveness.
Bleach or other EPA approved disinfectants are most highly
recommended.
Should an employee be involved in an exposure incident, it must
be reported to their immediate supervisor and an exposure
incident report completed. Universal precautions should be
followed and all exposed areas cleaned and sanitized. If
medical attention is warranted, the staff should get medical
attention as appropriate. The supervisor will provide follow-up
with the individual or health care provider.
Information and Training
The information provided in this Plan will be available to all employees
and caregivers within the Bair Foundation. Training will be provided at
orientation.
XI.
Record keeping
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The Bair Foundation will maintain an accurate record of all exposure
incidents to include:
1. The name of the employee
2. A copy of their Hepatitis B vaccinations
3. A copy of all examinations, medical testing and follow-up as a
result of the exposure incident.
The Bair Foundation will keep this record in accordance with their
record retention policy.
XII.
Review of the Bloodborne Pathogen Exposure Control Plan
The Bloodborne Pathogen Exposure Control Plan will be reviewed
annually.
IX.
Forms
 Exposure Incident Report Form
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EXPOSURE INCIDENT REPORT FORM
Name:_______________________ Date/Time of Incident:_______________
Location Incident Occurred:_________________________________________
Description of Incident:____________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Witnesses:
Name:_______________________
Name:_______________________
Name:_______________________
Name:_______________________
Relationship:_______________________
Relationship: _______________________
Relationship:________________________
Relationship:________________________
Actions Taken: (Check all that apply)







Universal Precautions Used
Basic First Aid Used
Medical Attention Sought (PCP)
Emergency Room
Hospital Admission
Incident Reported to Supervisor
Paperwork completed within 24 hours
____________________________ Date Report Completed:_______________
(Signature)
____________________________ Date Report Reviewed:________________
(Signature)
*File in PQI Notebook.
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INFECTION CONTROL PLAN
I.
Introduction
 Purpose
II.
Education
III.
Environmental Control
IV.
Storage of Cleaning Materials
V.
Health Programs
 Client/Caregiver
 Employee
VI.
Employee Health work Guidelines
VII.
Reporting
VIII. Health Forms
 Employee Physical Forms
 Client Medical Forms
 Foster Parent Physical Forms
I.
Introduction:
The Bair Foundation is committed to protecting and providing safe work
environments for its employees and consumers. The Infection Control Plan is
designed to assist in giving practical knowledge and safeguards in the
prevention and spread of contagious illnesses or diseases. Often illnesses
and diseases are spread before individuals have symptoms of being sick.
Because we cannot tell whether an individual is a carrier of an illness or
infectious disease, it is important to learn ways to protect ourselves.
“Universal precaution” should be practiced with everyone since we do not
know who could infect us with illness or disease.
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Casual contact with another person does not pose a risk of catching a
disease, which is transmitted through the blood, but it could expose use to
other varieties of viruses.
II.
Education:
The Bair Foundation encourages and makes provision for employees and
caregivers to take advantage of educational opportunities provided by the
Bair Foundation or within the community. Employees and Caregivers will be
trained on the Infection Control Plan in its entirety.
III.
Environmental Control
The Bair Foundation encourages employees to maintain good hygienic
practices to avoid the spread of illness. All bathrooms are cleaned and
disinfected on a regular basis. Antibacterial soap is available for employee
and others using the facility for use in hand washing after each visit.
It is the policy of The Bair Foundation to require skin tuberculosis testing to
be completed on all staff prior to employment (unless verification of a skin
tuberculin test within one year prior to employment can be produced).
Each child is required to have a physical within 30 days of admission into the
program or within a timeframe (number of days depends upon licensing
regulations for each state) upon admission to the Bair Foundation Foster
Care Program.
If an employee contracts an infectious disease, physical documentation of
non-contagious status will have to be presented to the agency prior to their
resuming full job responsibilities.
IV.
Storage of Cleaning Supplies:
All cleaning materials are to be stored in their original container.
V.
Health Programs
 Client/Caregivers
Physicals are required for both clients within the program and also
individuals wanting to become Foster Parents. Annually, physicals and
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
VI.
dentals are completed for children. Routine medical care is sought with a
primary care physician and referrals are made to specialists with regard to
particular diagnosis.
Employees
Employees having direct client contact are required to have a TB test
completed, prior to any client contact to ensure they are void of
communicable diseases.
Employee Health Work Guidelines

Hand washing:
Proper hand washing is the cornerstone of infection control. The following
technique is recommended to minimize the spread of pathogens:

Avoid wearing rings other than a plain band. Remove wristwatch or push it to
the middle of your forearm.

Stand in front of the sink, keeping your hands and clothing away from the
sink surface.

Turn on the water and adjust the temperature to warm.
 Wet your hands and wrists thoroughly under the running water.

Keep hands and forearms lower than your elbows to prevent water from
flowing from the most to the least contaminated area.

Apply enough soap to produce a good lather. (If you use bar soap, rinse it
before and after you use it) Lather vigorously.

Using plenty of lather and friction, wash your hands for 10 to 15 seconds.
Vigorously wash the palms and backs of your hands, each finger, the areas
between your fingers, and your knuckles, wrists and forearms. Wash at
least one inch above any area of contamination. Washing loosens the germs.

Keeping your hands down, rinse your hands, wrists and forearms thoroughly.

With a clean paper towel, blot your hands from the fingers toward your
wrists and forearms.
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
Turn water off by using the paper towel to avoid contaminating you hands.

Dispose of paper towel in a proper receptacle.
General and Personal Hygiene:
Cover any cuts or lesions on your skin or the client’s skin. Wash hands using
the proper technique listed above, each time the bathroom facility is used.
Eliminate any opportunity for germs to spread by reducing the risk using
good hygiene practices. Do not eat or drink after anyone as germs can be
easily spread in this manner.
Coughs and sneezes:
Bacteria is spread in aerosol form by coughing and sneezing. The mouth and
nose should be covered before coughing or sneezing to limit the possible
spread of infection. Hands should be washed after each use of tissue where
practical. Soiled tissues should be disposed of in a covered container with a
plastic liner that can be tied and disposed of in the garbage.
Good Housekeeping Practices:
Good housekeeping practices are essential to the elimination of the
infections in bathrooms, food preparation areas, with beddings and the
handling of sick individuals. Latex gloves are recommended to be used when
cleaning these areas particularly when any bodily fluids containing blood are
present. Remember to always wash your hands even after using gloves.
It is recommended that bathrooms are disinfected routinely with
antibacterial disinfectants. Anti-bacterial disinfectants are the first attack
on contaminated surfaces, but the actual removal of microorganisms is the
combination of the cleaning agents and scrubbing. Food preparation areas
should be disinfected after each use. Special precautions should be taken
after preparing meats and chicken.
As always, good infection
control practices can eliminate the potential spread of infections and germs.
When dealing with ill children it is important to remember good hand washing
techniques. Your persistence to infection control practices could avoid a
breakout of illness within the whole family or agency.
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Dealing with bites:
When dealing with young children there is often a concern for dealing with
bites or scratches. At the present time there has been no evidence that
the HIV virus is transmitted in this manner, although the risk of
transmission increases if there is evidence of blood from the individual
biting and the individual being bitten.
Hepatitis B may be transmitted by a carrier through a biting incident by
either the biter or the recipient.
It is imperative that if the skin is broken during a biting incident, that the
area be cleaned by an individual using latex gloves. The area should be
dressed with an antiseptic and a dressing applied. Medical attention should
be sought.
VII.

Reporting
Communications:
Staff and Foster Parents are asked to advise the agency if their children or
themselves have contracted any infectious diseases so that appropriate
measure can be adopted by the other staff members.
VIII.










Health Forms
Employee Physical Forms
OH – No requirements
OK- Child Care Staff Health Record
PA -Medical Report on Child Care Staff
TX – Documentation of TB test.
Client Medical Forms
OH Medical History Outline Form, EPSDT screening
OK Medical/Dental Treatment Form
PA Foster Child’s Initial and Periodic Medical Examination
TX Medical/Dental Treatment Form
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




Foster Parent Physical Forms
OH- ODHS 1653 Medical Statement
OK- Medical Examination Report
PA- Medical Report on Foster Parents
TX-No medical required, Documentation of TB
To Be Reviewed By New Mexico Employees Only:
New Mexico Orientation Manual Addendum
INTERACTION CONSULTANTS
A strength-guided, goal-oriented approach to the positive growth and development of people and
services.
This page is provided courtesy of Gary Direnfeld, MSW, RSW. In addition to learning about
professional boundaries, please feel free to browse the many articles related to family, parenting
and separation and divorce issues. Use the links above.
The following article comes from the College of Psychologists of Ontario. It is an
excellent article that informs health-care service providers and clients alike of
issues and ethics pertaining to therapeutic relationships.
While the article is directed to members of the College of Psychologists of
Ontario, the information and recommendations therein are applicable to other
health-care providers.
Clients whose health-care provider acts in a way to contravene any of the boundary
issues or recommendations discussed below are advised to address the matter as
may be determined by the circumstance. This may include discussion with their
health-care provider, their supervisor or employer or their appropriate regulative
body. In severe cases the matter may be brought to police.
In all instances, clients should expect appropriate care and safety from harm or
harassment.
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Professional Boundaries in Health-Care Relationships
Reprinted from The Bulletin, The College of Psychologists of Ontario, VOLUME 25, NO 1, JULY 1998.
http://www.cpo.on.ca/Bulletin/Selected%20Articles/Professional%20Boundaries.htm
The Client Relations Committee of the College has been reviewing this complex,
sensitive area in an effort to assist members in their understanding and
management of boundary issues in professional practice. It is evident that the
majority of members treat their clients respectfully, compassionately and
responsibly and would not knowingly compromise the professional relationship
established with them. This does not mean that relationship dilemmas or difficult
situations do not arise.
The following article discusses the nature of the professional relationship,
provides information to help members recognize potential problem situations, and
suggests some strategies to consider in managing professional boundaries.
Characteristics of Professional Boundaries
Boundaries are the framework within which the therapist/client relationship
occurs. Boundaries make the relationship professional, and safe for the client, and
set the parameters within which psychological services are delivered. Professional
boundaries typically include fee setting, length of a session, time of session,
personal disclosure, limits regarding the use of touch, and the general tone of the
professional relationship. In a more subtle fashion, the boundary can refer to the
line between the self of the client and the self of the therapist.
The primary concern in establishing and managing boundaries with each individual
client must be the best interests of the client. Except for behaviours of a sexual
nature or obvious conflict of interest activity, boundary considerations often are
not clear-cut matters of right and wrong. Rather, they are dependent upon many
factors and require careful thinking through of all the issues, always keeping in
mind the best interests of the client.
Who Negotiates the Boundaries in the Professional Relationship
In any professional relationship there is an inherent power imbalance. The
therapist’s power arises from the client’s trust that the therapist has the
expertise to help with his or her problems, and the client’s disclosure of personal
information that would not normally be revealed. The fact that services cannot be
provided unless clients are willing to cooperate, does not change the fundamental
power imbalance. Therefore, the therapist has a fiduciary duty to act in the best
interest of the client, and is ultimately responsible for managing boundary issues
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and is therefore, accountable should violations occur. Given the power imbalance
that is inherent in the professional/client relationship, clients may find it difficult
to negotiate boundaries or to recognize or defend themselves against boundary
violations. As well, clients may be unaware of the need for professional boundaries
and therefore, may at times even initiate behaviour or make requests that could
constitute boundary violations.
Typical Areas Where it May Be Difficult to Draw A Line or Where Boundaries
Can Become Blurred
There are a number of areas in which one has to maintain boundaries, that is, draw
a line. Below are some typical areas that can present difficulties.
Self disclosure. Although in some cases self disclosure may be appropriate,
members need to be careful that the purpose of the self disclosure is for the
client’s benefit. A number of dangers may exist in self disclosure including shifting
the focus from the needs of the client to the needs of the therapist or moving the
professional relationship toward one of friendship. The blurring of boundaries can
confuse the client with respect to roles and expectations. The primary question to
be asked is, "Does the self disclosure serve the client’s therapeutic goal?"
Giving or receiving significant gifts. Giving or receiving gifts of more than token
value is contrary to professional standards because of the risk of changing the
therapeutic relationship. For example, a client who receives a gift from a member
could feel pressured to reciprocate to avoid receiving inferior care. Conversely, a
member who accepts a significant gift from a client risks altering the therapeutic
relationship and could feel pressured to reciprocate by offering "special" care.
Dual and overlapping relationships. Dual relationships should be avoided. These
occur in situations where the member is both the clinician and also holds a
different significant authority or emotional relationship with the same person.
Examples can include course instructor, work place supervisor, or family member.
Members needs to remain cognizant that the purpose of avoiding dual relationships
is to avoid exploiting the inherent power imbalance in the therapeutic relationship.
Overlapping relationships, while potentially problematic, may not always be possible
to avoid. Overlapping relationships, where a member has contact, but no significant
authority or emotional relationship with the client, may occur particularly for
therapists who are members of small communities, or for clinicians who work with a
particular client population with which they are also affiliated. Such overlapping
relationships can occur in situations where, for example; the client is a member of
a particular religious or ethnic group and tends to practice within this community;
the therapist is gay or lesbian and works with gay or lesbian clients; or, the
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member has a child with a learning disability, is active in a local association, and
also does learning disability assessments. Situations where there may be
overlapping relationships need to be judged on a case by case basis.
Members should avoid relationships with their clients outside of therapy where
either the therapist or client is in a position to give a special favour, or to hold any
type of power over the other. For example, some situations to be avoided include
employing a client or his or her close relatives, involving oneself in business
ventures where one could benefit financially from a client’s expertise or
information, or engaging in therapy or assessment with a current student.
Similarly, members should refrain from requesting favours from clients, such as
baby-sitting, typing, or any other type of assistance that involves a relationship
outside therapy.
Becoming friends. Generally, members should avoid becoming friends with clients
and should refrain from socializing with them. Although there are no explicit
guidelines that prohibit friendships from developing once therapy has terminated,
members must use their clinical judgment in assessing the appropriateness of this
for the individual client. Potential power imbalances may continue to exist and
influence the client well past the termination of the formal therapeutic
relationship.
In the course of therapy, some clinicians, on occasion, may engage in activities that
resemble friendship, such as going on an outing with a child or adolescent, or
attending a client’s play, wedding, or special event. In all cases it is the clinician’s
responsibility to ensure that the relationship remains therapeutic and does not
develop into a friendship or a romantic involvement. The definition of "sexual
abuse" within the legislation makes it clear that it is unacceptable to date a
current client. Since power imbalances may continue to influence the client well
past termination, professional standards prohibit a member from engaging in a
sexual relationship with a former client to whom any professional service was
provided in the past two years. Members are reminded that even the most casual
dating relationship may lead to forms of affectionate behaviour that could fall
within the definition of sexual abuse.
Maintaining established conventions. Ignoring established conventions that help
to maintain a necessary professional distance between clients and members can
lead to boundary violations. Examples include providing treatment in social rather
than professional settings, not charging for services rendered, not maintaining
clear boundaries between living and professional space in home offices, or
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scheduling appointments outside of regular hours or when no one else is in the
office.
Physical contact. There are a variety of ways of using touch to communicate
nurturing, understanding and support such as a pat on the back or shoulder, a hug
or a handshake. Such touch can however, also be interpreted as sexual or
inappropriate which necessitates careful and sound clinical judgment when using
touch for supportive or therapeutic reasons. Clinicians must be cautious and
respectful when any physical contact is involved, recognizing the diversity of
cultural norms with respect to touching, and cognizant that such behaviour may be
misinterpreted.
Diagnostic and therapeutic work with children requires special consideration. Some
agencies or institutions for example, advise their staff to avoid any touching of
children. In other settings however, touching may be permitted, and this would
ordinarily be open to public scrutiny. In working with children and considering the
question of touching, one might ask, "Would I do this in the presence of my
colleagues or this child’s parents?" Again, good clinical judgment should prevail for
the protection of both the client and the practitioner.
Some clinical situations such as neuropsychological testing and biofeedback, or
clinical interventions such as bioenergetics, require touching the client. When such
touch is necessary, it is important to explain this to the client and ensure the
client’s understanding, and the client’s fully informed consent. If there is concern
that a particular client may misinterpret a therapist’s actions, members may wish
to have someone else present in the session, consider an alternate treatment
approach, or think about a referral to another practitioner.
Questions to Consider in Examining Potential Boundary Issues
In each individual case, boundary issues may pose dilemmas for the clinician and
there may be no clear or obvious answer. In determining how to proceed,
consideration of the following questions may be helpful.
• Is this in my client’s best interest?
• Whose needs are being served?
• Will this have an impact on the service I am delivering?
• Should I make a note of my concerns or consult with a colleague?
• How would this be viewed by the client’s family or significant other?
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• How would I feel telling a colleague about this?
• Am I treating this client differently (e.g., appointment length, time of
appointments, extent of personal disclosures)?
• Does this client mean something ‘special’ to me?
• Am I taking advantage of the client?
• Does this action benefit me rather than the client?
• Am I comfortable in documenting this decision/behaviour in the client file?
• Does this contravene the Regulated Health Professions Act, the Standards of
Professional Conduct or the Code of Ethics, etc.?
Boundary Violations and Sexual Abuse
Sexualizing a professional, health-care relationship is against the law. In Ontario,
the Regulated Health Professions Act (RHPA) prohibits sexual involvement of
health-care professionals with clients . The RHPA[1(3)] defines sexual abuse
broadly as: sexual intercourse or other forms of physical sexual relations between
a member and a client; touching, of a sexual nature of the client by the member;
or, behaviour or remarks of a sexual nature by a member toward a client.
There are NO circumstances in which sexual activity between a psychologist or
psychological associate and a client is acceptable. Sexual activity between a client
and practitioner is always detrimental to client care, regardless of what
rationalization or belief system the health-care professional chooses to use to
excuse it. Because of the unequal balance of power and influence, it is impossible
for a client to give meaningful consent to any sexual involvement with his or her
therapist; client consent and willingness to participate in a personal relationship
does not relieve the member of his or her duties and responsibilities for ethical
conduct in this area. Failure to exercise responsibility for the professional
relationship and allowing a sexual relationship to develop is an abuse of the power
and trust which are unique and vital to the therapist/client relationship.
Warning Signs
There may be times in the practice of psychology when a member could find
himself or herself drawn toward a client or could experience feelings of attraction
to a client. It is vital that the psychologist or psychological associate recognize
these feelings as early as possible and take action to prevent the relationship from
developing into something other than a professional one. If a client attempts to
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sexualize the relationship, the obligation is always on the psychologist or
psychological associate not to cross the line.
Research has shown that before actual physical contact or abuse occurs there are
often a number of warning signs, or changes in the therapist’s behaviour. Members
should be alert to such signs that suggest he or she may be starting to treat a
particular client differently. These may include sharing personal problems with the
client, offering to do therapy in social situations such as over dinner, offering to
drive a client home, not charging for therapy, or making sure the client's
appointments are scheduled when no one else is in the office.
In addition, miscommunication between a psychologist or psychological associate
and a client may cause the client to misunderstand a member’s intent. While it may
seem harmless to make a personal compliment about a client’s appearance, or tell a
‘racy’ joke, this type of behaviour can be misinterpreted by a client as an interest
in him or her personally.
Prevention and Avoidance of Sexual Misconduct
The best way to maintain the appropriate boundaries in a professional/client
relationship is through the clinician’s focus on maintaining good, personal
psychological health, an awareness of potential problems and good, clear
communication. One’s power and control over a client should not be underestimated.
One should also remain aware that the client may experience touch, personal
references and sexual matters very differently from the clinician due to a variety
of factors including gender, cultural or religious background, or personal trauma
such as childhood sexual abuse. Risky situations should be avoided and the proper
boundaries of any professional/client relationship should be communicated clearly
and early in the treatment process. The following guidelines suggest approaches to
prevent boundary violations and avoid complaints of sexual misconduct.
1. Respect cultural differences and be aware of the sensitivities of individual
clients.
2. Do not use gestures, tone of voice, expressions, or any other behaviours which
clients may interpret as seductive, sexually demeaning, or as sexually abusive.
3. Do not make sexualized comments about a client’s body or clothing.
4. Do not make sexualized or sexually demeaning comments to a client.
5. Do not criticize a client’s sexual preference.
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6. Do not ask details of sexual history or sexual likes/dislikes unless directly
related to the purpose of the consultation.
7. Do not request a date with a client.
8. Do not engage in inappropriate 'affectionate' behaviour with a client such as
hugging or kissing. Do offer appropriate supportive contact when warranted.
9. Do not engage in any contact that is sexual, from touching to intercourse.
10. Do not talk about your own sexual preferences, fantasies, problems, activities
or performance.
11. Learn to detect and deflect seductive clients and to control the therapeutic
setting.
12. Maintain good records that reflect any intimate questions of a sexual nature
and document any and all comments or concerns made by a client relative to alleged
sexual abuse, and any other unusual incident that may occur during the course of,
or after an appointment.
What Members Can Do?
If a member finds himself or herself having a problem with how he or she is
treating or feeling about a client or how clients are feeling about them, members
should get assistance as soon as possible. If the client has been sexualizing the
relationship, this should be documented, as should actions taken to diffuse the
situation. Members are encouraged to talk to a trusted colleague or mentor, seek
professional help from a qualified practitioner in the psychological community or
elsewhere, or call the practice advisory service at the College.
20 Suter Crescent, Dundas, ON, Canada L9H 6R5 Tel: (905) 628-4847 Email: gary@yoursocialworker.com
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Indian Child Welfare Act of 1978
What is the Indian Child Welfare Act?
The Indian Child Welfare Act (ICWA) is a federal law which regulates placement
proceedings involving Indian children. If your foster child is a member of a tribe or
eligible for membership in a tribe, your child has the right to protection under the
ICWA. These rights apply to any child protective case, adoption, guardianships,
termination of parental rights action, runaway/truancy matter, or voluntary
placement of your children.
When was this law passed?
The ICWA was created in 1978 by the federal government in order to re-establish
tribal authority over the adoption of Native American children. The goal of the act
when it passed in 1978 was to strengthen and preserve Native American families
and culture.
Why was this law passed?
Before the ICWA was passed, a very high percentage of Indian families were
broken up because non-tribal agencies removed children from their homes. One
reason for the high removal rate was because state officials did not understand or
accept Indian culture. Today, the ICWA sets minimum standards for the removal
of Indian children from their homes.
Who does it apply to?
The law applies to Native American children who are unmarried and under age
eighteen. The child must be either a member of a federally recognized Indian tribe
or must be eligible for membership in a federally recognized Indian tribe.
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What does the law do?
The ICWA requires that placement cases involving Indian children be heard in
tribal courts if possible, and permits a child's tribe to be involved in state court
proceedings. It requires testimony from expert witnesses who are familiar with
Indian culture before a child can be removed from his/her home. If a child is
removed, either for foster care or adoption, the law requires that Indian children
be placed with extended family members, other tribal members, or other Indian
families.
What if a child is not living on the reservation does the ICWA still apply?
Yes. The ICWA has a notice requirement. This means that if a state takes a child
into custody, it must give notice to the child's tribe, wherever the child may be in
the U.S.
Does the act apply to a couple getting a divorce?
No.
What if a parent allowed someone else to become a guardian of their child and
later changes their mind?
The ICWA provides that an Indian parent always has the right to revoke a
guardianship.
Which Main tribes does the law apply to?
The law applies to all four Main tribes: the Aroostook Band of Micmacs, the
Houlton Band of Maliseet Indians, the Passamaquoddy Tribe and the Penobscot
Indian Nation. The Indian Child Welfare Act defines an Indian tribe as any Indian
tribe, band, nation, or other organized group or community of Indians recognized
as eligible for the services provided to Indians by the Secretary [of the Interior]
because of their status as Indians.
Who decides if someone is a member of the tribe?
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The law does not apply a specific blood quantum as the criteria for membership. It
leaves it up to each Native American tribe to make such determinations on their
own.
What court can hear a case involving a Native American child?
Currently only the Penobscot and Passamaquoddy Tribes can decide these cases in
Tribal Court. Cases involving Micmac or Maliseet children are likely to be held in
Probate or District Court.
For complete Indian child Welfare Act of 1978 policy go to:
http://www.tribal-institute.org/lists/chapter21_icwa.htm
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THE BAIR FOUNDATION
Staff Training Report
Name:______________________________________________
Date:_______________________________________________
Office Location:______________________________________
Purpose or Title: Orientation Manual Training :
Overview of organization and programs
Policies
 Children’s Rights and Responsibilities
 Code of Ethics
 Confidentiality
 Duty to Warn
 National Reporting Policy
 Prohibition of Corporal Punishment
Staff Training Requirements
Emergency and Safety Plan
Bloodborne Pathogens Exposure Control Plan
Infection Control Plan
New Mexico Orientation Manual Addendum (For New Mexico Employees)
Number of Hours: 1 hour
Staff
Signature:_____________________________________________________
Supervisor’s Initials:____________
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