Statewide Rollout of Therapeutic Foster Care Will Complete the Third and Final Service Component of the Longstanding Katie A. Reform Lawsuit
California took its first step towards implementing a new intensive community-based mental health service for children and youth with serious mental health needs. Earlier this month, the California Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) issued an information notice providing initial guidance to counties about how to rollout Therapeutic Foster Care (TFC), an intensive and highly coordinated short-term treatment for children with complex emotional and behavioral needs. County Mental Health Plans are expected to start delivering TFC services to youth starting January 1, 2017 through the Medi-Cal Specialty Mental Health Services (SMHS) program.
Therapeutic Foster Care is a specialized mental health treatment for young people with complex emotional and behavioral needs who require more intensive support. Delivered in a family setting using specially trained foster parents, TFC provides a home-based alternative to more restrictive institutional settings, such as hospitals and group homes. TFC services allow young people to receive intensive treatment and improve their overall functioning and wellbeing while remaining in a community setting.
Implementation of this long awaited service will complete the full trio of intensive mental health treatments and supports known as “Katie A. services,” named after the 2002 class action lawsuit that lead to their development in California. In addition to TFC, this service array includes Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS). Together, these services are designed to help youth with more intensive mental health needs succeed in their own homes and communities, avoiding unnecessary hospitalizations or out-of-home placements in facilities far away from their families.
The State’s most recent information notice provides the first round of instructions for counties on TFC’s service definition and treatment components, provider qualifications, payment methodology, and agency responsibilities. Key highlights include:
- Service Definition: TFC is a short-term, intensive, and highly coordinated rehabilitative service that is both individualized to a young person’s needs and delivered according the principles of trauma informed care. TFC provides a home-based alternative to young people who might otherwise be placed in more restrictive institutional settings. Youth receiving TFC services are placed with specially trained foster parents who are intensely supervised and supported by mental health clinicians. Working closely with these clinicians, TFC foster parents help create a family-based therapeutic treatment environment that more effectively allows a young person to develop, practice, and improve their functional skills, such as self-care, self-management and/or peer relations, among others.
- Eligibility Criteria: TFC services are available to Medi-Cal eligible youth with complex emotional and behavioral needs who require intensive and frequent mental health support in a one-on-one environment. DHCS is in the process of finalizing more specific eligibility for this treatment.
- Foster Parents: To qualify to provide this service, TFC parents must not only meet the child welfare system’s requirements for foster parents, but also receive extensive training on therapeutic foster parenting. This training will likely include at least 40 hours of initial training and 24 hours of annual ongoing training.
- Coordination with Clinician and Child & Family Team: TFC parents will provide therapeutic services under the direction and supervision of a Licensed Mental Health Professional. In addition, TFC parents will participate as members of the young person’s Child & Family Team (CFT) to help develop a mental health care plan and continue to consult with fellow CFT members to implement needed mental health interventions.
- Service Limits: Medi-Cal reimbursement for TFC services is limited to payment for therapeutic services. TFC services do not cover reimbursement for the cost of room and board or other foster care program related services, which are paid separately using federal, state, or local foster care funding sources.
DHCS and DSS are continuing to work with stakeholders and experts to finalize more specific guidance on California’s TFC model and its key service components. Initial drafts of the TFC Model and TFC Services Parent Qualifications were included with the initial information notice. Additional guidance is expected from both state agencies before TFC services become available on January 1, 2017.
Therapeutic Foster Care and other Katie A. services give youth with serious mental health needs an opportunity to receive intensive treatment in their own communities and avoid the damaging effects of unnecessary institutionalization. Katie A. services help provide young people better life outcomes – better school performance, less involvement with police and the courts, more satisfying relationships – and less disruption, a fact affirmed by research and practice nationwide.