Therapeutic Foster Care for Children (TFC)

Active Treatment – The member is expected to be engaged in active treatment. This means services available at this level of care can reasonably be expected to:

• Improve the member’s condition in order to achieve discharge from the TFC at the earliest possible time, and
• Facilitate the member’s return to primarily outpatient care in a non-therapeutic/non-licensed setting.

Assessment - An analysis of the member’s needs for physical health services or behavioral health services to determine which services a health care institution shall provide to the member

Caregiver - An adult who provides for the physical, emotional and social needs of a child who is under their care, custody and control. Examples of caregivers include birth parent(s), foster parent(s), adoptive parent(s), kin or relative(s), group home staff. Caregivers can be licensed or unlicensed.

Child – An individual under the age of 18, unless the term is given a different definition by status, rule or policies adopted by AHCCCS.

Child and Family Team (CFT) - A defined group of individuals that includes, at a minimum, the child and his or her family, a behavioral health provider, and any individuals important in the child’s life that are identified and invited by the child and family to participate. The size, scope, and intensity of involvement of the team members are determined by the objectives established for the child, the needs of the family in providing for the child, and by who is needed to develop an effective service plan and can therefore expand and contract as necessary to be successful on behalf of the child.

Crisis Plan - A written plan established by the member that is designed to prevent or reduce the effects of a behavioral health crisis. This plan identifies what is or is not helpful in crisis prevention through the identification of contacts and resources, and actions to be taken by the member, family, parents, guardians, friends, or others.

Discharge Plan - During the development of the initial treatment plan, a comprehensive discharge plan is created and reviewed and updated at each treatment plan review thereafter. The discharge plan must document the following:

• Clinical status for discharge
• Member/guardian/designated representative and, CFT/ART/TRBHA as applicable, understands follow-up treatment, crisis and safety plan, and
• Coordination of care and transition planning are in process (e.g. reconciliation of medications, applications for lower level of care submitted, follow-up appointments made).

Individualized Service Plan (ISP) - A comprehensive written description of all covered health services and other informal supports which includes individualized goals, family support services, care coordination activities and strategies to assist the member in achieving an improved quality of life. The ISP is created and managed by the CFT. It is a dynamic document that is regularly updated to adequately match the strengths and needs of the member and family.

Informal Support - Non-billable services provided to a member by a family member, friend or volunteer to assist or perform functions such as, but not limited to, housekeeping, personal care, food preparation, shopping, pet care, or non-medical comfort measures.

Therapeutic Fost Care (TFC) – The TFC Agency Provider is credentialed by MCOs to oversee professional TFC Family Providers and holds contracts with pertinent health plans and/or DCS to provide TFC services to children.

Therapeutic Foster Care (TFC) Family Provider - Specially trained adult(s) in a family unit licensed by DCS and endorsed to provide TFC services to children. Also known as TFC Parent(s).

Therapeutic Foster Care (TFC) Treatment Plan – A plan that details the specific behavioral goals that the TFC Family and TFC Agency Providers will help the member achieve during member’s time in TFC. The TFC Treatment Plan are to:

• Be developed in conjunction with the CFT,
• Describe strategies to address TFC Family Provider needs and successful transition for the member to begin service with TFC Family Provider, including pre-service visits when appropriate as well as respite planning,
• Complement and not conflict with the ISP and other defined treatments, and include reference to the member’s
  • Current physical, emotional, behavioral health and developmental needs
  • Current educational placement and needs
  • Current medical treatment
  • Current behavioral treatment through other providers
  • Current prescribed medications
• Update the member’s current Crisis Plan to be in alignment with the TFC setting
• Address safety, social, and emotional well-being, discharge criteria, acknowledgement of member’s permanency objectives and post-discharge services,
• Include short-term, proactive treatment goals that are measurable, time-limited, and in keeping with the ISP,
• When age and developmentally appropriate, youth and biological, kinship, and adoptive family participation in development of the TFC Treatment Plan is required,
• Include specific elements that build on the members’ strengths, while also promoting pro-social, adaptive behaviors, interpersonal skills and relationships, community, family and cultural connections, self-care, daily living skills, and educational achievement,
• Include specifics to coordinate with natural supports and informal networks as a part of treatment,
• If the TFC Treatment Plan includes co-parenting engagement with the member’s Caregiver(s), specific goals shall be developed to prepare the receiving Caregiver(s) and successfully transition the member to the new placement,
• Include plans for engagement of the member’s biological family, kinship family, adoptive family, and/or transition foster family and other natural supports that can support the member during TFC placement and after transition,
• Include respite planning,
• Be reviewed by:
  • The TFC Family Provider and TFC Agency Provider at every home visit,
  • The TFC Agency Provider and Clinical Supervisor at each staffing, and
  • The TFC Agency Provider, and CFT at each revision or minimum quarterly.
• Include documentation of the TFC Treatment Plan which shall be kept by the TFC Family Provider and the TFC Agency Provider and shared with the CFT.

Treatment Outcomes - Treatment outcomes align with:

• The Arizona Vision-12 Principles for Children’s Behavioral Health Service Delivery as specified in, and
• The member’s individualized physical, behavioral, and developmentally appropriate needs.

Treatment Goals – Treatment goals are:

• Specific to the member’s behavioral health condition that warranted treatment,
• Measurable and achievable,
• Cannot be met in a less restrictive environment,
• Based on the member’s unique needs,
• Include input from the member’s family/healthcare decision-maker and designated representative’s choices where applicable, and
• Support the member’s improved or sustained functioning and integration into the community. the member’s improved or sustained functioning and integration into the community.

Applicable To: Medicaid – Care1st Health Plan Arizona

Arizona Care1st

• Authorization requests for TFC are to be treated as expedited requests with a determination decision communicated to the provider within 72-hours of receipt of the request.
• Room and Board is not a covered service

Exclusionary Criteria

Admission to TFC is not be used as a substitute for the following:

• An alternative to detention or incarceration.
• As a means to ensure community safety in an individual exhibiting primarily conduct disordered behaviors.
• As a means of providing safe housing, shelter, supervision or permanency placement.
• As an alternative to parents’ / Health Care Decision Makers’ or other agencies’ capacity to provide for the member.
• A behavioral health intervention when other less restrictive alternatives are available and meet the member’s treatment needs, including situations when the member/Health Care Decision Maker is unwilling to participate in the less restrictive alternative, or
• An intervention for member runaway behaviors unrelated to a behavioral health condition.

Criteria for Admission

• There is evidence that the member’s Child and Family Team recommended TFC.
• There is evidence of an assessment by a licensed Behavioral Health Professional that indicates the member’s behavioral health diagnosis, and symptoms and behaviors that necessitate TFC placement.
• There is evidence that – within the last 90 days - the member has had a disturbance of mood, thought or behavior that has a moderate impairment of functional and/or psychosocial abilities, such that the member is incapable of independent or age-appropriate self-care or self-regulation.
  • This disturbance shall be due to the assessed behavioral health condition in item 2.
  • This functional and/or psychosocial impairment is such that (a and b, or c):
    • It cannot be reasonably expected to improve in response to a less intensive level of care, and
    • Does not require or meet clinical criteria for a higher level of care, OR
    • Demonstrates that appropriate treatment in a less restrictive environment has not been successful or is not available, therefore warranting a higher level of care.
• There are documented plans at admission for discharge and transition which include:
  • Participation of Health Care Decision Maker and all stakeholders,
  • Identified tentative disposition/living arrangements, and
  • Recommendations for aftercare treatment based upon treatment goals.

Criteria for Continued Stay

• All of the following must be met for continued stay:
  • The member continues to meet the diagnostic threshold for the behavioral health condition that warranted admission to TFC.
  • It is expected that continued treatment at the TFC will result in improvements to the member’s condition, such that, this type of service shall no longer be needed, and
  • There is evidence of the following:
    • The CFT is meeting at least monthly to review progress.
    • The CFT has revised the TFC Treatment Plan and Individualized Service Plan (ISP) to respond to any lack of progress, and
    • The Caregiver to whom the member shall be transitioned to after discharge from a TFC has been identified and is actively involved in the member’s care/treatment, if applicable.
• In addition, all of the following shall be met for continued stay:
  • The member continues to demonstrate (within the last 90 days) moderate functional or psychosocial impairment as a result of the behavioral health condition, as identified through disturbances of mood, thought, or behavior, which substantially impairs independent or age appropriate self-care or self-regulation,
  • Active treatment is reducing the severity of disturbances of mood, thought, or behaviors, which were identified as reasons for admission to TFC, and
  • Treatment at the TFC is empowering the member to gain skills to successfully function in the community.
  • Active discharge planning is evident including
    • Evidence of discharge planning details in the TFC Treatment Plan
    • Evidence of monthly CFT review and update of the treatment plan
    • Evidence that the Health Care Decision Maker is identified and involved in discharge planning
    • Evidence of engagement of receiving Caregiver(s) to participate in transitionary visits.
    • Evidence that the receiving Caregiver(s) is provided with appropriate coaching and mentorship

Criteria for Discharge

• Sufficient symptom or behavior relief has been achieved, as evidenced by, completion of the TFC treatment goals.
• The member’s functional capacity is improved, and the member can be safely cared for in a less restrictive level of care.
• The member can participate in needed monitoring and follow-up services, or a Caregiver is available to provide monitoring in a less restrictive level of care.
• Appropriate services, providers, and supports are available to meet the member’s current behavioral health needs at a less restrictive level of care.
• There is no evidence to indicate that continued treatment in TFC would improve member’s clinical outcome.
• There is potential risk that continued stay in TFC may precipitate regression or decompensation of member’s condition.
• A current clinical assessment of the member’s symptoms, behaviors, and treatment needs has been reviewed by the CFT and has established that continued care in TFC is setting no longer adequate to provide for the safety and treatment. The CFT will then discuss if a higher level of care is necessary. In the event that the member has not been successful in TFC and the decision is made to move the member to a higher level of care, the TFC Family Provider and TFC Agency Provider in collaboration with the CFT will work to make this transition as seamless as possible

References:

Arizona Health Care Cost Containment System Medical Policy Manual (AMPM) Policy 100-AHCCCS Medical Policy Manual Overview.

Arizona Health Care Cost Containment System Medical Policy Manual (AMPM) Chapter 320-W-Therapeutic Foster Care for Children.

Medical Policy Committee History and Revisions:

Therapeutic Foster Care for Children (TFC)
Original Effective Date: 12/2020
Revised Date(s): 12/2021