Back to Basics Policy Training

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Back to Basics Policy Training
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• The Georgia Department of Human Services,
  Division of Family and Children (DFCS)
  administers the Comprehensive Child and Family
  Assessment and Wrap-Around Programs to assist in
  the provision of services to families whose
  children have suffered abuse or neglect.

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Division of Family and Children (DFCS) Overview

• DFCS has the primary responsibility for child
  welfare programs, which are supervised at the
  state and regional levels and administered at the
  county level.
• Children and families receive direct services
  through 159 county DFCS departments grouped into
  17 regions under Field Operations, which has
  overall responsibility for the administration and
  management of the States public child welfare
  programs in the counties.
• DFCS is divided into two primary functional
  sections Social Services and Family
  Independence. Social Services addresses the
  continuum of child welfare services, and Family
  Independence addresses financial and related
  assistance for families, such as TANF, Food
  Stamps and Medicaid.

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DFCS Vision and Mission

• DFCS Vision for Child Welfare
• Georgia children, youth and families have the
  support they need to be safe and secure, and to
  achieve their greatest potential.
• This vision is in keeping with DHRs overall
  mission as well as the values of the division
• DHR Mission
• To strengthen Georgia families - supporting their
  self-sufficiency and helping them protect their
  vulnerable children and adults by being a
  resource to their families, not a substitute.

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DFCS Core Vaues

• DFCS Core Values
• Children need and deserve to grow up safe, free,
  and protected from abuse and neglect.
• Children do best when they have strong families,
  preferably their own, and when that is not
  possible a stable relative, foster or adoptive
  family.
• All children deserve to live in a family that is
  safe and permanent.
• All individual families and communities have
  strengths we can enhance a familys ability to
  care for their children.
• Placement moves are inherently traumatic. A move
  should occur only after all parties to the case
  meet to discuss the issues and to consider
  services or other supports that could help
  preserve the placement.
• Race, gender, ethnic background, economic or
  social status should not play a role in
  determining the childs experience in the foster
  care or protective services system.
• Children need to have a connection to an adult in
  their life that provides unconditional love and
  acceptance. These types of bonds are best formed
  in families.
• All children have connections to caregivers,
  siblings, and community. These connections are
  important to the childs development and identity
  and should be preserved.
• Families and children need to be given
  ownership over the decisions that impact their
  lives. These decisions will not be made without
  their input.
• Targeted prevention strategies used at all points
  in the child welfare continuum will improve
  outcomes relating to safety, permanency and
  well-being.
• Prerequisites to success are accountability,
  evidence-based decision-making, self-evaluation
  and continuous quality improvement.

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DFCS Principles

• DFCS Principles
• Advocate on behalf of children and their families
  with other all related state departments and
  community organizations in assuring appropriate
  utilization of public and private resources.
• In making determinations about plans and
  services, we consider the childs safety and
  health paramount.
• We must provide relevant services with respect
  for and understanding of childrens needs and
  childrens and families culture.
• No child or family will be denied a needed
  service or placement because of race, ethnicity,
  sexual orientation, physical or emotional
  handicap, religion, or special language needs.
• Where appropriate, families will be provided with
  the services they need in order to keep their
  children safe and at home in order to avoid the
  trauma of removal.
• Understanding the disproportionate representation
  of children and families of color among those
  supervised by DFCS, we will continually assess
  our tools, services and strategies to prevent
  racial and ethnic bias.
• Foster care will be as temporary an arrangement
  as possible.

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DFCS Principles Continued

• If at all possible, children in out-of-home
  placements will be safely reunified with their
  families within 12 months. Families will be
  provided with the services they need to allow for
  safe reunification whenever possible.
• If a child cannot be safely reunified within
  timeframes established under federal and state
  law, DFCS will find a permanent home for the
  child, using child-specific recruitment plans
  when necessary, preferably guardianship or
  adoption with an appropriate relative or an
  adoptive family.
• We must work to ensure children in out-of-home
  placement have
• Stable placements that promote the continuity of
  critical relationships, including with their
  parents, siblings and capable relatives, to
  achieve a sustainable permanent family setting.
• Placements in settings that are the least
  restrictive and meet their individual needs.
• Decision-making that is informed by a long-term
  view of the childs needs, informed by the family
  team, and is consistent with federal and state
  timelines about achieving an exit from care to a
  sustainable, safe permanent home.

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What is CCFA?

• The Child and Family Comprehensive Assessment
  (CCFA) is the process by which DFCS assesses the
  strengths and needs of families whose children
  are in foster care (FC). The child and his/her
  family, both immediate and extended, are engaged
  in the assessment process.
• Foster Care includes any out-of-home placement
  (e.g. foster homes, relative homes, fictive kin,
  group homes, institutions or CCIs or CPAs).

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Purpose of CCFA

• The goal of the Family Assessment is to provide a
  comprehensive assessment of the family.
• The assessment provides the foundation for
  effective case planning, intervention and
  decision-making.
• DFCS staff use the assessment information to
  inform
• Placement decisions and
• The identification of services to ensure the
  safety, permanency and child and family
  well-being.
• Observations and information from the Family
  Assessment will be presented at the
  Multi-Disciplinary Team staffing (MDT) and
  reviewed at the Family Team Meeting (FTM).

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Purpose Continued

• Children entering care are at higher risk than
  the general population for delays and
  disabilities. In addition, the trauma of
  placement can result in emotional distress and
  trauma.
• Comprehensive screening or assessment of the
  child and family can have a positive life
  changing impact, if problems are identified and
  early treatment interventions are implemented.

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Purpose Continued

• The CCFA provides DFCS and other providers
  working with the child and
• family a better understanding of the
• Degree of parent-child attachment and where the
  child feels a sense of belonging
• Childs extended family as a potential resource
  for support and/or the placement of the child
• Familys history and/or patterns of behavior
  e.g., prior CPS involvement or foster care
  placements, past experience with handling crisis,
  problems with addiction, criminal behavior, etc.
• Strengths and resources from which the family can
  tap
• Core needs of the family which, at a minimum,
  must be changed or corrected for the child to be
  safely returned within a reasonable period of
  time
• Probability of the child returning home or the
  likelihood of an alternative permanency plan and
• Identified medical, emotional, social,
  educational and placement-related needs of the
  child.

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Who is referred?

• All children entering foster care.
• Any child in care whose CCFA is more than twelve
  months old, and additional information is needed
  for case planning activities.

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Guiding Principles of CCFA

• Assessment Driven
• Safety Focus
• Family Team Meeting
• Multi-Disciplinary Team Meeting
• Integrated Services
• Foster Parent Partnership
• Public and Private Partnership
• Results Driven
• Cultural Responsibilities
• The foundation for the development of the case
  plan

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CCFA Service Component

• Medical Component
• Health Check Screening (ages 0-18). Includes
  Early and Periodic Screening, Diagnostic and
  Treatment (EPSDT)
• Developmental Screens (age 0-3)
• Dental Screens (age 3-18)
• Educational Component (ages 5-18 or 4 under)
• Psychological Component (ages 4 18)
• Adolescent Psychological Assessment Component
  (ages 14-18)
• Family Assessments
• Relative Home Evaluation
• MDT Report
• Family Team Meeting
• Each CCFA service component must be referred and
  billed separately. All information received or
  developed as part of the CCFA assessment or work
  with the family is the property of DFCS.

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CCFA Services

• The county department will decide which
  components and reports are needed for the
  assessment process and will only pay for the
  completed components. The Comprehensive Child
  and Family Assessments (CCFA) will include one or
  more of the following components and reports
• The County Department agrees to pay the
  contractor per referral according to the progress
  payment schedule. Payment is contingent upon the
  completion of tasks as identified in the Progress
  Payment Schedule and compliance with the
  standards.
• Information obtained by DFCS to be used in the
  family assessment will not be billed for under
  the CCFA component schedule. For example, if
  DFCS obtains the medical information and
  provides it to the provider for inclusion in the
  family assessment report, the provider may not
  bill for the medical component.

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Component Payment Schedule

• Medical Component- 150 per child
• Educational Component (ages 5-18 or 4 under)-
  150 per child
• Psychological Component (ages 4 18)- The
  Psychological Evaluation will be billed to
  Medicaid. 300 per child
• Family Assessments (including MDT)- 600 and 300
  for each additional child (more than one child)
• Relative Home Evaluation- 350 This rate includes
  costs related to a Family Team Meeting.
• The provider may be reimbursed for any costs,
  (which exceeds the above-referenced 350 fee),
  related to the following mandatory reports
• Drug Screening Checks and
• Medical statements
• NOTE These items apply to all relative
  caregivers and household members, 18 years or
  older. Criminal Background Checks (fingerprint
  checks, both GCIC and NCIC). Receipts are
  required before reimbursement is made for theses
  expenses.
• Adolescent Assessment (ages 14-18)
• Family Team Meeting

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CCFA Referral Assessment Procedure

• If child remains in care following the 72-Hour
  Hearing, an immediate referral must be made for
  the completion of a CCFA via the Referral for
  Assessment to an approved CCFA Provider form
  (form 1).
• The DFCS SSCM must
• Schedule the date and time of the Family Team
  Meeting (FTM). FTM must be held within nine (9)
  days of childs placement.
• Schedule the date and time of the
  Multi-Disciplinary Team meeting (MDT). The MDT is
  facilitated by the CCFA provider and must be held
  within 21 days of the referral date.
• Ensure that a Health Check is completed within
  ten (10) days of the child entering FC. This may
  be referred as part of the CCFA process.
• A CCFA is not required if the child was assessed
  in the previous twelve months.

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CCFA Referral and Assessment Procedure

• The referred provider has 24 Hours to accept or
  decline the referral via Form 1.
• Within 24 Hours of the providers acceptance of
  the referral the SSCM
• Sends a referral letter to the parent and
  caregiver that outlines the process of the CCFA
  including identifying the CCFA provider with a
  copy to the CCFA provider.
• Provides the provider with a Pre-Evaluation
  Checklist with all applicable documents attached.

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CCFA Referral and Assessment Procedure

• If the provider declines the referral, the SSCM
  must make a referral to a different CCFA
  provider.
• Within two days of accepting the referral, the
  provider must
• Make a face-to-face contact with each family
  member referred for services, presenting a
  picture ID and a copy of the referral letter.
• Schedule a time to review the case record at the
  DFCS office.
• Schedule all necessary appointments and arranges
  transportation.
• The provider must advise the county within five
  days of the referral date if a determination is
  made that they are unable to complete the
  accepted CCFA assessment or if the family is
  unwilling to cooperate.
• Within thirty days of the referral, the provider
  must submit the final written report (CCFA) and
  an assessment invoice to the designated county
  staff. A waiver may be requested of the county
  director within fifteen days or referral receipt
  if the written report will be unable to be
  completed by the thirty day deadline.

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Partial/Cancelled Assessments

• The county may cancel the scheduled components if
  the child is returned home at the 10 Day Hearing.
• The county office will compensate the provider
  for work done to date.
• The county may provide partial payment if
• The components received are not completed per
  standards or
• The components are not submitted timely.

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Family Assessment Component

• The family assessment must include (if
  applicable), but is not limited to, the following
  information
• Reason for Referral
• Household Composition/Key Data
• Clinical Observation
• Prior Agency Involvement
• Living Arrangements
• General Financial Status and Employment History
• Health of All Household Members
• Marriage Status
• History of Criminal Activity (parents and
  children)
• Education Status

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Family Assessment Component Continued

• Relationship between Parent and Child
• Relationship between Placement Resource and Child
• Family and Community Resources (i.e.
  Transportation)
• Family's Strengths and Needs
• Relatives and resources for support, placement,
  and possible permanency
• Efforts to place siblings together and reasons
  they were not placed together, if applicable
• Does the parent or child have Native American
  Heritage?
• Reason child is placed a substantial distance
  from their home, if applicable.
• Genogram and Ecomap (as a required attachment)
• Summary, Conclusions, and Recommendations

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The Family Assessment as a Dynamic Process

• The family assessment is based on a combination
  of observations, interviews, self-report measures
  and social history.
• Family self-reporting and case history review is
  insufficient. Observations are needed to confirm
  or not confirm a self-report. The family must be
  observed in action (enactments). The assessment
  must be dynamic (it should reveal the family's
  energy, style, and behavior). If at all feasible,
  see families over a period of time. Having only
  one observation session may result in a distorted
  picture.
• The focus of the assessment is on the dynamic
  observations and interactions observed during the
  assessment. Standardized self-report instruments
  may be used to gather information. Although a
  social history and a background information
  section need to be included, this section is only
  one of the sections of the assessment or report.
  Integrate the history and background sections
  into the conclusions and recommendations.

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The Family Assessment as a Dynamic Process

• All parents must be interviewed. This includes
  absent or incarcerated, putative, legal, adoptive
  or any other parent category not listed. The
  required method is a face-to-face interview. If
  a parent is absent or incarcerated, then a
  telephone or written interview is appropriate.
  In any case, a written explanation must be
  included in the report explaining why a
  face-to-face interview was not accomplished. This
  statement should document all attempts to secure
  interviews.
• Extended family members must be contacted. If the
  custodial parents refuse to permit contact with
  extended family members, the DFCS case manager
  determines if contact should occur despite the
  custodial parent's protest. When interviewing
  the extended relatives, the provider should
  explore resources for support, placement and
  possible permanency. The Provider may also
  obtain information on other relatives to contact.
  
• The CCFA Provider should contact DFCS
  immediately, if a relative is identified as a
  placement resource for the child.
• DFCS may request an approved CCFA provider to
  complete a home evaluation on a relative.

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Family Interviews

• The family subsystems should be seen together and
  in separate units. It is recommended that the
  assessment take place in two or three stages.

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Stage 1 Parent/Caregiver Interviews

• See the parent/caregiver(s) first. During this
  stage the family assessor can
• Determine who is in the household.
• Identify family members (not living in the
  household) relatives who have an impact or
  important role for this family (e.g.
  grandmothers, parents, etc.). Are any of these
  individuals potential placement resources for
  the child?
• Identify non-family members who are important to
  this family (e.g. boyfriend/girlfriends, pastors,
  neighbors, etc.).
• Obtain a developmental history of the child
  (children). This history will provide an
  opportunity to obtain the parent's perception of
  their child, knowledge of developmental issues
  and parenting skills.
• Explore individual caregiver issues and obtain an
  initial mental status for each caregiver. At this
  stage, it may be determined that a parent(s)
  require a psychological evaluation and/or a
  substance abuse evaluation.
• This first stage can provide an opportunity for
  the initial assessment of the couple's
  relationship.

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Stage 2 The Child Interview

• Each child should be seen alone to obtain the
  child's perception of his parents and his family.
  If there is more than one child in the family
  they should be observed together in stage three.

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Stage 3 Family Subsystems

• Stage III The family subsystems should be seen
  together and in separate units.
• The family should be seen together unless there
  is a serious, well-documented basis preventing
  the family system to be seen as a unit. For
  example
• Child with parent (or caregiver) 1 and 2 (both
  caregivers together with child)
• Child with parent or caregiver 1
• Child with parent or caregiver 2
• Family unit (household unit-parents/caregivers,
  siblings, target child (children)
• Extended Family/Community As many family
  members/community resources that can be gathered
  for the assessment.
• Family Team Meeting

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Family Assessor Qualifications

• Minimum of a Masters level of education in
  Social Work, Counseling, or Psychology with an
  LCSW, LMFT or LPC granted by the State of
  Georgias Composite Board of Counselors, Social
  Workers, and Marriage and Family Therapists.
  Assessors must have a current license with the
  above referenced authority.
• Individuals with a Masters degree who are under
  the supervision of an LCSW, LPC or LMFT may also
  conduct a CCFA Assessment. In which case, the
  Assessment requires two signatures the licensed
  supervisors and the Masters level assessor.

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Psychological Evaluation Component

• To obtain information on the childs mental
  health, children (ages 4-18) are required to
  complete a psychological evaluation.
• A psychologist (identified as part of your vendor
  network) participating in the Medicaid program,
  Peach Care, Georgia Better Healthcare or the
  child's insurance plan should complete a
  Psychological evaluation.
• A psychological evaluation is a written report of
  the information collected during the evaluation.
  This report should include, but is not limited
  to, the psychological status of the child or
  adolescent at the time they enter foster care.
  If the psychological evaluation yields any
  psychological or developmental delays or
  concerns, the psychological summary and report
  must provide detailed recommendations and actions
  to be taken.
• The Psychological Evaluation should not be
  completed until the hearing and vision screening
  results are available.
• Infants and toddlers (age 0-3) will undergo a
  developmental screen as part of the Health Check
  Screen.

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Pre-Evaluation Activities

• Before a psychological evaluation is conducted,
  the CCFA provider and SSCM, shall take the
  following actions
• Generate referral questions, based on the
  Pre-Evaluation Checklist) before the request for
  a psychological evaluation is sent to the
  psychologist. An individual or a team may
  generate the referral question. Ideas for a
  referral question may be gathered from case
  managers, foster parents, biological family
  members, facility representatives, physician,
  teachers, etc. Referral questions may be general
  or specific. (General We are seeking a childs
  cognitive ability level, current achievement
  level and an emotional profile.) (Specific Does
  this child have dyslexia? Does this child have
  ADHD?)
• Provide background information. The case
  manager, foster parent and/or facility
  representative must be available to the
  psychologist to provide background information
  and to complete developmental and behavioral
  questionnaires. If an adult who has limited
  knowledge of the child provides transportation,
  then it is the responsibility of the case manager
  and/or placement provider to set up an in-person
  or telephone appointment. The purpose of this
  appointment is to provide the information within
  72-hours of the evaluation so the report can be
  completed in a timely manner.
• Provide copies of previous reports. Copies of
  all prior psychological evaluations,
  psycho-educational reports and other relevant
  reports should be provided to the psychologist
  when the child is transported to the evaluation.
  Provide information on medications. Inform the
  psychologist if the child is on medication at the
  time of the evaluation. A list of all medications
  should be provided to the evaluator at the time
  of the evaluation.

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Psychological Report Format

• 1. Identifying Data
• Name
• Date of Birth
• Child's Social Security Number (if applicable)
• Date of Referral
• Date of Evaluation
• Names of the following
• Parent/Guardian
• Foster parent
• Referring person and agency
• 2. Reason for Referral
• 3. Background Information
• History of child/youth
• Present placement

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Psychological Report Format

• 4. Summary of Past Evaluations and Treatment
• 5. Behavior Observations/Mental Status
• 6. Evaluation Results
• Include name of test and scores (standard scores,
  percentiles, grade equivalent scores)
• Summarize results and findings of each test
• It is the responsibility of the Psychologist to
  review previous psychological reports to
  determine if an IQ test needs to be repeated
  within the three-year window. If an IQ test does
  not need to be repeated, it is expected that the
  psychologist will use the extra time for extended
  achievement screening or personality measures.

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Psychological Report Format

• A. Intellectual Assessment
• IQ score from the WISC-III, Stanford-Binet,
  WAIS-R, DAS (Differential Abilities Scale),
  Bayley Scales of Infant Development, WPPSI-R
• An IQ test does not need to be repeated
• If a child has had an IQ score completed with the
  WISC-III or Stanford-Binet within three calendar
  years,
• If the child was at least 7 (seven) years of age
  at the time of the earlier IQ test, and
• If a child will not be referred for Level of Care
  services.
• An IQ test must be repeated
• If a child was under 7 (seven) years of age at
  the time of the earlier IQ test,
• If the child has had a head injury or evidence of
  serious mental illness has emerged since the
  initial evaluation,
• If the child was not on medication (such as
  Ritalin) during the earlier evaluation, and
• If a child will be referred for Level of Care
  services, an IQ test must be current and
  completed within one calendar year.
• NOTE Abbreviated scales (Kaufman Brief
  Intelligence Test -KBIT or Wechsler Abbreviated
  Scale of Intelligence -WASI) are acceptable only
  if the child's scores fall at the Low Average or
  above. Children with Borderline or Intellectually
  Disabled scores on an abbreviated instrument will
  need an IQ score from a Full battery. Children
  with evidence of Learning Disabilities will need
  an IQ score from a Full battery.

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Psychological Report Format

• B. Adaptive Behavior Scales
• If IQ falls within or below the Mildly Mentally
  Retarded Range an Adaptive Behavior Scale must be
  administered (i.e. Vineland, AAMD).
• C. Academic Screening and Assessment.
• WRAT - 3 (Wide Range Achievement Test) may be
  used for screening. WJ II - The (Woodcock-Johnson
  II) or WIAT - (Wechsler Individual Achievement
  Test) is preferred for assessment.
• Assessment will need to target problems
  highlighted by the screening or referral
  question. Further referrals for additional
  evaluation may be required.
• D. Personality Measures
• Choice of measures based on age, referral
  question, IQ, etc.
• Objective (e.g. MMPI-A, RCDS, RADS)
• Projective (e.g. TAT, RAT-Roberts Apperception
  Test, Rorschach)
• E. Standardized Behavioral Check List
• For example, Achenbach, CAFAS, BASC
• Report significant Problem Areas.

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Psychological Report Format

• 7. DSM IV - Multi-Axial Diagnosis
• Include all 5 axes and numerical codes.
• 8. Summary and Recommendations
• Summary and recommendations must address the
  referral question, presenting problems, and the
  reason the child came into care.
• Supplemental recommendations may be listed.
  These recommendations should address the
  underlying reasons, which impact the child and
  family functioning.
• A validity statement should be included (i.e.
  This evaluation appears to be a valid reflection
  of this childs current level of functioning).
• Recommendations for placement (if appropriate)
• Recommendations for Treatment
• Referrals for additional assessment (if
  necessary)
• 9. Name, Signature of Psychologist and Date
  Completed
• License Number
• Only Licensed Psychologists are eligible to
  complete and sign psychological evaluations.
  Psychometricians may be used to administer and
  score tests. The psychologist is responsible for
  diagnoses, summaries and treatment
  recommendations.
• NOTE Standards developed by Wendy Hanevold,
  Ph.D., Licensed Psychologist 1574 (Georgia)
  404-583-7333

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Psychological ReportsInclude

• Identifying Data
• Reasons for Referral
• Backgrounds Information
• Past Evaluations/Treatment
• Behavioral Observation/ Mental Status
• Evaluation Results
• DSM IV Diagnosis
• Summary and Recommendations
• Addresses the Referral Question and Presenting
  Problems
• Placement Recommendations
• Treatment Recommendations
• Validity Statement
• Name, Signature, Credentials, Dates

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Adult Psychological and Specialized Assessments

• Services including Psychological, Psychiatric,
  Speech Therapy (formerly known as PPST) and
  specialized assessments may be utilized when
  Medicaid is not available. The following are
  eligible to receive assessment and treatment
  services
• Children in foster care,
• Birth parents of children in care when the
  permanency plan is reunification or when another
  permanency plan may need to be selected,
• Relative care givers of children in care when the
  permanency plan is placement with a fit and
  willing relative or when another permanency plan
  may need to be selected, and
• Foster Parents serving special needs children who
  require consultation about a specific child in
  the home.
• If an adult or specialized assessment is
  recommended, and there is no identified funding
  source to cover the cost of the assessment, the
  county department may authorize payment using
  assessment funds.
• Prior approval from the county department is
  required before an adult or specialized
  assessment is initiated. The county department
  will provide the CCFA provider with Form 535,
  Authorization and Claim for Psychological,
  Psychiatric or Speech Therapy Services, completed
  and signed by the County Director/designee. The
  county department must provide instructions to
  the CCFA provider for submitting the claim to the
  county department for services rendered.

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Who Can Complete a Psychological or Psychiatric
Evaluation?

• Psychological evaluations are to be completed and
  signed by a licensed psychologist and/or a
  psychiatrist. Providers must be licensed for the
  service performed i.e., psychiatric and
  psychological evaluations and therapy must be
  conducted by a psychiatrist (M.D.) or by a
  licensed clinical psychologist (Ph.D. or Psy.D.).
  
• These assessments must be completed by a provider
  who accepts Medicaid, Peach Care, Georgia Better
  Healthcare or the child's insurance plan and must
  be charged at the Medicaid billable amount.
  Prior approval must be obtained by the County
  Director to utilize a provider who does not
  accept Medicaid.
• A non-licensed individual (CCFA provider) from an
  agency (Bachelors level education or
  paraprofessional) may accompany the child to the
  appointment and provide all background
  information including the referral question to
  the Psychologist.
• The provider must ensure that a copy of the
  Psychological evaluation is submitted with the
  CCFA report.

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Differences between a Psychological Evaluation
and a Family Assessment
PSYCHOLOGICAL EVALUATIONS FAMILY ASSESSMENTS
IQ test Social History
Adaptive level of functioning-everyday functioning for people with Developmental Disabilities Family Dynamics
Academic Skill Levels Family Strengths and Challenges
Mental Health Diagnosis (DSM-IV) Exploring Parenting Skills
Neuropsychological Factors e.g. Head Injuries (Developmental Current) Reviewing Parents Perceptions of the Child(ren)
Individual Psychological History (Developmental Current) Child's Perception of Parent or Parents
Assessing the Couples Relationship (If Appropriate)
Extended Family Resources
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Some behaviors may require a specialized
assessment. Examples of specialized assessments
are
Disassociate Disorders Fire setting
Learning Disability Neuropsychological
Occupational Therapy Evaluation Psychiatric Evaluation
Sexual Perpetrator Specialized Medical
Speech and Language Evaluation Substance abuse Trauma Assessment (sexual, physical)
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• Traditional individual psychological evaluations,
  parenting evaluations and family assessments do
  not provide information about
• Guilt or Innocence (Did an individual sexually
  abuse or physically abuse a child?)
• Substance Abuse
• These factors have to be evaluated by experts in
  the field and through forensic channels.

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CCFA Adolescent Assessment

• The adolescent component is administered to
  youth, ages 14-18, if at a Judicial or Citizens
  Panel Review
• the plan for permanency changes to emancipation
  for the youth and
• the assessment is deemed necessary or
  appropriate as part of the review plan.
• The assessment must be coordinated with the
  Independent Living Coordinator (ILC) and ensure a
  copy of the assessment is forwarded to the ILC
  when completed.
• The adolescent component is designed to generate
  information critical to successfully guiding
  young people in their journey from foster care to
  achieving self-sufficiency.
• Used to assist in developing a Written
  Transitional Living Plan (WTLP)
• Identifies services to assure safety, permanency
  and youth well being.
• The assessment is strength-based and
  solution-oriented and is completed in partnership
  with teens who assist in identifying their own
  areas of strength and challenges as they move
  toward transition.

44
Adolescent Assessment Cont

• The adolescent component of the assessment serves
  as a determinant for participation in DFCS
  Transitional Living Program (TLP).
• The TLP is a supervised, scattered site apartment
  program for youth ages 18-21 who are moving from
  the foster care system back into communities.
• Youth appropriate for the TLP Adolescent
  Assessment are generally those who
• Are between the ages of 17.5 and 20.5,
• Are currently in foster care with a signed Form 7
  (Consent to Remain in Foster)
• were formerly in foster care i.e. youth in
  Aftercare status, who remained in foster care
  until age 18,
• have completed high school, and
• have assessment approval from the local ILC

45
CCFA Adolescent Assessment

• The following areas and domains are evaluated and
  included as an integral part of the assessment
• 1. Independent Living Skills
• Daily Living Tasks
• Self Care
• Housing and Community Resources
• Social Development
• Money Management
• 2. Family of Origin Strength and Issues
• 3. Interpersonal Relationships and Social
  Support Networks
• 4. Future Perspective
• 5. Pre-Vocational and Vocational Goals
• 6. Alcohol and Drug Use
• 7. Coping Skills and Self Esteem
• 8. Sensitive Issues
• 9. Interviews with Youth, Caregivers, Case
  Managers and Teachers
• 10. Functioning

46
Required Interviews

• The assessment is youth centered.
• Collateral interviews should be completed with
• parents,
• case managers and/or
• teachers.
• Collateral material may also be available in the
  Family Assessment and Psychological Evaluation.

47
CCFA Adolescent Component

• Data Section
• Background and Summary of the Adolescent
  Comprehensive Child and Family Assessment
• Reason for Referral and Background Information
  (e.g. for youth transitioning out of foster care,
  for a significant, extenuating circumstance
  concerning the child and/or family, etc.)
• Individual Assessment
• Summarize Assessment Conclusions
• Include Diagnostic Impression
• Axis I
• Axis II
• Axis III
• Axis IV
• Axis V Global Assessment of Functioning
  (Current)
• Family Assessment Recommendations and
  Conclusions. (Include agency name and date
  completed)

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CCFA Adolescent Component

• List Instruments Used
• All instruments and the name of the person
  completing each must be used for youth ages 14 to
  20.5.
• Draw Your Strength
• Genogram
• Ecomap
• Draw Your Future
• Road of Life
• Rosenberg Self-Concept Scale
• Alcohol and Drug Questionnaire
• Sensitive Issues Inventory
• ACLSA-Level III
• Interview
• Results of Assessment
• A sample adolescent profile template can be found
  in Appendix C.
• Summary and Recommendations
• Name, Signature and Date Completed

49
Adolescent Assessor Qualifications

• The Adolescent Assessment is to be completed by
  an individual with a minimum of a Masters level
  of education in Social Work, Counseling, or
  Psychology with an LCSW, LMFT or LPC granted by
  the State of Georgias Composite Board of
  Counselors, Social Workers, and Marriage and
  Family Therapists. Assessors must have a current
  license issued by an above listed authority.
• Individuals with a Masters degree who are under
  the supervision of an LCSW, LPC or LMFT may also
  conduct the Transitional Youth Assessment. In
  which case, the Assessment requires two
  signatures the licensed supervisors and the
  Masters level assessor.

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CCFA Educational Standards

• Completed on children in Early Intervention or
  School-aged
• Educational History
• Grades
• Discipline Reports
• Attendance Reports
• Achievements
• Current Grade Level Functioning
• Who can complete

51
Required Adolescent Assessment Tools

• 1. Independent Living Skills (Ages 16-20.5)
• Ansell-Casey Life Skills Assessment (ACLSA) This
  scale is available for free at www.caseylifeskills
  .org
• Daily Living Tasks
• Self-care
• Housing and community resources
• Social Development
• Money Management
• Work Study Habits
• 2. Family of Origin (all youth)
• Genogram. To help youth explore their roots and
  history.
• 3. Interpersonal Relationships (all youth)
• Ecomaps (Focus on youths friendship and social
  support network)
• 4. Draw Your Future Perspective (ages 16 - 20.5)
• Have youth write a passage about their goals and
  dreams.
• Have youth draw their future goals (e.g. crystal
  ball drawing - present a line
• drawing of a crystal ball and ask youth to draw
  their future)

52
Required Adolescent Assessment Tools Cont

• 5. Alcohol and Drug Questionnaire (all youth)
• This is a two-part questionnaire that asks youth
  about their current and past substance abuse.
• This questionnaire is not scored. It is a
  qualitative instrument. The evaluating team will
  need to use their professional judgment to
  determine if a referral for a drug screen and/or
  substance abuse evaluation is recommended. A
  copy can be obtained at http//dfcs.dhr.georgia.go
  v/fostercare.
• 6. Coping Skills and Self-Esteem (ages 16 -
  20.5)
• The designated Self-Esteem Rosenberg
  Self-Concept Scale
• Draw Your Strength
• 7. Life Experience-Inventories and
  Questionnaires (All Youth)

53
Educational Component

• The educational component is a comprehensive
  assessment of the child's educational history
  prior to placement in foster care. The purpose
  of the educational assessment is to determine a
  childs educational needs and to ensure that
  necessary supports are provided to give the child
  the best chance for academic and social success.
  Typically the educational assessment is completed
  for school age children, five to eighteen.
  However, if a child under the age of four (4)
  participates in early intervention, then
  components of the report must be completed.

54
Educational Component Cont

• The educational component should include, but are
  not limited to, the following
• Current school records
• Current Individual Education Plans (IEP)?.
• Educational History
• Test scores from standardized tests such as Iowa,
  Stanford IV, CRCT, etc.
• Psychological evaluations ?
• Grades
• Discipline Reports
• Attendance Records
• Achievements
• A Brief Summary of the childs functioning in the
  current grade level and any other significant
  issues.

55
Educational Component Cont

• IQ Testing
• An IQ test does not need to be repeated
• If a child has had an IQ score completed with the
  WISC-III or Stanford-Binet within three calendar
  years.
• If the child was at least 7 (seven) years of age
  at the time of the earlier IQ test
• An IQ test must be repeated
• If a child was under 7 (seven) years of age at
  the time of the earlier IQ test
• If the child has had a head injury or evidence of
  serious mental illness has emerged since the
  initial evaluation
• If the child was not on medication (such as
  Ritalin) during the earlier evaluation
• A summary of the childs educational history and
  current status must be included in the family
  assessmentreport.
• The three (3) page Educational Evaluation Report,
  which may be filled out by Provider but must be
  signed by a certified school official.
• The SSCM or CCFA provider must have a parent
  sign a Release of Information Form to collect
  this information, if required by the school.

56
Educational Component Cont

• The provider may complete and sign the
  educational evaluation or the official school
  personnel may complete form and sign.
• The provider who may be Masters level individual
  (preference to a M.Ed. specialist) must
  specifically list in the report the name and
  title of the school official and the date the
  information was obtained.

57
Educational Component Qualifications

• Minimum of a Masters level of education in
  Social Work, Counseling, Education or Psychology
  with an LCSW, LMFT or LPC granted by the State of
  Georgias Composite Board of Counselors, Social
  Workers, and Marriage and Family Therapists.
  Assessors must have a current license with the
  above referenced authority.
• Individuals with a Masters degree who are under
  the supervision of an LCSW, LPC or LMFT may also
  conduct a CCFA Assessment. In which case, the
  Assessment requires two signatures the licensed
  supervisors and the Masters level assessor.

58
Medical Assessment Component Report

• The medical component is a comprehensive
  assessment of the child's overall health status.
  
• This information is used by DFCS staff, judges,
  CASAs and others to ensure that the medical
  needs of children in foster care are addressed.
• Health Check (EPSDT) is Medicaids comprehensive
  and preventive child health program. Health
  Check includes periodic screening, vision,
  dental, hearing services, etc. Health Check
  should be billed to Medicaid.
• To strengthen the Departments collaboration with
  the Division of Public Health, children may
  receive Health Check screens at the local health
  department or with an approved Health Check
  provider. For a list of approved Health Check
  providers, go to www.ghp.georgia.gov.

59
Medical Assessment Report

• The following are included in Health Check
  services
• Comprehensive Health and Development history
• Developmental Assessment including mental,
  emotional, and behavioral screens
• Comprehensive unclothed physical exam
• Immunizations according a Recommended Childhood
  Schedule by the Advisory Committee on
  Immunization Practices (ACIP)
• Certain Laboratory procedures (including, but
  not limited to, blood lead level screening)
• Measurements
• TB and Lead Risk Assessment
• Anticipatory Guidance and Health Education
• Vision Screening
• Dental/Oral Health Assessment
• Hearing Screening

60
Comprehensive Child and Family Assessment
Medical Assessment Report

• The medical component must include
• copies of the medical history- for cases of
  physical abuse or children identified as being
  medically fragile/special needs.
• Recommendations and referrals

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Infant Toddler Developmental Screening and
Assessment

• Children 0-3
• Two Part Process
• Screening-Completed in Health Check
• Assessment- Referral made by Health Check
  provider to Babies Cant Wait (BCW)

62
Health CheckDental Screen

• Completed on all children ages 3-18 with Health
  Check Screen
• Recommendations and referrals by Health Check
  Provider

63
Medical Report Standards

• Standard I
• Patient Name
• Medical Record Number
• Medicaid Number (if applicable)
• Date of Visit
• Standard II
• Completed Georgia Department of Human Resources
  Immunization Form 3231
• Standard III
• Childs Medical History Provider must collect a
  verbal medical history on all children and obtain
  medical records from birth to present for
  medically fragile children and children in
  protective custody as a result of severe physical
  abuse.
• Family Health History - Provider should make
  every effort possible to obtain this information
  through interviews with the family prior to the
  childs Health Check appointment. (DHR Form 419
  Background Information on State Agency Child)

64
Medical Report Standards

• Standard IV
• Impressions of child's current medical needs.
• Ongoing Treatment Plan (as outlined by Health
  Check Provider)/Recommendations, if applicable.
• Referrals, if applicable.
• The Medical Report must include the following
  attachments in order to be complete
• Health Check Service Documentation/flow chart
• Medical Records (medically fragile children and
  severe physical abuse)
• DHR Form 419 Background Information for State
  Agency ChildAvailable online at
  http//dfcs.dhr.georgia.gov/fostercare. This form
  must be typed and contain as much information as
  possible.
• DHR Form 3231 Certificate of Immunization

65
Medicaid and Dental Treatment

• When any routine and/or emergency treatment
  (outside of Health Check services) is identified
  during the course of the medical assessment, the
  county DFCS must be notified.
• Prior to any treatment being provided, a DFCS
  staff member must authorize by signature.
  Treatment examples include ear tubes, minor
  surgery, etc.

66
Medical Assessor Qualifications

• The provider must complete the medical assessment
  report and summarize the findings from the Health
  Check appointment. The provider, who may be
  Bachelors level, must specifically list in the
  report the name, title, and date, of any licensed
  medical official from whom the information is
  obtained. The licensed medical professional
  completing the Health Check screen must sign the
  Health Check documentation forms/flow chart.

67
Medical Assessment Report Format

• The title and format of the report is as follows
  and must include the following four (4) sections
  and all accompanying documentation.
• Report Title Medical Assessment Report
• 1. Identifying Data
• Childs Name
• Medicaid Number (if applicable)
• Date of Visit
• Summary statement regarding the current overall
  health/medical status of the child.
• 2. Medical History
• Childs History of Present Illness
• DHR Form 3231 Certificate of Immunization
• Family Health History Provider should make
  every effort to interview the family to obtain as
  much information about the childs and familys
  health history See the prior history Form in the
  current Health Check Policy and Procedures manual
  (www.ghp.georgia.gov)

68
Medical Assessment Report Format

• 3. Summary and Recommendations
• Development of an Individualized Medical
  Treatment Plan (as outlined by the approved
  Health Check Provider)
• Recommendations, if applicable
• Referrals if applicable
• 4. Name, Signature, and Date Completed
• The provider must complete the medical assessment
  report, which is a summary of the findings of the
  Health Check appointment with the medical
  professional. The provider, who may be
  Bachelors level, must specifically list in the
  report the name, title, and date, of any licensed
  medical official from which the information is
  obtained.
• Print Name
• Signature
• Job Title
• Date

69
Medical Assessment Report Format

• The Medical Assessment Report must include the
  following attachments in order to be complete
• Health Check Service Documentation
• Medical Records for medically fragile children or
  physical abuse cases.
• DHR Form 419 (Background Information for State
  Agency Child) --Available online at
  http//dfcs.dhr.gerogia.gov/fostercare. This form
  must be typed and completed in its entirety.
• DHR Form 3231 Certificate of Immunization

70
Multi-Disciplinary Teams

• A comprehensive assessment on any child or family
  is not complete until a Multidisciplinary team
  meets to review all relevant aspects of the
  information.
• It is the team's responsibility to make the best
  and most appropriate recommendations for services
  and placement (if appropriate) that meets the
  needs of the child and family.
• The team will select reasonable, achievable
  goals/objectives that are positively stated,
  measurable, clear, concise, and address the
  specific behaviors or conditions that must be
  addressed for the child to be safely returned to
  the parent and incorporated into the initial case
  plan.
• DFCS as the legal custodian of the child may or
  may not follow the recommendations of the MDT.
  When the MDT recommendations are not implemented
  or included in the initial case plan, the reasons
  why must be clearly documented on the MDT
  Staffing Recommendation Form 3.

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MDT Meeting Participants

• Multidisciplinary teams consist of persons
  representing various disciplines associated with
  key components of the assessment process. The
  disciplines which may participate as part of the
  MDT should include, but are not limited to the
  following
• Legal Custodian (DFCS - Case Manager, CPS
  Investigator, CPS Ongoing Case Manager,
  Supervisor, Independent Living Coordinator for
  any youth 14 or older) All case managers
  involved with the child/family should be present
  at the MDT.
• CCFA Provider (Provider who conducted the actual
  assessment.)
• Educational (School system representative who has
  direct knowledge of the educational status of the
  child(s) or an appropriate designee)
• Medical (Medical system representative who has
  direct knowledge of the medical dental status
  of the child(s) or an appropriate designee.) A
  representative from the local health department
  should be invited to attend the MDT for every
  child assessed. If a child receives services
  from Babies Cant Wait (BCW), the BCW service
  coordinator should be invited to the MDT meeting.
  
• Psychological (The actual psychologist who
  conducted the psychological evaluation or an
  appropriate designee)
• Judicial (A representative from the appropriate
  court system if the child (s) had any court or
  law enforcement involvement. This may include
  local law enforcement officials or a Court
  Appointed Special Advocate (CASA)).

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MDT Meeting Participants

• Mental Health (A representative from the MHMRSA
  system that may have direct knowledge of mental
  health or substance abuse issues affecting the
  child (s) or family).
• Foster Parent(s) or placement provider where the
  child(s) resided during the assessment process
  that has direct knowledge of the child(s)
  behavior and activity during the assessment.
  DFCS foster parents may earn 1.5 in-service
  training hours for their attendance and
  participation at a MDT meeting for a child(ren)
  placed in their home. Upon completion of the MDT
  meeting, the CCFA provider will sign the
  Certificate of Attendance (attached and available
  at http//dfcs.dhr.state.ga.us/fostercare) and
  provide a copy to the foster parent for tracking
  purposes.
• Any other individual having appropriate
  information directly related to the case.
• ?Note An appropriate designee may be a county
  school system counselor, a public health
  representative, or a clinician that regularly
  sits as part of the MDT.

73
Family Team Meeting

• Georgia Family Conference Model

74
Life Changes

• Informal Resources
• Formal Resources

75
Georgia Family Conference Model

• A solution-based approach
• Draws on the familys strengths and resources
• Resources of the child welfare system
• Draws on the strengths of other community
  agencies and individuals

76
Family Team Meeting (FTM)

• CCFA/WA Providers must be trained to facilitate
  FTM.
• Education and Training Services
• www.gadfcs.org
• Contact person Kennisha Powell
• [phone]

77
Principles that make Family Conferencing work

• Focus on needs rather than symptoms
• Most people are capable of change
• Most people and families have strengths
• Builds a foundation for a trusting relationship
  and a platform for change
• Allows for the processing of information that
  family members bring to the table

78
Principles Contd

• Family is more invested in a plan in which they
  participate
• Family members and their support persons can
  frequently identify more through solutions than
  the agency
• Family and friends provide an atmosphere of
  caring
• Process provides a level of accountability and
  responsibility

79
Goals of Family Conferencing

• Ensure safety
• Identifies permanency options/plans
• Reaches out to extended family
• Empowers and acknowledges family members

80
Family Conference Logistics

• Who should attend?
• Where should the Family Conference be held?
• Is held within nine (9) days of childs placement
  in foster care

81
Roles and Responsibilities

• Providers
• May assist as part of the assessment process
• DFCS
• Makes contact with family and other important
  parties
• Plans conference logistics and provides
  facilitation.