DISCUSSION

The mission of the Division of Family and Children Services (DFCS) foster care program is to strengthen families, protect children from further abuse and ensure that every child has a permanent family. The private provider community is an important and integral part of DFCS’s ability to achieve its mission. The Room Board and Watchful Oversight (RBWO) providers follow and support the DFCS mission. 

RBWO is the provision of lodging, food and attentive responsible care to children. Providers shall be responsible for the provision or acquisition of services to ensure that each child’s physical, social, emotional, educational/vocational, nutritional, spiritual/cultural and permanency needs are met. These services are defined as follows: 

1. Physical – all health services pertaining to the body (medical and dental). This includes medication monitoring, documenting and administering by staff or foster parents trained in medication dispensing. 
2. Social – the provision of an environment in which the child’s relationships with peers, staff, significant others and community are improved through the use of recreational and leisure activities. 
3. Emotional - a support network that implements recommendations of treatment providers; provides access to treatment; and recognizes behaviors, such as anger, and negative and positive stress, often accompanied by physiological or psychological changes. 
4. Educational/Vocational – enrollment of youth in an accredited educational school system; monitoring of progress and support of the youth’s education by participation in student support team (SST) meetings, individual education planning (IEP) meetings, parent/teacher conferences and disciplinary meetings; opportunities for participation in school-related extra-curricular activities; for those youth who have completed high school or who have achieved a high school diploma or GED, access to academic or vocational opportunities that will prepare them to lead self-sufficient lives. 
5. Nutritional – the provision or acquisition of food services to ensure healthy physical and emotional development, which is inclusive of the child’s religious, cultural, and health needs in accordance with the United States Department of Agriculture (USDA) guidelines for servings per child.
6. Spiritual/Cultural – awareness, sensitivity and competence in understanding the child’s and family’s religious values, belief system, mores, customs, training, social growth or development. 
7. Permanency – providing the child with continuous and guided interaction with family members and significant others for the purpose of transitioning the child back to the home and community and/or working to secure another permanent option for the child. Permanency planning begins during the admission process and continues through discharge.

The DFCS Office of Provider Management (OPM) is responsible for establishing and maintaining standards for child placing agency (CPA) foster family homes, child caring institutions (CCI), and Independent Living Programs which are reasonably in accord with recommended standards of national organizations concerned with standards for such institutions or homes, including standards related to admission policies, safety, sanitation, and protection of civil rights and which shall permit use of the reasonable and prudent parenting standard. The standards so established are applied by DFCS to any CPA foster family home or CCI receiving funds under Titles IV-E or IV-B. The standards shall require, as a condition of each contract entered into by a CCI to provide foster care, the presence on-site of at least one official who, with respect to any child placed at the CCI, is designated to be the caregiver who is authorized to apply the reasonable and prudent parent standard to decisions involving the participation of the child in age or developmentally-appropriate activities, and who is provided with training in how to use and apply the reasonable and prudent standard in the same manner as prospective foster parents are provided the training pursuant to paragraph 471(a)(24). 

The standards for foster family homes and CCIs shall include policies related to the liability of foster parents and private entities under contract by the State involving the application of the reasonable and prudent parent standard, to ensure appropriate liability for caregivers when a child participates in an approved activity and the caregiver approving the activity acts in accordance with the reasonable and prudent parent standard. DFCS may provide waivers of such standards only on a case-by-case basis for non-safety standards (as determined by DFCS) in relative foster family homes for specific children in care. 

In order for a child to be eligible for Title IV-E funding, the licensing file for a CCI must contain documentation which verifies that safety considerations with respect to the staff of the institution have been addressed. In order for a child to be eligible for title IV-E funding, the licensing file for a CCI must contain documentation which verifies that safety considerations with respect to the staff of the institution have been addressed. DFCS shall provide procedures for any CCI, including a group home, residential treatment center, shelter, or other congregate care setting, to conduct criminal record checks, including fingerprint-based checks of national crime information databases (as defined in section 534(f)(3)(A) of title 28, United States Code), and child abuse registry checks, on any adult working in a CCI, including a group home, residential treatment center, shelter, or other congregate care setting (see policy 19.8 Case Management: Criminal Records Checks and 19.9 Case Management: Safety Screenings).

RBWO providers contracted with DFCS adhere to a set of guiding principles outlined in the RBWO Minimum Standards. RBWO Minimum Standards are focused on securing positive permanency, health and education outcomes for children and on reducing risks to their welfare and safety. Providers shall aim to provide the best care possible for the children under their supervision. Observing the Minimum Standards is essential, but only a part of the overall responsibility to safeguard and promote the welfare of each individual child placed. The Minimum Standards are intended to be qualitative, in that they provide a tool for judging the quality of care provided and are also designed to be measurable. 

The OPM shall monitor RBWO providers against the Minimum Standards using annual comprehensive and random safety reviews. During monitoring visits, the OPM will look for evidence that the requirements are being met. Provider practices that exceed the requirements of the Minimum Standards will also be identified and documented in the OPM monitoring report. The following are the six broad areas comprising the Minimum Standards: 

1. Safety; 
2. Quality of care;
3. Permanency support; 
4. Family foster homes; 
5. Child caring institutions; and 
6. General administrative matters.

OPM may execute the following reviews of contracted CCIs/CPAs and Independent Living Programs (ILP) to ensure adherence to the high standard of care and contractual obligations: 

1. Annual Comprehensive Review (ACR) - an overall assessment of provider performance in the areas of safety, permanency and well-being; it is done to determine the provider’s compliance with RBWO Minimum Standards as well as DFCS policy. ACRs are conducted on each CCI and CPA at least annually without prior notice to the provider. However, the list of files selected for review is withheld until the actual ACR. ACRs can take approximately two to four days to complete depending on the size of the agency. The ACR includes: 
   1. Staff and/or foster parents and child record reviews; 
   2. Staff and/or foster parents and child interviews;
   3. Physical plant inspection;
   4. All service delivery aspects incorporating safety, permanency and well-being; and 
   5. Review of agency’s policies. 
2. Safety Review (SR) – conducted to assess and identify immediate safety issues within a CPA, CCI, or Independent Living Program (ILP) and ensure that the agency staff and/or foster parent(s) have the capacity and support needed to maintain the child’s safety. During a SR: 
   1. The family composition is assessed; 
   2. Children are interviewed; 
   3. Staff and/or foster parent(s) are interviewed; and 
   4. A walkthrough of the facility/home is conducted. A SR is designed to be employed randomly and frequently across all CCIs, CPAs, and ILPs. A SR may be used in response to risk and safety concerns instead of a full comprehensive review. A SR usually takes about 60 to 90 minutes to complete, and prior notice to the provider is not provided.
3. Foster Home Approval Review and Re-Evaluations – a random desk review of newly approved or re-approved foster homes. During this review, documentation is reviewed to determine if DFCS policies 14.10 Resource Development: Initial Family Evaluation and 14.13 Resource Development: Family Re-evaluation were followed during the approval or re-approval process (CPAs only). 
4. Performance Based Placement Review – a review of self-reported provider data in GA Shines. Self-reported data includes staff training, placement stability, sibling contacts, Health Checks (medical & dental visits), academic supports, every child every month (ECEM) visits and general contacts. This visit is announced. 
5. Safety Desk Check – A Safety Desk Check is conducted quarterly to review all safety screenings completed on employees of providers (i.e., Criminal Background (OIG), CPS History Check, Pardons and Parole, GA Sex Offender Registry and Department of Corrections).

Description of Program Types 

Child Caring Institution (CCI): 

A CCI is a private or public child care institution that accommodates no more than 25 children and is licensed by the State in which it is situated or has been approved by the agency of such State responsible for licensing or approval of institutions of this type as meeting the standards for approval except, in the case of a child who has attained 18 years of age, the term includes a supervised setting in which the individual is living independently. Children in Georgia age 18 and older are not eligible for Title IV-E funding. The definition of CCI for Title IV-E purposes may not include detention facilities, forestry camps, training schools or any other facility operated primarily for the detention of children who are determined to be delinquent. 

The children in CCIs are residing outside of their own home environment. These facilities provide care, supervision and oversight in a residential setting, including neighborhood-based group homes, campus-based arrangements and self-contained facilities. The CCI’s Human Service Professionals or Child Care Workers work as a team to provide a stabilizing and nurturing environment that breaks down barriers to support the child stepping down to a less restrictive environment. 

1. Maternity and Parenting Support Programs 
   1. Maternity Programs (MP) are specialized, RBWO programs established for the purpose of caring for pregnant youth 21 years of age or younger. Services may be provided by a CCI or CPA and include full-time residential care, support and supervision for more than one pregnant youth. Program providers who offer services in a residential setting must be licensed through Residential Child Care Licensing (RCCL) as a Maternity Home. A Maternity Home may provide services to pregnant youth, before, during or within two weeks after childbirth for a maximum period of eight weeks following delivery unless also providing Parenting Support Program (AKA Second Chance Home) services.
   2. Parenting Support Programs (PSP), also called Second Chance Homes, are specialized, adult supervised RBWO programs established for young mothers and their children. A PSP is a licensed maternity home that provides full-time residential care, support, and supervision to pregnant and parenting youth (21 years of age or younger) and their children. Services can be provided by a CCI or CPA (in a residential setting, supportive foster home, transitional or independent living environment) and are expected to last for more than an eight-week period following delivery. Program services help young mothers develop parenting skills and improve their knowledge of child development. Additionally, services assist with education, job training, family budgeting, health and nutrition, and transitioning to independent living. PSP providers who offer services in a residential setting must be licensed through RCCL as a Maternity Home and may serve no more than a total of 16 residents (i.e. parenting youth and their children).
2. Qualified Residential Treatment Program (QRTP) – a QRTP is a program that: 
   1. Has a trauma-informed treatment model that is designed to address the needs (including clinical needs as appropriate) of children with serious emotional or behavioral disorders or disturbances and, with respect to a child, is able to implement the treatment identified for the child by the assessment of the child required under section 475A(c) of the Social Security Act; 
   2. Has registered or licensed nursing staff and other licensed clinical staff who: 
      1. Provide care within the scope of their practice as defined by State law; 
      2. Are on-site according to the treatment model referred to in subparagraph (a); and 
      3. Are available 24 hours a day and 7 days a week; 
   3. To extent appropriate, and in accordance with the child’s best interests, facilitates participation of family members in the child’s treatment program; 
   4. Facilitates outreach to the family members of the child, including siblings, documents how the outreach is made (including contact information), and maintains contact information for any known biological family and fictive kin of the child; 
   5. Documents how family members are integrated into the treatment process for the child, including post-discharge, and how sibling connections are maintained; 
   6. Provides discharge planning and family-based aftercare support for at least six months post-discharge; and 

   7. Is licensed in accordance with section 471(a)(10) of the Social Security Act and is accredited by any of the following independent, not-for-profit organizations: 

      1. The Commission on Accreditation of Rehabilitation Facilities (CARF). 
      2. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). 
      3. The Council on Accreditation (COA). 
      4. Any other independent, not-for-profit accrediting organization approved by the Secretary of Health and Human Services. 

      NOTE: Georgia has not implemented QRTPs

3. Children’s Transition Care Center (CTCC) - provides a temporary, home-like environment for medically fragile children, technology-dependent children and children with special health care needs, who are deemed clinically stable by a physician but are dependent on life-sustaining medications, treatments and equipment. These children require assistance with activities of daily living to facilitate transitions from a hospital or other facility.
4. Outdoor Child Caring Program “Specialty” Camp (OCCP) - provides room, board and watchful oversight in a wilderness or camp environment that is designed to improve the emotional and behavioral adjustment of the children in care. The use of physical, environmental, athletic and other challenging activities is designed to improve the functioning of the children and to teach them pro-social and adaptive skills. 
5. Independent Living Program (ILP) – a specialized RBWO program for youth 18 through 21 years of age. ILP is different from transitional living in that youth may live in an alternative living arrangement (i.e., community-based housing) rather than a group home or other residential type facility. Independent living placements shall begin no earlier than a youth’s 18th birthday. Youth in ILP will experience “graduated independence” regarding program expectations, skill development and levels or types of supervision provided. The goal of an independent living placement is to prepare youth to become socially, emotionally and personally independent of social services while connecting them to life-long permanency connections and laying the foundation for the pursuit of educational and career opportunities. 
6. Transitional Living Program (TLP) - a specialized RBWO program for youth at least 16 years of age. Youth may be older than 18 years old if they have agreed to participate in the Extended Foster Care program. Transitional living is designed for youth who are ready to enter a phase of care that will eventually transition them to independent living. Transitional living affords youth an opportunity to practice basic independent living skills in a variety of settings with decreasing degrees of supervision. This specialized RBWO placement provides youth the opportunity to experience increased personal responsibility, so youth can become responsible for their own care when they exit foster care. The goal of a transitional living placement is to prepare youth to become socially, emotionally and personally independent of social services while connecting them to lifelong permanency connections and laying the foundation for the pursuit of educational and career opportunities.

Child Placing Agency (CPA): 

A CPA is an agency that places children in foster and adoptive homes for individualized care, supervision and oversight. CPAs are responsible for assessing the appropriateness of the room, board and watchful oversight that the prospective foster and adoptive families will provide. The CPA’s employees and their foster and adoptive parents work as a team to provide a stabilizing and nurturing environment that promotes safety, permanency and well-being. 

Foster Family Home 

A foster family home is the home of an individual or family approved as meeting the standards established by the State licensing or approval authority(ies) that provides 24-hour out-of-home care for children. The term may include group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care by DFCS. Foster families that are approved must be held to the same standards as foster family homes that are licensed. Anything less than full licensure or approval is insufficient for meeting Title IV-E eligibility requirements. A foster family home may be operated by a CCI or a CPA.