Foster Parent

KVC Behavioral HealthCare, Inc.
Foster Parent
Policy & Procedure
Manual
State of Kansas
Child Placing Agency
Effective:
February 2006
Updated July 2012
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June 24, 2012
Dear Foster Family:
I am pleased to welcome you to KVC Behavioral HealthCare. KVC is a private, not-for-profit
organization providing services to children and their families since 1970. The agency’s full
continuum of care ranging from intensive in-home services to inpatient psychiatric care
represents one of the most extensive programs in the state. KVC Behavioral HealthCare
provides safe, supportive placements in a family setting for children and youth. Foster family
care offers a nurturing environment as the permanency goals are addressed for children and
youth.
KVC is committed to serving children and youth in the least restrictive setting possible. Your
dedicated service as a foster parent allows many children to live and grow in a family setting that
is safe and supportive.
The agency works closely with you as a member of the professional team to achieve the highest
level of care for each child or youth receiving services. KVC provides a variety of services for
foster families including continued training, resources and 24-hour staff support.
KVC has great appreciation for your work as a foster parent. To open your home and your heart
to a child or youth in need is truly an act of kindness. Thank you for working with KVC to make
a difference in the lives of children.
Sincerely,
Chad Anderson
President, KVC Behavioral HealthCare
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TABLE OF CONTENTS
SECTION I. OVERVIEW
MANUAL PURPOSE ........................................................................................................................ 6
KVC MISSION ................................................................................................................................... 6
KVC HISTORY .................................................................................................................................. 7
AGENCY PHILOSOPHY .................................................................................................................. 8
SECTION II. KVC FAMILY FOSTER CARE PROGRAM
PROGRAM GOAL ........................................................................................................................... 10
PROGRAM DESCRIPTION ............................................................................................................ 10
TYPES OF FOSTER CARE PLACEMENTS ................................................................................. 11
SATELLITE FOSTER CARE .................................................................................................. 11
STEP FOSTER CARE ............................................................................................................. 11
TRANSITIONAL FOSTER CARE ......................................................................................... 11
INTENSIVE FOSTER CARE .................................................................................................. 11
SUPPORTIVE FAMILY LIVING ........................................................................................... 12
POLICE PROTECTIVE CUSTODY ....................................................................................... 13
DCF 4-HOUR CARE ............................................................................................................... 13
LICENSED DAYCARE PROVIDERS WITH EXCEPTIONS TO DO FOSTER
CARE ....................................................................................................................................... 14
REQUIRED DOCUMENTS ............................................................................................................ 15
PROGRAM PHILOSOPHY............................................................................................................. 16
ROLE OF FAMILY SERVICE COORDINATOR .......................................................................... 17
RESPONSIBILITIES ............................................................................................................... 17
GOOD START MEETING...................................................................................................... 18
CONTINUED SUCCESS MEETING ..................................................................................... 19
STRUCTURED DECISION MAKING SYSTEM .......................................................................... 20
GRIEVANCE PROCESS ................................................................................................................ 20
COMPLIMENT/CONCERN PROCESS ......................................................................................... 20
SATISFACTION SURVEY ............................................................................................................ 21
CLOSURE OR WITHDRAWAL OF SPONORSHIP..................................................................... 21
FOSTER FAMILY EXIT INTERVIEW ......................................................................................... 21
SECTION III. BILL OF RIGHTS FOR FOSTER CHILDREN .................................................. 21
CLIENT RIGHTS ............................................................................................................................. 22
SECTION IV. FOSTER PARENT GUIDELINES ......................................................................... 24
ROLE DESCRIPTION ..................................................................................................................... 24
QUALIFICATIONS AND RESPONSIBILITIES ........................................................................... 24
FOSTER FAMILY PROVIDER REQUIREMENTS ...................................................................... 26
FOSTER PARENT CODE OF ETHICS .......................................................................................... 26
PREAMBLE .............................................................................................................................. 26
PRINCIPLES ............................................................................................................................. 26
FOSTER FAMILY RESOURCES ................................................................................................... 27
SECTION V. FOSTER FAMILY PLACEMENT INFORMATION ........................................... 28
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PLACEMENT PROCESS OVERVIEW .......................................................................................... 28
HOW PLACEMENT AFFECTS THE CHILD/YOUTH................................................................. 28
PLACEMENT .................................................................................................................................. 29
WHAT ARE CHILD FILES/RED BOOKS? ................................................................................... 30
WHAT A FOSTER PARENT MUST HAVE WHEN A YOUTH IS PLACED ............................. 31
INITIAL TEAM MEETING ............................................................................................................ 33
CASE PLANNING AND ADMINISTRATIVE REVIEWS ........................................................... 34
VISITATION.................................................................................................................................... 34
REPORTS TO THE COURT ........................................................................................................... 36
COMMUNICATION ....................................................................................................................... 37
CONFIDENTIALITY POLICY ....................................................................................................... 37
WHEN TO CALL THE FAMILY SERVICE COORDINATOR .................................................... 38
REPORTING CRITICAL INCIDENTS .......................................................................................... 38
RUNAWAYS ................................................................................................................................... 39
CONTACT WITH LAW ENFORCEMENT ................................................................................... 39
FOSTER PARENTS AS MANDATED REPORTERS ................................................................... 40
ALLEGATION OF ABUSE AGAINST FOSTER PARENTS ....................................................... 40
DISCIPLINE POLICY ..................................................................................................................... 41
SECTION VI. KVC POLICY AND PROCEDURES .................................................................... 42
DEFINITIONS OF FOSTER FAMILY CARE ............................................................................... 42
FINANCIAL INFORMATION ........................................................................................................ 43
DAILY RATE OF REIMBURSEMENT .................................................................................... 43
CHANGE IN LEVEL OF CARE AND DAILY RATES ........................................................... 43
RESPITE CARE ......................................................................................................................... 44
FEDERAL INCOME TAX ......................................................................................................... 44
INSURANCE .............................................................................................................................. 44
FINANCIAL EXPENSES ......................................................................................................... 45
ABSENTEE REIMBURSEMENT POLICY .............................................................................. 46
TRANSPORTATION ................................................................................................................. 46
MILEAGE ................................................................................................................................... 46
DAYCARE .................................................................................................................................. 47
CLOTHING ................................................................................................................................. 49
MEDICAL CARE AND HEALTH SAFETY INFORMATION ..................................................... 49
MEDICAL CARE AND THE MEDICAL CARD ...................................................................... 49
KAN BE HEALTHY/DENTAL SCREEN ................................................................................. 50
LICE TREATMENT ................................................................................................................... 50
MEDICATION ADMINISTRATION ........................................................................................ 50
MEDICAL RECORDS................................................................................................................ 51
EMERGENCY PROCEDURES ................................................................................................. 51
UNIVERSAL PRECAUTIONS ................................................................................................. 51
USE OF CAR SEATS ................................................................................................................. 52
FIRE SAFETY ............................................................................................................................ 52
TORNADO SAFETY.................................................................................................................. 53
EDUCATION ................................................................................................................................... 53
SCHOOL ENROLLMENT ......................................................................................................... 53
ENROLLMENT PROCEDURES ............................................................................................... 54
SCHOOL WITHDRAWAL PROCEDURES ............................................................................. 54
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EDUCATIONAL ADVOCATES ............................................................................................... 54
HOME SCHOOLING ................................................................................................................. 54
TUTORING ................................................................................................................................ 55
SUMMER ACTIVITIES AND SUMMER SCHOOL................................................................ 55
DRIVER’S EDUCATION .......................................................................................................... 55
DRIVING AND RIDING WITH OTHER YOUTH................................................................... 55
LEGAL FEES ....................................................................................................................................... 55
BEDS .................................................................................................................................................... 56
CHURCH ATTENDANCE .................................................................................................................. 56
DATING ............................................................................................................................................... 56
EMPLOYMENT ................................................................................................................................... 56
FIELD TRIPS, ACTIVITIES, AND SPORTS PARTICIPATION ...................................................... 56
HIGH RISK SPORT OR RECREATIONAL ACTIVITY ......................................................... 56
SWIMMING ............................................................................................................................... 57
HAIRCUTS........................................................................................................................................... 57
OVERNIGHTS WITH FRIENDS ........................................................................................................ 57
VACATION.......................................................................................................................................... 57
LEAVING CHILD OR YOUTH UNATTENDED, SELF-CARE PLANS ......................................... 57
VISITATION ........................................................................................................................................ 58
INFORMAL VISITATION .................................................................................................................. 58
COMMON SENSE ............................................................................................................................... 58
OUTDOOR SAFETY PLAN ............................................................................................................... 58
SAFETY PLAN .................................................................................................................................... 59
PLACEMENT HOLD REQUESTS ..................................................................................................... 59
FOSTER PARENT LICENSING AND ONGOING ASSESSMENT ................................................. 59
FOSTER FAMILY MOVES ................................................................................................................ 61
FOSTER PARENT CONCERNS/INVESTIGATIONS ....................................................................... 61
ADMISSIONS RESPONSIBILITIES AND PROCEDURES FOR MOVING CHILDREN DURING
THE INVESTIGATION OF A KVC FOSTER HOME ....................................................................... 61
PROTOCOL TO ADDRESS CONCERNS REGARDING A KVC FOSTER FAMILY .................... 62
FOSTER FAMILY DEVELOPMENT PLAN ..................................................................................... 63
LIFEBOOKS......................................................................................................................................... 63
LIFE SKILLS........................................................................................................................................ 68
ADOPTION SERVICES ...................................................................................................................... 70
APPENDIX
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SECTION I. OVERVIEW
MANUAL PURPOSE
This manual is intended to provide basic information concerning KVC Behavioral
HealthCare (KVC) policies and procedures that will support successful foster family
placements.
KVC MISSION
"...To enrich and enhance the lives of children and their families by providing medical
and behavioral healthcare, social services and education."
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KVC HISTORY
In 1970 Wyandotte House was established for eight homeless boys by the Junior League
of Johnson and Wyandotte County, the Jaycees and the juvenile courts. Through the
years not only did the programs grow but the need to expand services to meet the needs
of the children and youth, birth to 22, who had been removed from their homes because
of abuse, neglect and abandonment, grew as well. In the mid-1980's the President/CEO
and Board of Directors made a decision to undertake not one, but two, capital campaigns
to build a facility on a 55 acre site donated by the City of Kansas City, Kansas and the
Board of Public Utilities. The facility is located near the Kansas River or as it is locally
known, Kaw River. Following the successful completion of these campaigns and the
development of the campus the name of the organization was changed in 1992 from
Wyandotte House to Kaw Valley Center (KVC) because a house was no longer
descriptive of the organization. In 2004 the agency name was legally changed to KVC
Behavioral HealthCare, Inc.
KVC, a private, not-for-profit organization providing services to children and families is
accredited by the Joint Commission on Accreditation of Healthcare Organizations and
represents one of the largest continuums of care in the state of Kansas. Services include:
case management, in-home intensive family services, runaway services, psychiatric and
medical services, foster family care, adoption, outpatient treatment, emergency services,
residential care, intensive treatment, psychiatric, medical, educational and independent
living programs and transitional living, and training and education. Children and youth
receive care based on individual need from trained foster families, youth care attendants,
specialists, family service coordinators (FSC), case managers, master's level therapists,
special education teachers, nurses, pediatricians, psychologists and psychiatrists. For the
most current information on programs and services, please see the web site at
www.kvc.org.
Today KVC provides foster family care services throughout Kansas from the Nebraska to
the Oklahoma borders and Missouri to Colorado borders. More than 400 licensed social
workers, therapists and case managers provide services to more than 6,000 children each
year. Over 540 KVC foster families provide homes for children and youth, which are
removed from their families due to abuse/neglect.
KVC currently operates a residential facility in Kansas City, Kansas. Offices are located
in Chanute, Junction City, Kansas City, Lawrence, Leavenworth, Lenexa, Olathe,
Ottawa, Topeka and Wichita. KVC’s Corporate Office is located at 21350 W. 153rd
St., Olathe, Kansas 66101-5413, (913) 322-4900.
Based on the successful model programs KVC developed in Kansas, the agency is also
providing quality family services in West Virginia, Missouri, Kentucky and Nebraska.
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AGENCY PHILOSOPHY
KVC Behavioral HealthCare
•
Provides a well-maintained physical environment - safe, secure, healthy and
clean.
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•
Maintains that children and youth have rights, the most basic of which is
inherent worth, privacy and the right to confidentiality.
•
Expects all persons representing KVC are equally accountable for carrying out
the organizational mission.
•
Recognizes that, although it is an organization made up of a number of diverse
programs and services, it is one organization whose function is to strive for
the betterment of the organization as a whole.
•
Recognizes the need for sound financial principles and practices.
•
Has a commitment to excellence in the quality of our services.
•
Encourages community involvement through volunteer participation.
•
Encourages children and youth to maintain relationships with their family
members, whenever possible and appropriate. KVC resists adopting a
judgmental posture toward either parent or children and youth.
•
Supports the personal and professional growth of all KVC staff and
representatives through continuing education, encouraging innovation and
creativity, advancement and recognition of outstanding service.
In working with children and youth and their families, KVC operates from a belief system
founded upon the following philosophical principles:
•
Children and youth should feel safe in their environment.
•
The most desirable place for children and youth to grow up is in their own,
caring families, when those families are able to provide safe and nurturing
relationships intended to last a lifetime.
•
Every child’s and youth’s family, however family is defined (including
nuclear, blended, extended, tribe or clan, or adoptive), is unique and has value,
worth, integrity and dignity.
•
Every family has potential.
•
All parents can make good decisions for their family.
•
All families have inherent, individual strengths.
•
All families should have equal access to quality services.
•
All families deserve respect and understanding for their individual belief
and/or value systems.
•
Crisis situations can present an opportunity for change.
•
The possibility of successful reintegration of children and youth placed out-ofhome decreases in direct correlation to the time they remain in out-of-home
care.
KVC’s mission statement, value structure and philosophy are not delineated by
program service, rather, they serve as guideposts for the full continuum of care
that has been the hallmark of KVC’s approach to service delivery.
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Section II. KVC Family Behavioral Healthcare, Inc., Child
Placing Agency (CPA)
PROGRAM GOAL
KVC’s foster family program, also known as the KVC Child Placing Department,
provides safe, supportive family settings in which children and youth can be supervised
and cared for as their permanency goals are addressed utilizing a family centered practice
approach.
Children and youth in the foster family program are exposed to the values, attitudes and
skills that enable them to function successfully in the mainstream of society. The
program adheres to the principles of least restrictive environment and experiential
learning. A second goal of this intervention is to help children and youth learn new
behaviors and ways of viewing their world, allowing the potential for breaking the cycle
of abuse and neglect.
PROGRAM DESCRIPTION
KVC Behavioral HealthCare is a state licensed Child Placing Agency fulfilling the
requirements and standards for the State of Kansas. KVC provides foster care services
for children and youth that have been removed from the home due to abuse or neglect.
Foster families provide 24-hour substitute care for children and support for their parents
while children are removed from birth family due to physical abuse, sexual abuse, neglect
or other circumstances requiring out-of-home care.
It is the role of the child or youth’s placement to provide a safe, healthy (both physical
and emotional) setting that supports the child or youth and family in moving towards
permanency. Individual daily needs and structure should be provided so that the child or
youth progresses in their identified daily program and receives the necessary medical and
dental prevention or treatment and continues with as little additional disruption to their
lives as is possible during this extraordinarily difficult time. Clear expectations and
consistency are of utmost importance in making a child or youth feel safe.
KVC specializes in providing Satellite, Step, Transitional, and Intensive foster family
homes to foster care state contractors, adoption contractors and other agencies in need of
temporary family settings for children and youth. Throughout the manual, some
requirements, policies and procedures may apply only to Satellite Foster Care, Step
Foster Care, Transitional Foster Care, or Intensive Foster Care.
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TYPES OF FOSTER CARE PLACEMENTS
Satellite Foster Care Homes
Satellite Foster Care Homes are foster family homes recruited, trained and licensed by a
Child Placing Agency. The full range of support services of the sub-contract agency are
utilized to provide training and support to the foster family and child(ren) placed in the
home.
Duties to include but are not limited to:
Provide 24-hour care in a safe, nurturing foster family home and provide food, shelter,
clothing, education, medical care, daily care, supervision and transportation.
Step Foster Care Homes
Step Foster Care Homes are foster family homes recruited, trained and licensed by a
Child Placing Agency. The full range of support services of the sub-contract agency are
utilized to provide training and support to the Foster family and child(ren) placed in the
home. Youth served are typically stepping down from transitional foster care.
Duties to include but are not limited to:
Provide 24-hour care in a safe, nurturing foster family home and provide food, shelter,
clothing, education, medical care, daily care, supervision and transportation.
Transitional Foster Care Homes
Transitional Foster Care are highly trained foster family homes which have been
recruited, trained and licensed by a Child Placing Agency to offer an alternative to group
residential facilities or institutional care. Youth served shall be in need of diversion or
transition from a shelter, PRTF or as a prevention placement from a higher level facility.
Duties to include but not limited to:
Provide 24-hour care and supportive services to assure each child receives sufficient care
and supervision to prevent placement in a more restrictive setting and to facilitate his/her
return to a less structured alternative environment. Care and supervision included, but
not limited to, food, shelter, clothing, education, medical care, daily care, supervision and
transportation.
Intensive Foster Care
Intensive Foster Care homes are highly trained foster family homes which have been
recruited, trained and licensed by a Child Placing Agency. These homes provide more
structure than a family or transitional home but continue to provide it in a homelike
environment. Youth served in these homes may be exhibiting moderate to severe
aggression, sexualized behaviors, drug/alcohol abuse, school difficulties (including
truancy, suspensions, expulsions, special education, etc.). A family can provide
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Intensive, Transitional, Step and Satellite foster care at the same time for different
children in their home.
Duties to include but are not limited to:
Provide 24-hour care and supportive services to assure each child receives sufficient care
and supervision to prevent placement in a more restrictive setting. Care and supervision
include food, shelter, clothing, education, medical care, daily care and transportation.
Supportive Family Living Homes
Supportive Family Living Homes are specialized foster family homes for children who
are mentally retarded, developmentally disabled, medically fragile or have other special
health care needs. These homes are recruited, trained and licensed by a Child Placing
Agency. There can be no more than a total of two foster care placements, including the
child on the MRDD or TA Waiver in the home at one time. However, both children in
foster care placement may be on the MRDD or TA Waiver. An exception must be
requested and granted from the Community Developmental Disability Organization
(CDDO) that serves the county where the foster family resides for any additional
child(ren) to be placed in the home. Specialized care is provided for children to avoid
placement in institutional or other congregate residential settings when they cannot
remain with their birth parents. The rate of pay for non custody youth is determined by
the tier that the child/youth qualifies for which is set by the Community Developmental
Disability Organization.
KVC and other Contractors across the state will reimburse for children in DCF custody
who are on the MR/DD waivers based on the child’s Community Developmental
Disability Organization (CDDO) BASIS assessment for higher needs children with more
severe disabilities. Beginning July 1, 2009, reimbursements rates will be paid at the
following reimbursement levels for all new and existing placements:
Tier 1=$95/day
Tier 2=$75/day
Tier 3, 4 and 5 will be determined by KVC’s or another Contractor’s level of care
screening for other foster care children’s room/board rates. These are typically described
as satellite, step, diversion and intensive foster care.
Each supportive family living foster home shall perform, at minimum, the following
duties:
Provide 24-hour care and supportive services to assure each child receives sufficient care
and supervision to prevent placement in a more restrictive setting and to facilitate his/her
return to a less structured environment. Duties may include but are not limited to:
•
•
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Daily living services
Transportation
•
•
•
•
•
•
•
Recreation
Situational counseling
Situational training
Case Planning
Assist in planning and working towards treatment goals that shall be concrete and
measurable.
Progress of goals shall be recorded in child/youth’s Case Planning Conference every
six months and quarterly treatment reviews.
Notification of CPA Division within 1-hour of any critical incident. (See page 37)
Families, as always, are strongly encouraged to utilize the services children are eligible
for through their CDDO. These services are identified on the child’s Plan of Care and
may include services such as respite care, attendant care and additional case management
services for the child and family.
Police Protective Custody Homes
Police Protective Custody (PPC) Homes are foster family homes recruited and licensed
by a Child Placing Agency. These homes agree to permit a child to remain in the foster
home for the length of police protective custody status (not to exceed 72 business day
hours) or until transitioned to another placement. The foster family will insure there is no
contact between the child and family members (including email, telephone,
correspondence and face-to-face) unless arranged and approved by DCF, no school
attendance by child and no occasion when the child is not supervised by a responsible
adult. Day care is not provided.
The foster family will notify their FSC of any health care concerns/needs before seeking
medical care except in those cases of extreme emergency. The foster family will assist
KVC in transitioning child to another placement including assisting with transportation of
child when child is released from PPC and returning to parent.
The police protective custody order form will be used as a medical consent and medical
release in the event medical care is necessary for a youth placed in police protective
custody.
DCF 4 Hour Temporary Care
In some Regions across the state DCF contracts with KVC to secure local foster homes to
provide up to 4 hours of temporary care to children initially referred for out of home
placement. DCF contacts the designated FSC or KVC staff and verbally requests the
service. DCF enters into a client service agreement with KVC. DCF provides basic
information to the FSC including the child’s name, d/o/b or other identifying information
such as the social security number. The FSC coordinates the service with a foster home
and notifies DCF. The foster parent and DCF coordinate transportation of the child(ren)
to the foster home. DCF notifies the Contractor where to pick the child up within the 4
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hours. The FSC confirms with the foster parent the date and times the service was
provided. The designated KVC staff person submits billing to DCF. DCF pays KVC.
The designated KVC staff person notifies accounting. The KVC Accounting Department
reimburses the foster parent $7 per hour per child.
On rare occasions a child may stay over night in the foster home. In the event this
occurs, the family is reimbursed a flat rate of $35.
Licensed Day Care Providers with Exceptions to Provide Foster Care
• A KBI and CANIS must be completed on any foster youth 10 years of age or older
prior to being placed in a licensed daycare home with an exception to foster. If
results indicate a prohibited person, the youth will not be placed in the licensed
daycare home. Documentation shall be maintained in the family file.
• CPA may run the KBI check internally. CPA may work in conjunction with the
child’s case manager to obtain a CANIS check from the child’s DCF worker in order
to expedite proposed placement.
• CPA, Permanency and the foster parent will assess the appropriateness of each
placement in a licensed daycare providers home with an exception to foster prior to
placement to determine the families ability to meet both the foster child and day care
children’s needs. Documentation shall be maintained in the family file.
• In some instances completion of a safety plan may be warranted.
• FSC’s will document in the recruitment database under the comment section if a
home is a licensed daycare with an exception to foster. This comment will alert
Admissions staff to coordinate with the FSC to obtain background checks prior to any
placement.
REQUIRED DOCUMENTS
Each service provider needs to maintain required documents for Kansas Department of
Health & Environment (KDHE):
The following documents are required to be on file on or before placement per KDHE
(this does not apply to PPC placements)
Items required on or before placement per KDHE
1 Approval of the sponsoring CPA
2 Medical and surgical consent
3 Medical card
4 Placement Agreement
5 Reason for custody and reason for circumstances
leading to current placement
6 Description of child’s recent circumstances, including
medical problems, mental health concerns, and safety
concerns, including any assaultive behavior and
victimization concerns
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7 Information about the child’s medication and dietary
needs, and the name of the child’s current health care
provider
8 Any allergies from which the child suffers
9 Name, address and telephone number of the contact
individual for the last educational program the child
attended
The following documents are required no later than 14 days after placement in the foster
home.
Items required no later than 14 calendar days after
placement in foster home
1 A copy of the court order authorizing the CPA to place
the child in foster care
2 A designation of the race or cultural heritage of the
child, including tribal affiliation, if any
3 A completed and signed copy of the placement
agreement with emergency contact information listed.
4 The name, address and telephone number of the child’s
parents or legal guardians
5 The spiritual or religious affiliation of the child and the
child’s family
6 The child’s placement history summary, including
name, address and telephone number of any advocates.
7 A description of positive attributes and characteristics
of the child and, if available, any related information
from the child, the child’s family including siblings,
and concerned individuals of the child’s life
8 The name, address, telephone number and email
address of the CPA who is responsible for supervising
the child’s placement
9 A copy of the current case plan, if completed. If this
plan has not been completed, the foster home shall
receive a copy within 14 calendar days of the
completed plan
10 Authorization regarding disclosure of confidential
information
11 If applicable, documentation on case plan authorizing
the use of physical restraint
12 Current copy of Medical record/KBH conducted by a
licensed physician and/or nurse with a current license to
practice in Kansas
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13 Current copy of dental record
14 Immunization record
15 EEIF, School records, IEP
16 Social Security Card
17 Birth Certificate
18 GAL name, number and email
19 Foster parent report to the court form and cover letter
PROGRAM PHILOSOPHY
Child abuse and neglect are insidious problems that affect children and youth that come
into custody of the Kansas Department for Children and Families (DCF). By the time
this population of children and youth reach adolescence they have often endured years of
abuse and/or neglect. To survive this ordeal they may have developed many survival
skills that are maladaptive in relation to societal values and norms. These behaviors are
so entrenched in their lives that children and youth may need consistent professional help
to learn to come to terms with their past and to develop positive behaviors that will
enable them to live independently and successfully.
KVC believes that every child and youth deserves a “permanent” family or support
system and children and youth should not grow up in foster care. Studies show that once
removed from the home, the longer the child or youth remains out of the home, the more
difficult it will be to reunify that child or youth successfully.
It is the goal of KVC to provide support to foster families. This allows the foster family
to adequately provide for the child in the least restrictive environment, in which the end
result enhances the child’s social, physical, educational and psychological needs. Safety
of the child within a family setting is key.
The KVC CPA program is based on the following assumptions:
1. Children and youth often come into custody deficient in positive attitudes, skills
and the knowledge necessary for successful independence.
2. Foster family care, devoted to modeling success attributes, can lead to better
performance by children and youth after leaving the foster care system and is
somewhat less restrictive than traditional group home care.
3. Attitudes and skills learned within a family setting are more likely to be
internalized and generalized than if taught in an academic setting. New skills and
attitudes will also be learned allowing the children and youth to function more
successfully once released from custody.
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4. Foster families will accept and encourage contacts between the child and his/her
parent and siblings, and provide the child with emotional support even when the
contacts with his/her parent and siblings are disrupting and confusing to the child.
ROLE OF FAMILY SERVICE COORDINATOR
The KVC Family Service Coordinator (FSC) is a licensed professional, with a bachelor’s
or master’s degree in social work or a bachelor’s degree in a behavioral or social science
field with an exception from KDHE. The FSC is responsible for coordinating all support
needed by a foster family and acts as a liaison between the foster family and the
contracting agency. The FSC’s primary goal is to provide support to the foster family
and assure that children or youth placed in the family’s home are safe. The FSC is also
responsible for recruiting, training, and licensing new foster family homes.
RESPONSIBILITIES
Provide support to the foster family home:
• Monthly home visits
• Regular phone calls
• Complete Good Start Meetings
• Complete Structured Decision Making Assessments as required
• Complete Continued Success Meetings
• Complete crisis and safety planning as needed
Provide support to the foster family home during a crisis.
Assure that the appropriate paperwork for the child is received at the time of the
placement. If the paperwork was not received, the FSC will request such paperwork from
the child’s permanency worker/case manager.
Assist the foster parent with the following services:
• Enrollment in school
• Follow-up with medical appointments, which includes, medical, dental and vision
• Therapy appointments
Provide Contractor’s permanency worker/case manager with monthly update reports at
approximately 30 day intervals.
Responsible for all licensing related activities for foster family homes.
Locate training for the foster family.
• A licensed satellite foster family home is responsible for 16 hours of training
annually.
• A licensed step, transitional, intensive or supportive family living foster family home
is responsible for 24 hours of training annually.
• Each licensee shall obtain at least 8 clock-hours of training in a licensing year,
including at least two clock-hours obtained through participation in group training.
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Attend Case Plans and court hearings.
Attend Individual Education Plan or other school meeting as required.
Assist in the arrangement of respite when requested by the foster parent at least seven
days in advance. The FSC will also inform the case manager of the temporary
placement.
GOOD START MEETING
The purpose of the GOOD START MEETING is to begin the placement with a cohesive,
collaborative plan to ensure that the child's needs can be met by the family and service
providers. It also serves as a wrap-around support plan for the family. The meeting will
be initiated by the KVC Family Service Coordinator assigned to the foster home the child
will be going to. This will occur within 2 working days of the "placement found" email
being generated by KVC Admissions. Those attendees shall be:
•
•
•
•
The KVC Family Service Coordinator for the family
The Case Manager
The Foster parent
Child as appropriate
The Case Manager and therapist attendees may participate by phone if necessary. When
appropriate, the previous foster home or placement should be encouraged to participate.
This decision will be made by the case manager and should occur only if the previous
placement can provide positive, constructive feedback that will lend itself to the child's
successful placement. The Family Service Coordinator will complete the "Good Start
Meeting Form" and provide copies to all persons involved in the meeting.
•
•
•
•
•
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Once the FSC has been alerted that a new placement has been found the FSC has 48
business hours to schedule the meeting.
FSC will contact case manager, and new foster parents to set up the meeting. If possible,
the previous placement, Therapist if KVC, and CASA will be invited as well. The most
important people to have at this meeting are the FSC, case manager, and new foster
parent. If appropriate the birth parents may participate.
The meeting can take place in the FSC or case manager’s office, or in the new foster
home.
FSC should facilitate the meeting; some of the discussion will surround establishing
services. The goal is to avoid lapse of services and give those responsible for
establishing the service a goal date.
Following the meeting, it is the responsibility of the FSC to provide the form to those
who participated.
THE CONTINUED SUCCESS MEETING
The CONTINUED SUCCESS MEETING is intended to provide an ongoing support
network for the foster family as the placement continues or is demonstrating signs of
instability. This meeting will be initiated in one of two ways. The meeting shall occur
within 2 business days of request by the KVC Family Service Coordinator assigned to the
foster home, the foster home, or the Case Manager. It shall also occur within 2 business
days of a 14-day notice to move request. Attendees at this meeting, which occurs in the
placement shall be:
•
•
•
•
•
•
•
•
The KVC Case Manager in person if the placement is within 60 miles of the Case
Manager's office
The KVC Family Service Coordinator for the family
The foster parent
The CASA if assigned
The KVC Therapist as available
Child as appropriate
The birth family as appropriate
All other invitees as deemed appropriate by the team
The Family Service Coordinator will complete the "Continued Success Meeting" form
and provide copies to all persons involved in the meeting. Within 30 days of this
meeting, the FSC will survey the family to determine how helpful this meeting was.
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•
FSC will schedule meeting upon request from case manager, foster parent, or 14 day
notice. The FSC can also request this meeting. The foster parent should request this
meeting prior to putting in 14 day notice if at all possible.
•
This meeting should be in the foster home and the case manager should be present unless
it’s over 60 miles.
•
Involved parties should be FSC, case manager, KVC therapist, CASA, birth parent if
appropriate. The child should also be involved if it is deemed valuable to the process.
•
If the placement is saved then respite should be strongly encouraged at least once,
especially for families who have never used respite.
•
FSC is responsible for providing paperwork to all parties.
STRUCTURED DECISION MAKING SYSTEM
•
The Structured Decision Making assessment is intended to assess what type of care a
placement is prepared to provide, to determine if the child will be safe in the home
considering other placements in the home and how much support the foster parent will
need to ensure placement stability.
•
The Provision Of Care Assessment is a comprehensive, structured assessment of a care
provider’s ability to provide care for children in various domains of functioning. This
tool is utilized by the FSC and foster parent during initial licensing and at annual
licensing renewal.
•
The Placement Assessment is used to verify child safety at the time of placement by
assessing the combination of children potentially placed in the home, the placement
household, and the home environment. The tool is also used to determine if there are
available resources to provide appropriate protection if intervention is needed. This
assessment is completed by the FSC with the foster parent within five days of placement.
•
The Support Assessment identifies placements that may need additional support, training,
and/or monitoring. This assessment is completed within 30 days of a foster home taking
a new placement. This is completed by the FSC and may involve the foster parent’s
input.
•
The Placement Safety Assessment is completed whenever there is an investigation of
alleged abuse/neglect in placement; a regulatory complaint has been made against the
placement; there are concerns regarding behaviors among children in placement; or there
are significant changes in a placement that impact child safety.
GRIEVANCE PROCESS
It is KVC’s goal to keep all problems to a minimum. Therefore, it is important that all
persons involved with the child or youth communicate clearly and openly. If a foster
parent has a disagreement with a KVC FSC, first try to discuss such disagreement
directly and come to a compromise solution. If, after meeting with the KVC FSC, the
foster parent does not feel that the issue is resolved, then ask to meet with the FSC’s
Supervisor. If there is continued dissatisfaction, contact the KVC Child Placing
President.
COMPLIMENT/CONCERN PROCESS
Another method of expressing a compliment or concern is by completing the
Compliment/Concern form. KVC Compliment/Concern forms are mailed periodically in
the monthly KVC foster family newsletter and provided in the Appendix of this manual.
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SATISFACTION SURVEY
The Public Affairs Department sends out annual satisfaction surveys to all KVC foster
parents. The survey requests information regarding the family’s overall satisfaction with
KVC, as well as satisfaction with trainings, professionalism, and communication.
CLOSURE OR WITHDRAWAL OF SPONSORSHIP
According to Kansas Department of Health and Environment (KDHE) regulations, a
foster family “may terminate the license by notifying KDHE if the licensee no longer
wishes to maintain a family foster home.” KVC can also choose to withdraw agency
sponsorship of a foster family’s license at any time. Generally this occurs when a family
fails to meet the KVC requirements set out in the Foster Care Provider Requirements or
the policies and guidelines outlined in the Foster Family Provider Placement Agreement
and the Foster Family Policy and Procedure Manual.
FOSTER FAMILY EXIT INTERVIEW
When a KVC foster family decides to transfer to another Child Placing Agency or
decides not to continue providing services for children in foster care, KVC will conduct
an exit interview with the foster family. The Foster Family Exit Interview form will be
used to improve retention by identifying concerns and suggestions to avoid future
closures. It will also identify areas of need for the agency to improve relationships with
foster parents.
SECTION III. BILL OF RIGHTS
FOR FOSTER CHILDREN
Ratified in Congress Hall, Philadelphia, Saturday, the Twenty-eighth of April, Nineteen
hundred and seventy-three.
EVEN more than for other children, society has a responsibility along with parents for
the well being of foster children. Citizens are responsible for acting to insure their
welfare.
EVERY foster child is endowed with the rights inherently belonging to all children. In
addition, because of the temporary or permanent separation from and loss of parents and
other family members, the foster child requires special safeguards, resources and care.
EVERY FOSTER CHILD HAS THE INHERENT RIGHT:
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Article the first…To be cherished by a family of his own, either his family helped by
readily available services and supporters to reassume his care, or an adoptive family or by
plan, a continuing foster family.
Article the second…To be nurtured by foster parents who have been selected to meet his
individual needs and who are provided services and supports including specialized
education, so that they can grow in their ability to enable the child to reach his potential.
Article the third…To receive sensitive, continuing help in understanding and accepting
the reasons for his own family’s inability to take care of him, and in developing
confidence in his own self-worth.
Article the fourth…To receive loving care and respect as a unique human being…a child
growing in trust in himself and others.
Article the fifth…To grow up in freedom and dignity in a neighborhood of people who
accept him with understanding, respect and friendship.
Article the sixth…To receive help in overcoming deprivation or whatever distortion in his
emotional, physical, intellectual, social and spiritual growth may have resulted from his
early experiences.
Article the seventh…To receive education, training, and career guidance to prepare him
for a useful and satisfying life.
Article the eighth…To receive preparation for citizenship and parenthood through
interaction with foster parents and other adults who are consistent role models.
Article the ninth…To be represented by an attorney at law in administrative or judicial
proceedings with access to fair hearings and court review of decisions, so that his best
interests are safeguarded.
Article the tenth…To receive high quality of child welfare services, including
involvement of the natural parents and his own involvement in major decisions that affect
his life.
CLIENT RIGHTS
KVC Behavioral HealthCare supports and protects the fundamental human, civil, constitutional
and statutory rights of clients.
Statement of Rights:
A client of KVC, has the right to:
1. adequate and humane treatment regardless of income, race, religion, ethnicity or handicap.
2. recognition of personal dignity in the provision of care and treatment.
3. services in the least restrictive environment possible.
4. individualized treatment and planning.
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5. be advised of alternate service options and providers.
6. be an active participant, along with your parent/guardian, in planning your case services.
7. the periodic review of your case plan.
8. participate in discharge and aftercare planning.
9. confidentiality.
10. refuse to participate in any research project without compromising your access to KVC
services.
11. be informed and give consent or denial for special observation and audiovisual techniques
and other procedures where consent is require by law.
12. safe and sanitary housing.
13. medical care and treatment.
14. a nourishing, well balanced diet.
15. freedom from verbal and physical abuse.
16. receive visitors according to your visitation plan.
17. make phone calls according to phone policy.
18. speak to legal counsel and/or your social worker within a reasonable amount of time.
19. send and receive mail. (If clinically indicated, mail may be opened by the person caring for
you and checked for contraband. When this becomes necessary, documentation will be
included in the client record.).
20. have visitation, telephone and outdoor restrictions clearly explained to you and your
parent/guardian. Such restrictions will be reviewed regularly.
21. have explained to you and your parent/guardian the nature, rationale and most common side
effects of all medication prescribed.
22. provision of an adequate number of competent, qualified and experienced staff to supervise
and implement your case plan.
23. know the names and titles of all staff members involved in your case.
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24. know the nature of the care you will receive.
25. know the rules of your placement.
26. wear appropriate personal clothing.
27. be heard, to identify problems and to express grievances in accordance with written
procedure
SECTION IV. FOSTER PARENT GUIDELINES
ROLE DESCRIPTION
The KVC foster parent is a highly trained parent who volunteers to assume the
responsibility and high expectations related to caring for special needs children and
youth. Foster parents are licensed by the Kansas State Department of Health and
Environment. The foster parent(s) provides a nurturing, supportive family setting for
children and youth in need of out-of-home placement.
Non-discrimination Policy for KVC Foster Families
KVC does not discriminate against prospective or licensed families based on race, color,
religion, gender, national origin, age, disability or any other characteristic protected by
law. The family must be able to provide the child with a safe environment that
recognizes and respects his/her cultural and religious heritage.
QUALIFICATIONS AND RESPONSIBILITIES
1. A foster parent is required to complete the 30-hour Partnering for Safety and
Permanence - Model Approach to Partnerships in Parenting (PS-MAPP) class or
Deciding Together prior to receiving a temporary license. First Aid, Universal
Precautions, and Medication Management must be completed before a full license
may be issued. Subsequently, the foster parent is responsible for completing 16 hours
of training annually for Satellite and Step foster care or 24 hours of training annually
for Intermediate, Diversion, Intensive or Supportive Family Living foster care. The
training must be of a related topic to the children or youth served in foster care. Of the
needed training hours each foster parent in the home must complete a minimum of
eight hours.
2. Each foster family is required to provide a minimum of three individuals who will be
contacted as references for the family. One reference may be from a family member
and two shall be from non-family members. Each of the three individuals will be sent
the KVC Foster Family Reference Questionnaire. The reference will be asked to
complete the entire questionnaire to the best of their knowledge. Information
gathered on the prospective questionnaire will be used by KVC in determining
sponsorship of the prospective foster family. Each KVC foster family must have at
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least three positive references on file and complete all licensing requirements prior to
taking a placement of a child. It is the responsibility of the KVC FSC and his/her
supervisor to review the reference questionnaires for each family before making
placements in the foster home.
3. Have knowledge of federal, state, and local laws, regulations, and codes pertaining to
licensing and providing foster care.
4. Have knowledge of positive parenting and child development.
a. Provide supervision, protection, and care in accordance with the identified need(s)
of the children and youth placed in the home.
b. Provide situational counseling and crisis intervention as needed.
5. Follow the Foster Family Provider Requirements as they are written.
6. Follow the Placement Agreement Requirements as they are written.
7. Ability to establish and maintain a working relationship with KVC, the children or
youth in care, and birth parents of the children or youth in care, schools, community,
courts, and DCF.
8. Foster parents will accept and encourage contacts between the child and his/her
parent and siblings and cooperate by:
• supporting the child’s contact with his/her parents and siblings
• having the child ready for each contact
• having clothing packed for overnight visits
• providing transportation or a place to visit when agreed to in the visitation
plan
• helping the child accept each separation from his/her parent following contact
• reporting the child’s reactions after contacts with his/her family to the FSC
• notifying KVC of any unplanned contacts between the child and the parent, or
between the foster parent and parent
9. Foster parent will notify the KVC FSC, or call the emergency pager phone, within
one (1) hour of any contact from a child or youth who was formerly in a foster
placement (e.g., child or youth informs foster parent of current or intended behavior
such as running away, needing a place to stay, school difficulties, family conflict,
etc).
10. Ability to communicate effectively.
11. Foster parents are mandated reporters which means all foster parents are
required to report any possible abuse or neglect to the authorities or the Kansas State
Hotline (1-800-922-5330).
12. A copy of the KDHE licensing regulations are to be maintained on file in the foster
home.
13. Foster parent will participate in the development of the child’s case plan.
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FOSTER FAMILY PROVIDER REQUIREMENTS
The Foster Family Provider Requirements (refer to appendix) were designed to outline
the basic expectations of foster families. They can be used as guidelines and reminders
for foster parents. The requirements are signed by each parent upon initial licensing and
annually thereafter. The family is given a copy and the original is maintained in their
master file located in the Corporate local office.
FOSTER FAMILY CODE OF ETHICS
PREAMBLE
Foster family care for children and youth is based on the theory that no unit in our
society, other than the family, has ever been able to provide the special qualities needed
to nurture children or youth to their fullest mental, emotional, and spiritual development.
If, for a certain period, a family ceases to provide these special qualities, substitute care
must be used. It is recognized that, ideally, foster care is temporary in nature. Foster
parents must have commitment, compassion and faith in the dignity and worth of children
or youth, recognize and respect the rights of parents and be willing to work with the CPA
to develop and carry out a plan of care for the child and youth.
Foster care is a public trust that requires that the foster parents be dedicated to service for
the welfare of children and youth and that they utilize a recognized body of knowledge
about human beings. Foster parent’s interactions must be committed to gaining
knowledge of community resources that promotes the well being of all without
discrimination.
Each foster parent has an obligation to maintain and improve the practice of fostering,
constantly to examine, use and increase the knowledge upon which fostering is based,
and to perform the service of fostering with integrity and competence.
PRINCIPLES
1. I shall regard as my primary obligation the welfare of the child (ren) or youth served.
2. I shall work objectively with the agency in providing effective planning for the child
(ren) or youth in my care.
3. I hold myself responsible for the quality and extent of the services performed.
4. I accept the reluctance of the child or youth to discuss her/his past.
5. I shall keep confidential from the community information pertaining to any child or
youth placed in my home.
6. I treat with respect the findings, views, and actions of fellow foster parents and use
appropriate channels, such as a foster parent organization, to express my opinions.
7. I shall take advantage of available opportunities for educating and training designated
to upgrade my performance as a foster parent.
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8. I respect the worth of all individuals regardless of race, religion, sex or national
ancestry in my capacity as a foster parent.
9. I agree to abide by all federal and state laws and state rules and regulations in regards
to being a foster parent.
FOSTER FAMILY RESOURCES
Foster Family Monthly Newsletter
A newsletter is published monthly for foster families and is available on the KVC web
site. The purpose of the newsletter is to spread the good news about children or youth and
families. It is also used as a tool to share information, such as reminders about licensing
regulations and parenting tips. The newsletter lists the monthly Foster Family Support
Groups. Other training, such as PS-MAPP classes, may be listed.
Area Foster Family Support Group
KVC hosts a number of support groups across the state for foster families. The purpose of
the meetings is to learn skills to better accommodate the child(ren) or youth’s needs and
to give the families the support needed to take on this challenge. The topic of the support
groups range from discipline to building self-esteem. The families are encouraged to
make suggestions as to what topics would best benefit them.
Foster Parent Training Opportunities
KVC offers many opportunities for foster families to receive the required annual 16 or 24
hours of continuing education that includes topics required by KDHE and the DCF
contract. There are monthly KVC support group meetings that provide training for
families. Other support groups may exist that also provide training opportunities. Details
of the KVC support groups are in the Foster Family newsletter that is published monthly.
When available these classes are also listed in the monthly newsletter and on the KVC
web site. Families also receive training hours at the KVC Annual Foster Family
Conference.
The Children’s Alliance of Kansas has developed a Training Department that offers
classes to foster families. These classes are spread across the state and are free of charge.
The Foster Family Newsletter will list the training when it is made available. The
Children’s Alliance can also be reached at (785) 235-5437 or www.childally.org. The
Children’s Alliance has online training available. You can visit the CWLA website at
www.cwla.org.
Numerous other web sites and online trainings are available on the internet.
The Kansas Department for Children and Families & Kansas Department of Health &
Environment have established guidelines for granting foster parent training hours.
Contact your FSC for more information.
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Foster families are required to turn in copies of their training certificates as they complete
them to their FSC. Families are also responsible for keeping track of their training hours.
This can be done by keeping the certificates and/or completing the Continued Education
Record Form. Refer to the Forms section in the Appendix for the Continuing Education
Record form.
NOTE: As of July 1, 2000 the training requirements for licensed foster family homes
apply to licensed relative homes and agency approved homes. For further information
contact your FSC.
KVC Recruitment Finder’s Fee
A monetary award of $300.00 will be made to an eligible foster parent who refers a
potential foster family candidate to KVC. The award will be paid once a family has
completed the following: PS-MAPP/DT training, the licensing process, and takes their
first placement. Former KVC Foster Families who left the agency in good standing, who
are not currently licensed as a foster home, are also eligible for a Recruitment Finder’s
Fee. These families must be willing to undergo annual KBI background checks to remain
eligible.
SECTION V. FOSTER FAMILY
PLACEMENT INFORMATION
PLACEMENT PROCESS OVERVIEW
When a child(ren) or youth is accepted for placement by KVC, KVC will attempt to
match the child(ren) or youth’s needs to the appropriate foster family. The FSC or an
Intake Coordinator from the Admissions Department will review with the foster parent
ALL information that has been received on the child(ren) or youth. If the foster parent
and the referring agency each accept placement and are in agreement that the identified
foster family can best meet the needs of the child(ren) or youth, he/she will be placed in
that home.
HOW PLACEMENT AFFECTS THE CHILD OR
YOUTH
Placement in a foster family can be a traumatic event causing the child(ren) or youth to
experience a wide range of emotions. Children and youth in care are likely to be affected
by any or all of the following emotions:
• Fear…“What will happen to me and my parents”; not knowing whether he/she will
go home, whether these strangers will be nice to him/her.
• Loneliness…Everything familiar has been taken away. Loss of friends, family,
surroundings, routines, objects of importance.
• Anger…Angry with self, Mom, Dad, the agency, DCF, and foster parents.
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•
•
Guilt and Shame…Often feel responsible for being unable to live at home. The
child(ren) or youth feels that he/she is a bad person.
Powerlessness…The child(ren) or youth has been uprooted without any choice.
PLACEMENT
When determining the most suitable placement for a child in out of home care KVC adheres
to several core beliefs:
•
•
•
In the absence of a relative or kinship placement, we strive to have children placed in the
most family-like and least restrictive placement. This placement needs to be able to
support children’s success in placement and in coping with the emotional demands of
major life changes, visitation, and feelings of loneliness, guilt, anger, fear, and happiness.
This placement should be culturally responsive to the children and family.
We strive to place siblings together.
We strive to place children in the same school boundaries in which their parents reside.
When that is not possible, we strive to have children be in their home county. We hope
that this will facilitate frequent visitation, a key component in successful reintegration.
KVC maintains a comprehensive database of information on their licensed foster homes
in order to adhere to these core beliefs. The database query can be completed taking into
consideration several variables. These variables include but are not limited to:
•
•
•
•
•
•
•
•
•
Foster family school
Home community
Number of openings and ability to accommodate sibling groups
Licensed age range of the home
Other children in the home
Ability/willingness to care for children experiencing challenges in the areas of education,
physical health, mental health, developmental delays, and emotional health.
Level of challenges accepted
Desire to foster to adopt
Family pets
Family Service Coordinators work in concert with Case Managers and Admissions to
locate the most appropriate placement for children based upon our core placement
philosophy, the child’s strengths and needs, and the foster families’ abilities and
competencies to meet these needs. The Admissions department queries the MIS database
and locates potential foster families who fit the criteria for a potential match to a child.
The Family Service Coordinator and the child’s Case Manager determine if the child and
family are a match and then facilitate placement into the home.
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WHAT ARE CHILD FILES/RED BOOKS?
Each child or youth should enter the foster family home with a file or notebook, provided
by the contracting agency that should contain the following sections:
•
Section A - Medical
Includes the child’s or youth’s Medical Card, Medical Consent to Treatment,
Immunization Records, Kan Be Healthy screenings, Kansas Department of Health
and Environment medical and dental forms, prescription and non-prescription
drug records, authorization to dispense medication at school and in foster home
and medication profile.
•
Section B - Admissions
Includes child’s or youth’s placement agreement, intake/referral form, birth
certificate, social security card, audio/video release, child’s or youth’s rights,
release of information, clothing inventory, and court reports.
•
Section C - Education
Individual Education Plan (IEP), Educational Advocate, educational notices and
grade cards.
•
Section D - Daily Logs
Progress notes from a residential center placement or daily logs from a foster
home placement (if appropriate).
•
Section E - Monthly Reports
Monthly reports from the foster family home placement and foster family home
court reports.
•
Section F – Other
•
Lifebook
Youth and foster parents are responsible for maintaining this record to be
transferred with the child as the child moves toward permanency.
Foster parents are EXPECTED to complete the daily and monthly log sheets and share the
information with the FSC.
Other pertinent information is located in the appropriate section. The file should be taken to
medical and dental appointments as well as other appointments in which the information may be
needed. All documentation needs to remain in the child’s file. When the child(ren) or youth
leaves the foster family home, the file accompanies the child(ren) or youth. The file must be
returned to the referring agency or KVC FSC when the child(ren) or youth is reintegrated with
birth parent(s) or relative.
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WHAT A FOSTER PARENT SHOULD HAVE
WHEN A CHILD OR YOUTH IS PLACED…
The following documents are required to be on file on or before placement per KDHE
Items required on or before placement per KDHE
1 Approval of the sponsoring CPA
2 Medical and surgical consent
3 Medical card
4 Placement Agreement
5 Reason for custody and reason for circumstances
leading to current placement
6 Description of child’s recent circumstances, including
medical problems, mental health concerns, and safety
concerns, including any assaultive behavior and
victimization concerns
7 Information about the child’s medication and dietary
needs, and the name of the child’s current health care
provider
8 Any allergies from which the child suffers
9 Name, address and telephone number of the contact
individual for the last educational program the child
attended
The following documents are required no later than 14 days after placement in the foster
home.
Items required no later than 14 calendar days after
placement in foster home
1 A copy of the court order authorizing the CPA to place
the child in foster care
2 A designation of the race or cultural heritage of the
child, including tribal affiliation, if any
3 A completed and signed copy of the placement
agreement with emergency contact information listed.
4 The name, address and telephone number of the child’s
parents or legal guardians
5 The spiritual or religious affiliation of the child and the
child’s family
6 The child’s placement history summary, including
name, address and telephone number of any advocates.
7 A description of positive attributes and characteristics
31
of the child and, if available, any related information
from the child, the child’s family including siblings,
and concerned individuals of the child’s life
8 The name, address, telephone number and email
address of the CPA who is responsible for supervising
the child’s placement
9 A copy of the current case plan, if completed. If this
plan has not been completed, the foster home shall
receive a copy within 14 calendar days of the
completed plan
10 Authorization regarding disclosure of confidential
information
11 If applicable, documentation on case plan authorizing
the use of physical restraint
12 Current copy of Medical record/KBH conducted by a
licensed physician and/or nurse with a current license to
practice in Kansas
13 Current copy of dental record
14 Immunization record
15 EEIF, School records, IEP
16 Social Security Card
17 Birth Certificate
18 GAL name, number and email
19 Foster parent report to the court form and cover letter
When the Kansas Department of Health and Environment goes to visit a foster family home, if
the above items are not present, the foster family home may be cited for a regulation violation.
KVC may also be cited for not providing the appropriate information. To request a child file or
specific information for a child, contact your FSC.
On-going communication with the KVC FSC ensures the appropriate information and records
are provided to the foster home.
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INITIAL TEAM MEETING
One of the most critical steps during the early stages of service delivery is KVC’s first
contact with the child’s birth family. The Initial Team meeting will occur no later than
two business days from the time of referral. At a minimum, DCF, KVC, the child (age
appropriate), the birth parent(s) and /or the primary caregiver and the foster family should
be in attendance at this meeting.
The following are goals for this Initial Team meeting:
1. Families are provided with the opportunity to describe their experiences, identify their
needs and play a lead role in the development of the initial service plan. Families in
most instances can find solutions to their own problems if provided the opportunity,
safe environment and the supports.
2. When the meeting is over, families feel that their perspectives are valued and that
there is a commitment to helping them achieve success.
3. Supports for the family have been identified—and safety plans created.
4. Roles and responsibilities of all team members are clarified; birth families, child (age
appropriate), contractors, DCF, foster families, service providers and other team
members.
5. Full Disclosure occurs—this includes expectations of DCF, consequences of actions,
and timelines for decisions about child permanence and the location of the child(ren)
including the address and telephone number, unless some compelling reason may
exist for not sharing this information (if safety would be compromised).
6. Plan for the continued gathering of assessment information that can support the initial
case plan. This includes the signing of releases to review information already
collected, or to contact individuals to obtain new information.
7. If the child was placed in emergency foster care, search for relatives or a foster family
home that can meet the child’s needs until he/she can safely return to their birth
family.
8. If the child has been removed from the home, a detailed plan for visitation and child
parent interaction is developed.
9. If the child was removed from their home, the foster family and the birth family
partnership roles and responsibilities are defined.
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CASE PLANNING AND ADMINISTRATIVE REVIEWS
A Child/Family/Child Case Plan, must be developed in concert with DCF, the birth
family and any other key members of the service team within 20 days of referral. The
purpose of the conference is to bring service providers, foster parents, natural resources,
the child, and the family together to determine the services, supports and other needs of
the child and family that will contribute to the child’s safety, permanency and well-being.
Ongoing Child/Family/Child Case Planning meetings are held at least every 170 days.
The purpose is to re-evaluate the case plan and modify it as needed to better meet family
and child needs. Foster parents are strongly encouraged to attend the child/family case
planning meetings. The foster parents will receive completed copies of each plan.
Policies regarding confidentiality will be reviewed at each case plan conference for:
• Child
• Birth family
• Foster parent
VISITATION
Parent/Child Contacts
A visitation plan is a part of the Child/Family/Child Case Plan. The child’s worker will
supply the foster parent with a written visitation plan which identifies the frequency,
length, location and who is involved in the visits. Every child in KVC’s care is expected
to have at least one naturally occurring interaction (visit) each week with the
reintegrating parent(s). If foster families include birth parents in activities with the child,
these interactions will be documented with the child’s case worker and added to the
child’s file.
If appropriate, visits may be supervised by foster parents.
Parent/Child visits/interactions may occur in a foster/relative/kin home. Guidelines for
this interaction shall be reviewed, including identifying everyone’s roles and
responsibilities, in advance.
Permanency Worker/Child Contacts
Face to face worker/child contact shall occur a minimum of once a month. For all
children placed 60 miles or less from the Home County, the assigned Case Manager or
Family Support Worker shall see the child in the placement at least once per month. The
assigned Case Manager shall complete the face-to-face worker/child contact at least
every other month. If the Case Manager is not the one seeing the child, the Case
Manager must have at least one telephone contact with the youth that month, which shall
be documented in the file. Plans for Worker/Child contact shall be made at the case
planning conference.
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When the child is placed 60 miles or more away from the home county, the policy is
applied in quarters. In each quarter (3 consecutive months), visits are to occur as follows
(this applies whether the child is in the same placement for the entire quarter or not):
o In one month, the face-to-face visit shall occur in the placement by the
assigned Case Manager
o In one month, the face-to-face visit shall occur in the placement by a member
of the child’s Case Management Team. This person will complete the face-toface visit log for the month. In this instance, the Case Manager must have at
least one telephone contact with the youth and the placement, which should be
documented in the file.
o In one month, the face-to-face visit shall be completed by the assigned Case
Manager in any location. The Case Manager must have at least one telephone
contact with the placement to discuss the child’s progress, which should be
documented in the file.
Approved members of the Case Management Team may include: the assigned Case
Manager or the Family Support Worker that has direct case knowledge who is part of the
child’s planning team.
Family Service Coordinator/Child Contacts
Face to face worker/child contact shall occur a minimum of once a month by the FSC.
All FSC/child contacts shall be documented in the case file. The visit should occur in the
foster family home. Only rarely should the visit occur outside the home, as the visits
provide an opportunity to assess the family foster home and to assess the child’s
interactions with the family in the home.
Family Service Coordinator/Foster Family Contacts
Face to face FSC/foster parent contact shall occur a minimum of once a month by the
FSC in the foster family home when a child is placed in the home. A minimum of one
face to face contact in the foster home shall occur quarterly when a child is not placed in
the foster family home. Whenever this occurs, once monthly phone or email contact
between the FSC and the foster parent shall occur.
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REPORTS TO THE COURT
K.S.A. 38-2261 provides the right of foster parents and parents to submit a report to the
court at the time of each court hearing. The report made by foster parents shall in a
specified format. Appendix 6-B provides a sample cover letter and a sample of the report.
The report submitted by the parent and/or foster parent shall be available to all parties.
The Child Welfare Case Management Provider shall inform the child's parents and foster
parent(s) of the right to submit a report directly to the court. The Child Welfare Case
Management Provider shall provide the parents and foster parents with information as to
the name and address of the Judge to whom the report may to be sent, as well as the dates
of the court hearings. Documentation of this task shall be placed in the child's case file.
A report to the court is available in the appendix of this manual.
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COMMUNICATION
It is KVC’s goal that all persons involved with the child or youth communicate clearly
and appropriately. KVC encourages foster parents to cultivate an interactive relationship
with all other professionals; however, the foster parent cannot make program changes
without involving the planning team. The planning team consists of the child or youth
(when feasible), birth parents or relatives, a representative from DCF, foster parent, and
contracting agency staff. If there is a need for change in any part of the plan for the child
or youth, the request should be made in writing to the KVC FSC or case manager. The
change will be staffed with the planning team and a decision reached as to the feasibility
of the proposed change. If the birth parents have needs, concerns, questions, or difficulty
with any aspect of the program, they should be addressed to the KVC FSC or case
manager, not the foster parent as they are prohibited from making any changes without
first staffing them with the planning team. If there is dissatisfaction with any aspect of the
plan, the foster parent may follow the steps in the grievance process.
CONFIDENTIALITY POLICY
Records necessary for delivery of services for each child or youth in care shall be kept for
at least five years after release by the contracting agency. It is important that all
evaluation material accumulated for each child or youth is kept confidential from people
in the community. The material is only for use by the referring agency, KVC, DCF and
the Court. Otherwise, it may be detrimental to the child or youth when he/she returns to
the community. Confidential information would include material in the child’s or youth’s
life, behavior of child or youth while in the program, log entries including detailed
information about the child or youth. Additionally, the posting of pictures, names and
identifying information on Face Book, My Space or other similar social networking
websites is prohibited and considered a violation of confidentiality.
It is possible to discuss the program with other people without identifying particular
persons or discussing some of the extreme behaviors that may exist. Disclosure of
specific information relevant to a child or youth or their family is prohibited without
written consent of the recipient of services, his/her parent or guardian, or upon the order
of an appropriate court. Likewise, downgrading or criticizing other involved
professionals to someone in the community is not only detrimental to that particular
person, but to the entire program at KVC. Any grievances one may have about another
professional should be brought to the attention of that person who will mediate the
situation. Violation of confidentiality may result in KVC not sponsoring the foster
family’s foster care license.
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WHEN TO CALL THE FAMILY SERVICE COORDINATOR
Do not wait until a major problem arises before contacting the FSC or the referring
agency case manager. The foster parent, the FSC and case manager will be working
closely together, sharing information, problems and successes.
When you have a problem or need help, the first person to contact is the FSC. If you are
unable to reach the FSC, and it is an emergency, contact the KVC FSC Emergency Pager
Phone for assistance. Some examples of when to call the FSC might include, but are not
limited to, the following:
• Facilitate visitation arrangements with birth family
• Information about the child or youth or foster parenting and answers to specific
questions
• Child or youth has experienced a critical incident, e.g. accident, suspension from
school, runaway, etc.
• Suggestions on how to handle problems and help in decision-making
• Emergency assistance
• Encouragement
• To advocate for child or youth or self
If you have disagreements with the FSC, discuss such disagreements with the FSC
directly. If, after meeting with the FSC, you do not feel that the issue is resolved, contact
the FSC’s Supervisor.
REPORTING CRITICAL INCIDENTS
Critical incidents are defined as those actions that include, but are not limited to the
following:
• Death
• Serious accidental injury
• Emergency room visit
• Unanticipated psychiatric hospitalization
• Unanticipated medical hospitalization
• Alleged abuse or neglect
• Emergency change in placement
• Emergency respite
• Criminal assault of any kind
• Any action of a serious nature that poses physical or emotional danger to family
members or staff
• Placement disruption
• Runaway from school or other
• Suicide or attempted suicide
• Police intervention and/or arrest
• Communicable diseases and/or serious physical illness
• Staff or foster family injuries as related to client action
• Health Department violations/confirmation
• Negative press/media attention
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•
Any other incident that is critical to the child (ren)’s care
Foster Parents are required to report critical incidents immediately to the child’s child
placing agent and sponsoring child-placing agency. Foster parents must also submit a
written report for each critical incident to the sponsoring child-placing agency by the next
working day. The report should contain the child’s name and birth date, the date and time
of the incident, factual summary of the incident, including the names of those involved,
summary of actions taken, the signature of the foster parent, and the date of the report. A
copy of each critical incident report should be kept on file in the family foster home.
Foster parents are required to complete written critical incidents on the following
incidents:
•
•
•
•
•
•
•
•
•
•
Fire damage or other damage to the foster home or damage to the property that
affects the structure of the dwelling or the safety of the child in foster care
A vehicle accident involving any child in foster care
A missing or runaway child in foster care
The physical restraint of a child in foster care
The injury of a child in foster care that requires medical attention
The death of a child or any other resident of the family foster home
The arrest of a child in foster care
Any incident involving the presence of law enforcement
All complaint investigations by the department or the Kansas Department for
Children and Families.
Any other incident that jeopardizes the safety of a child in foster care
RUNAWAYS
If a child or youth runs away or is missing from your home (for more than ½ hour),
phone the FSC and case manager (or Emergency Pager Phone, if appropriate)
immediately. If unable to reach the FSC or case manager, call the Emergency Pager
Phone. Also notify the local police department at once. Be prepared to give a description
of the child or youth, what he/she was wearing and, if known, where the child or youth
may be going.
CONTACT WITH LAW ENFORCEMENT:
Foster families should only call law enforcement if a child is at imminent or extreme risk
of self harm or harming someone else, to report a crime or to report the AWOL status of
a child. Law enforcement should not be used for assistance in disciplinary or truancy
issues. If a child is behaviorally dysregulated the following resources may be utilized for
assistance.
•
•
•
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During business hours contact the FSC and/or Case Manager
After regular business hours, including weekends or holidays, contact the on call
emergency phone.
If available (verify with the FSC) contact the Community Mental Health Center
crisis line.
FOSTER PARENTS AS MANDATED REPORTERS
The Kansas Code for Care of Children mandates that when any person licensed to
provide child care services with the Kansas Department of Health and Environment has
reason to suspect that a child or youth has been injured as a result of physical, mental, or
emotional abuse/neglect or sexual abuse, the person shall report the matter promptly to
the local DCF office, law enforcement or the abuse hotline.
The process of reporting suspected abuse or neglect is:
1. The foster parent observes a situation that might be considered abusive.
2. The foster parent calls the local DCF office, law enforcement, or the abuse hotline
(1-800-922-5330). The foster parent should make sure that they provide the name,
address, child or youth’s parents and individuals responsible for care, location, child or
youth’s condition, alleged perpetrator, and any other information.
3. The call can be “anonymous” if the reporter wishes. All calls will be confidential. The
hotline or law enforcement will forward the report to DCF for investigation.
It is a class B misdemeanor for persons who willfully and knowingly fail to make a report
of suspected abuse or neglect and/or prevent or interfere with an investigation.
ALLEGATION OF ABUSE AGAINST FOSTER PARENTS
If there are abuse and/or neglect allegations against KVC-sponsored foster parents,
several steps will occur:
The concern will be directed to the local DCF office. DCF Intake and Assessment will
review the concern and determine if an investigation will occur. If DCF determines that
there is due cause for an investigation, they will notify the family that there is a concern
and begin the interview process.
1. The family should immediately notify their KVC FSC.
2. DCF will refer the concern to KDHE for review.
3. KDHE will screen the complaint and determine if there are regulatory issues they
need to investigate. KDHE may make an unannounced visit to the foster home.
KDHE may ask to conduct a walk-through of the home. KDHE will determine if
there are regulatory violations in the home. A notice of survey findings will be
completed and sent to the family. In the event of an emergency, KDHE may suspend
the foster home license.
4. The family should again immediately notify their assigned FSC of the complaint.
5. KDHE or DCF will decide if there were any violations and report the findings to the
family.
6. The family should copy any notice of survey findings and give to their FSC.
7. If there are regulatory violations/citations noted on the KDHE Notice of Survey
Findings, the family has five days to respond in writing to KDHE. The FSC can be
available to assist in the family’s response. A copy of the final response shall be
provided to the FSC.
8. The licensing team, which consists of the FSC and the FSC supervisor will review the
reports/results of the investigation and determine if A Foster Family Development
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Plan is needed.
9. The family has the right to request their FSC be present should KDHE or DCF visit
the home for investigative purposes.
10. The FSC cannot discuss the details of the incident with the foster family until the
investigations are completed.
KVC reserves the right to remove children or youth in care from a foster home if it is
determined in the best interest of the child or youth while an investigation is being
conducted, and place the foster home on hold.
DISCIPLINE POLICY
Since many children and youth in care have been neglected or abused, it is important that
alternative discipline methods be developed. Foster parents should also be aware that the
Department of Health and Environment regulations prohibits striking or any physical
punishment, threatening, the use of derogatory remarks, making a child or youth feel fear,
and others.
KVC supports this viewpoint and encourages families to utilize discipline as a means of
education and consequence. The ideal situation would mandate that the consequence be
logically (if not naturally) related to the behavior which called for such measures.
Discipline that is harming, humiliating, frightening, or physically hurtful, shall not be
used at any time. The child or youth shall be protected against all forms of neglect,
exploitation, or degrading forms of discipline. No child or youth shall be confined in a
locked or dark area or have food, water, or toilet facilities withheld.
The Discipline Policy is signed upon initial licensing and annually thereafter. The family
will receive a copy of the signed policy while the original will be maintained in the
master file. A copy of the Discipline Policy is available in the appendix of this manual.
KVC does not condone the use of physical restraint of youth in care by a foster parent.
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SECTION VI.
KVC POLICY AND PROCEDURES
DEFINITIONS OF FOSTER FAMILY CARE
1. Family Foster Care or Satellite provides on-going care to children and youth while a
permanent plan is implemented for the children or youth. A total of 16 hours of
training is required annually, with a minimum of 8 hours being obtained by each
foster parent in the home, 2 of which are to be completed in a group setting.
2. Emergency Foster Care for Children in Police Protective Custody provides short-term
care (up to 72 hours) for children or youth placed in police protective custody by law
enforcement. Weekends and legal holidays are excluded from the 72-hour time
period. Families must be available on an on-call basis. Daycare is not provided.
3. Step Foster Care are foster family homes recruited, trained and licensed by a Child
Placing Agency. The full range of support services of the sub-contract agency are
utilized to provide training and support to the foster family and child(ren) placed in
the home. Youth served are typically stepping down from diversion foster care.
4. Diversion Foster Care is provided in highly trained foster family homes that have
been recruited and specifically trained to offer an alternative to group residential
facilities. Youth served shall be in need of transition or diversion from residential
placement or to prevent placement into a higher level institution. Transitional foster
care requires 24 hours total of training annually with a minimum of 8 hours being
obtained by each foster parent in the home, 2 of which are to be completed in a group
setting. Placements are reviewed every 30 days by the referring agency for continued
placement qualification.
5. Intensive Foster Care provides more structure than a family or transitional home but
continues to provide it in a homelike environment. Youth served in these homes may
be exhibiting moderate to severe aggression, sexualized behaviors, drug and alcohol
abuse, school difficulties (including truancy, suspensions, expulsions, special education, etc.). A family can provide intensive, transitional and family foster care at the
same time for different children in their home. Intensive foster care requires 24 hours
total training annually with a minimum of 8 hours being obtained by each foster
parent in the home, 2 of which are to be completed in a group setting.
6. Supported Family Living Care is provided in specialized foster family homes for
children who are mentally retarded, developmentally disabled, or have other special
health care needs. Specialized care is provided for children to avoid placement in
institutional or other congregate residential settings when they cannot, for whatever
reason, remain with their birth parents. No more than two children may be placed in
a foster home designated as providing Supported Family Living. Supported Family
Living Care requires 24 hours total training annually with a minimum of 8 hours
being obtained by each foster parent in the home, 2 of which are to be completed in a
group setting. Tier rates vary based on the disability and need of the child. Rate of
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pay is determined by tier rate, which is the level set, by the Community
Developmental Disability Organization.
FINANCIAL INFORMATION
DAILY RATES OF REIMBURSEMENT
Satellite Family Foster Care
$20.00 per day
Emergency Foster Care for Children in
Police Protective Custody
$24.00 per day
Step Foster Care
$25.00 per day
Diversion Foster Care
$35.00 per day
Intensive Foster Care
$45.00 per day
Supported Family Living (SFL)
See Below
KVC and other Contractors across the state will reimburse for children in DCF custody
who on are on the MR/DD waivers based on the child’s Community Developmental
Disability Organization (CDDO) BASIS assessment for higher needs children with more
severe disabilities. Beginning July 1, 2009, reimbursements rates will be paid at the
following reimbursement levels for all new and existing placements:
Tier 1=$95/day
Tier 2=$75/day
Tier 3, 4 and 5 will be determined by KVC’s or another Contractors level of care
screening for other foster care children’s room/board rates. These are typically described
as satellite, diversion and intensive foster care.
NOTE: KVC pays for the first day a child or youth is placed but not the day the child or
youth leaves.
CHANGE IN LEVEL OF CARE AND DAILY RATES
The following level of care and daily rate information pertains to children in KVC’s care.
Other agencies may have different policies. Please verify with your FSC if you have
questions pertaining to a child whose case is managed by another agency.
Level of Cares (LOCs) are completed by the child’s case manager to determine the rate
of pay, based on the child’s needs. The CM is automatically prompted to enter a level of
care anytime they request the diversion rate or higher for a child. CMs are also required
43
to submit a level of care re-assessments every 90 days for any child who is placed at the
diversion rate or higher. This is to determine whether or not they continue to qualify for
a higher rate. Finally, CMs can submit a level of care rate change request at anytime for
a child if they would like to request a rate increase or decrease. There is one designated
intake coordinator in KVC Admissions who handles all level of care re-assessments and
rate changes.
Rate Increases. If a child’s foster home would like to request a higher rate of pay, the
child’s case manager can submit a rate change request. If the child qualifies for the
requested rate based on the new level of care submitted, their rate will be increased,
effective the date the request was submitted. A new placement agreement will be sent
out for the rate increase. Their rate will also be changed in the database. If the child does
not qualify, their rate will not change.
Re-Assessments and Rate Decreases. Every 90 days, the case manager is required to
submit a level of care re-assessment for any child who is placed above the satellite rate.
If the child continues to score for the same rate or higher, their rate will not change. If
the child no longer qualifies for the rate they are placed at, 30 days notice is sent to the
CM and to the FSC. The FSC should notify the foster family of the 30 day notice to
change the rate. FSC’s have 30 days to appeal the rate decrease on behalf of the foster
family. All appeals must be approved by the Permanency Director. After 30 days if the
rate decrease has not been appealed, the child’s rate will be changed in the database and a
new placement agreement will be sent out.
Case managers may also submit rate decrease requests if they would like a child’s rate
lowered. If a rate decrease request is submitted, 30 days notice for the rate drop will
automatically be given, even if the child continues to qualify for the higher rate. The
child will be added to the rate decrease list. After 30 days, the child’s rate will be
changed in the database and a new placement agreement will be sent out.
RESPITE CARE
Provide notification to your FSC anytime you will be utilizing respite. Generally, only
foster family homes licensed by KVC may be utilized to provide respite care. The foster
parent is responsible for payment to the respite provider at the rate reimbursed by KVC if
the respite provider is another KVC foster parent. If the respite provider is with another
agency, it must be coordinated through Admissions and payment for respite may be
handled by the KVC Accounting department, depending upon the other agency’s policy.
FEDERAL INCOME TAX
KVC suggests that foster parents consult with their local IRS office or accountant for
further information.
INSURANCE
Foster family care providers are strongly encouraged to maintain appropriate renter’s,
homeowner’s, and household insurance to cover physical damages that might occur as a
44
result of a child or youth being placed in the foster family’s home. Although KVC
maintains professional liability insurance for negligence involving licensed foster parents,
this insurance does not cover such losses. KDHE regulations require foster families to
obtain accident & liability car insurance. The foster parent understands that the agency
takes no responsibility for replacing or repairing any items damaged by the child or youth
in care.
FINANCIAL EXPENSES
Foster Families are not required to turn in timesheets to Accounting. Families are
encouraged to keep track of days child is in their home for their own records. Payments
are generated from the Database that tracks the foster placements. FSC’s will be
provided a payment reconcilliation report twice once a month and have 2 business days to
review and submit any corrections. If an error occurs the FSC must submit a payment
correction request through the Magic Request KVC helpdesk that is located on the KVC
portal. Foster Parents must submit requests for reimbursement for mileage on the KVC
Mileage form and submit the form to the KVC Accounting Department.
The foster parent will be reimbursed for each day the child(ren) or youth is in the foster
home. No reimbursement will be made for the day of discharge. The reimbursement
periods are typically processed on the 10th business day of the month for days 1 through
30 of the prior month. Foster parents may contact their FSC with any questions.
From the reimbursement the foster parents are expected to provide for the child(ren) or
youth’s basic needs.
A guideline for how the reimbursement should be used to meet those needs is as follows:
•
Clothing and Personal Items: approximately $30.00 a month used for
clothing for each child or youth in care in the home. Please refer to
paragraph labeled “Clothing” for additional information regarding a
clothing allowance.
•
Personal items may include: diapers, formula, deodorant, shampoo, etc.
•
Day Care: Payment for deposits, activity and enrollment fees for day care.
For more information see section on Day Care.
•
Allowance: Each family is encouraged to work out a fair allowance policy.
•
Personal Enrichment: This might include being allowed to participate in
music or dance lessons, band, etc. This does not apply to emergency
placement.
•
Family Activities: Activities the whole family participates in.
•
Recreational Activities: YMCA, football, basketball, gymnastics, baseball,
cheerleading, etc.
•
Independent Living Needs: If the youth is 15 or older, it is likely that
he/she will be receiving independent living services; if so, the foster parent
will assist the youth in collecting items (such as dishes, bedding, furniture,
etc.) that will be needed when the youth is released from the foster care
program. This does not apply to emergency placement.
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No reimbursement will be made for the day of discharge. Foster family homes who have
placed the child(ren) or youth in a respite home or facility should notify their FSC prior
to doing so.
ABSENTEE REIMBURSEMENT POLICY
When a child is out of your home due to an extended visit, hospitalization or runaway,
it is up to the individual contractors to determine if the bed will be held and paid for
and for how many days. The FSC should confirm with the foster family their interest
in taking the child back. If the Foster Family is interested then the FSC should contact
the child’s case manager to verify the family’s willingness to hold the bed and the
agencies’ willingness to pay for the held bed.
TRANSPORTATION
Foster parents are responsible for transporting children or youth in their home within the
first 30-mile radius (60 miles roundtrip). This includes children who are the responsibility
of another Child Placing Agency. Foster parents who have children placed in their home
by Youthville are responsible for transporting children or youth in their home within the
first 60-mile radius (120 miles roundtrip). Foster parents are responsible for transporting
children and youth in care to school, medical appointments, therapy, job, visits, case
plans, court and extra-curricular activities.
If the foster parent chooses to complete transportation beyond the 30-mile radius, FSC
should contact the agency’s case manager for written authorization. The FSC will then
provide the family verbal approval to complete the transport. The FSC will need to
provide written documentation of the authorization to the appropriate accounting staff.
Email notification shall be sufficient.
Reimbursement for transportation to medical appointments and therapy may be requested
by prior approval through the medical transportation contractor, Medical Transportation
Management. Contact MTM at 1-888-240-6947 for more information.
KDHE regulations require the person who transports be at least 18 years of age, have a
valid driver’s license and proper insurance. The vehicle must be in good working
condition and have working seatbelts. Seatbelts or car seats must be used when
transporting. Smoking in the vehicle is not allowed while transporting. For more
information refer to the KDHE regulation handbook.
MILEAGE
Foster parents are reimbursed at a minimum of $.34 per mile for transporting the child or
youth to family visitations, case plans, or court hearings, respite care only. KVC does not
reimburse mileage for day-to-day transportation such as school, school activities, day
care, etc. The reason for mileage should be completed for each trip along with the name
of the family member. The Foster Parent Mileage Report Form should be completed
monthly.
46
If the foster parent has a child or youth placed in their home referred by another agency,
the reimbursement varies between agencies. The variations include, but are not limited
to: distance the foster family is responsible to transport, a pre-authorization code
requirement, etc. As KVC is a service provider for many different agencies throughout
the State, and as many agencies are continuously developing criteria for reimbursement,
the FSC should request information as needed from the responsible Contractor.
Reimbursement for transportation to medical appointments and therapy may be requested
by prior approval through the Medical Transportation Management. Contact MTM at 1888-240-6497 for more information.
DAYCARE
The individual contractors are responsible for determining their day care guidelines for
the children whose case is managed by them.
Following is the policy for children whose case is managed only by KVC:
Effective February 2006
Many of the children in KVC’s care are in family settings in our foster homes. Some
children and families may require additional services in order to meet the children’s
needs and achieve their permanency goals. Based upon the needs of the child and the
foster home, KVC may provide for the additional support of daycare services.
Daycare is obtained by completing a Daycare Request Packet. This packet consists of
basic information about our daycare policies and application forms to be completed.
Page one of the application requests personal information on the family. Page two
contains the requested daycare schedule. Included on this page is the daycare provider
information, which is required in order to get the Provider Enrollment forms to the
daycare. The last pages are Employment Verification forms to be completed in their
entirety and given to your Family Service Coordinator. These forms will be sent from
Accounting to your work for verification. If there is any change in employment, please
report the change to Accounting within 10 days. After the initial Daycare approval,
employment will be subject to verification on a periodic basis. If a home already has a
child in the home receiving daycare or has had a placement that received daycare within
two weeks of the next placement, the home will only be required to fill out the daycare
schedule form and submit that form to Accounting.
Daycare payments are made directly to the daycare provider by KVC around the 15th of
the month. KVC pays according to DCF established rates. KVC does not pay for
deposits, enrollment fees, application fees, or transportation charged by the daycare.
These charges are the responsibility of the foster parents and should be paid from the
daily rate received by the foster parents. If a child is in daycare for more than the
approved hours for the foster family, the foster family will be responsible for payment for
the extra hours. KVC will pay a maximum of three absent days per month for full time
daycare for the usual number of hours per day that a child is approved for day care. KVC
will not pay for an absent day on a holiday that the foster parents are not scheduled to
47
work and/or attend school. KVC will not pay for daycare hours when a child is attending
school and not present at the daycare.
The foster parents are responsible for signing in and out each child and noting the time on
the Daily Attendance Record when a child is taken and picked up from daycare. KVC is
not responsible for giving the Daycare provider notice when a child leaves our care or
changes daycare providers. This is the responsibility of the foster parents. KVC does not
pay notice days when a child leaves the care of the provider. In the event that a child or
youth needs emergency daycare (i.e. suspended from school, family emergency, etc.),
KVC may be able to assist the foster parents in obtaining temporary arrangements.
However, the primary responsibility to arrange for emergency daycare, including
transportation, rests with the foster parents. KVC must approve all emergency daycare
providers and requires a CANIS and KBI screen for each emergency daycare provider.
A foster parent who operates a full-time licensed/registered daycare in their home must
utilize the daycare slot for a foster child in their home. Daycare payments are not
provided by KVC for children or youth residing in residential settings.
Daycare providers must be licensed or registered through the Kansas Department of
Health and Environment. A copy of the license and a W-9 form is required by KVC.
Please call 913-322-4931 4900 and ask to be directed to the accounting department if
you have any questions.
Amount of Eligible Daycare
If there are two verified full-time foster parents, the foster family will qualify for 50
daycare hours for non-school-aged children and 15 hours for school-aged children.
If there is one full-time and one part-time foster parent, then, for non-school-aged
children, the foster family will qualify for 1.25 daycare hours times the number of hours
that the part-time foster parent works. The amount of daycare for school-aged children is
determined by taking .3 hours times the number of hours that the part-time foster parent
works.
If there is one full-time foster parent and the other foster parent does not work, then the
foster family will not qualify for daycare.
Exceptions
School-Aged Children
Spring Break, in-service days, and other school related days off are taken into
account; the foster family will be covered for daycare on these days up to 10
hours for two full-time foster parents. Families with one part-time parent will
receive the number of hours the part-time parent works plus one hour, up to 10
hours. In order to be reimbursed for school related days the foster family must
turn in to accounting the child’s official school schedule reflecting the days off
each time this exception is accessed.
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Special Needs Children
KVC realizes that special needs children may require extra daycare to relieve the
foster family. Foster families that have a part-time worker or a stay at home
parent may qualify for extra daycare. Those families that have two full-time
workers will not qualify for extra daycare.
Specialized daycare may only be authorized for children needing additional
services beyond regular daycare who have been evaluated by a qualified
professional such as a licensed mental health worker or MR/DD provider. Staff
must have completed specialized training to deal with the difficult needs of the
child. Specialized daycare rates are ONLY available to centers that are licensed
as specialized daycare providers.
Foster Parents in College
It may be the desire of some foster parents to attend college. KVC will consider
12 hours of college courses full-time employment. KVC will reimburse daycare
for any foster parent taking less than 12 hours by computing the number of hours
he or she is taking divided by twelve and multiplied by 50 hours. Night classes
will only be considered if the Foster Family is a single person. If the foster parent
is employed full-time and attending school, the foster family will receive 50
daycare hours. If the foster parent is employed part-time (20 hours) and goes to
school part-time (6 hours) the Family will receive a maximum of 50 daycare
hours.
Self Employed Foster parents
If a foster parent is self-employed the following documentation is required in
order for the family to be considered for daycare:
• Federal Tax Identification Number
• State Business License
• IRS Form 1040, including Schedule C
• Brief description of the business
• Foster parent’s role in the business and number of hours worked
CLOTHING
The FSC must attempt to obtain clothing from the child or youth’s referring agency prior
to requesting a Clothing Allowance. A Clothing Allowance is available for some
children or youth served in foster care or relative placements depending on the
contracting agency.
MEDICAL CARE AND HEALTH SAFETY INFORMATION
MEDICAL CARE AND THE MEDICAL CARD
Children or youth that come into DCF custody are issued a Medical Card. The Medical
Card is to cover medical and dental expenses for the child or youth, including over-the49
counter and prescription medication, lice treatment and other medical needs. Some
medical procedures require prior approval, which must be obtained through Medicaid’s
Consumer Assistance Unit at 1-800-766-9012. In non-life threatening situations, the child
or youth’s physician must be contacted before taking the child or youth to the Emergency
Room. KVC is not responsible for medical bills due to Medicaid procedures not
being followed correctly.
It is the responsibility of the foster parent to arrange for a medical screening within 30
days of the child or youth’s placement and a dental screening within 60 days of the child
or youth’s placement in the foster home. These can be done locally by any doctor/dentist
who accepts the Medical Card. In addition, the foster parent is responsible for arranging
any doctor’s appointments (injury/illness), medication checks (renew prescriptions, blood
level checks, etc.) and counseling appointments.
Foster parents do not sign as the responsible party. This prevents billing from
being sent to them.
KAN BE HEALTHY/DENTAL SCREEN
Once the child or youth has had an initial Kan-Be-Healthy (KBH), (within 30 days of
placement) there is a set schedule based upon age as to when he/she will need to be
screened again. The American Pediatrics Association and KVC recommend that the Kan
Be Healthy be completed within 72 hours of initial placement. The Kan Be Healthy is a
thorough medical check-up usually conducted at the health department or local hospital.
If neither provides these services, you will need to contact a physician who does. The
dental screen is required annually. Compliance with screening guidelines will be checked
when the home is re-licensed. Foster parents should request a completed exam form for
the KBH and the dental screen at the time the appointment is conducted. A copy of the
completed forms should be provided to the FSC and CM as well as being maintained in
the child’s file located in the foster family home. Refer to the Kan Be Healthy fact sheet
in the Appendix.
LICE TREATMENT
With a written prescription, children or youth who have a Medical Card can receive overthe-counter and prescription lice treatment at no cost if they are under the age of 18. A
co-pay may be required for youth ages 18 and over. For information about which head
lice treatment Medicaid covers, contact the pharmacist or the Consumer Assistance Unit
at 1-800-766-9012. KVC does not reimburse foster parents for lice treatment.
MEDICATION ADMINISTRATION
KDHE requires that accurate records be kept of all medications, including prescription
and over-the-counter, given to children and youth in foster care. Prescription medications
must be dispensed from the bottle with the label noting the medication name, dosage,
physician name, child’s or youth’s name and date filled. Medicine must be labeled, in a
prescription bottle, when it is to be dispensed at school, day care, or other site. The
pharmacy where the prescription is filled can prepare a separate bottle for schools if
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asked in advance. The FSC will review the records of medicine disbursement during the
monthly home visits. All medication given to foster children must be documented,
including over-the-counter medication. The Medication Administration Forms are
available in the appendix of this manual.
MEDICAL RECORDS
It is the policy of KVC that foster families keep updated medical records on file for each
child or youth placed in their home. These records should follow the child or youth
throughout his/her placements while in custody.
Medical records that should be maintained in the child’s or youth’s file include:
1. Daily Medication logs
2. Medical treatment is documented on the State of Kansas’s Medical Care for Children
form. This form must accompany the child or youth on every medical visit 3. Dental
treatment is documented on the State of Kansas’s Dental form. This form should also
accompany the child or youth on every dental visit
4. Over the counter medication approval form signed by a physician
5. Medical Consent form
6. Current medical card
7. Documentation and warning of any allergies to medication or food
8. Emergency medical procedures for health needs such as asthma, severe allergic
reactions, seizures, diabetes, etc.
EMERGENCY PROCEDURES
Foster families must inform the child’s case manager and FSC within 1 hour in case of:
•
Death or serious injury or illness of a child or youth
•
Suicide attempt
•
Communicable diseases
•
Any other incident that is critical to the child’s or youth’s care
Foster families must inform KDHE within 1 hour in case of:
•
Death of a child or youth
•
Communicable diseases
In case of emergencies, the foster parent will transport the child or youth to the nearest
hospital and take the CONSENT TO MEDICAL CARE form and child’s medical card.
The foster family will refer questions concerning payment and billing to the child’s case
manager. The child’s legal guardian or DCF social worker must give medical consent for
transfusions, surgery, and other invasive procedures.
UNIVERSAL PRECAUTIONS
All foster families and staff should use Universal Precautions when caring for a sick or
injured child(ren) or youth as well as providing day to day hygiene care. This procedure
is to protect the caregivers from possible blood-borne pathogens such as HIV and
Hepatitis B.
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The following is a list of ways to prevent the spread of infectious diseases:
1. Use protective barriers such as latex gloves, gowns, masks, and eyewear when
cleaning up feces, blood, or other possible contaminants.
2. Disinfect surfaces with a water bleach solution (¼ cup bleach to 1 gallon
water).
3. Wash hands thoroughly (minimum of 15 seconds) with soap (antibacterial) and water
after providing care and prior to meal preparation.
Since the only way to determine if someone has an infectious disease is through medical
testing, then all persons should be treated using these Universal Precautions.
USE OF CAR SEATS
Children must ride in a rear facing car seat until they reach one year of age or twenty
pounds. Children ages one through three must be properly restrained in a forward-facing
child seat. Children ages four through seven must ride in a booster seat unless the child
weighs more than eighty pounds, or the child is taller than four feet, nine inches, or only a
lap belt is available. Children ages eight through thirteen must be protected by a seat belt.
This law applies to:
• All drivers transporting children or youth
• Residents and nonresidents alike
• All seating positions
• Passenger cars
• Vans designed for carrying 10 or fewer passengers
• Pickup trucks registered for 12,000 pounds or less
• Farm trucks registered for 16,000 pounds or less
The Child Passenger Safety Law is a primary law, meaning a driver can be stopped
for this violation alone.
Foster parents are required to obtain child safety seats for the children or youth in their
care. Foster parents should refuse to release a child to any person providing
transportation without a federally approved child safety seat. The foster parent will
report any such incident to the appropriate KVC Supervisor.
FIRE SAFETY
Foster parents will be responsible for conducting and documenting fire drills once a
month. Foster parents will also review fire drill procedures with children, youth and
child care providers in the home on a monthly basis. Foster parents will be responsible to
ensure that fire extinguishers and smoke detectors are working properly. There must be a
smoke detector on each floor and in each bedroom. Each floor must have a carbon
monoxide detector. An escape route for all floors of the house will be posted. In case of
an actual fire, Foster parents must use common sense to provide for everyone’s safety.
Foster Parents should ensure that everyone is out of the home before they leave the
house. The following procedure should be used and taught to the children and youth.
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Depending on the children or youth in their care and the severity of the fire, not all steps
may be possible or practical.
1. Close windows
2. Wear a coat and hard-sole shoes
3. Grab a towel to place over your face in case of smoke
4. Leave bedroom open Foster parent will shut doors after checking to ensure
everyone is out
5. Go to the nearest exit. Do not run or push
6. When outside, meet at the designated spot and face away from the house. Do not
return to the house until so instructed.
TORNADO SAFETY
Foster parents will be responsible for conducting and documenting tornado drills once a
month between March and October. Foster parents will also review tornado drill
procedures with children, youth and child care providers on a monthly basis. The route
to the shelter must be posted on each floor. Foster parents will ensure that everyone else
has taken cover before they go to shelter. Foster parents must use common sense in any
given situation to keep everyone as safe as possible. The following procedure should be
used in drills and taught to the children or youth in the case of an actual tornado warning.
However, not all steps will be possible for all children and youth in care and not all steps
will be logical in certain situations. Foster parents must use good judgment in these
situations.
1. Keep doors and windows closed (according to the National Weather Service)
2. Wear coat and shoes
3. Grab a blanket and radio, if possible
4. Go to designated shelter without running or pushing
5. Do not leave the shelter until instructed by the National Weather Service
Foster parents who have a child or youth in their home who is physically challenged must
have a plan established for that child or youth. If the shelter is in the basement and the
foster parents cannot safely get that child or youth to the basement, an alternate plan must
be available, such as an inner hallway or room without windows. The Tornado Drill
form will be reviewed by the FSC at the annual re-licensing visit. A copy of this form is
available in the appendix of this manual. Refer to the appendix for the KVC Foster Care
Fire Drill, Tornado Drill and Smoke Detector Monthly Record form.
EDUCATION
SCHOOL ENROLLMENT
It is the responsibility of the foster parent to enroll the child or youth in the appropriate
educational program as specified by the child’s or youth’s treatment plan. Each child or
youth enrolled in public school should be eligible for free lunches and free textbook
rental. It is the responsibility of the foster parent to complete the lunch form and to
inform the school that the child or youth is in foster care so that the child or youth
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receives the textbook rental free of charge. Any item, such as vocational or educational
supplies, school lab fees, etc, is the responsibility of the foster parent(s).
DCF has implemented a form to be completed by the contractor case manager or
permanency worker. The form, Education Enrollment Information Form (EEIF) is to
assist in providing the school with the necessary basic information for children in state
custody.
ENROLLMENT PROCEDURES
When preparing to enroll a child or youth in school, please call in advance to make an
appointment. Some schools do not enroll every day and it may be necessary to meet with
specific personnel. The following documents are required by many school districts.
• Completed Education Enrollment Information Form (EEIF)
• Withdrawal form from last school attended
• Immunization record
• Copy of the birth certificate
• Proof of residency
• Copy of last grade card
• Medications in prescription-labeled container
• IEP
If you have a question about enrollment or documents are not available, talk to someone
at the school. They may help you get school records and may give you time to get some
items.
SCHOOL WITHDRAWAL PROCEDURES
It is very important to handle moves and withdrawals from school with care. Most
schools require a day’s notice to gather grades and prepare withdrawal papers. It is
also very important for the students and school staff to have an opportunity to say
goodbye. When students do not get to say goodbye, new grief issues are created. One of
the biggest complaints of school authorities is students disappearing without any warning
or planning. Please keep these issues in mind.
EDUCATIONAL ADVOCATES
Educational advocates are volunteers assigned by the State of Kansas. Students who
receive special education services and whose parental rights have been terminated should
have an advocate. The DCF worker must request an advocate and a liaison can assist in
this process. The advocate has been trained in special education issues and should attend
Individual Educational Plan (IEP) meetings and is the only person who can legally sign
an IEP and Consents for Evaluation or Educational Placement.
HOME SCHOOLING
It is the policy of KVC that children in the custody of the State of Kansas must attend a
public or private school that is licensed and accredited. Home schooling of children in
foster care is not allowed.
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TUTORING
KVC strongly encourages foster parents to utilize school services, and especially
advocate for those services to be provided by the school through the child’s or youth’s
IEP. In some areas local scholarships are available for children and youth in foster care.
Contact the FSC to obtain information about scholarship programs.
SUMMER ACTIVITIES AND SUMMER SCHOOL
KVC strongly encourages foster parents to utilize free summer activities. In some areas
local scholarships are available for children and youth in foster care. Contact the KVC
FSC to obtain information about scholarship programs. Foster parents who qualify for
KVC day care due to both parents working full time (35 hours or more per week) may
discuss with their FSC the possibility of exchanging day care for a summer camp
program. Foster parents must continue to work full time and the cost for the summer
camp program must not exceed the day care rates paid by KVC.
DRIVER’S EDUCATION
Youth must have approval from his/her birth parent(s) and /or guardian or case manager
to participate in driver’s education.
DRIVING AND RIDING WITH OTHER YOUTH
Before a child in foster care may drive permission must be obtained from the child’s
parent or legal guardian. Permission to drive must be included in the child’s case plan,
and the child must have a valid driver’s license and insurance.
Any child in foster care who attends middle school or junior high school may be
transported to and from school without an accompanying adult by a driver between the
ages of 16 and 18 if certain conditions are met. The driver must reside in the foster home.
The driver must have a valid license and insurance, and the parent or legal guardian of
the child in foster care and the child’s child placing agent give written approval.
Any child in foster care who attends high school may be transported to school, work, or
social activities without an accompanying adult by a driver between the ages of 16 and 18
if certain conditions are met. The driver must have a valid driver’s license and insurance.
The parent or legal guardian of the child in foster care and the child’s child placing agent
give written approval. If transportation is to work or social activities, not more than one
passenger is in the vehicle.
Permission forms for driving are available in the appendix of this manual.
LEGAL FEES
Child in Need of Care (CINC) fees are the responsibility of the child’s or youth’s birth
parent. A child or youth may be held responsible for legal fees accrued by criminal
and/or juvenile offender charges.
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BEDS
Foster parents must provide beds for the capacity for which they are licensed. Foster
parents must have a separate bed for each child or youth regardless of sex or relationship.
KDHE does not allow futons, trundle beds, rollaway beds or hide-a-beds for children and
youth in foster care. Bunk beds are to be used only for children over the age of 7. The
top bunk must have a guard rail. Waterbeds are only permitted with approval for older
children.
CHURCH ATTENDANCE
It is the right of the birth parents to determine their child’s or youth’s religion and to
request that their child or youth be placed in a foster home of the same religious faith. If
it is not possible to place the child or youth in a home of the same faith, it is the
responsibility of the foster parent to see that the child or youth attends services and
appropriate programs, in accordance with the mandates of his/her religious faith.
DATING
When a youth is placed in a foster family home, the foster parents should establish
guidelines concerning dating privileges, curfew, and other “house” rules. The birth
parents or legal guardian, DCF social worker, referring agency, FSC and foster parents
should document the guidelines so they are clear to all persons involved with the youth. It
is recommended that a youth’s case plan reflect his/her ability to date.
EMPLOYMENT
A teenager should be encouraged to work outside the home. Employment allows the
youth a greater opportunity to become self-sufficient and it also encourages a higher
sense of self-worth, helping the youth grow toward maturity and independence.
A youth in foster care is permitted to save up to $1,000 of his/her money for “future
identifiable needs.” A portion of his/her earnings may be used for day-to-day expenses.
FIELD TRIPS, ACTIVITIES, SPORTS PARTICIPATION
The FSC should notify the referring agency if a child or youth in care wishes to
participate in school, church, or community events, such as field trips. Prior approval
should be obtained from the birth parents or from the child’s or youth’s DCF social
worker.
HIGH RISK SPORT OR RECREATIONAL ACTIVITY
Foster parents may permit children in foster care to engage in certain high-risk sport or
recreational activities if certain conditions are met. The child’s parent, legal guardian, or
legal custodian and child’s child placing agent must provide written permission for the
child to participate in the specific activity. The foster parent should assess child specific
risk factors before giving permission. These include but are not limited to the child’s age
and maturity level, impulsive behaviors, or developmental delays. If required for the
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activity, protective safety gear must be used. Safety plans following general safety
guidelines and manufacturer’s recommendations should be developed. Adult supervision
must be provided. Permissions forms for high risk activities can be located in the
appendix of this manual.
SWIMMING
The KDHE licensing regulations require that a certified lifeguard be on duty wherever a
child or youth is taken to swim. If a lifeguard is not present, an adult with First Aid and
CPR training who can swim must be present and the location must be approved for
swimming by the county Health Department or KDHE. Refer to KDHE regulations for
requirements regarding home swimming pools. A child under the age of 6 is not allowed
to swim in ponds or lakes according to KDHE regulations.
HAIRCUTS
Routine “trimming” of original hairstyles is appropriate, but anything drastic (e.g. use of
chemicals for coloring or perms or other, very long hair cut short, Mohawks, etc.)
requires permission from the birth family, which will be requested by the FSC through
the child’s case manager.
OVERNIGHTS WITH FRIENDS
When a child or youth is placed in a foster home, the foster parents should establish
guidelines concerning overnights with friends, curfew, and other “house” rules. The birth
parents or legal guardian, DCF social worker, FSC, referring agency and foster parents
should document the guidelines so they are clear to all persons involved with the child or
youth. The Case Plan should also reflect this. In the case of overnights with friends, the
foster family must confer with the FSC about who will be supervising the child or youth
during the overnight stay and provide background information on the overnight host.
KDHE regulations require that any person transporting a child or youth in foster care be
at least 18 years of age, have a valid driver’s license and proof of insurance. Any
exception must be obtained through KDHE.
VACATION
You are encouraged to take the child and youth in care with you on family vacations.
You must contact the FSC and the referring agency to obtain prior approval to take the
child or youth with you if you will be traveling out of state. A written authorization will
be sent to you. Always remember to take the child’s or youth’s medical consent form,
medical card and any medication the child is currently taking.
LEAVING CHILD OR YOUTH UNATTENDED, SELF-CARE
PLANS
Any child in foster care at least twelve years of age may be permitted to stay at home
without adult supervision for certain periods of time between the hours of six a.m. and
midnight if certain requirements and conditions are met. The potential for self-care must
be identified and approval must be written into the child’s case plan. When developing
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the self-care plan, each child’s specific risk factors must be included. These should
include age, maturity level, behavioral and emotional needs, impulsive or thrill seeking
behaviors, self-harm behaviors, and developmental delays. In addition, the foster home
environment, including number of other children in the home and neighborhood safety
issues should be considered. Minimum age requirements and maximum timeframes apply
to self-care plans. Refer to KDHE regulations for specific details. Self-care plans and
forms are available in the appendix of this manual.
VISITATION
The referring agency must arrange all visitations between the child or youth and his/her
birth family. There are no exceptions to this policy. If a problem arises after visitation,
notify the FSC or referring agency as soon as possible. The foster parent should not be
expected to comply with a visit not pre-approved by the referring agency.
INFORMAL VISITATION
Foster parents may identify extended family members ages 18 or older as resources for
informal visitation. For extended family members identified as resources foster parents
should work with their Family Service Coordinator to meet certain requirements as part
of the informal visitation plan. The relationship of the individual to the foster home must
be documented. Background checks must be completed and copies of current driver’s
licenses need to be obtained. Foster parents must document that individuals identified for
informal visitation have read and agree to the discipline and confidentiality policies of the
child placing agency. The foster parent needs to ensure that the individuals have access to
emergency contact numbers and that a crisis plan has been developed in case of an
emergency.
KVC must approve all informal visitation plans and have knowledge of dates on which
informal visitation will occur and the identified extended family member’s name and
address.
Templates for Informal Visitation are available in the appendix of this manual.
COMMON SENSE
Think in terms of conservative common sense decisions you would make for your own
child and then take an additional conservative step backwards when making decisions for
someone else’s child.
OUTDOOR SAFETY PLAN
A foster home must develop and maintain a written outdoor safety plan before a child in
foster care can be outdoors in an unfenced area of the family foster home. The plan
should be developed with and approved by the Family Service Coordinator. See the
appendix following this manual for an outline of an Outdoor Safety Plan.
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SAFETY PLAN
If a safety plan is necessary for a child and or foster family’s well being and safety, the
FSC will follow up with the foster parents on a regular basis to ensure the plan is being
followed. In most instances the child’s case manager FSC will complete a safety plan
with the child and foster family and will provide a copy for the FSC CM. However,
there will be some occasions in which the FSC CM must complete a safety plan with the
child and foster parent.
PLACEMENT HOLD REQUEST
There are times when a youth leaves a foster home for a few days for reasons of AWOL,
Medical Hospitalization, Psychiatric Hospitalization and Law Enforcement Intervention.
Agencies that KVC Behavioral Healthcare, Inc. contracts with have different
requirements as to whether the agency will hold a bed for payment. The foster parent
should notify the FSC whether they would like the child returned to their care in the event
the child leaves the home. The FSC should then contact the child’s case manager and
advise of the foster parent’s request. If the foster parent would like the child to return to
their home then the FSC should obtain written authorization from the child’s agency
indicating the request to hold the foster bed open and the number of days and daily rate in
which the agency will pay to hold the bed.
FOSTER PARENT LICENSING AND ONGOING ASSESSMENT
KDHE Regulations effective March 28, 2008 can be located by referring to this
website:
http://www.kdheks.gov/bcclr/regs.html
A blanket exception to these regulations was issued 09/08/10. This can be accessed
by clicking on:
http://www.kdheks.gov/bcclr/foster_care.html
KDHE Forms can be located by referring to this website:
http://www.kdheks.gov/bcclr/forms.html
The revised Family Foster Home Guidance Handbook can be located by referring to
this website, listed under “Guidance Material”:
http://www.kdheks.gov/bcclr/foster_care.html.
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After completing the required training to become a licensed foster parent, the foster parents
must complete the licensing process. KVC works with the Kansas Department of Health and
Environment (KDHE) to license each foster family home. The KVC Family Service
Coordinator is responsible for working with the foster family to complete the initial licensing
process. Once a license application has been received and processed by the state, KDHE will
complete a walk through of the foster home before issuing a license that will allow the family
to provide foster care. The foster family license must be renewed yearly. The licensing
process includes the completion of the following documents:
•
•
•
•
•
•
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License Application- The application includes information regarding the foster parent’s
intent, legal name, address and phone number, employment, training and references.
Request for criminal background checks for all adults living in the home- Each adult’s
information will be checked by the Kansas Bureau of Investigation and the Kansas Child
Abuse and Neglect Information System, a registry of all individuals in Kansas who have
been substantiated for child abuse or neglect.
Finger Print results from KBI and the FBI (only for initial licensing).
Recommendations for Use/Continued Recommendations for Use- This document allows
the family and the Family Service Coordinator to review together what types of
children’s behaviors and conditions the family is willing to consider. This document also
allows the Family Service Coordinator to make recommendations regarding the number
of children, age range, and gender of children appropriate for placement in the home.
Foster Home Floor Plan- The floor plan reflects the dimensions of each room and
window as well as exit locations.
License and Approved Family Foster Home Survey- The survey is completed by the
Family Service Coordinator. The survey verifies that the family meets state regulations in
regard to but not limited to :
o Birth Parent Access
o Background Checks
o Health of Persons in the Home
o Safety and Emergency Plans
o Swimming and Wading Activities
o Transportation
o Pets in the Home
o Child Care Practices
o The Safety of the Structure and Home Environment
o Health Care and Illness Policies
o Policies Regarding the Reporting of Child Abuse
• Signed agreements with the family regarding discipline, confidentiality, and agency
requirements.
• Sample Menu
• Verification of Vehicle Insurance and Vehicle Safety
• Health Assessments
• Foster Family References
In addition to the state required licensing documents, KVC gathers additional information
to assist in matching the family with a child. This information includes family support
systems, hobbies, strengths and interests. KVC completes a written Family Assessment.
This assessment evaluates the family’s strengths and needs, attitudes, and capabilities.
The licensing process occurs annually. KVC completes ongoing assessment during each
interaction with the foster parent.
FOSTER FAMILY MOVES
Foster families must notify their Family Service Coordinator prior to moving to a new
location. The FSC will complete a walk-through of the new home to determine any
possible problems with licensure. A new license packet must be completed and
submitted to KDHE. Only children currently placed in the home may move into the new
location with the family. The family is placed on inactive status when they occupy the
new home until such time as a new temporary permit for that facility is received from
KDHE. During the inactive period, no new placements can occur.
FOSTER PARENT CONCERNS/INVESTIGATIONS
ADMISSIONS RESPONSIBILITIES AND PROCEDURES
FOR MOVING CHILDREN DURING THE
INVESTIGATION OF A KVC FOSTER HOME
The KVC Admissions Department must be directed by KVC child placing staff or the
direct Supervisor/Director or Division President of those positions) to begin the process
of removing any child from a KVC foster home due to an allegation or investigation of
abuse and/or neglect.
1. The FSC will contact Admissions when a foster home is being investigated and the
children must be moved. The FSC will then contact the case manager to submit a PCF
for the children in the home. If the child in the home is a non-contract child, then the
FSC needs to contact Admissions and the case manager for the child. The case manager
will be responsible for moving the child. The FSC is responsible for informing the foster
family that the children are being removed. The case managers are responsible for
sending the appropriate placement communication form to Admissions to request a new
placement for the child/youth.
2. If Admissions receives a telephone call or a PCF from a case manager requesting removal
of a child from a KVC foster home due to an allegation, Admissions staff should request
that the appropriate FSC be contacted. If Admissions staff do not receive a call from the
FSC within one hour regarding the specific foster home, Admissions will page the FSC’s
Supervisor.
3. For children being served under the contract, KVC Admissions is responsible for locating
a new foster home for children that are being removed. The case manager is responsible
61
to arrange transportation. The case manager is responsible for letting the foster home
know when/what time the child will be leaving. The case manager is responsible for
informing the child that he/she is leaving. For children served by other Contractors that
are placed in a KVC foster home, the FSC for that home will work with the contracting
agency staff to facilitate the move of the child.
4. Should the foster home contact Admissions regarding the investigation or allegations
being made, refer the telephone call to the appropriate FSC for that foster home. If the
foster home calls regarding the child’s pickup time or circumstances around their actual
departure, refer the call to the case manager or the FSC and provide the emergency pager
information for the CPA in the foster family’s area. Under no circumstances is
Admissions staff to provide the foster family with information regarding the
investigation.
PROTOCOL TO ADDRESS CONCERNS REGARDING A KVC
FOSTER FAMILY
If a KVC Foster Family is hot lined due to allegations of sexual abuse:
1. Notify Director of CPA.
2. Complete critical incident form through KVC portal and it will then be forwarded to the
Director.
3. KVC may recommend children in care be moved or placed in respite until allegations are
cleared.
4. The FSC will place the family on hold for further placements until the investigation
and/or any subsequent development plans are completed.
If a KVC Foster Family is hot lined due to allegations of physical abuse:
1. Notify Director of CPA.
2. Complete critical incident form through KVC portal and it will then be forwarded to the
Director.
3. The team will determine if placement is to be changed.
4. The FSC should place the family on hold for future placements until the investigation is
completed and/or any subsequent development plans are completed.
If a KVC Foster Family is hot lined due to other allegations:
1. Notify Director of CPA.
2. Complete critical incident form through KVC portal and it will then be forwarded to the
Director.
3. The team will determine if placement is to be changed. Notify Director of CPA of
outcome.
4. The FSC will place the family on hold for future placements until the investigation and/or
subsequent development plans are completed should it be determined necessary as staffed
between the FSC and Supervisor and/or Director.
62
FOSTER FAMILY DEVELOPMENT PLAN
•
•
•
KVC foster families will be asked to complete a Foster Family Development Plan when a
family fails to meet:
KVC requirements set forth in the Foster Family Provider Requirements,
Policies and guidelines outlined in the Foster Family Policy and Procedure Manual,
KDHE licensing requirements for family foster homes.
A Foster Family Development Plan may also be put in place when DCF and/or KDHE
findings from investigations have been received concerning the family or for other issues
identified by the FSC.
The KVC Foster Family Development Plan form will be used to document the plan. The
FSC will be responsible for working with the family to document progress toward
meeting the goals and steps outlined in the plan.
The original plan and subsequent progress notes will be filed in the family’s central file.
KVC may withdraw sponsorship for families failing to meet the goals and steps outlined
by the due date.
A template of a Foster Family Development Plan is available in the Appendix of this
manual.
KVC POLICY FOR CLOSING A FOSTER HOME OR
WITHDRAWING AGENCY SPONSORSHIP
According to Kansas Department of Health and Environment (KDHE) regulations, a
foster family “may terminate the license by notifying KDHE if the licensee no longer
wishes to maintain a family foster home.” KVC can also choose to withdraw agency
sponsorship of a foster family’s license at any time. Generally this occurs when a family
fails to meet the KVC requirements set out in the Foster Family Provider Requirements
or the policies and guidelines outlined in the Foster Family Policy and Procedure Manual.
(this information is already located on page 21 )
FOSTER FAMILY EXIT INTERVIEW
When a KVC foster family decides to transfer to another Child Placing Agency or
decides not to continue providing foster care, KVC will conduct an exit interview with
the foster family. The Administrative Assistance/Quality Assurance Specialist (QAS)
will conduct the exit interview on the KVC Foster Family Exit Interview form. The form
will be used to improve retention by identifying concerns and suggestions to avoid future
closures. It will also identify areas of need for the agency to improve relationships with
foster parents. (This information is already on page 21)
63
LIFEBOOKS
Each child placed in DCF custody in out of home placement should have a life book.
The lifebook should travel with the child from one placement to the next. The foster
family should encourage the youth to work on their life book or if the child refuses, is too
young or unable, the foster parent should provide information to the life book on a
monthly basis. Items the family can provide are pictures, school awards and mementos,
etc.
LIFEBOOK
A Lifebook is a record of the life of a child who is in out of home placement. A Lifebook
is a tool and a process to help the child better understand his or her past life experiences,
examine the present and explore the future. It incorporates a collection of physical and
social histories that most children normally would receive from their family of origin and
otherwise would be lost as the child moves through the foster care system. A Lifebook
can increase the child’s understanding of events of the past, provide chronological
continuity, and serve as a vehicle for the child to share his/her past experiences with
others.
The Lifebook should be started when a child enters out of home care and follows them
through to adoption. While the KVC Case Manager is responsible to ensure the Lifebook
is initiated and updated during the entire episode of out of home placement, the birth
parents, foster families, child and social worker should facilitate it together. Each person
brings important information to add to the child's Lifebook. It is essential that the child
participate in the development and maintenance of their own Lifebook. The book
belongs to the child, and they determine with whom this book is shared. Each child's
Lifebook is an original and information from the original format can be added and taken
away, as it is appropriate.
Following are the instructions that explain each section of the Life Book. Blank Life
Books are available and should be in the child's red book.
LIFEBOOK INSTRUCTIONS
Importance of a Lifebook
A Lifebook is a tool and a process to assist youth in understanding their past experiences
and developing a connection with their future. By creating a Lifebook, young people can
identify tangible links from their past to help form a continuity within their lives. A
Lifebook can also provide a record of the youth’s growth and development in order for
the youth to build a better self-image. Assisting youth to understand what has happened
and looking at separations and losses encountered enables youth to share feelings. It is
important to acknowledge and discuss these feelings during the Lifebook process.
64
This format was developed for social workers, youth, foster parents, and biological
parents to use as a guide when completing Lifebooks for youth in foster care. The youth
will need to actively participate in the making of the Lifebook. The amount and time of
participation will vary greatly depending upon the age and/or developmental capabilities
of each child. Portions of the Lifebook may need to be edited by the adults to keep
information factual (e.g. family tree, firsts). The Lifebook is just a tool to be utilized in
connecting youth with their past and their future.
Gathering Lifebook Information
The ideal time to begin a Lifebook is when a youth enters out of home placement.
Information for a Lifebook may be collected by:
Reviewing case records;
Interviewing biological parents, grandparents, relatives, teachers, CASA
volunteers, etc.;
Gathering and reviewing reports from mental health facilities, hospitals, doctor
offices, schools, churches, police departments, and the court; and
Reviewing newspapers for birth announcements, marriage announcements, court
actions (divorces), and obituaries.
Once a Lifebook has been started, keeping it current and up-to-date will require
cooperation among the youth, the foster care provider, and the social worker. It is
important that all these people be involved in the Lifebook process. Including the
biological parents as much as possible is also important. The Lifebook should be
reviewed and updated during Case Planning Conference, at a minimum.
Part of the above information was adapted from Lifebook Format. Prepared by the State
of Kansas Department for Children and Families, Topeka, KS, 1985, Published by the
Kansas Department for Children and Families.
LIFEBOOK: CONSTRUCTION
The pages of the Lifebook have been designed so that the order of pages may be changed,
pages may be inserted where appropriate, and/or deleted entirely. Creativity needs to be
used when working on the Lifebook. Remember, each book is an original.
The following are suggestions as to what may need to be addressed in relation to specific
pages included in the Lifebook. Remember, this is just a guide. Each youth will have
different experiences to discuss and include in the Lifebook.
Feelings: This page is provided to aid the youth, worker, and foster care providers in
discussing feelings when preparing a Lifebook. A list of “feeling” words is provided.
Many of these feelings, and others not listed, will be shared by youth in completion of
65
their Lifebooks. Adults need to allow the youth ample time to explore and discuss these
feelings during the preparation process.
My Birth: This page should include the youth’s birthday, birth weight, birth length, and
any other circumstances known about the youth’s birth. Also important to list here are
the youth’s doctor, hospital, and place of birth. This is an appropriate place for a copy of
the youth’s birth certificate or other hospital records, such as footprints. Space is allowed
on the page for baby photos, drawings, or a picture of the hospital. Biological parents, if
available, are valuable resources for obtaining the information for this page.
My Birth Parents: This page is to provide the youth with information about the youth’s
birth parents. Youth can write about their birth parents and what they remember about
being with them. Adults may wish to help by sharing facts about the parents such as
ages, birthplaces, physical descriptions, or occupations. Information about the birth
parents’ personalities, interests, and hobbies may also be added. Oftentimes, youth enjoy
knowing where the parents grew up, what their parents’ childhoods were like, and how
they met one another. Facts about grandparents may also be shared. Special memories
youth have about being with their parents can be included. If birth parents are available,
this page can be completed by the youth and parents.
My Brothers and Sisters: This page is for pictures or drawings of birth siblings.
Memories of siblings can also be written down. Discussing continued contact between
the youth and siblings is appropriate if the children are placed separately.
My Own Story: On this page the youth may write the story about the youth’s life. The
youth may use this page to write about anything important in the youth’s life, such as
what is remembered as a youth, child, memories of the birth family and other relatives,
and feelings about being placed in foster care. The youth may use these pages to write
about anything important to the youth.
My Family Tree: Adults should help the youth develop a family tree on this page. Be
sure to include stepparents, stepsiblings, extended family members, and friends or
guardians. A list of where family members are now and any information known about
each person may also be appropriate.
My Firsts: This page is to record developmental milestones. Adults will need to help the
youth complete this section from information gathered for social history purposes.
Including birth parents, grandparents, and/or other relatives in the development of this
page is important.
My Foster Family: These pages are for information about the youth’s foster home
placement(s). The foster families and the worker can assist the youth with the specific
information such as dates of placement, foster parents’ and foster siblings’ names. The
youth may also want to write about special memories of each placement (important
events, traditions, special activities), how the youth feels about the placement (likes and
dislikes), and how the youth feels about leaving the placement. The foster family and/or
66
worker may want to discuss with the youth how the youth was or was not prepared for
each move and how the youth reacted to the move(s).
Other Places I Have Lived: This page is to write about other placements the youth may
have had while at home or while in foster care. Examples may be with grandparents,
relatives, or friends of the family. This page can also be used for recording placements
other than foster homes, such as group homes, shelters, etc. This page is to help organize
these past experiences and record memories of these placements.
Where I Have Lived: This page is to mark where the youth has lived within Kansas.
The youth may wish to use stickers to mark the map or to number the locations indicated
to help establish their order of sequence. Allow the youth to be creative.
Schools I Have Attended: This page is for listing schools attended by the youth. Be sure
and include the schools’ addresses and the grade level attended by the youth at each
school. The youth may wish to list teachers’ names or other school information in this
section.
School Memories: This page is for the youth to write about the youth’s favorite teachers
and favorite subjects. The youth may wish to include school friends, special
achievements in school, and educational plans or goals.
People Who Are Important To Me: This page is for the youth to keep a list of names,
addresses, telephone numbers, and e-mail addresses of important people in the youth’s
life.
Look How I Have Grown: This page is a chart to record growth of a youth from infancy
into adulthood. This information may be easiest to obtain on younger children, but can
be rewarding and fun for an older youth. Special accomplishments the youth may wish to
include are learning to walk, to ride a bike, or to drive a car.
Medial Records: This page is to record important medical information such as birth
information, genetic information, immunization records, childhood illnesses,
developmental milestones, serious illnesses, operations and dates of hospitalizations, a
list of doctors, dentists, and other professionals who have provided services to the youth,
dates of the youths health screenings, and a physical description of the youth (age,
weight, height, eye and hair color, and identifying marks). Depending on the age of the
youth, the worker may wish to keep these records separate from the Lifebook.
Special Events: This page is for memories of vacations, school trips, souvenirs, birthday
cards, holiday cards, etc.
My Hobbies: This page is to write about the youth’s hobbies and interests. A lines page
can follow to allow space for the youth to share about the youth’s hobbies.
67
My Dreams: This page is provided to help discuss the future with a youth. The youth
may write about dreams the youth has in regard to education, career, or plans for
marriage and a family. This page may also be used when a youth is being adopted to
discuss the youth’s expectations of the youth’s new adoptive family and what type of
family the youth wishes for. Remember, each child is unique – let the youth decide
what the youth wants to put in the Lifebook.
Blank and Lines Page: These pages are provided to allow additional space for
completing any section in the Lifebook. They can also be used to develop new sections
the youth or worker may wish to include.
Preparing for Adulthood: This page is to be used for older youth. Information the
youth will need to retain for future use is the youth’s work history or resume (a list of
employers by name, address, telephone number, and dates of employment).
Picture Pages: Plastic pages for pictures are included for the youth to place any pictures
she/he wishes.
My Adoptive Family: This page should be added to the Lifebook when a youth has a
new adoptive family. The worker may wish to work on this section with the youth when
discussing information about the adoptive family prior to placement. This page can also
be completed by the youth and the adoptive family after placement. These pages should
include information on all members of the adoptive family. The youth can also write
about common interests the youth may share with the family and also some of the
differences.
Remember, the Lifebook belongs to the youth and is his/her book to record past,
present, and future life experiences. Adults should assist the youth in completing the
Lifebook, however; caution must be taken to allow the youth to share his/her
memories, dreams, hopes, feelings, and expectations.
EACH YOUTH IS UNIQUE
EACH LIFEBOOK IS A REFLECTION OF THAT YOUTH
Confidentiality of the Lifebook:
This Lifebook is the property of the youth named within. Confidential information has
been provided and recorded to help the youth better understand his/her past experiences,
examine his/her present circumstances, and to explore the future. This Lifebook and the
information enclosed are confidential and not for public disclosure.
68
LIFE SKILLS
During childhood, every child gradually moves toward self sufficiency. Children in care
need support and guidance in order to develop and enhance a range of life skills. These
skills are not unique to children in foster care, but are the tasks and developmental stages
faced by children in general. Skills training services shall be made available to all eligible
youth that are ages four and older referred to KVC. This type of training is preparation
for leaving foster care and should begin the child’s first day of care. The child’s support
system and placement play a key role in helping a child develop and enhance their daily
life skills. It is the responsibility of those involved in a child’s life to work with that child
to better prepare them for making the transition to self sufficiency by focusing their
efforts on achieving the outcomes that are known to lead to a greater success for these
youth. Foster families are expected to support and integrate life skills services into daily
living activities with youth. Youth shall be given opportunities to learn these life skills
through daily living activities practiced in their placements. KVC case managers will
provide direction as to life skills training through the Ansell Casey life skills assessment.
KVC case managers and family service coordinators shall work with and ensure that
foster homes integrate life skills services into daily living activities with youth. These
activities will be specifically documented for the child’s file. Family service coordinators
will work with case managers and foster parents to ensure that youth are provided
resources and training in the competencies identified in the following age appropriate life
skill domains:
Career Planning
Communication
Daily Living
Home Life
Housing & Money Management
Self Care
Social Relationships
Work Life
Work & Study Skills
69
ADOPTION SERVICES
KVC’s Child Placing Department is responsible for completing adoption home studies
for our licensed foster homes who wish to pursue adoption of KVC kids. The Family
Service Coordinator should advocate for foster families and support them throughout the
adoption process. The Child Placing Department is also responsible for, with the foster
parents’ permission, making the family’s home study available on the statewide adoption
exchange. The adoption home study template is available in the appendix of this manual.
The KVC Family Service Coordinator can assist families who wish to adopt by helping
them navigate through KVC’s adoption website. The FSC is also responsible for
submitting a family’s home study for consideration for Best Interest Staffings.
Foster families wishing to pursue adoption through KVC must complete an Adoption
Application Packet.
In most instances, the KVC FSC may complete an adoption home study for KVC foster
parents wishing to adopt children whose case is managed by another agency. In these
instances KVC must receive a referral and contractual agreement from the child’s agency
to move forward with home study completion.
70
APPENDIX
FOSTER FAMILY DEVELOPMENT PLAN ............................................................................... 72
FOSTER PARENT REPORT TO THE COURT ........................................................................... 74
MONTHLY RECORD FOR TORNADO AND FIRE DRILLS .................................................... 76
FOSTER PARENT MONTHLY REPORT .................................................................................... 77
INFORMAL VISITATION PLAN RESOURCE INFORMATION .............................................. 79
INFORMAL VISITATION PLAN................................................................................................. 80
DECLARATION OF NO PROHIBITIVE OFFENSES FOR KDHE LICENSURE..................... 81
KVC BEHAVIORAL HEALTHCARE POLICY STATEMENT ON DISCIPLINE .................... 83
KVC CONFIDENTIALITY OR NON-DISCLOSURE POLICY ................................................. 84
FOSTER FAMILY PROVIDER REQUIREMENTS .................................................................... 85
HIGH RISK SPORT OR RECREATIONAL ACTIVITY PERMISSION FORM ........................ 88
OUTDOOR SAFETY PLAN ......................................................................................................... 90
SAFETY PLAN .............................................................................................................................. 91
FIRST AID INSPECTION FORM ................................................................................................. 93
FOSTER PARENT SATISFACTION SURVEY ........................................................................... 94
FOSTER PARENT MEDICATION LOGS ................................................................................... 95
DETERMINING SEXUALLY APPROPRIATE VERSUS INAPPROPRIATE BEHAVIORS
DISPLAYED BY YOUNG CHILDREN ....................................................................................... 98
SEXUAL BOUNDARIES SAFETY CHECKLIST ..................................................................... 103
SEXUAL BOUNDARIES SAFETY PLAN ................................................................................ 107
VERIFICATION OF EMPLOYMENT FOR DAYCARE ELIGIBILIT ..................................... 109
APPLICATION FOR DAYCARE, DAYCARE SCHEDULE .................................................... 110
APPLICATION FOR DAYCARE ............................................................................................... 111
FOSTER PARENT MILEAGE REPORT .................................................................................... 112
SELF CARE PLAN ...................................................................................................................... 113
AUTHORIZATION FOR DIRECT DEPOSIT ............................................................................ 115
FOSTER PARENT COMPLIMENT/CONCERN FORM ........................................................... 116
QUESTIONS FOR FOSTER PARENTS TO ASK PRIOR TO PLACEMENT OF A CHILD .. 118
FOSTER PARENT CRITICAL INCIDENT FORM ................................................................... 120
71
Foster Family Development Plan
Foster Family Name: _______________________________________________________________
Family Service Coordinator: ___________________________________________________________________
Date Completed: _______________________________________________________________________________
Narrative Regarding Issue to be Addressed:
Development Plan – Goals:
Begin Date: _____________________________
Due Date:_______________________________
Steps to be Completed:
72
Possible Rewards/Consequences of Completing or not Completing the Plan:
Foster Parent(s) Signature:
______________________________________________________________________________
______________________________________________________________________________
KVC Staff Signature:
______________________________________________________________________________
Today’s Date: _________________________________________________________________
73
State of Kansas
Department of Social & Rehabilitation Services
Children and Family Services
Appendix 6B
Jan 2007
Page 1 of 2
FOSTER PARENT REPORT TO THE COURT
Re:
To: Foster Parents
KSA 38-2261 reads as follows:
“The secretary shall notify the foster parent or parents that the foster parent or parents have a
right to submit a report for each court hearing. Copies of the report shall be available to the
parties and interested parties. The report made by foster parents shall be on a form created and
provided by the department for children and families.”
As DCF contracts with private licensed child placing agencies to provide services to children and their
families when the children are have been placed by the court in the custody of DCF for out of home
placement, the duty to notify the foster parents and parents is conferred to these agencies.
A sample report is being provided which is to be used if you are making a report to the court.
The following is the name of the Judge and the address of the court to which the report may be sent. If the
name of the Judge or address changes, we will provide notice to you. You will be notified in advance of the
hearing dates.
Name of Judge: ______________________________
Address of Court: ____________________________
We hope you will take advantage of this opportunity to communicate your thoughts with the court.
Sincerely yours,
Appendix 6B
Revised Jan. 2007
74
Page 2 of 2
REPORT TO COURT FROM FOSTER PARENTS
Child’s Name:
Current Address:
Foster Parent Name(s):
Date of Report:
Child’s Case Manager:
Please circle the word which best describes the child’s progress
1.
Child’s adjustment in the home
excellent
good
satisfactory
needs improvement
2.
Child’s interaction with foster parents and family members
excellent
good
satisfactory
needs improvement
3.
Child’s interaction with others
excellent
good
satisfactory
needs improvement
Child’s respect for property
excellent
good
satisfactory
needs improvement
Physical condition of the child
excellent
good
satisfactory
needs improvement
Emotional condition of the child
excellent
good
satisfactory
needs improvement
4.
5.
6.
7.
School status of child:
____________________________
School
Grades:
Attendance:
Behavior:
Good
Good
Good
_______________________
Grade
Fair
Fair
Fair
Poor
Poor
Poor
If interaction with parents has occurred, describe the frequency of interactions, with whom,
supervised or unsupervised, and any significant events which have occurred.
Your opinion regarding the overall adjustment, progress, and condition of the child:
Do you have any special concerns or comments with regard to the child not
addressed by this form? Please specify.
75
KVC Behavioral HealthCare, Inc.
Monthly Record
Fire Drill, Tornado Drill and Smoke Detector
Jan
Feb
Monthly Test – Smoke Detector
March April May June July
Aug
Sept
Oct
Nov
Dec
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Smoke Detector Battery Test Completed on ________________
Jan
Feb
March April
Monthly Test – Fire Drill*
May June July
Aug
Sept
Oct
Nov
Dec
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Time:
Jan
NA
Feb
NA
Monthly Test – Tornado Drill*
March April May June July
Aug
NA
Date:
Date:
Date:
Date:
Date:
Time:
Time:
Time:
Time:
Time:
Time:
*All drill schedules need to be rotated with dates and times recorded.
76
Sept
Date:
Oct
Nov
Dec
NA
NA
NA
FOSTER PARENT MONTHLY REPORT
This can be used to prepare for your FSC’s home visit
Child: _________________________
Family Living: (How is the child interacting with the family and others who may
live in the home?)
School: (How is the child interacting with peers at school and at extracurricular
school activities?)
Grades:
Community: (What is the child’s involvement in community activities and how is
he/she behaving during these activities?)
77
Medical Information: (List any doctors or dentist appointments by date and any
tests with the results.)
Current Medication, including dosage:
Life Skills/Interdependent Living Skills: (List the activities used to help prepare
him/her for living in the community independently.)
Home Visits: (List any dates and any other information that is pertinent to a home
visit including .)
Areas of Growth: (List areas the child has improved in or mastered in the past
month.)
Areas of Need: (List specific needs the child is working on at present or needs to
work on.)
78
Informal Visitation Plan Family Information
Foster Family Name: ___________________________________________
Address: _____________________________________________
Identified Family Resource: _____________________________________
Relationship to Licensee(s):______________________________
Resource Address and Phone Number: ____________________________________________ DOB: ___________________________________
Request for Background Check submitted as specified in K.A.R. 28-4-805.
Copy of Driver’s License attached.
Copy of signed Discipline Policy and signed Confidentiality Policy attached.
Copy of Kansas Laws and Regulations for Licensing Family Foster Homes for Children given to Identified Family Resource.
Identified Resource approved by Family Service Coordinator.
FSC: _________________________________________________
79
Informal Visitation Plan
Identified Resource: _________________________________ Date of Visitation: _________________________
Emergency Contact Numbers:
Foster Parent Emergency Contact Information: _____________________________________________________
Family Service Coordinator: _________________________ Emergency Contact Number: __________________
Child in Placement
Case Manager Name
Phone Number
Emergency Number
In case of emergency, contact foster parent and KVC Family Service Coordinator.
In case of immediate emergency, call 911.
Poison Control: 1-800-222-1222
Physician Name and Phone Number: ________________________________________________________________
Nearest Hospital Name, Address, Phone Number: ______________________________________________________
80
Medical
Consent/Health
Assessment
Received (Y/N)
State of Kansas
Department of Social & Rehabilitation Services
Children and Family Services
Declaration of No Prohibitive
Offenses for KDHE Licensure
Appendix 5F
Rev. July 05
Page 1 of 2
By signing this document, I declare, to the best of my knowledge, a check of the KBI criminal
History database will reveal I have not been convicted of any of the listed crimes, or the
Conviction for any of these offenses has been expunged. These offenses would prohibit me
From residing in or working in a home that is licensed by KDHE as a family foster home. This
Applies to juvenile as well as adult offenses.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
21-3301
21-3401
21-3402
21-3403
21-3404
21-3405
21-3406
21-3407
21-3408
21-3409
21-3410
21-3411
21-3412
21-3413
21-3414
21-3415
21-3416
21-3417
21-3418
21-3419
21-3419a
21-3420
21-3421
21-3422
21-3422
21-3423
21-3424
21-3425
21-3460
21-3427
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
K.S.A.
21-3428
21-3430
21-3434
21-3435
21-3437
21-3438
21-3439
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Attempt of any act of K.S.S. 21-3401 – K.S.A. 21-3612
Murder in the First Degree
Murder in the Second Degree
Voluntary Manslaughter
Involuntary Manslaughter
Vehicular Homicide
Assisting Suicide
Assault
Assault of a Law Enforcement Officer
Aggravated Assault
Aggravated Assault of a Law Enforcement Officer
Battery
Battery against a Law Enforcement Officer
Aggravated Battery
Aggravated Battery against a Law Enforcement Officer
Unlawful Interference with a Firefighter
Permitting Dangerous Animal to be at Large
Criminal Threat
Aggravated Criminal Threat
Kidnapping
Aggravated Kidnapping
Interference with Parental Custody
Aggravated Interference with parental Custody
Interference with Custody of a Committed Person
Criminal Restraint
Mistreatment of a Confined Person
Robbery
Aggravated Robbery
Blackmail
Income Tax Returns; Disclosure of Use for Commercial Purposes
Information Obtained in Preparing
Promoting or Permitting Hazing
Exposing Another to a Life Threatening Communicable Disease
Mistreatment of a Dependent Adult
Capital Murder
Mistreatment of a Dependent Adult
Stalking
Capital Murder
State of Kansas
Department of Social & Rehabilitation Services
Children and Family Services
Declaration of No Prohibitive
Offenses for KDHE Licensure
Appendix 5F
Rev. July 05
Page 2 of 2
K.S.A. 21-3440
K.S.A. 21-3441
K.S.A. 21-3442
Injury to a Pregnant Woman
Injury to a Pregnant Woman by Vehicle
Involuntary Manslaughter While Driving Under the Influence of Alcohol or
Drugs
K.S.A. 21-3443
Battery against a School Employee
K.S.A. 21-3502
Rape
K.S.A. 21-3503
Indecent Liberties with a Child
K.S.A. 21-3504
Aggravated Indecent Liberties with a Child
K.S.A. 21-3505
Criminal Sodomy
K.S.A. 21-3506
Aggravated Criminal Sodomy
K.S.A. 21-3507
Adultery
K.S.A. 21-3508
Lewd and Lascivious Behavior
K.S.A. 21-3509
Enticement of a Child
K.S.A. 21-3510
Indecent Solicitation of a Child
K.S.A. 21-3511
Aggravated Indecent Solicitation of a Child
K.S.A. 21-3512
Prostitution
K.S.A. 21-3513
Promoting Prostitution
K.S.A. 21-3514
Promoting Prostitution
K.S.A. 21-3515
Patronizing a Prostitute
K.S.A. 21-3516
Sexual Exploitation of a Child
K.S.A. 21-3517
Sexual Battery
K.S.A. 21-3518
Aggravated Sexual Battery
K.S.A. 21-3520
Unlawful Sexual Relations
K.S.A. 21-3601
Bigamy
K.S.A. 21-3602
Incest
K.S.A. 21-3603
Aggravated Incest
K.S.A. 21-3604
Abandonment of a Child
K.S.A. 21-3604a
Aggravated Abandonment of a Child
K.S.A. 21-3605
Nonsupport of a Child or Spouse
K.S.A. 21-3608
Endangering a Child
K.S.A. 21-3609
Abuse of a Child
K.S.A. 21-3610
Furnishing Alcoholic Liquor to a Minor
K.S.A. 21-3610a
Furnishing Cereal Malt Liquor to a Minor
K.S.A. 21-3610b
Furnishing Alcoholic Beverages to a Minor for Illicit Purposes
K.S.A. 21-3611
Aggravated Juvenile Delinquency
K.S.A. 21-3612
Contributing to a Child’s Misconduct or Deprivation
K.S.A. 21-4301
Promoting Obscenity
K.S.A. 21-4301a
Promoting Obscenity to Minors
Any felony of a crime of K.S.S. 65-4104 through K.S.A. 65-4175—prohibited drug crimes
________________________________________
___________________
FULL NAME
DATE
________________________________________
FULL NAME
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___________________
DATE
KVC BEHAVIORAL HEALTHCARE
POLICY STATEMENT ON DISCIPLINE
Discipline is an essential part of child rearing and when used positively it contributes to the
healthy growth and development of a child and establishes positive patterns of behavior in preparation for
adulthood. The object of discipline is to promote behaviors that are beneficial to the child’s development
and welfare and to change and/or eliminate behaviors that are injurious to his or her well being.
Therefore, we encourage positive discipline as a most important aspect of child rearing services and care.
Positive discipline, when used for purposes of guiding and teaching the child, provides the child
encouragement, a sense of satisfaction and helps the child understand the consequences of his/her
behavior. Effective positive discipline provides behavioral limits on the child that can provide the child a
sense of security, engender a respect for order and enable the child to predict and understand his/her
surroundings. This type of discipline effectively enlists the child’s help rather than locking the child and
adult into a power struggle or adversarial punishing relationships and promotes the child’s discovery of
those values that will be of the greatest benefit to the child, both now and in the future.
There are laws, which protect adults against actions, which many children must endure and suffer
under the guise of discipline. Many children who are in care have previously suffered too much physical
pain, fear, humiliation, and emotional stress. We cannot perpetuate this when we assure the positive roles
in our child rearing practices of which positive discipline is an essential part.
Therefore, KVC does not view as positive, acceptable discipline any action administered in a
fashion which may cause any child to suffer physical or emotional damage. Disciplinary acts which cause
pain, such as hitting, beatings, shakings, cursing, threatening, binding, closeting, prolonged isolation,
denial or meals and derogatory remarks about the child or his/her family are not acceptable.
While the foregoing statement is not all-inclusive in terms of unacceptable forms of discipline, it
does provide a guide for the establishment of the following statement of policy:
IT SHALL BE THE POLICY OF KVC THAT NO FOSTER PARENT USE DISCIPLINARY
ACTS WHICH CAUSE PAIN, SUCH AS HITTING, BEATING, SHAKING, CURSING,
THREATENING, BINDING, CLOSETING, PROLONGED ISOLATION, DENIAL OF MEALS AND
DEROGATORY REMARKS ABOUT THE CHILD OR HIS OR HER FAMILY.
By signing this document, I hereby acknowledge that I have read the policy statement and
understand that the use of prohibited disciplinary methods MAY RESULT IN CLOSURE OF MY
FOSTER HOME.
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Name
Date
Name
Date
CONFIDENTIALITY OR NON-DISCLOSURE
All KVC personnel, subcontractors, and volunteers are responsible for maintaining
the confidentiality of information relating to KVC client(s), client families, staff
persons(s), or program business. The general expectation that personnel or
subcontractors will keep information confidential does not apply when disclosure
is necessary to prevent serious, foreseeable, and imminent harm to a client or other
identifiable person or when laws or regulations require disclosure without a client's
consent. In all cases what is disclosed will be the least amount of confidential
information necessary to achieve the desired purpose; only information that is
directly relevant to the purpose for which the disclosure is made should be
revealed.
By my signature below, I attest that I have read and understand the Confidentiality
or Non-disclosure agreement and will abide by it.
____________________________________
Signature
_________________________
Date
____________________________________
Signature
_________________________
Date
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KVC Behavioral HealthCare
Child Placing Agency
21350 W. 153rd Street
Olathe, KS 66061
(913) 322-4900
FOSTER FAMILY PROVIDER REQUIREMENTS
________ GENERAL REQUIREMENTS:
• I agree to complete required pre-service training (PS-MAPP or Deciding Together & First
Aid) and license with the Kansas Department of Health & Environment, prior to accepting a
foster/adoptive child into care.
• I agree to accept placements ONLY as approved through KVC Admissions and KVC’s CPA
and will utilize the provided list of questions regarding child’s behaviors to determine
appropriateness of placement for my home.
• I agree to provide KVC at least 14 calendar days notice when asking for removal of child
unless the child is in imminent danger to themselves or others (as defined by admission to a
psychiatric or detention facility. Child must meet screening guidelines). I will assist KVC in
transitioning child to another placement. I agree to provide 30 calendar days notice when
asking for the removal of a child who has been in my home for six months or longer.
• I agree to complete the required annual in-service training and provide documentation of
training to KVC Family Service Coordinator (FSC).
_______ 16 hours per family for Satellite Foster Care, Step, and/or Emergency Foster Care
_______ 24 hours per family for Diversion Foster Care, Intensive Foster Care, or SFL
(Each parent must complete a minimum of 8 hours of the total required for the family)
________ CHILD AND FAMILY:
• I will respect the right of confidentially relating to information regarding the foster child or
his/her family.
• I will strive to maintain an objective, positive attitude and understanding toward the birth
parents and other family members of the child in care.
• I agree to incorporate the child into the family affording him/her the same privileges and
responsibilities as other family members, appropriate to his/her age and abilities.
• I agree to preserve and maintain all personal possessions and documented records of the child
and relinquish said belongings, including those acquired while in our care, upon their leaving
our home.
• I will notify KVC FSC of any changes or impending changes in family/household
composition including, but not limited to moving, new persons living in the home, marriage,
death, divorce, adoption, or serious illness.
• I understand that KVC strongly suggests that we maintain appropriate renter’s, homeowner’s,
household and car insurance to cover physical damages that might occur as a result of a child
being placed in our home. Although KVC maintains professional liability insurance for
negligence involving licensed foster parents, this insurance does not cover such loses.
_______ ABUSE/NEGLECT:
• I understand that any allegation of abuse or neglect may result in immediate removal of foster
children from the home until the investigation is complete. Foster children may temporarily
be placed in respite care until otherwise notified.
• I understand that by law, foster parents are mandated reporters and must call the Kansas
Protection Report Center (1-800-922-5330) to report suspected child abuse or neglect for any
child or youth, whether or not the child or youth is in care.
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________ REIMBURSEMENT:
• I agree to utilize foster care payments to meet the needs and expenses of the individual child.
Expenses may include but are not limited to increase in utility bills due to placement, food,
clothing, hygiene needs, school expenses, etc.
• I understand that if any child in my care is placed outside my home for respite, I will be paid
for this period and will be responsible for payment to the respite provider at the rate
reimbursed by KVC. There is no reimbursement for pre-placement visits.
_________ EMERGENCIES:
• In case of emergencies, I agree to transport the child to the nearest hospital. I will take the
CONSENT TO MEDICAL CARE form and the child’s medical card and will refer questions
concerning payment and billing to the child’s social worker.
• I agree to inform the KVC FSC or, if after hours, the CPA on call worker within 1 hour of
any of the following critical incidents:
The death of a child or any resident of the family
foster home
Attempted suicide
Unanticipated psychiatric hospitalization
Unanticipated medical hospitalization
Emergency room visit
Communicable diseases and/or serious physical
illness
Serious accidental injury
Health Department violations/confirmation
Any action of a serious nature that poses physical or
emotional danger to family members or staff
Staff or foster family injuries as related to client
action
Fire damage or damage to the home that affects the
safety of the child in foster care
All complaint investigations by DCF
Alleged abuse or neglect
•
Use of illegal drugs
Placement disruption
Emergency respite
Emergency change in placement
Police intervention and/or arrest
Criminal assault of any kind
Runaway from school, home or other
Sexual acting out between children/youth
Negative press/media attention
Any other incident that is critical to the child(ren)’s
care
The physical restraint of a child in foster care
A vehicle accident involving any child in foster care
I agree to document critical incidents in writing and submit the documentation to my Family
Service Coordinator within one business day.
________ DAY-TO-DAY DUTIES:
• I agree to comply with all KDH&E licensing standards and regulations.
• I will act as substitute parents by transporting child in care to school, medical/dental
appointments, mental health appointments, work, visits, case plans, court and activities. I
understand that transportation by foster parents is required for all transportation, including
family visits, up to 30 miles in each direction. If over 30 miles in each direction,
transportation through the KVC Transportation Department may be arranged.
• I will participate actively to facilitate the development and implementation of the child’s Case
Plan.
• I agree to obtain needed/prescribed medical, dental, psychiatric care including KAN-BEHEALTHY medical screenings when appropriate, and maintain current medical records on
appropriate forms in the home and provide copies to KVC FSC, along with other necessary
records.
• For a school-aged child, I will work on the child’s behalf to facilitate a smooth enrollment
process and ongoing communication with the schools. I will work with the schools to obtain
free textbooks and school lunches when applicable.
86
•
I will obtain DCF’s permission, through KVC, prior to taking the child out of state or moving
to another residence.
_________ RESPITE:
• If I provide short-term respite care, I understand that my license may be exceeded by a
maximum of 2 additional children in foster care or a sibling group of any size.
• I agree to adhere to KDHE licensing laws and regulations when providing short-term respite
care.
• I understand that short-term respite care is conducted for a child in foster care for less than 24
hours per week (each week begins at 12:01am on Sunday).
• I understand that my Family Service coordinator must pre-approve any short-term respite care
that I provide.
• I agree to notify my Family Service Coordinator of my intent to provide short-term respite
prior to providing the care.
This family is approved to provide short-term respite
This family is approved for respite care not to exceed license capacity
_______________________________
__________________________
Family Service Coordinator
Date
________ I understand that any violation of these requirements may result in removal of the child from
my home, withdrawal of sponsorship of foster care license, or other corrective action measures.
________ I have read and understand this agreement. KVC staff reviewed each of the requirements and
answered any and all questions to my satisfaction.
___________________________________________________________________________
Foster Parent
Date
___________________________________________________________________________
Foster Parent
Date
___________________________________________________________________________
Agency Representative
Date
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High Risk Sport or Recreational Activity Permission Form
Youth’s Name: ___________________________________
D/O/B: __________________________________________
Case Manager: ___________________________________
Foster Parent(s): __________________________________
Family Service Coordinator: _________________________
Youth in foster care are often excluded from normal activities due to events out of their control. In
order to allow children in foster homes normal activities that youth participate in, please note below
a checklist granting permission to participate in specific high-risk sport or recreational activities.
Please initial the activities that you are willing to allow the youth to participate in. A copy will be
provided to foster parents upon receipt and placed in the child file. This will also assist foster
families and the Child Placing Agency to comply with KDH&E Licensing Regulations. Thank you
for your assistance.
____ Foster Parents are approved to allow youth to go swimming with appropriate supervision
and a CPR certified adult present.
____ Foster Parents are approved to allow youth to go bike riding, roller blading/skating with
appropriate supervision or monitoring.
____ Foster Parents are approved to allow youth to go horseback riding with appropriate
supervision.
____
Foster Parents are approved to allow youth to go fishing with appropriate supervision.
____ Foster Parents are approved to sign for school or church related field trips that occur in
State.
____ Foster Parents are approved to allow youth to participate in occasional overnight stays,
which will be appropriately monitored/supervised and with prior notification to the youth’s
worker.
____ Foster Parents are approved to travel out of state for “day” trips, for reasons such as
shopping, visiting foster family relatives, etc. Overnight stays will require written permission
and approval prior to travel.
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_____ Foster Parents are approved to dispense over the counter/non-prescription medications as
needed to the youth (i.e. cold and cough medications, headache medications, allergy and sinus,
etc.) Please note any allergy-related medications: ____________________________________
____________________________________________________________________________
____ Foster Parents are approved to allow youth to get a “normal” haircut as needed. All other
hair care needs, such as coloring or perming, require prior approval.
____ Foster Parents are approved to allow youth to participate in shooting fireworks on the 4th
of July with appropriate monitoring and/or supervision.
____ Foster Parents are approved to allow youth 12 years of age or older to operate a push
lawn mower with appropriate monitoring and/or supervision.
____ Foster Parents are approved to allow youth 16 years of age or older to operate power
equipment (riding lawn mower, chain saws, carpentry saws, etc) with appropriate monitoring
and/or supervision.
____ Foster Parents are approved to take the youth camping, boating/water skiing with
appropriate supervision.
____ Foster parents are approved to allow the youth to ride on all terrain vehicles (four
wheeler, go-carts and motorcycles) with appropriate supervision.
____ Foster parents are approved to allow the youth to participate in sports and other school
related activities.
____ Other: ________________________________________________________________
____________________________________________________________________________
By initialing any of the above items you are acknowledging your assessment of the child
including age, maturity level of the child, behavior disorders, suicidal tendencies, developmental
delays, thrill seeking behavior and difficulty with anger control.
___________________________________________
Signature of Parent or Legal Guardian
Date: ______________________________________
___________________________________________
Signature of Youth’s Case Manager
Date: ______________________________________
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OUTDOOR SAFETY PLAN
(This form is required by KDHE before a child is allowed outdoors in an unfenced area of the foster family home)
Foster Family: ________________________________________________________________
Family Service Coordinator: ___________________________ Date Completed: _______________________
A) List a description of any safety hazard and of any natural or man-made barrier separating the area from
the safety hazard
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
B) List the approximate distance from the unfenced area to each safety hazard
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
C) Describe provisions for increased supervision
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
D) Foster Parent agrees for a caregiver to be outdoors with each child in foster care less than six years of age
_____YES
____NO
Foster Parent(s) Signature:
______________________________________________________________________________
______________________________________________________________________________
KVC Staff Signature: _____approve
_____deny
______________________________________________________________________________
Today’s Date: _________________________________________________________________
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Safety Plan
Foster Family Name: _________________________________________________________
Family Service Coordinator: ___________________________________________________
Date Completed: _____________________________________________________________
Narrative Regarding Issue to be Addressed:
Goals:
Begin Date: ____________________ Due Date: _____________________
91
Steps to be Completed:
Possible Rewards/Consequences of Completing or not Completing the Plan:
Parent(s) Signature:
___________________________________________________________________________
___________________________________________________________________________
KVC Staff Signature:
___________________________________________________________________________
Today’s Date: ______________________________________________________________
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KVC Child Placing Agency
First Aid Inspection Form
3/14/08
Foster Parent:
Vehicle Make:
Model:
Year:
1.
Band Aids: __________________________________________________________________
2.
Adhesive Tape: _______________________________________________________________
3.
Gauze (roll): _________________________________________________________________
4.
Scissors: ____________________________________________________________________
5.
4 x 4 Gauze Squares: ___________________________________________________________
6.
EPA Approved Disinfectant: _____________________________________________________
7.
Elastic Bandage (Ace): _________________________________________________________
8.
Latex Gloves: ________________________________________________________________
Foster Parent Signature: ______________________________ Date: ______________________________
Inspector’s Signature: ________________________________ Date: ______________________________
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FOSTER PARENT SATISFACTION SURVEY
Foster Parent Name:
Date:
County:
FSC:
Satisfaction Scale
5 points = Always.
4 points = Usually.
3 points = Sometimes.
2 points = Rarely.
1 point = Never.
0 points = No opinion.
Satisfaction
Level
Area
Comments
Case Manager
FSC
Transportation Department
Respite Care
Do you attend Support Group?
Yes
No
Yes
No
Preferred Day/Time for Support Group
Are your training needs met?
Is the monthly newsletter helpful?
Foster Family Finder’s Fee
Overall Satisfaction with KVC
Other
PLEASE COMPLETE THIS FORM AND RETURN IT IN THE ENCLOSED ENVELOPE.
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DETERMINING SEXUALLY APPROPRIATE VERSUS INAPPROPRIATE
BEHAVIORS DISPLAYED BY YOUNG CHILDREN
(Portions of the following have been revised for KVC from research and treatment completed by Licensed Clinical Psychologist Toni Cavanagh Johnson, Ph.D.,)
Behaviors Related to Sex and Sexuality in Kindergarten Through Fourth Grade Children
The following chart attempts to describe behaviors which relate to sex and sexuality of children of normal intelligence in
kindergarten through fourth grade. Available literature and empirical data on child sexuality have been studied and consultation
with hundreds of mental health professionals, parents and child care providers has been sought to prepare this chart. It is a first step
in defining behaviors related to sex and sexuality which are within the Expected range, behaviors which raise concern and behaviors
which require immediate consultation. Where and under what conditions a child engages in the sexual behaviors is important in the
assessment. This chart is not meant for use in the assessment of child sexual abuse.
The behaviors in the first column are those which are in the Expected range. This range is wide and not all children will engage in
all of the behaviors, some children may engage in none while some may only do one or two. There will be differences due to the
amount of exposure the child has had to adult sexuality, nudity, explicit television, videos, pictures and the child’s level of interest.
The child’s parents’ attitudes and values will influence the child’s behaviors.
The second column describes behaviors which are seen in some children who are overly concerned about sexuality, who lack
adequate supervision, or live in sexualized environments, and other children who have been, or are currently being, sexually
maltreated.
When a child shows several of these behaviors, or the behavior persists in spite of interventions, consultation with a professional is
advised.
The third column describes behaviors which are often indicative of a child who is experiencing deep confusion in the area of
sexuality. This child may or may not have been sexually and emotionally abused or physically maltreated. It may be that the level
of sex and/or aggression in the environment in which the child has lived overwhelmed the child’s ability to integrate it and the child
is acting out the confusion. Consultation with a professional who specializes in child sexuality or child sexual abuse should be
sought.
Sex Play
Children in kindergarten through fourth grade are trying to understand their bodies, their abilities, how to make friends and life. The
world is a marvelous place full of things to learn and explore, amongst these are sex and sexuality. Everything related to sex and
sexuality, including the genitals, breasts, differences between males and females, love, marriage, intercourse, dirty books and
pictures, dancing, hugging, touching, etc. are the objects of great curiosity. Young school-age children are often very active in their
exploration of these topics. At times children engage in solitary sexual behaviors, at other times similar age children engage in
exploratory behavior together or make up games involving sexual themes in which groups of children engage together. Curiosity
about sex is natural and is engaged in with liveliness and good humor. Children engaged in sex play mutually agree to participate
and are generally giggly and silly. When one child wants to stop, the other/s stop also. If discovered in sexual behaviors, a child
may feel guilty or ashamed but this passes, if the adult treats it as natural.
Areas of Concern
Concern arises when the child focuses on sex and sexuality to a greater extent than 1) other areas of the child’s environment or, 2)
his or her peers. Sexual interest should be in balance with the curiosity and exploration of all other aspects of the child’s life. Most
sexual behaviors related to “looking and touching” go underground or stop as children learn that many adults are unaccepting of
much of their overt exploration and curiosity. When a child continues to do sexual things in the view of adults who say “no,” this
raises concern. Most sexual behaviors by young school-aged children are engaged in with children of similar age, usually within a
year or so, younger or older, of their own age. The wider the age range between children engaged in sexual behaviors, the greater
the concern. Sex play usually occurs between friends and playmates. A child who keeps asking unfamiliar children or children,
who are uninterested to engage in sexual activity, raises concern. Children who appear anxious, tense, confused about sexual issues,
or who are continuously involved in sexual activity, or children who do not understand others’ admonitions against overt sexual
behavior, also raise concern
If a child shows several behaviors, or the behavior persists in spite of interventions, professional advice is recommended.
When to Seek Professional Consultation
When anger, anxiety, tension, fear, sadness, coercion, force, ongoing destructive or aggressive impulses or compulsive interest and
activity are associated with sexuality, professional advice should be sought.
98
Generally, there is little concern about peer sexual exploration yet there can be manipulation and coercion between same-aged peers.
When assessing peer sexual behaviors which are considered problematic, the every day relationship between the children is the best
measure of how the children interact. If a child is regularly aggressive and controlling in interactions with another child, this
relationship may be the same when sexual behaviors are occurring. Sexual behaviors between children where one is pressuring the
other to engage in the behaviors can be very serious. If other children repeatedly complain about a child’s sexual behavior even
after the child has been spoken to, an assessment by a professional is advisable.
Behaviors Related to Sex and Sexuality in
Kindergarten Through Fourth Grade Children
Natural and Expected
Asks about the genitals, breasts,
intercourse, babies
Of Concern
Shows fear or anxiety about sexual
topics.
Interested in watching/peeking at
people doing bathroom functions.
Keeps getting caught watching/
peeking, at others doing bathroom
functions.
Continues to use “dirty” works
with adults after parents says “no”
and punishes.
Frequently plays doctor and gets
caught after being told “no”.
Boy keeps making believe he is
having a baby after month/s.
Wants to be nude in public after
the parents says “no” and punishes
child.
Plays with feces. Purposely
urinates outside of toilet bowl.
Uses “dirty” works for bathroom
functions, genitals, and sex.
Plays doctor, inspecting others’
bodies.
Boys and girls are interested in
having/birthing a baby.
Show others his/her genitals.
Interest in urination and defecation.
Touches/rubs own genitals when
going to sleep, when tense, excited
or afraid.
Plays house, may simulate all roles
of mommy and daddy.
Thinks children of the other sex are
“gross” or have “cooties”. Chases
them.
Talks about sex with friends.
Talks about having a girl/boy
friend.
Wants privacy when in bathroom
or changing clothes.
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Continues to touch/rub genitals in
public after being told “no”.
Masturbates on furniture or with
objects.
Humping other children with
clothes on. Imitates sexual
behavior wit dolls/stuffed toy
Uses “dirty” language when other
children really complain.
Sex talk gets child in trouble.
Romanticizes all relationships.
Becomes very upset when
observed changing clothes.
Seek Professional Help
Endless questions about sex.
Sexual knowledge too great for
age.
Refuses to leave people alone in
bathroom.
Continues us of “dirty” words even
after exclusion from school and
activities.
Forces child to play doctor, to take
off clothes.
Displays fear or anger about babies
or intercourse.
Refuses to put on clothes. Exposes
self in public after many scoldings.
Repeatedly plays with or smears
feces. Purposely urinates on
furniture.
Touches/rubs self in public or in
private to the exclusion of normal
childhood activities. Masturbates
on people.
Humping naked. Intercourse with
another child. Forcing sex on other
child.
Uses bad language against other
child’s family. Hurts other sex
children.
Talks about sex and sexual acts a
lot. Repeatedly in trouble in regard
to sexual behavior.
Aggressive or tearful in demand
for privacy.
Natural and Expected
Likes to hear and tell “dirty” jokes.
Looks at nude pictures.
Of Concern
Keeps getting caught telling “dirty”
jokes. Makes sexual sounds, e.g.
moans.
Continuous fascination with nude
pictures.
Plays games with same-aged
children related to sex and
sexuality.
Draws genitals on human
figures.
Wants to play games with
much younger/older children
related to sex and sexuality.
Draws genitals on one figure
and not another. Genitals in
disproportionate size to body.
Explores differences between Confused about male/female
males and females, boys and differences after all questions
girls.
have been answered.
Takes advantage of
opportunity to look at nude
child or adult.
Pretends to be opposite sex.
Stares/sneaks to stare at nude
persons even after having
seen many persons nude.
Wants to be opposite sex.
Wants to compare genitals
with peer-aged friends.
Wants to compare genitals
with much older or much
younger children or adults.
Continuously wants to touch
genitals, breast, and buttocks
of other child/ren. Tries to
engage in oral, anal, vaginal
sex.
French kissing. Talks in
sexualized manner with
others. Fearful of hugs and
kisses by adults. Gets upset
with public displays of
affection.
Touches/stares at the
genitals, breasts, buttocks of
adults. Asks adult to touch
him/her on genitals.
Continuous erections
Forces others to play sexual
games. Group of children
forces child/ren to play.
Genitals stand out as most
prominent feature. Drawings
of intercourse, group sex.
Plays male or female roles in
a sad, angry or aggressive
manner. Hates own/other
sex.
Asks people to take off their
clothes. Tries to forcibly
undress people.
Hates being own sex. Hates
own genitals.
Demands to see the genitals,
breasts, buttocks of children
or adults.
Manipulates or forces other
child to allow touching of
genitals, breast, buttocks.
Forces or mutual oral, anal,
or vaginal sex.
Overly familiar with
strangers. Talks/acts in a
sexualized manner with
unknown adults. Physical
contact with adult causes
extreme agitation.
Sneakily or forcibly touches
genitals, breasts, buttocks of
adults. Tries to manipulate
adult into touching him/her.
Painful erections.
Puts something in own
genitals/rectum when it feels
uncomfortable. Puts something
in the genitals/rectum of other
child.
Any coercion or force in putting
something in genitals/rectum of
other child. Anal, vaginal
intercourse. Causing harm to
own/others genitals/rectum.
Wants to touch genitals,
breasts, buttocks of other
same-age child or have child
touch him/her.
Kisses familiar adults and
children. Allows kisses by
familiar adults and children.
Looks at the genitals,
buttocks, breast of adults.
Erections
Puts something in own
genitals/rectum out of
curiosity and exploration.
100
Seek Professional Help
Still tells “dirty” jokes even after
exclusion from school and
activities.
Wants to masturbate to nude
pictures or display them.
Recommendations for Caregivers of Children with Sexual Behavior Problems
1. Close supervision is important when the child is with other children. Children, particularly young
children, should have continuous visual supervision when with other children. Visual supervision
means that a supervising adult can see the child at all times when the child is with other children.
Continuous visual supervision is difficult to maintain and the family will have to work closely as a
team to accomplish it. It is important that the supervision be accomplished without fail to insure the
safety of other children and to prevent the behavior from becoming a habit.
2. The child should not sleep in the same bed with other children. Also, if possible, the child should
sleep in a room alone.
3. The adults should communicate clear rules and expectations about privacy and appropriate sexual
behavior to the child. It is important that all members of the family know and observe these rules. All
children in the home should be included in a discussion of the Private Parts Rules and/or the Sexual
Behavior Rules and a plan developed to deal with any touching problems that arise.
Private Part Rules
(For Preschool Children)
1. No touching other people’s private parts. (This includes kicking, hitting, biting, etc.)
2. No other people touching your private parts.
3. No showing private parts to other people. (or Keep your clothes on when other people can see you.)
4. No touching private parts in public.
Sexual Behavior Rules
(For School-Age Children)
1. It is not okay to show your private parts to other people.
2. It is not okay to look at other people’s private parts.
3. It is not okay to touch other people’s private parts.
4. No touching private parts in public.
5. It is not okay to use sexual language or make other people uncomfortable with your sexual behavior.
4.
5.
6.
7.
8.
101
If the child has nightmares or sleeping problems, the child should be comforted and put back in
his/her own bed or allowed to sleep in the caregiver’s room in a sleeping bag on the floor (for young
children).
The child should bathe alone and should take care of personal self-care in the bathroom without the
presence of other children. If the child is young enough to need help with toileting, bathing, etc., an
adult should provide assistance.
The child should not be given any opportunities for assuming a role of authority over younger or more
vulnerable children. This means that the child should not baby sit and should not be told to “watch”
other children while mom and dad cooks dinner, runs a quick errand, etc.
Sexually explicit materials, such as magazines, videos, catalogues, and television programs, should not
be available to the child in the home. Children should be monitored closely while they are on the
computer to make sure that they are viewing appropriate material.
Adults should enforce privacy in the bedrooms and bathrooms. There should be established rules
about entering the adults’ bedroom (i.e. knock before entering). If engaging in sexual activity, the
adults should take steps (i.e. lock the door) to ensure that children cannot come in or observe.
9. Adults should use modesty in the child’s presence. There should be no nudity, partial nudity, or
explicit displays of sexual behavior by either parent or other adults in front of the child. It is, however,
appropriate for adults to show normal (i.e. holding hands, kissing, hugging) affection to each other and
the children.
10. Prevent sexual behavior with helping youngsters engage in other activities such as puzzles, games, or
drawing and increase the children’s physical activities, such as riding bikes, jumping rope, or skating.
Intervention
Intervene when a child is sexually acting out or inappropriate. A consistent response to behavior can help a
child learn boundaries and appropriate behavior.
Patricia Ryan Ph.D. developed the following techniques:
• Stop the behavior! Change the situation, stop, distract or change the environment. Push the child’s
hands away, separate the children, draw the “victim’s” attention away toward something else, tell the
child to stop what they are doing, or have the children pull up their pants, separate and get dressed.
• Define the behavior. Be clear what the child is doing that is inappropriate. If we respond with
general anger, the child may interpret our anger as “I’m bad.” Instead of “What I’m doing is wrong.”
o Avoid: “Stop that!” or “Don’t do that!” or “That’s bad!”
o Try “You are poking Billy’s private parts and that’s not okay!” or “You are being sexual with
the dog and we already talked about how it is not okay.”
• State the house rules. Repeat the house rules or exception if it applies.
o Try: “In this house we…” or “The rule is…” or “We expect everyone in our family to…” Be
direct but don’t lecture, they will stop listening.
• Enforce the Consequence or Redirect the Child. For younger children you can redirect or distract
to more appropriate behavior. If the child is older and this behavior is repetitive, you may wish to add
a non-punitive consequence. Don’t hurt or humiliate but it may be helpful to include a consequence or
time-out, an extra chore or writing exercise. End the encounter on a positive note and praise the child
when he acts in the way you suggest.
102
KVC-Behavioral HealthCare
Sexual Boundaries Safety Checklist
A Sexual Boundaries Safety Checklist is a tool used when a youth, who has a history of breaking
sexual boundaries, resides in the home/placement. This checklist is intended to provide
information that can be utilized in the development of a sexual boundaries safety plan. The safety
plan, as well as the information in the checklist, can provide the home/placement with a
significant amount of protection and prevention. The checklist addresses the level of structure the
youth needs to keep their behavior in check. The safety checklist process should include the whole
family system as sexual abuse often develops in secrecy and isolation. The following adaptations
can be made to ensure the youth does not have access to anything or anyone that may trigger
further breaking of sexual boundaries. A structured safety plan can be developed from the
information provided within the checklist. The safety plan addresses strict prevention tactics to
keep other members of the family safe. A sexual boundaries safety plan that is closely followed
provides added reassurance that the home/placement can continue to provide a safe environment
for not only the youth with sexual boundary issues, but the entire family as well.
This form should be completed under the leadership of the child placing agency staff in conjunction with the care provider/family.
After completion of this form please fax or mail back to the following: Name _____________________________________
Agency ___________________________________
Fax # _____________________________________
Address ___________________________________
Form Completed by and on: ____________________________________________________________________________
Name of Child Placing Agency Staff _______________ Relationship to Youth ______________ Date _________________
Person(s) Involved in completing the Safety Checklist and Relationship to the Youth:
Name of Youth ______________________ Age _________________________________ Date ____________
Name _____________________________ Relationship to Youth _________________ Date ____________
Name _____________________________ Relationship to Youth _________________ Date ____________
Name _____________________________ Relationship to Youth __________________ Date ____________
Name ______________________________ Relationship to Youth ___________________ Date ____________
Neighborhood
Address of Residence _________________________ City ________________ State _________ Zip ________
Mark all of the following that are within walking distance from the residence:
□ Nursery/Pre-School
□ High School
□ Shopping Mall
□ Park
□ Elementary School
□ Bus Stop
□ Recreational Facility □ Store
□ Junior High School
□ Other __________
Who knows about the youth’s sexual behavior in the neighborhood?
________________________________________________________________________________________
103
Name of Youth: _______________
Daily Living Activities
During a typical week what are the (proposed) activities and/or places frequented by the youth? Please give a brief description of
each and who will be monitoring the youth during these activities.
□ School _________________________________________________________________________________________
□ Work __________________________________________________________________________________________
□ Church __________________________________________________________________________________________
□ Leisure/Recreation ________________________________________________________________________________
□ Other __________________________________________________________________________________________
Residence
Type of Residence: □ Apartment
□ Single Family Dwelling
□ Other ______________________________________
Complete the following table for ALL children who reside at this residence or who may spend the night in the near future.
Name
Age
Gender
Relationship to Youth
Has knowledge about the
(First Name Only)
(Circle one)
(Circle One)
youth’s behavior?
Male / Female Foster Child / Sibling
□ Yes
□ No
Other:____________
Male / Female
Foster Child / Sibling
Other:____________
□ Yes
□ No
Male / Female
Foster Child / Sibling
Other:____________
□ Yes
□ No
Male / Female
Foster Child / Sibling
Other:____________
□ Yes
□ No
Male / Female
Foster Child / Sibling
Other:____________
□ Yes
□ No
Male / Female
Foster Child / Sibling
Other:____________
□ Yes
□ No
Monitoring/Supervision
Please check “YES” or “NO” and answer accordingly. If any of the following are answered “No”, the completion of a Sexual
Boundaries Safety Plan is indicated.
□ Yes □ No Do all bathrooms and bedrooms have working doors? If NO, can a door be installed? _________________
□ Yes □ No
Do all bathrooms and bedrooms have locking doors? If NO, can privacy locks be installed? ____________
□ Yes □ No
Are “1-900” numbers blocked on phones in the residence? If NO, can you monitor phone calls? ________
□ Yes □ No
Do all the residents of the house bathe alone? If NO, who bathes together? __________________________
□ Yes □ No Do the children change for bed or for the day in private? If NO, can they change out of the view of alleged
sexual abuser? _____________________________________________________________________________________
104
Name of Youth: _________________________
Please check “YES” or “NO” and answer accordingly. If any of the following are answered “YES”, the completion of a Sexual
Boundaries Safety Plan is indicated.
□ Yes □ No Does anyone in the home provide day care or babysitting? If YES, is the youth supervised around these children
and who is supervising? _________________________________________________________________________________
□ Yes
□ No
Will the youth share a bedroom? If YES, with whom? ____________________________________________
□ Yes
□ No
Will the youth have any contact with others who have had sexual problems of any kind in the past.
If YES with whom? ______________________________________________________________________
□ Yes
□ No
Will the youth be left alone? If YES, what time(s)? ______________________________________________
How often? _____________________________________________________________________________
□ Yes
□ No
Will there be contact with prior alleged victim(s)? If YES, Who? __________________________________
Is the contact supervised? _________________ By whom? _____________________________________________________
Are any of the following found in the residence? If the following are answered “YES” and the items have not been blocked or
locked, the completion of a Sexual Boundaries Safety Plan is indicated.
□ Yes
□ No
Digital Cable or Satellite TV? If YES, have you blocked adult channels? _____________________________
□ Yes
□ No
Computers with Internet Access? If YES, have you blocked adult sites? ______________________________
□ Yes
□ No
Adult videos or Pictures of nude or partially nude people? If YES, have you locked them up? _____________
Special Recommendations/Other Concerns (If the following Special Recommendations/Other Concerns indicate a specific
issue(s), the completion of a Sexual Boundaries Safety Plan is indicated):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
_____________________________________________________________________ ________________________________
105
Name of Youth:_______________________
Please draw a simple floor plan that includes bedrooms and who sleeps in which rooms.
First Floor
Second Floor (If applicable.)
106
KVC-Behavioral HealthCare
Sexual Boundaries Safety Plan
This form should be completed under the leadership of the child placing agency staff in conjunction with the care provider/family.
Form Completed by and on:
Name of Child Placing Agency Staff _____________ Relationship to Youth ______________ Date _________
Person(s) Involved in completing the Safety Plan and Relationship to the Youth:
Name of Youth _______________________________________ Age _____ DOB _______________
Name ______________________________________ Relationship to Youth ___________________
Name ______________________________________ Relationship to Youth ___________________
Name ______________________________________ Relationship to Youth ___________________
Name ______________________________________ Relationship to Youth ___________________
The following problems were generated from the Sexual Boundaries Safety Checklist. Specific answers found in the
Monitoring/Supervision section, or any specific issue(s) found in the Special Recommendations/Other Concerns section of the
Sexual Boundaries Safety Checklist have indicated a need for the following plan.
Description
Problem
Goal
Strength
Plan
Who?
Will do what?
By when?
Description
Problem
Goal
Strength
Plan
107
Who?
Will do what?
By when?
Description
Problem
Goal
Strength
Plan
Who?
Will do what?
By when?
Description
Problem
Goal
Strength
Plan
Who?
Will do what?
By when?
Description
Problem
Goal
Strength
Plan
Who?
Will do what?
By when?
We agree that we will participate in the above plan.
Signature of Participants and Date:
____________________________ ___/___/___
______________________________ ___/___/___
____________________________ ___/___/___
______________________________ ___/___/___
____________________________ ___/___/___
______________________________ ___/___/___
108
KVC Behavioral HealthCare
VERIFICATION OF EMPLOYMENT FOR
DAY CARE ELIGIBILITY
Employee:
The above named individual is a licensed foster parent providing foster care for a child in State SRS
custody. KVC - Behavioral HealthCare, a contractor with SRS, has agreed to pay for approved
day care services for the foster child in his/her home. To do so, we need verification of his/her
employment with you. Please provide the information requested below:
The above named individual is employed at:
Name
Address
City, St
Phone #
Hire Date:
His/her normal work schedule is:
Monday
AM/PM
to
AM/PM
OT Required
Tuesday
AM/PM
to
AM/PM
Yes or NO
Wednesday
Thursday
AM/PM
AM/PM
to
to
AM/PM
AM/PM
# of OT hours
Friday
AM/PM
to
AM/PM
Expected per wk
Saturday
AM/PM
to
AM/PM
Sunday
AM/PM
to
AM/PM
Signature of Employer / Title
Date
Return directly to: Accounting Services
KVC - Behavioral HealthCare
21350 West 153rd Street
Olathe, KS 66061
(913) 322-4900
Authorization to Release Information:
I hereby authorize my employer to release to KVC - Behavioral HealthCare any information
needed to establish my eligibility for day care services.
109
Employee Signature
Date
KVC - Behavioral HealthCare
Application for Day Care Payments
Day Care Schedule
Foster Child Name
Provider Name, Address and Phone Number
To the best of my knowledge, I certify that all the information included in this application is complete and co
Signature of Applicant
110
Date
KVC - Behavioral
KVCHealthCare
- Behavioral HealthCare
Application For
Application
Day Care For Day Care
Important: This entire Application and Verification of Employment must be completed before KVC will
approve day care payment. Your employer(s) should return the Verification of Employment form(s) to:
KVC - Behavioral HealthCare
Accounting Services
21350 WEST 153rd STREET
OLATHE, KS 66061
Foster Family Name:
Foster Family Address:
City, State, Zip:
County:
Phone:
Foster Parent:
Social Security #:
Date of Birth:
Employer:
Employer Address:
City, State, Zip:
Phone #:
Foster Parent:
Social Security #:
Date of Birth:
Employer:
Employer Address:
City, State, Zip:
Phone #:
Work/School Schedule
111
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Work/School Schedule
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
KVC- Behavioral HealthCare
FOSTER PARENT MILEAGE REPORT
Provider Name: ______________________________________________
Provider Address: ____________________________________________
Month: _____________________
City: _________________________ State: _____
Year: _______________________
Child’s Name
Date
Zip: ______________
Destination
Odometer
Odometer
(Beginning)
(Ending)
Total
Miles
Family Visit
From:
_____________
To:
(Family Member)
Family Visit
From:
_____________
To:
(Family Member)
Family Visit
From:
_____________
To:
(Family Member)
Family Visit
From:
_____________
To:
(Family Member)
Mileage Grand Total and Reimbursement Amount
Please return this form by the 5th of each month to: Accounting Services, 21350 W. 153rd Street Olathe, KS 66061
I attest that the above information is accurate and represents mileage incurred in the performance of my Foster Parent responsibilities.
Signature: _______________________________
112
Reason for Mileage
Date: __________________
x $.34/ mi. = $
Court
Hearing
Case
Plan
Court
Hearing
Case
Plan
Court
Hearing
Case
Plan
Court
Hearing
Case
Plan
SELF-CARE PLAN
Name
Date of Birth
Contracting Agency
Case Manager
______
Placement Date
____
______
CM Location
____
________________________________________________________________________________________________
Foster Home
FH Location
Family Service Coordinator
FSC Location
Plan Date
Completed By
______
___________
______
___________
Check One:
Child who is at least 12 years of age may be in self-care for a maximum of two consecutive hours, for no
more than four hours per day
Child who is at least 14 years of age may be in self-care for a maximum of four hours per day
Child who is at least 16 years of age may be in self-care for no more than 10 hours per day
Self-Care Plan Details:
o Emergency numbers and contacts
Police: ___________________________________________
Fire: _____________________________________________
Ambulance: _______________________________________
Poison control: _____________________________________
Foster Parent Cell Phone: _____________ or _____________
Other: Name: _____________ Number: _____________
o
Only children residing in the home may be present during self-care
o
Child must stay within outlined boundaries of the property while in self-care which include:
__________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
o
Policy of phone use while Foster Parent is not in the home: __________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
113
o
Policy on answering the door while Foster Parent in not in the home:__________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
o
Other: _____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
114
Family Service Coordinator Signature and Date
Family Service Supervisor Signature and Date
Foster Parent Signature and Date
Child Signature and Date
Authorization Agreement for
Direct Deposit
Please read this form carefully and write clearly.
If this is a new account, you must:
1. Already have the account set up at your bank
2. Find out if they accept direct deposits. Verify banks transit # and your account # (including dashes)
3. Notify the bank that you are going to set up direct deposit through accounting. Make sure that there isn’t anything special you need to
do as far as they are concerned.
Please check the action and fill out form below:
□
□
□
□
Canceling account (complete item C below). Do not close an account unless you cancel it through accounting first.
Direct Deposit already set up, changing $ amount only (complete C through E below).
A new account (complete A through E below).
A new account to replace a direct deposit already set up (complete A through E below).
Which account are you replacing? ____________________________________________________
A. Bank Name: ______________________________________________________________________
B. Bank TBA #:
C. Bank Account #:
D. □ Checking
E. □ Full Deposit
□ Savings
PLEASE RETURN TO THE ACCOUNTING DEPT. WITH A VOIDED CHECK.
•
•
•
I authorize Security Bank and the bank listed above to deposit my net pay or option thereof as indicated above into my account
each payday.
If funds to which I am not entitled are deposited to my account, I authorize Security Bank to direct the bank to return said funds.
I understand that my deposit may not be credited to my account until 5:00 p.m. on the date indicated on the check voucher.
Applicant Signature: ____________________________________________________
Name (printed): _____________________________________________
Date: _________________
Please return to: KVC Accounting Services, 21350 W 153rd St. Olathe, Ks. 66061
115
FOSTER PARENT COMPLIMENT/CONCERN FORM
Please utilize this form when you want to express a compliment or concern about an employee or procedure of KVC Behavioral
HealthCare. This form will be utilized to give recognition as needed, and address concerns that are brought to the attention of KVC.
Name of Foster Parent: _______________________________ Today’s Date: ________________
COMPLIMENT
Who would you like to compliment? ______________________________________________
Please tell us why this person should be recognized:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
CONCERN
Type of Concern:
____ Services to the Child
____ Services to Foster Home
____ Permanency Plan
____ Agency Personnel
Name of Child (if appropriate): _______________________________________________________
Name of Case Manager (if appropriate): _______________________________________________
Description of Concern:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Date of Occurrence: _________________________________
116
Have you talked with a member of the Support Team, a supervisor, or anyone else at the agency about this concern?
____ Yes
____ No
If yes, who? ___________________________________
When? ____________________________
What did he/she tell you regarding this concern?
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Please tell us your suggestions on how to resolve this concern:
1. ________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
2. ________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Signature: _______________________________________________
Mail or Deliver this form to:
KVC Behavioral HealthCare, Inc.
Child Placing Division
12301 West 106th Street
Overland Park, KS 66215
Telephone: 913/322-4900
FAX: 913/780-1284
117
QUESTIONS FOR FOSTER PARENTS TO ASK PRIOR TO PLACEMENT OF A CHILD
Foster parents need to make an informed decision about their ability to meet the needs of any child placed with them. To help with this
task the following is a list of questions to ask prior to accepting a placement. Please note this is only a guide. KVC may not have all of
this information. When a child is referred from another agency, KVC Admissions will only have the information supplied by the
sponsoring agency.
1.
Name, gender, age
a. Does the child have any siblings placed in another home?
b. Are there concerns with the child being around other children – older or younger?
c. Has the child ever mistreated a pet?
2.
Reason for placement and child’s permanency plan
a. Is this an initial placement, disruption or police protective custody?
b. Reintegration/adoption/independent living/guardianship?
c. If the case plan goal is Independent Living what are the specific goals for the youth, i.e. job, savings account,
gathering household items, etc.
3.
Previous placements
a. Reason for removal
b. Has the child made any allegations against previous foster parents/group home?
4.
Reimbursement rate
5.
Visitation
a. Who does the child have visits with and how often? Is there a visitation schedule?
b. Who is the child allowed to have contact with, i.e. siblings, grandparents, etc.
c. Who is the child NOT allowed to have contact with?
d. Is there a risk of abduction?
6.
Child’s medical history and current medical needs
a. Medical diagnosis – When was the last KAN BE HEALTHY?
b. Psychological diagnosis
c. Current medication – Is the child bringing medication with them?
d. Neurological diagnosis
e. Dental
7.
Siblings
8.
Developmental level
9.
Is the child in therapy?
a. Where does therapy take place?
b. How often?
c. What is the therapist’s name and contact information?
10.
School last attended and current grade
a. Has the child been diagnosed with any learning disorders?
b. Is the child attending special education?
c. Does the child have a current IEP?
d. Does the child have an education advocate?
11. Known or suspected dangerous propensities/behaviors
a. Gang affiliations
118
b.
c.
d.
e.
f.
g.
119
Fire starter
History of lying or stealing
Sexually acting out – Has the child been sexually abused? What is the gender of the abuser?
Is there a risk of the child “running away?”
Are there drug and/or alcohol concerns
Has the child been convicted of any crimes? If so, what, when and where?
12.
Legal status
a. Have the child’s parental rights been terminated?
13.
Anticipated length of placement
14.
Is religion a concern?
15.
Does the child have unusual habits? Likes? Dislikes?
KVC Behavioral Healthcare, Inc.
KAR 28-4-807 (d): Reporting Critical Incidents
Foster Family Critical Incident Report
Foster Family Name:
Foster Home Address:
Child’s Name:
Date of Birth:
Case Manager:
Date of Incident:
Time of Incident:
Incident Type: (Please Check)
Fire Damage or other damage to property that affects the
structure of the dwelling or safety of the child in foster
care.
Complaint investigations by the licensing
department or the Kansas Department of Social &
Rehabilitation Services.
Missing or Runaway child in foster care.
Physical Restraint of a child in foster care.
Injury or illness of a child in foster care requiring
Medical Attention.
Death of a child or any other resident of the foster
family home.
Arrest of a child in foster care.
Any incident involving the presence of law
enforcement.
Vehicle accident involving any child in foster care.
Other incident that jeopardized the safety of a child
in foster care.
Hospitalization of a child in foster care.
Suspected Abuse or neglect.
Factual Information of Incident, including each individual involved:
Actions Taken, including the names of each individual involved:
This critical incident must be completed and sent to the KVC Licensing worker by the next working day.
________________________________________
Foster Parent Signature
________________________________________
Foster Parent Signature
________________________________________
Licensing Worker
120
_____________
Date of Report
_____________
Date of Report
_____________
Date