CABINET FOR HEALTH

CABINET FOR HEALTH AND FAMILY SERVICES

Department for Community Based Services

922 KAR 1:310. Standards for child-placing agencies.

RELATES TO: KRS 2.015, 17.165, 17.500(8), 158.135(1)(c), 194A.060, 199.011, 199.430(3), 199.470, 199.492, 199.493, 199.510, 199.520, 199.570, 199.572, 199.590, 199.640, 199.645, 199.650-199.670, 202A.011(12), 202B.010(12), 216.300, 273.161(7), 311.720(9), 311.840(3), 314.011(5), (7), (9), 503.110(1), 600.020, 605.090(1), 610.110(6), 615.010-615.990, 620.020, 620.030, 620.090(2), 620.140(1)(d), 620.230(3), 625.040, 625.043, 16 C.F.R. 1508 and 1509, 45 C.F.R. Parts 160, 164, 1355.34, 8 U.S.C. 1151, 42 U.S.C. 671(a)(23), 42 U.S.C. 677(a)(1)-(6), 14901-14954

STATUTORY AUTHORITY: KRS 194A.050(1), 199.640(5)(a), 605.150, 615.050

NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the Secretary of the Cabinet for Health and Family Services to promulgate, administer, and enforce those administrative regulations necessary to implement programs mandated by federal law or to qualify for the receipt of federal funds and necessary to cooperate with other state and federal agencies for the proper administration of the cabinet and its programs. KRS 199.640(5)(a) requires the Secretary of the Cabinet for Health and Family Services to promulgate administrative regulations establishing basic standards of care and service for child-caring facilities and child-placing agencies. KRS 605.150 permits the cabinet to promulgate administrative regulations to implement the provisions of KRS Chapter 605. This administrative regulation establishes basic standards for child-placing agencies.

Section 1. Definitions.

(1) "Adequate supervision" means adult oversight of a child’s activities with consideration of the child’s past and current:

(a) Incidents;

(b) High risk behaviors; and

(2) "Adoption" means the legal process by which a child becomes the child of a person or persons other than biological parents.

(3) "Aftercare" means services provided to the child after discharge from a child-placing agency.

(4) "Applicant" means an individual or a family subject to approval by the child-placing agency as a:

(a) Foster home; or

(b) Adoptive home.

(5) "Board of directors" is defined by KRS 273.161(7).

(6) "Case management" means a process whereby a state agency or child-placing agency assesses the individualized needs of a child or family, arranges for the provision of services, and maintains documentation of actions and outcomes.

(7) "Child" is defined by KRS 199.011(4) and 600.020(8) and may include:

(a) A person age eighteen (18) or older whose commitment to the cabinet has been extended or reinstated by a court in accordance with KRS 610.110(6) or 620.140(1)(d); or

(b) A child who meets the exceptions to the age of majority in accordance with KRS 2.015.

(8) "Child-placing agency" is defined by KRS 199.011(7).

(9) "Community resource" means a service or activity available in the community that shall supplement those provided by the child-placing agency in the care and treatment of a child.

(10) "Executive director" means the person employed by the board of directors to be responsible for the overall administration and management of a child-placing agency.

(11) "Home study" means an assessment done on a prospective foster or adoptive home by a social services worker.

(12) "Independent living program" means a planned program that:

(a) Is licensed by the cabinet and designed to teach a child age sixteen (16) or older life skills that enable a child to become self-sufficient; and

(b) Meets requirements specified in Section 17(1) of this administrative regulation.

(13) "Independent living services" means services provided to an eligible child, as described in Section 16 of this administrative regulation, to assist the child in the transition from dependency of childhood to living independently.

(14) "Individual treatment plan" or " ITP " means a plan of action developed and implemented to address the needs of a child.

(15) "Licensed health care professional" is defined by KRS 216.300(1).

(16) "Medically-fragile child" means a child who is determined to have a medical condition as specified in 922 KAR 1:350.

(17) "Mental health treatment" means services provided to an individual determined to have emotional, mental, or behavioral problems.

(18) "Placement" means a foster or adoptive home that has been approved by completing an application process, home study and required preparation.

(19) "Program director" means the person responsible for supervising the day-to-day operation of the program.

(20) "Respite care" means temporary care provided by another individual or family to:

(a) Provide relief to a foster care parent, therapeutic foster care parent, or medically-fragile foster parent; or

(b) Allow an adjustment period for the child placed in out-of-home care.

(21) "Social services" means a planned program of assistance to help an individual move toward a mutual adjustment of the individual and the individual's environment.

(23) "Social services worker" means a person who meets the qualifications as specified in Section 2(4)(c) of this administrative regulation.

(24) "Supervision Plan" means a written supplement to a child’s ITP , developed pursuant to Section 6(7)(b)2 of this administrative regulation, that details a child-placing agency’s roles and responsibilities to assure adequate supervision of a child in the agency’s care, including those roles and responsibilities delegated to a foster home parent.

(25) "Therapeutic foster care" is defined by KRS 158.135(1)(c).

(26) "Therapeutic services" means clinical or supportive services provided to a child with severe emotional or behavioral needs.

(27) "Treatment director" means an individual who meets the qualifications as specified in Section 2(4)(d) of this administrative regulation.

Section 2. Administration and Operation.

(1) Licensing procedures.

(a) Licensing procedures for a child-placing agency shall be administered pursuant to 922 KAR 1:305.

(b) An independent living program is an optional component of the child-placing agency's license.

(c) A child-placing agency shall obtain accreditation within two (2) years of initial licensure or within two (2) years of acquiring an agreement with the cabinet to provide private child care services, whichever is later. Accreditation shall be from a nationally-recognized accreditation organization, such as:

1. The Council on Accreditation; or

2. The Joint Commission on Accreditation for Healthcare Organizations.

(2) Board of directors. The child-placing agency shall have a board of directors, or an advisory board if the child-placing agency is a privately-held for-profit organization, that shall:

(a) Consist of a minimum of seven (7) members;

(b) Meet at least quarterly;

(d) Be responsible for and have the authority to ensure the continuing compliance with the requirements established by this administrative regulation;

(e) Approve a mission statement delineating the:

1. Purpose;

2. Objective;

3. Scope of services to be provided; and

4. Intake policy specifying the type of child to be accepted for care;

(f) Hire, supervise, and annually evaluate the executive director of the child-placing agency; and

(g) Delineate in writing the duties of the executive director.

(3) Executive director.

(a) The executive director shall:

1. Be responsible for the child-placing agency and its affiliates, pursuant to the child-placing agency's written policies and procedures;

2. Oversee all aspects of the child-placing agency; and

3. Report to the board, on a quarterly basis, the following:

a. Evaluation of program services;

b. Measure attainment of the goals and objectives established pursuant to subsection (2)(e)2 of this section;

c. Staff training; and

d. Incident reports.

(b) The criteria and process of this evaluation shall be approved by the board annually.

(c) If the executive director is not available, a designated staff person shall be responsible for the day-to-day operation of the child-placing agency.

(4) Staff qualifications.

(a) An executive director shall possess the following qualifications:

1.a. A master's degree in any of the following human services fields:

(i) Social work;

(ii) Sociology;

(iii) Psychology;

(iv) Guidance and counseling;

(v) Education;

(vi) Religious education;

(vii) Business administration;

(viii) Criminal justice;

(ix) Public administration;

(x) Child-care administration;

(xi) Nursing;

(xii) Family studies; or

(xiii) Another human service field related to working with families and children; and

b. Two (2) years of work experience in a human services program; or

2. A bachelor's degree with a major in a discipline designated in subparagraph 1 of this paragraph, and four (4) years work experience in a human services program.

(b) A licensed child-placing agency shall have one (1) member of the social work staff designated as program director who shall hold:

1. A master's degree in social work or in a discipline designated in paragraph (a)1 of this subsection; or

2.a. A bachelor's degree in social work or in a discipline designated in paragraph (a)1 of this subsection; and

b. At least two (2) years professional experience in working with a child or family.

1. Be responsible for social work, counseling or planning and coordinating services to a child; and

2. Hold at least a bachelor’s degree in social work or a human services field.

(d) A treatment director shall:

1. Oversee the day-to-day operation of the treatment program;

2. Hold at least a master's degree in a human services discipline; and

3. Have at least five (5) years total experience in mental health treatment, with a minimum of three (3) years experience in mental health treatment of children with emotional or behavioral disabilities and their families.

(e)1. A child-placing agency contracting for the service of a social services worker not on the staff of the child-placing agency shall obtain documentation that the social services worker meets the qualifications in paragraph (c) of this subsection.

2. An agreement for this provision of service shall be on file at the child-placing agency and shall specify the qualifications of the social services worker.

(f) The program director shall supervise social service staff.

(g) In a therapeutic foster care program, approval and evaluation of services shall be carried out by a person meeting the qualifications of a treatment director.

(h) Social services staff shall not carry a caseload of more than twenty (20) children.

(5) Personnel policy.

(a) A child-placing agency shall have and comply with written personnel policies and procedures.

(b) An employee shall:

1. Be at least eighteen (18) years of age;

2. Submit to a criminal background check in accordance with KRS 17.165 and a central registry check in accordance with 922 KAR 1:470; and

3. Submit to a new criminal background check in accordance with KRS 17.165 and central registry check in accordance with 922 KAR 1:470 at least once every two (2) years.

(c) 1. A person against whom has been made a substantiated allegation of abuse, neglect, or exploitation of a child shall not be employed in a position involving direct contact with a child.

2. The cabinet shall respond to allegations of abuse, neglect, or exploitation of a child in accordance with 922 KAR 1:330 and 922 KAR 1:480.

(d) A current personnel record shall be maintained for an employee that includes the following:

1. Name, address, Social Security number, date of employment, and date of birth;

2. Evidence of qualifications, including degree, current registration, certification, or licensure;

3. Record of participation in staff development;

4. Record of performance evaluation;

5. Criminal records and central registry checks pursuant to paragraph (b)2 and 3 of this subsection;

6. Record of a physical exam related to employment, as specified in the child-placing agency's policies and procedures;

7. Personnel action;

8. Application for employment, resume, or contract; and

9. Evidence of personnel orientation.

(e) The child-placing agency shall have an ongoing staff development program under the supervision of a designated staff member.

(f) An employee under indictment, legally charged with felonious conduct, or subject to a cabinet investigation in accordance with 922 KAR 1:330 shall:

1. Be immediately removed from contact with a child; and

2. Not be allowed to work with the child until:

a. A prevention plan has been written and approved by a designated regional cabinet staff;

b. The person is cleared of the charge; or

c. A cabinet investigation reveals an unsubstantiated finding, if the charge resulted from an allegation of child:

(i) Abuse;

(ii) Neglect; or

(iii) Exploitation.

(g) Unless the volunteer is a practicum student, a volunteer who performs a similar function as paid staff described in subsection (4) of this section shall meet the same requirements and qualifications.

(h) Practicum students and volunteers shall submit to a background check and any other mandatory requirements listed in subsection (5)(b) and (c) of this section.

(i) A current personnel record shall be maintained for a practicum student or volunteer that includes the following:

1. Name, address, Social Security number, starting date, and date of birth;

2. Evidence of qualifications if the volunteer performs a similar function as paid staff; and

3. Criminal records and central registry checks pursuant to paragraph (h) of this subsection.

Section 3. Interstate Placement.

(1) Prior to accepting a child from another state or prior to placing a child outside Kentucky , the child-placing agency shall comply with:

(a) KRS 615.030 to 615.040, Interstate Compact on Placement of Children;

(b) KRS 615.010, Interstate Compact on Juveniles; and

(2) If a child committed to the cabinet makes a brief visit out of state, not accompanied by child-placing agency personnel, the child-placing agency shall obtain prior consent of designated regional cabinet staff.

(3) A child-placing agency shall comply with subsection (1) of this section, if a child placed with the child-placing agency visits or receives respite care in another state for a period to exceed:

(a) Thirty (30) days; or

(b) The child’s school vacation period.

(4) If an emergency placement of a child into a licensed child-placing agency is made, compliance with KRS 615.030 to 615.040 shall be the responsibility of the placement source.

Section 4. Evaluation of an Applicant.

(1) A child-placing agency's social services staff shall recruit a prospective foster or adoptive home.

(2) A child-placing agency shall:

(a) Complete a home study; and

(b) Approve the home prior to the placement of a child.

(3) Documentation of the home study shall include the following:

(a) A personal interview with each member of the applicant's household;

(b) An assessment of the attitude of each member of the applicant's household toward the placement of a child into the home or adoption;

(c) Observations of the functioning of the applicant's household, including interpersonal relationships and patterns of interaction;

(d) The applicant's ability to accept a child's relationship with the child's family of origin;

(e) Proof of the applicant's:

1. Identity, such as a federally or state-issued photo identification card;

2. Age of twenty-one (21) years or older; and

3. United States citizenship, such as a birth certificate, or legal alien status, such as a permanent resident card, as described in 8 U.S.C. 1151;

(f) A statement for each member of the applicant's household that shall be signed by a licensed physician or licensed health care professional verifying that the individual:

1. Is free of a communicable or infectious disease; and

2. Has no illness or condition that would present a health or safety risk to a child placed in the applicant's home;

(g) A signed statement by a licensed physician or licensed health professional regarding the applicant's physical ability to provide necessary care for a child;

(h) Verification that the applicant has a source of income separate from:

1. Foster care reimbursement; or

2. Adoption assistance;

(i) The name of three (3) personal references who:

1. Are not related to the applicant; and

2.a. Shall be interviewed by the child-placing agency staff in person or by telephone; or

b. Shall provide letters of reference for the applicant;

(j) Verification that the applicant's financial stability has been assessed and approved in accordance with a child-placing agency's written policies and procedures;

(k) Documentation of any interview with an adult child of the applicant, who does not live in the applicant's home, regarding the applicant's parenting history;

(l) If applicable, verification from the applicant regarding a:

1. Previous divorce;

2. Death of a spouse; and

3. Present marriage;

(m) If the applicant does not have custody of the applicant’s own child:

1. A copy of a visitation order;

2. A copy of a child support order; and

3. Proof of current payment of child support;

(n) Proof that the child-placing agency performed background checks on the applicant and any member of the applicant’s household in accordance with criteria established in 922 KAR 1:490;

(o) Documentation that the applicant has access to:

1. Transportation that meets the child's needs;

2. School;

3. Recreation;

4. Medical care; and

5. Community facilities;

(p) If an applicant or household member will be transporting a foster child, proof that the individual possesses a valid driver's license and has automobile or driver's insurance coverage;

(q) Documentation that the applicant's home:

1. Does not present a hazard to the health and safety of a child;

2. Is well heated and ventilated;

3. Complies with state and local health requirements regarding water and sanitation; and

4. Provides in- or out-of-door recreation space appropriate to the developmental needs of a child placed in the applicant's home;

(r) Verification that:

1. No more than four (4) children, including the applicant's own children, shall share a bedroom; and

2. A foster parent shall not share a bedroom with a child in the custody of a state agency, unless prior approval is obtained from the state agency;

(s) Verification that an individual bed:

1. Is provided for each child in the home;

2. If the child is under age one (1), a crib that meets the Consumer Products Safety Commission Standards pursuant to 16 C.F.R. 1508 and 1509; and

3. Is age and size appropriate for the child;

(t) Verification that:

1. Medication is locked;

2. Alcoholic beverages and poisonous or hazardous materials are inaccessible to the child; and

3. Ammunition and firearms are locked and stored separately;

(u) Proof that the applicant has:

1. First aid supplies with unexpired dates available and stored in a place easily accessible by the foster parent;

2. A working telephone; and

3. A working smoke alarm within ten (10) feet of each bedroom;

(v) If a business open to the public adjoins the applicant’s household, consideration of potential negative impacts on the child and family, including:

1. Hours of operation;

2. Type of business; and

3. Clientele; and

(w) If an applicant was previously denied or approval to foster or adopt a child by another child-placing agency or the cabinet, verification of the denial or closure, and indication of whether the closure was at the request of the foster parents or the agency.

(4) Exception to subsection (3)(e)2 of this section may be granted if the applicant is:

(a) Between eighteen (18) and twenty-one (21) years of age;

(b) A relative of the child to be placed in the applicant's home; and

(5) For each potential applicant evaluated, the child-placing agency shall keep a written record of the findings of the home study and the evidence on which the findings are based.

(6)(a) Following approval as a foster home, the approving child-placing agency may request written approval from the state agency with custody of the child, for the foster home to provide services as a certified:

1. Provider of Supports for Community Living in accordance with 907 KAR 1:145;

2. Therapeutic foster care provider for adults in accordance with 907 KAR 3:030; or

3. Family child care home in accordance with 922 KAR 2:100.

(b) Except as provided in paragraph (a) of this subsection, an approved foster home shall not simultaneously:

1. Provide day care center services in accordance with 922 KAR 2:090; and

2. Be used as a licensed or certified health care or social service provider.

(7) An employee of the department who provides protection and permanency services shall be prohibited from becoming a foster parent or respite care provider for a child in the custody of the cabinet, unless the:

(a) Employee was a foster parent or respite care provider for the child at the time employment with the department in protection and permanency services began; and

(b) Commissioner approves, in writing, the employee to be a foster parent or respite care provider for the child.

(8) An employee of the department who provides protection and permanency services may apply to adopt a child in the custody of the cabinet if the:

(a) Employee had:

1. No relationship with the child or a parent of the child prior to the termination of parental rights in accordance with KRS Chapter 625, unless the employee is a relative of the child; or

2. Adopted a sibling of the child available for adoption; and

(b) Commissioner approves, in writing, the employee to adopt.

(9)(a) A child-placing agency shall develop written policies and procedures regarding employees of the child-placing agency serving as:

1. A foster parent;

2. An adoptive parent; or

3. A respite care provider.

(b) Policies and procedures developed in accordance with paragraph (a) of this subsection shall address the prevention or appearance of:

1. A conflict of interest; or

2. Misuse of influence.

(10) A child-placing agency may make an exception to subsection (3)(t)1 of this section if:

(a) The exception is documented in the ITP of a child placed in the foster or prospective adoptive home;

(b) The child is learning to self-administer medicine under the supervision of the foster or prospective adoptive parent or other caretaker; and

(11) If an applicant is approved as a foster home, adoptive home, or respite care provider by a state agency or another child-placing agency, a child-placing agency shall:

(a) Conduct a home study in accordance with subsections (2), (3), and (5) of this section; and

(b)1. Document that the applicant meets training requirements in accordance with Section 5, 7, 10, 13, or 19 of this administrative regulation; and

2. If an applicant lacks training in accordance with subparagraph 1 of this paragraph, the child-placing agency shall, prior to placement of a child in the home:

a. Provide training in accordance with Section 5, 7, 10, 13, or 19 of this administrative regulation; or

b.(i) Develop an individualized curriculum to fulfill unmet training needs; and

(ii) Document the applicant’s compliance with the individualized curriculum.

Section 5. Orientation and Preparation of a Foster Home.

A child-placing agency shall:

(1) Develop and maintain an orientation and preparation curriculum to be kept on file;

(2) Provide a minimum of twenty-four (24) hours of orientation and preparation to a prospective foster parent, to include the following:

(a)1. Child-placing agency program description with mission statement;

2. Information about the rights and responsibilities of the home; and

3. Background information about the foster child and the child’s family, including information in accordance with KRS 605.090(1)(b);

(b) An example of an actual experience from a foster parent that has fostered a child;

1. The stages of grief;

2. Identification of the behavior linked to each stage;

3. The long-term effect of separation and loss on a child;

4. Permanency planning for a child, including independent living services;

5. The importance of attachment on a child's growth and development and how a child may maintain or develop a healthy attachment;

6. Family functioning, values, and expectations of a foster home;

7. Cultural competency;

8. How a child enters and experiences foster care, and the importance of achieving permanency; and

9. The importance of birth family and culture and helping children leave foster care;

(d) Identification of changes that may occur in the home if a placement occurs, to include:

1. Family adjustment and disruption;

2. Identity issues; and

3. Discipline issues and child behavior management; and

(e) Specific requirements and responsibilities of a foster parent.

(3) Maintain an ongoing foster home preparation and training program that:

(a) Provides a minimum of six (6) hours foster home training annually; and

(b) Maintains a record of preparation and training completed.

Section 6. Placement, Case Management, and Supervision of a Child in a Foster Home, Medically-fragile Foster Home, or Therapeutic Foster Care Home.

(1) A child-placing agency shall:

(a) Place a child only in an approved foster home; and

(b) Keep a child who has been committed to the Department of Juvenile Justice for the commission of a sex crime in a separate foster home or prospective adoptive home from a child committed to the Cabinet in accordance with KRS 605.090(1), 620.090(2), and 620.230(3).

(2) A child-placing agency shall select a foster home for a child based upon the:

(a) The child’s assessment and ITP , if available;

(b) Any information concerning the child's needs in placement; and

(c) Measures to support the safety of the child, such as a placement restriction in accordance with subsection (1)(b) of this section, or another child in the foster home.

(3) A child shall participate in the intake process and in the decision that placement is appropriate, to the extent that the child's age, maturity, adjustment, family relationships, and the circumstance necessitating placement justify the child's participation.

(4)(a) The number of children residing in a foster home by a child-placing agency shall not exceed six (6), including the foster parent’s own children.

(b) The number of children residing in a foster home that cares for a child in the custody of the cabinet shall not exceed five (5), including the foster parent’s own children.

(5) A child-placing agency shall have a maximum of two (2) children under two (2) years of age placed in the same foster home at the same time, with the exception of a sibling group, who may remain together.

(6)(a) Justification for an exception to subsection (4)(a) or (5) of this section shall be:

1. Documented in the foster parent file; and

2. Authorized by the program director.

(b) For a foster home that cares for a child in the custody of the cabinet, the child-placing agency shall submit a written justification for an exception to subsection (4)(b) or (5) of this section in accordance with 922 KAR 1:350, Section 2(2).

(7) The child-placing agency shall:

(a) Assess a child to be placed in foster care;

(b) Within thirty (30) days of a child’s placement, develop:

1. An ITP based upon the individual needs of the child and, if appropriate, the child’s family, which addresses the:

a. Visitation, health, and educational needs of the child;

b. Child’s permanency goals and related objectives;

c. Methods for accomplishing each goal and objective; and

d. Designation of an individual or individuals responsible for completion of each goal and objective;

2. A supervision plan for the child which:

a. Is attached to the child’s ITP ;

b. Identifies the current supervision needs of and expectations for the child based upon the child’s recent and past:

(i) Incidents;

(ii) High-risk behaviors; and

(iii) Needs identified in the assessment conducted pursuant to paragraph (a) of this subsection;

c. Includes goals and objectives for the child’s improvement with tasks assigned to the child-placing agency and foster home parent;

d. Is signed and dated by the social service worker and foster home parent; and

e. Remains a part of the child’s record;

(c) Review a child’s ITP and supervision plan on a quarterly basis or more frequently as the child’s needs or circumstances dictate;

(d) Have a written agreement with the foster home stating the:

1. Responsibilities of the:

a. Child-placing agency; and

b. Foster home; and

2. Terms of each placement;

(e) Require a foster home to certify, in writing, that supervision from the child-placing agency or the state agency, which has custody of the child, shall be allowed;

(f) Document a placement in the foster home file;

(g) Report immediately to the state agency, which has custody of the child, if there is:

1. A life-threatening accident or illness;

2. An absence without official leave;

3. A suicide attempt;

4. Criminal activity by the child requiring notification of law enforcement;

5. Death; or

6. Possession of a deadly weapon by a child;

(h) Report, if applicable, within two (2) business days to the state agency, which has custody of the child, if there is a:

1. Change in address;

2. Change in the number of people living in the home; or

3. Significant change in the foster home, such as changes in health or income status of an individual living in the foster home;

(i) Establish policies and procedures for supervision of a foster home by a worker other than the social services worker assigned to the foster home, who meets qualifications specified in section 2(4)(c) of this administrative regulation to:

1. Include:

a. Frequency of an in-home visit with the foster parent;

b. Means of supervision;

c. Methods of supervision; and

d. Personnel conducting the supervision;

2. Ensure a foster child’s placement stability and safety; and

3. Be individualized, as needed, for the:

a. Child; or

b. Foster home;

(j) Identify and make available necessary supports to a foster home, including:

1. A plan for respite care in accordance with Section 13 of this administrative regulation;

2. Twenty-four (24) hour crisis intervention; and

3. A foster home support group;

(k) Assure that a child receives care and services, including independent living services:

1. In accordance with Section 16 of this administrative regulation; and

2. As prescribed by the child’s needs as assessed in the child’s ITP ;

(l) Provide information to a foster parent regarding the behavior and development of the child placed by the child-placing agency;

(m) Inform the foster parent, in accordance with KRS 605.090(1)(b), of:

1. Inappropriate sexual acts or sexual behavior of the child as specifically known to the child-placing agency; and

2. Any behaviors of the child that indicate a safety risk for the placement;

(n) Document each effort to:

1. Protect the legal rights of the family and the child; and

2. Maintain the bond between the child and the child’s family, in accordance with the child’s permanency plan;

(o) Assure that a child shall have, for the child’s exclusive use, clothing comparable in quality and variety to that worn by other children with whom the child may associate;

(p) Be responsible for monitoring the child's school progress and attendance;

(q) Secure psychological and psychiatric services, vocational counseling, or other services if indicated by the child's needs;

(r) Reassess and document quarterly, in the child’s ITP , placement and permanency goals, including independent living services, in accordance with Section 16 of this administrative regulation;

(s) Conduct and document a face-to-face visit with the child at least once per month; and

(t) Maintain foster care records in accordance with Section 18 of this administrative regulation.

(8) Without prior notification to and written authorization from the Kentucky Interstate Compact Administrator, a child shall not be:

(a) Placed with a family that normally resides in another state; or

(b) Permitted to go with a person to take up residence in another state.

(9)(a) An approved foster home in use shall be evaluated on an annual basis for compliance with responsibilities listed in the written agreement described in subsection (7)(b) of this section.

(b) Results shall be recorded in the foster parent file.

(10) Factors that shall result in a review of a foster home shall include:

(a) Death or disability of a family member;

(b) Sudden onset of a health condition that impairs a foster parent’s ability to care for a child placed in the home;

(d) Sudden, substantial decrease in, or loss of, income;

(e) Child birth;

(f) Use of a form of punishment that includes:

1. Cruel, severe, or humiliating actions;

2. Corporal punishment inflicted in any manner;

3. Denial of food, clothing, or shelter;

4. Withholding implementation of the child’s ITP ;

5. Denial of visits, telephone or mail contacts with family members, unless authorized by court of competent jurisdiction; and

6. Assignment of extremely strenuous exercise or work;

(g) A report of abuse, neglect, or dependency that results in a finding that is:

1. Substantiated; or

2. Reveals concern regarding the care of the child;

(h) If the foster parent is cited with, charged with, or arrested due to a violation of law other than a minor traffic offense;

(i) An incident required to be reported in accordance with Sections 6(7)(g) and (h), and 12(6) and (7) of this administrative regulation; or

(j) Other factors identified by a child-placing agency that jeopardize the physical, mental, or emotional well being of the child.

(11) The documentation of a review, specified in subsection (10) of this section, shall contain:

(a) Identifying information;

(b) Current composition of the household;

(d) An assessment of the family functioning to determine if the child’s needs are met; and

(e) Corrective action that may include a recommendation for closure of the foster home.

Section 7. Orientation and Preparation of a Therapeutic Foster Care Home.

(1) A child-placing agency shall:

(a) Maintain the orientation and preparation curriculum on file; and

(b) Provide a minimum of thirty-six (36) hours of orientation and preparation for a prospective therapeutic foster care parent that shall incorporate the following topic areas:

1.a. Child-placing agency program description with mission statement;

b. Information about the rights and responsibilities of the therapeutic foster care home; and

c. Background information about a foster child and the child’s family;

2. An example of an actual experience of a therapeutic foster care parent that has fostered a child;

3. Stages of grief;

4. Behaviors linked to each stage of grief;

5. Long-term effects on a child from separation and loss;

6. Permanency planning for a child, including independent living services;

7. Importance of attachment on a child's growth and development and the way a child maintains and develops a healthy attachment, including attachment disorder and associated behaviors;

8. Family functioning, values, and expectations of a therapeutic foster care home;

9. Changes that may occur in the home with placement of a child regarding:

a. Family functioning;

b. Family adjustment;

c. Identity issues;

d. Discipline issues and child behavior management; and

e. Family disruption;

10. Specific requirements and responsibilities of a therapeutic foster care home;

11. Behavior management;

12. Communication skills;

13. Skill teaching;

14. Cultural competency;

15. Behavior management de-escalation techniques;

16. The dynamics of the sexually-abused child; and

17. The effect of chemical abuse or dependence by the child or the child's biological parent.

(2) A therapeutic foster care home shall receive a minimum of twenty-four (24) hours of annual training.

(3) A child-placing agency that provides therapeutic foster care shall maintain an ongoing therapeutic foster care preparation and training program that:

(a) Provides a minimum of twenty-four (24) hours of annual training; and

(b) Maintains a record of preparation and training completed.

Section 8. Additional Requirements for Therapeutic Foster Care.

(1) A therapeutic foster care home shall accommodate the needs of a child who is unable to live with the child’s own family and who:

(a) May benefit from care in a family setting; and

(b)1. Has clinical or behavioral needs that exceed supports available in a foster home; or

2. Is transitioning from group care as part of the process of returning to family and community.

(2) The number of children residing in a therapeutic foster care home that does not care for a child in the custody of the cabinet, shall be limited to a total of six (6) children, including no more than two (2) therapeutic foster care children.

(3) Justification for an exception to subsection (2) of this section shall be:

(a) Documented in the therapeutic foster care parent’s file; and

(b) Authorized by the treatment director.

(4) The number of children residing in a therapeutic foster care home that cares for a child in the custody of the cabinet, shall be limited to a total of four (4) children, including no more than two (2) therapeutic foster care children.

(5) The child-placing agency shall request an exception to subsection (4) of this section in accordance with 922 KAR 1:350, Section 2(2).

(6) A treatment director shall supervise a treatment team and shall participate in the development of the ITP and the quarterly case consultation.

(7) A child-placing agency shall provide or contract, as specified in KRS 199.640(5)(a)(2), for therapeutic services individualized for the child, as needed, at least two (2) times per month.

(8) A therapeutic foster care parent shall be responsible for:

(a) Participation in the development of an assessment, ITP , and supervision plan as specified in Section 6(7) of this administrative regulation;

(b) Facilitation of in-home services provided by a social services worker at least two (2) times per month;

(c) Adequate supervision of the child and implementation of components of the ITP , including daily log documentation as specified in the ITP ;

(d) Working with the child-placing agency to promote stability and avoid disruption for the child;

(e) Working with the child-placing agency in the development of a plan for the smooth transition of the child to a new placement, in the event of a disruption; and

(f) Providing independent living services for a child twelve (12) years of age or older consistent with a child’s ITP .

(9) Except for a child who is the legal responsibility or in the custody of the cabinet or the Department of Juvenile Justice, the child-placing agency shall be responsible for:

(a) A preplacement conference, in a nonemergency placement, for the purpose of:

1. Developing permanency goals and a discharge plan for the child, including independent living services;

2. Developing a plan for the implementation of services;

3. Identifying the treatment goals; and

4. Developing a behavior management plan if applicable; and

(b) Inviting and encouraging attendance to the preplacement conference by:

1. The prospective therapeutic foster care home;

2. A respite care provider approved in accordance with section 13(4) of this administrative regulation;

3. The child, if appropriate; and

4. The child’s family.

(10) The social services worker shall:

(a) Have a first face-to-face visit with a child and therapeutic foster care parent on the day of the child's placement;

(b) Have another face-to-face visit with the therapeutic foster care parent or child within ten (10) calendar days of the child's placement;

(c) Telephone or visit, on a weekly basis, at least one (1) of the therapeutic foster care parents of each child on the therapeutic foster care worker's caseload;

(d) Visit a therapeutic foster care parent a minimum of two (2) times a month with at least one (1) visit being in the foster home;

(e) Visit the foster child face-to-face a minimum of two (2) times a month with at least one (1) visit in the therapeutic foster care home and one (1) visit outside the foster home;

(f) Carry a caseload of not more than twelve (12) therapeutic foster care children, taking into account:

1. Required responsibilities other than the case management of a child in foster care;

2. Additional support, contact, and preparation needed by a therapeutic foster care home, due to the extent of the needs of the child served; and

3. The intensity of services provided to the child and the child’s family;

(g) Conduct a quarterly case consultation, including the:

1. Foster home;

2. Child’s public agency worker;

3. Child-placing agency treatment director and social services worker; and

4. Child and the child’s family of origin, to the extent possible;

(h) Provide or contract for therapeutic services individualized for a child at least two (2) times each month based on the child’s needs assessed in the child’s ITP ;

(i) Identify the support needed by the foster family, including a:

1. Plan for respite care as provided in section 13 of this administrative regulation;

2. Plan for twenty-four (24) hour on-call crisis intervention; and

3. Foster home support group;

(j) Recommend and prepare an aftercare plan for a child, prior to discharge from therapeutic foster care, to ensure a successful transition; and

(k) Document a quarterly case consultation and revision to a child’s ITP as determined by the case consultations.

(11) The child-placing agency shall:

(a) Meet requirements specified in Section 6(1) through (3) and (7) through (11) of this administrative regulation; and

(b) Annually reevaluate a therapeutic foster care home in accordance with Section 15 of this administrative regulation.

Section 9. Medically-fragile Child.

1) A medically-fragile child shall be:

(a) A child in the custody of the cabinet; and

(b) Determined by the cabinet to meet the medically-fragile requirements of 922 KAR 1:350.

(2) The decision to accept a medically-fragile child shall be optional to a child-placing agency.

(3) If a child placed with a child-placing agency in a non-medically-fragile foster home becomes medically-fragile in accordance with subsection (1) of this section, the commissioner or designee and child-placing agency shall reevaluate the placement and ensure the child’s needs can be met.

Section 10. Preparation of a Medically-fragile Foster Home.

(1) A child-placing agency shall create a medically-fragile foster home only if the child-placing agency has:

(a) Staff meeting qualifications established in Section 2(4) of this administrative regulation supervising the home, who have received medically-fragile training in accordance with subsection 2(b) and (c) of this section; and

(b) A liaison established with the cabinet.

(2) A foster home may be approved to care for a medically-fragile child by a child-placing agency if the foster home:

(a) Includes a primary caregiver who is not employed outside the home, unless approved in writing by designated cabinet staff;

(b) Completes, in addition to training specified in Section 5 of this administrative regulation:

1. Twenty-four (24) hours of cabinet training to include first aid and cardiopulmonary resuscitation (CPR) certification if the foster parent is not currently certified in first aid and CPR;

2. Sixteen (16) hours of cabinet training if the foster parent is currently certified in first aid and CPR; or

3. Training approved in advance by the cabinet, in the areas of:

a. Growth and development;

b. Nutrition; and

c. Medical disabilities;

1. CPR; and

2. First aid;

(d) Is located within a:

1. One (1) hour drive of a medical hospital with an emergency room; and

2. Thirty (30) minute drive of a local medical facility; and

(e) Is evaluated in accordance with Section 4 of this administrative regulation.

(3) Professional experience related to the care of a medically-fragile child may substitute for the training requirement of the medically-fragile foster parent as specified in subsection (2)(b) and (c) of this section:

(a) Upon the approval by a designated cabinet staff; and

(b) If the foster parent is a licensed health care professional, to include a:

1. Physician as defined in KRS 311.720(9);

2. Registered nurse as defined in KRS 314.011(5);

3. Licensed practical nurse as defined in KRS 314.011(9);

4. Physician’s assistant as defined in KRS 311.840(3); or

5. Advanced registered nurse practitioner as defined in KRS 314.011(7).

(4) If the cabinet determines that a child currently in the care of a foster parent approved by the child-placing agency is a medically-fragile child in accordance with Section 9(1) of this administrative regulation, then the cabinet shall prioritize the foster home’s enrollment in training as specified in subsection (2)(b) and (c) of this section.