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Exhibit 18: Tennessee Contact: Odessa Krech, Program Director (615)253-6906 Daphne Billingsley, IV-B Program Manager (615)532-5539 [email protected] Useful Links: Tennessee General Assembly: http://www.legislature.state.tn.us/ Department of Children’s Services: http://www.state.tn.us/youth/fostercare.htm Attached Documents: House Bill 3114: Bill Summary Administrative Policies & Procedures 16.39: Subsidized Permanent Guardianship Administrative Policies & Procedures 16.4: Resource Home Approval

Exhibit 18: Tennessee - University of South Floridacenterforchildwelfare.fmhi.usf.edu/kb/PFFC/Exhibit 18 - Tennessee.pdf · Complete CS-0916,Subsidized Permanent Guardianship (SPG)

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Exhibit 18: Tennessee

Contact:

Odessa Krech, Program Director

(615)253-6906

Daphne Billingsley, IV-B Program Manager

(615)532-5539

[email protected]

Useful Links:

Tennessee General Assembly:

http://www.legislature.state.tn.us/

Department of Children’s Services:

http://www.state.tn.us/youth/fostercare.htm

Attached Documents:

House Bill 3114: Bill Summary

Administrative Policies & Procedures 16.39: Subsidized Permanent Guardianship

Administrative Policies & Procedures 16.4: Resource Home Approval

BILL SUMMARY

*HB 3114 BY *JONES S, GILMORE, RICHARDSON,HARDAWAY, TOWNS, COOPER B. (SB 3101 BY*MARRERO B, BARNES, BEAVERS, BERKE, BLACK, BUNCH,BURCHETT, BURKS, CROWE, FAULK, FINNEY L, FORD, O.,GRESHAM, HARPER, HAYNES, HENRY, HERRON, JACKSON,JOHNSON, KELSEY, KETRON, KYLE, MCNALLY, NORRIS,OVERBEY, SOUTHERLAND, STEWART, TATE, TRACY,WATSON, WOODSON, YAGER, RAMSEY.)

Fiscal Summary

Bill Summary

Page 1 of 4Bill Summary

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State of Tennessee Department of Children’s Services

Administrative Policies and Procedures: 16.39

Subject: Subsidized Permanent Guardianship

Authority: Fostering Connections to Success and Increasing Adoptions Act 2008 (P.L. 110-351), TCA 37-5-106, 37-1-801 et seq.

Standards: DCS 2-102 A, 2-104 A, 2-501, 2-600

Application: All Department of Children’s Services Family Service Workers, Permanency Specialists and Supervisory Staff

Policy Statement: Children who meet the eligibility criteria for Subsidized Permanent Guardianship under the Fostering Connections to Success and Increasing Adoptions Act 2008 (P.L 110-351) can receive a subsidy, based on the documentation of eligibility, so long as funds are available.

Purpose:Subsidized Permanent Guardianship monthly maintenance payments help defray some of the cost of caring for a child. It should be utilized to meet the child’s needs. This policy is to inform staff and guardians of the basic eligibility criteria, the process of applying for Subsidized Permanent Guardianship, and maintaining the Subsidized Permanent Guardianship payments.

Procedures:A child is eligible for a Subsidized Guardianship assistance payment if the DCS determines that:

A. Criteria for SubsidizedPermanentGuardianship Eligibility

1. The child has been removed from his or her home pursuant to a voluntary placement agreement or as a result of a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child;

and

2. The prospective guardian must complete all requirements as outlined in DCS policy 16.4, Resource Home Approval .

3. The child is eligible and reimbursable for Title IV-E foster care maintenance payments as outlined in DCS policy 16.36, Title IV-E Foster Care Funds,while residing for at least 6 consecutive months in the approved home of the prospective guardian.

Original Effective Date: 05/01/07 Page 1 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39,10/15/09 CS-0001 RDA S1615

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 2 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

4. Being returned home or adopted are not appropriate permanency options for the child.

5. The child demonstrates a strong attachment to the prospective guardian and the guardian has a strong commitment to caring permanently for the child.

6. Although a child of any age may be placed in permanent guardianship, a child who has attained 14 years of age must be consulted regarding the Permanent Subsidized Guardianship arrangement.

7. If it is determined that Permanent Guardianship is the appropriate goal and that the child and the prospective guardian are eligible for a subsidy, the case plan must include the components outlined in the Protocol forSubsidized Permanent Guardianship Case Planning and Policy 16.31, Permanency Planning for Children/Youth in the Department of Children’s Services Custody.

B. Determining Funding Source

Any child who is not eligible for Subsidized Permanent Guardianship Title IV-E funding, but was in the custody or guardianship of TN DCS immediately prior to the initiation of the guardianship proceedings may be eligible for Subsidized Permanent Guardianship through Tennessee State funding.

Note: A child’s Subsidized Permanent Guardianship funding source will be determined by the completion of form CS-0917, Certification of Eligibility for Subsidized Permanent Guardianship.

C. Subsidized PermanentGuardianship Request Process

1. Complete CS-0916, Subsidized Permanent Guardianship (SPG) Checklist and Approval, three weeks prior to the child/youth exiting custody to Permanent Guardianship. This step is necessary to confirm that the child’s/youth’s eligibility criteria is met.

2. Documentation must be gathered and reviewed with the potential guardian(s) in order to determine the child’s eligibility for Subsidized Permanent Guardianship.

3. If a Special or Extraordinary Rate is being requested, the documentation must include a statement from the child’s physician or treatment professional that provides the diagnosis and prognosis and identifies any current treatment being provided.

4. The Permanency Specialist with the Family Service Worker (FSW) or the Private Provider Representative gathers their initial supporting documentation in order to complete special or extraordinary rate requests.

5. During the initial Subsidized Permanent Guardianship negotiation, the following information must be explained to the prospective guardian(s):

a) All known medical/psychological/psychiatric needs of the child.

b) If the parent elects not to cover the child under available group family plan, TennCare will be the only available payment option for medically necessary expenses.

c) Title IV-E children who subsequently transition into the SubsidizedPermanent Guardianship (SPG) Program are categorically eligible for Medicaid.

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 3 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

d) Children receiving Subsidized Permanent Guardianship through state funding may be eligible for TennCare or successor plan in Tennessee if the child has medical or rehabilitative needs. Children receiving Subsidized Permanent Guardianship through state funding may be eligible for Medicaid if residing outside Tennessee depending on the regulations of that state.

e) Subsidized Permanent Guardianship will not pay medical, psychological, psychiatric, dental, hospitalization, residential treatment services or for medical equipment for a child who is eligible for private insurance or TennCare/Medicaid. In cases where such services are paid, the amount will be based on the TennCare rate for that service.

6. Following the documentation review and discussion, during the child’s CFTM (refer to the CFTM Summary in policy 16.31, Permanency Planning for Children/Youth in the Department of Children’s Services Custody), regarding the child’s current status if the child meets eligibility, and if the family agrees to continue the process, they will work with the permanency specialist to complete Intent to Obtain Permanent Guardianship/ Subsidized Permanent Guardianship Application, form CS-0719. This form will solidify the family’s intention to provide permanence through permanent guardianship for the child, allow them to request a subsidy, and will inform them of the proposed Subsidized Permanent Guardianship benefits prior to the transfer of guardianship.

8. In cases where a child’s needs are beyond the scope of a regular rate, a Special or Extraordinary Board Rates Request, form CS-0674 must also be presented with form CS-0719,Intent to Obtain Permanent Guardianship Placement Agreement ( Part 1) and Application for Subsidized Permanent Guardianship (Part2).

9. During the Subsidized Permanent Guardianship negotiation process, if the child is determined to be Title IV-E eligible, he or she will be qualified for the state sponsored insurance plan (i.e., TennCare) (see Criteria for AuthorizingTennCare). If the child is not Title IV-E eligible, he or she may qualify for TennCare according to the current Medicaid eligibility rules.

D. Subsidized PermanentGuardianship Agreement

1. The initial Subsidized Permanent Guardianship Agreement, form CS-0721, must be completed without leaving blank spaces using N/A as appropriate. It must also be reviewed, approved and signed by the TeamCoordinator of the Permanency Specialist. The Permanency Specialist’s Team Leader may sign all revisions or renewal/renegotiations.

2. Services for treatment related to a diagnosis documented prior to transfer of guardianship will be included in the initial agreement with a notation under cost as “TennCare or successor plan rate.”

3. The Permanency Specialist will review the Subsidized Permanent Guardianship Agreement, form CS-0721, with the guardian(s) and secure their signature prior to transfer of guardianship. The information on this form will include rates to be paid for the conditions discussed during the negotiation period and approved on form CS-0719, Intent to Obtain Permanent Guardianship Placement Agreement (Part 1) and

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 4 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

Application for Subsidized Permanent Guardianship ( Part 2). 4. All Subsidized Permanent Guardianship Agreements must be completed

prior to the transfer of guardianship. Subsidized Permanent Guardianship payments can begin following the transfer of guardianship and cannot be made prior to that time. The family will receive foster care board payments until the transfer of guardianship occurs.

5. Subsidized Permanent Guardianship payments are made monthly based on a daily payment amount for the previous month’s care.

6. Subsidized Permanent Guardianship Assistance payments made on behalf of a child shall not exceed the foster care maintenance payment which would have been paid on behalf of the child if the child had remained in a foster family home.

7. In cases where siblings are placed in the guardianship of the same family, assistance payments may be paid on behalf of each sibling so placed.

8. Subsidized Guardianship applications or Subsidized Guardianship agreements must be signed by the appropriate DCS staff in order to be valid.

9. The child’s guardian(s) will receive a copy of the Subsidized Permanent Guardianship Agreement after all appropriate approval signatures have been obtained.

10. Once approved, the Subsidized Guardianship agreement will remain in effect without regard to the state residency of the legal guardian, so long as the guardianship remains in effect or has not been terminated for another reason.

E. Payments and Services included in SubsidizedPermanentGuardianship

1. Payments and/or services included in the Subsidized Permanent Guardianship agreement will be based on the conditions that are supported by the accompanying documentation.

2. A statement from the treatment professional must be obtained documenting that treatment is medically necessary when requesting a Special or Extraordinary rate.

3. When the child is ineligible for private insurance and TennCare (Medicaid), the state will ensure the maximum TennCare payment rate.

4. If the state does not have a contract with the provider, the maximum payment for the service will be the TennCare (Medicaid) rate for that service.

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 5 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

F. Payments and Services Not Included in SubsidizedPermanentGuardianship

The following items or services cannot be considered in determining the Subsidized Permanent Guardianship rate if a Special or Extraordinary rate is being requested:

a) School Tuition and/or tutoring,

b) Summer Camp or Day Care,

c) Riding Therapy, Dance or Gymnastics,

d) Computers and/or Computer Software

(Exceptions may made be made for severely handicapped children by the Director of Foster Care and Adoptions)

e) Dentistry or Orthodontia

(Exceptions may be made for documented cases of medical necessity by the Director of Foster Care and Adoptions)

f) Vehicles to transport children

g) Major Home Renovations

(i.e. fences, pools, extra rooms, or accessibility modifications)

h) Routine medical expenses

(i.e. Over the counter medications, doctor visits or hospitalizations unrelated to the child’s documented special needs)

G. Subsidized PermanentGuardianship Rates

1. The Subsidized Permanent Guardianship Rates are categorized in three levels:

a) The Regular Subsidized Permanent Guardianship Rate-Check the following web link for the most current Subsidized Permanent Guardianship daily rate:http://www.intranet.state.tn.us/chldserv/AssistanceRatesChangeNotice.htm

b) The Special Circumstance Subsidized Permanent Guardianship Rate-Check the following web link for the most current Subsidized Permanent Guardianship daily rate:http://www.intranet.state.tn.us/chldserv/AssistanceRatesChangeNotice.htm

c) The Extraordinary Subsidized Permanent Guardianship Rates are determined on a case-by-case basis, but do not exceed $60.00 per day.

2. Each rate is negotiated, based on the age of the child and a review of the child’s documented level of need, and are not linked to the means of the resource family. The Subsidized Guardianship rate may not exceed the amount of a child’s final or most recent resource home board rate payment.

3. Any approved Subsidized Permanent Guardianship will be paid according to the terms outlined in Subsidized Permanent Guardianship Agreement, form CS-0721, subject to funding availability and may be modified at the annual renewal/renegotiation based on changes in policy or significant

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 6 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

changes in the child’s circumstances.

H. Regular Rates 1. The regular rate is available to any child who meets the criteria outlined in Section A of the procedural portion of this policy.

2. If there are significant changes in the child’s circumstances and the family wishes to request a different rate, the steps outlined for the special or extraordinary rates must be completed (Section N of this policy).

I. Special Circumstance SubsidizedPermanentGuardianship Rates

1. Special Circumstance Rates are designed for the children with unique needs due to a diagnosed medical or mental health condition or a child who requires a level of supervision exceeding that of his/her peers or extra care due to physical, emotional, or mental handicaps. Children with special behavioral problems or alcohol and drug issues may also be eligible.

2. Permanency Specialists must complete Section A of the Special or Extraordinary Board Rates Request, form CS-0674 and submit it to the team coordinator if the child is currently receiving this rate and it is being requested for Subsidized Permanent Guardianship.

3. If the child is residing in a Private Provider resource home and the family requests approval of the special circumstance rate, the Private Provider representative, in collaboration with the Permanency Specialist, must complete the form CS-0674,Special or Extraordinary Rate Request and submit it, along with supporting documentation from the treating professional involved with the child. The request must include proof of the rate the Private Provider pays the resource parent.

4. The team coordinator shall within five (5) working days respond in writing to the request. If approved, a copy of the approval, along with the supporting documentation must be filed in the child’s Subsidized Permanent Guardianship case file.

5. The Central Office Review Committee is available to provide assistance in cases where negotiations have reached an impasse at the regional level. Regional staff is encouraged to participate in the discussions with the CentralOffice Review Committee when such cases occur. Once the request for assistance is received in Central Office, the committee should convene within seven working days.

J. Extraordinary SubsidizedPermanentGuardianship Rates

1. Extraordinary Subsidized Permanent Guardianship rates are reserved for children whose needs are so unique and extensive that they cannot be met at the regular or special circumstance rate. The Permanency Specialist may submit a request to the Regional Administrator/designee for an extraordinary rate if the child is currently receiving this rate and the rate is being requested for Subsidized Permanent Guardianship. The Regional Administrator/designee will work with the Regional Health Units regarding children who may meet criteria, as outlined in the scope of services, for medically fragile.

2. The request must be made in writing to The Regional Administrator/designee, utilizing the Special or Extraordinary Board Rates Request, form CS-0674, and attaching medical and/or psychological documentation, as well as a functional assessment and/or any additional material needed to adequately

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 7 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

describe the child’s condition.

3. If the child is residing in a Private Provider resource home, the Private Provider Representative, in collaboration with the Permanency Specialist, must submit the request, form CS-0674, Special or Extraordinary Rate Request and supporting documentation to the Regional Administrator/designee responsible for approving Subsidized Permanent Guardianship. The request must include proof of the rate the Private Provider pays the resource parent.

4. The Regional Administrator/designee shall review the request for a special/extraordinary rate within five (5) days of receipt;

a) The Office of Foster Care and Adoption will provide updated rate codes to the Permanency Specialist and Private Provider Representative, so they may proceed with the regional process for contract completion.

b) A copy of the approval, along with the supporting documentation must be filed in the child’s Subsidized Permanent Guardianship case file.

c) Final rate determination is completed at Central Office.

5. An eligibility determination for an Extraordinary Resource Home Board Rate does not guarantee eligibility for an Extraordinary Subsidized Permanent Guardianship Rate. Only after a review of the current documentation presented with form CS-0674, Special or Extraordinary Rate Request willit be possible to determine the appropriate Subsidized Permanent Guardianship rate.

6. A permanent guardian may request re-negotiation of the Subsidized Permanent Guardianship rate at any point after the initial approval, if the child’s needs have changed. When the parent requests an increase in the Subsidized Permanent Guardianship rate, they must be informed that current medical/psychological documentation must be provided. The documentation must be reviewed to determine if the current level of assistance is still appropriate. This review is both at the regional level and subsequently at the Central Office level.

K. Non-Recurring SubsidizedPermanentGuardianship Assistance

1. Funding for non-recurring expenses related to obtaining legal guardianship is available to any child who meets the eligibility criteria outlined in Section A of the procedural portion of this policy. Non-recurring expenses can be paid only one time up to a maximum total of $2,000.00 per child.

2. Once the documentation of the non-recurring costs is received, the Permanency Specialist will verify the expenses and enter them onto Part 2 of DCS form CS-0719, Intent to Obtain Permanent Guardianship Placement Agreement Part1) and Application for Subsidized Permanent Guardianship (Part2).

L. SubsidizedPermanentGuardianship

1. Renewal/renegotiation of Subsidized Permanent Guardianship is required annually in order for Subsidized Permanent Guardianship, paid at any rate, to continue. The resource parents must return a completed Subsidized

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 8 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

Revisions or Renewal/ Renegotiations

Permanent Guardianship Renewal Affidavit, form CS-0722 within the timeframes outlined in form CS-0721, Subsidized Permanent Guardianship Agreement.

2. Revisions may be requested at any time that there is a significant change in the child’s circumstance and the permanent guardian can provide the required/requested documentation.

3. For all children who are approved for a special or extraordinary Subsidized Permanent Guardianship rate, the permanent guardian must attach current documentation received from the service provider, in addition to form CS-0674,Special or Extraordinary Rate Request. This documentation must verify the following:

a) Current diagnosis, prognosis, and summary of treatment services for the previous year.

b) An estimated summary of services which will be necessary to meet the continued special or exceptionally uncommon needs of the child.

4. At the time of renewal, if the supporting documentation shows that the child’s condition has improved, the state shall work with the guardian to renegotiate the subsidy agreement to the age appropriate Subsidized Permanent Guardianship rate.

5. Renewal/renegotiation requests for special or extraordinary rates will revert to the age appropriate regular Subsidized Permanent Guardianship rate if or until the supporting documentation is submitted and approved; this is provided form CS-0722, Subsidized Permanent Guardianship Renewal Affidavit was returned completely and timely. Once the appropriate documentation is received, reviewed, and approved for a special or extraordinary rate, the identified rate can begin upon approval. No retroactive payments of the special or extraordinary rate amounts will be made.

6. Documentation of continued eligibility is required annually for children who receive Subsidized Permanent Guardianship at any rate. The Subsidized Permanent Guardianship payments granted at the time of renewal will reflect the child’s current, documented level of need.

M. Termination or Modification of SubsidizedPermanentGuardianship Agreements

Termination or modification of an approved Subsidized Permanent Guardianship will occur if any one of the following circumstances occur:

1. Upon the permanent guardian(s) request,

2. If the permanent guardian(s)’ legal responsibility to the child ends,

3. If the state determines that the child is no longer receiving financial support from the permanent guardian(s),

If a child is receiving Subsidized Permanent Guardianship and enters state custody, the agreement will be terminated until such time that the child is reunified with the permanent guardian (see Protocol for Subsidized Permanent Guardianship when Children Re-enter Care).

4. Upon the conclusion of the terms of the Subsidized Permanent Guardianship Agreement,

Subject: Subsidized Permanent Guardianship 16.39

Original Effective Date: 05/01/07 Page 9 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

5. If the child turns 18,

6. If the child marries,

7. If the child joins the military,

8. If the child dies

N. Appeals Permanent Guardian(s) may appeal the Department’s decision to deny, terminate or change their child’s Subsidized Permanent Guardianship in accordance with rules and procedures of the State’s fair hearing and appeal process. Permanent Guardian(s) must appeal an adverse decision within ten (10) business days of written notice of adverse action. Subsidized Permanent Guardianship may continue pending the determination of an appeal, but payments will be suspended for appeals filed for circumstances identified in section N above. Families who receive a favorable ruling in their hearing would be entitled to assistance that had been suspended. If adverse action is upheld during an appeal, payments continued during the appeal period will be considered an overpayment and will be subject to recovery. The following are the steps of the appeals process:

1. If the DCS determines that Subsidized Permanent Guardianship will be denied, terminated or changed, the Permanency Specialist or Subsidized Permanent Guardianship Designee must notify the resource family immediately, in writing, utilizing Notice of Denial Termination, or Change in Subsidized Permanent Guardianship form, CS-0720. An Appeal for Fair Hearing, form CS-0403 must be given to the guardian(s) at the same time the Notice of Denial, Termination, or Change in Subsidized Permanent Guardianship form CS-0720 is given.

2. The notice form, CS-0720, must be dated with the same date it is mailed or, if hand delivered, the date it is hand delivered to the family.

3. The Administrative Procedures Division must also be sent a copy of all notification documents that were provided to the family.

4. The family must be informed about the timeframe in which the have to file an appeal. They must also be provided with the fax number and the mailing address to send the Appeal for Fair Hearing, form CS-0403.

5. The Administrative Procedures Division will notify the appropriate county office if an appeal of Subsidized Permanent Guardianship is received. Once notified by the Administrative Procedures Division, the county must follow the direction of that office to ensure due process protocol is followed.

6. DCS staff must complete an appeal summary as directed by the Administrative Procedures Division.

7. Additional information may be accessed by contacting the TN DCS Administrative Procedures Division at:

1268 Foster Avenue, NIX 1 Nashville, TN 37243

Phone: # 615-741-1110 FAX: 615-741-4518

Subject: Subsidized Permanent Guardianship 16.39

O. Records Management

Complete information about a child’s/youth’s eligibility for Subsidized Permanent Guardianship, including requests, agreements, revisions, yearly renewals and closures must be maintained in a Subsidized Guardianship case file. Case file documentation must be uniform for all active Subsidized Guardianship cases see Protocol For Subsidized Permanent Guardianship Case File Contents).

P. Notification of Change

Guardian parents should notify the Permanency Specialist Designee in their region, or the Permanency Specialist, of any changes in circumstances as soon as possible. Changes in circumstances might include the following:

1. The guardian parent(s) will notify the Department immediately if they are no longer legally responsible for the child.

2. If the guardian parent(s) is no longer providing financial support for their child.

3. The guardian parent(s) will notify the Department of any change of address.

4. When the child marries.

5. When the child’s custodial status changes.

6. When the child dies.

7. When the child turns 18.

Forms: CS-0403 – Appeal for Fair HearingCS-0674 – Special or Extraordinary Board Rates RequestCS-0719 – Intent to Obtain Subsidized Permanent Guardianship Placement Agreement ( Part 1) and Application for Subsidized Permanent Guardianship ( Part 2)CS-0720 – Notice of Denial, Termination, or Change in Subsidized Permanent GuardianshipCS-0721 –Subsidized Permanent Guardianship Agreement CS-0722 –Subsidized Permanent Guardianship Renewal Affidavit CS-0916, Subsidized Permanent Guardianship (SPG)Checklist and ApprovalCS-0917- Certification of Eligibility for Subsidized Permanent GuardianshipSubstitute W-9

Original Effective Date: 05/01/07 Page 10 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

Subject: Subsidized Permanent Guardianship 16.39

CollateralDocuments:

Documentation to support the Subsidized Permanent Guardianship Agreement

Protocol for Subsidized Permanent Guardianship When Children Re-enter Care

Protocol For Subsidized Permanent Guardianship Case File Contents

Glossary:

Criteria For Authorizing TennCare

Protocol for Subsidized Permanent Guardianship Case Planning

This is a DCS term used to identify the position previously known as DCS Adoption Specialists. This person is principally responsible for preparing children and families for permanence through subsidy contracts negotiating and preparing Adoption Assistance, and maintaining technical knowledge of all permanency options.

PermanencySpecialist:

The rates established by TennCare (Medicaid) or any subsequent plan for a particular medically necessary service or treatment.

TennCare (or successor plan) Rate:

The legal guardian of a child with whom the child is related to by blood, marriage, or adoption or with whom the child had a significant relationship that pre-existed placement in DCS custody such as a godparent, friend, neighbor, church member or teacher.

Guardian:

Original Effective Date: 05/01/07 Page 11 of 11 Revision date: DCS 16.39, 01/01/10Supersedes: DCS 16.39, 10/15/09 CS-0001 RDA S1615

State of Tennessee Department of Children’s Services

Administrative Policies and Procedures: 16.4

Subject: Resource Home Approval

Authority: TCA 36-1-101–142, 36-1-201, 37-4-201 et seq., 37-5-105, 37-5-106, 39-17-316, Adam Walsh Child Protection and Safety Act of 2006 HR 4472, Adoption and Safe Families, P.L. 109-239, Safe and Timely Interstate Placement Act of Children in Foster Care Act of 2006 - P.L. 109-239, and the Social Security Act, Fostering Connections To Success and Increasing Adoptions Act of 2008 ( P.L. 110-351.

Standards: DCS 2-501, 2-502, 2-503, 2-602, 3-301, 3-102, 3-200, 3-201, 3-203, 3-204, 6-102, 6-200, 6-301, 6-505 B, 6-509 C, 6-513 C, 7-200 A, 7-203 A

Application: DCS Foster Care Staff and Supervisory Staff, Private Provider Agency Staff.

Policy Statement: The TN Department of Children’s Services (DCS) will accept applications to become a DCS resource parent from persons 21 years of age or older (relatives 18 years of age or older may be considered to become a resource parent for a sibling or other blood relative), married or single, who have been a legal resident of Tennessee for at least six (6) months and a United States citizen. Applicants may also haveLegal Permanent Resident Status that has been approved by the United States Citizenship and Immigration Service regardless of gender, race, color, or national origin. Approval is a mutual selection process and will be based on the applicant’s ability to meet specific approval requirements as well as their ability to promote the Department’s Standards of Professional Practice.

The TN Department of Children’s Services or a DCS Private Provider will also accept a referral/request on an identified TN resident submitted in compliance with the Interstate Compact on the Placement of Children (ICPC) as an application to become a resource parent for a specific child and apply this policy accordingly.

Purpose: If a child/youth must be separated from their family, DCS is committed to place children/youth with families capable of meeting their needs. DCS is also committed to making every effort to ensure prospective resource parents are able to provide safety, permanency and well-being and that these persons are fully prepared to serve in this capacity. Serving as a resource parent for children in Tennessee is a privilege, not a right.

Procedures: A. DCS Response to

ProspectiveResource Parents

1. All inquiries received should be responded to within seven (7) calendar days.

2. Resource home referrals submitted to the region through the InterstateCompact on the Placement of Children (ICPC) should be contacted or

Original Effective Date: DCS 16.4, 07/01/00 Current Effective Date: 10/15/09 Page 1 of 14 Supersedes: DCS 16.4,02/28/09 CS-0001 S1615

Subject: Resource Home Approval 16.4

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responded to by the assigned home study writer within seven (7) calendar days of the referrals entry into the current child welfare information system1.

3. Staff responding to inquiries or referrals will give interested families an overview of resource parenting, the home study process and approval requirements.

4. The documentation of the contact will be entered into the Resource Home Section in the current child welfare information system.

5. DCS or Private Provider staff members are responsible for assisting families in completing their application and initial paperwork during the Parents as Tender Healers (PATH) orientation session.

6. The vast majority of children entering the guardianship of the State of Tennessee are adopted by their resource parents and the Department wants to maintain that stability for those children who cannot return home.

There are older children in full guardianship with special needs for whom the Department seeks permanency. In these unique situations, DCS needs resource families expressing an interest (and are willing) in adoption. This engagement is to include resource families whose initial interest involved the placement of a child in the custody/guardianship/jurisdiction of another public agency pursuant to the Interstate Compact on the Placement of Children.

B. Orientation andParents as Tender Healers (PATH) Schedule

1. At a minimum, each DCS region should schedule and offer at least one PATH course no less than one time per month.

2. Private Providers should offer orientation meetings as often as necessary to maintain a pool of families sufficient to meet their contract requirements.

3. Although there can be no changes to the PATH curriculum, DCS staff and/or Private Provider staff must obtain approval, in writing, from the Regional Administrator (the Director of Foster Care and Adoptions may be consulted if necessary) if any of the following PATH training formats are needed to better meet the needs of the family:

a. Use of PATH training with one individual, rather than in a larger, group format.

b. Substitution of other approved training and past fostering experiences accepted as PATH equivalent.

4. For compliance with ICPC, copies of any waivers to modify any portion of PATH or the approval requirements must be submitted to the Executive Director of the Office of Child Permanency/designee and copied to the Deputy Compact Administrator of the Interstate Compact on the Placement of Children/designee. Any waiver requests and responses become part of the resource home study record/resource family case file, a copy of which is retained in the TN ICPC record.

5. For resource homes wanting to be re-activated or re-classified, the Protocolfor Re-Activation and Re-Classification of Resource Homes must be

1 NOTE: Currently, TNKids is the DCS child welfare information system and will be replaced by the new computer system “TFACTS” in the future. When TFACTS is fully implemented, all references to TNKids or “current child welfare information system”will mean TFACTS.

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followed.

C. Opportunities for the Consideration of Relative/Kinship Resource Home Approval

1. When seeking to approve a relative or kin as a resource parent, certain non-safety approval standards (Fostering Connections to Success and Increasing Adoptions Act (H.R. 6893/P.L. 110-351) may be taken into consideration on a case-by-case basis during the approval process.

These considerations may include, but not be limited to, the following:

Income standard

Minimum number of bedrooms per inhabitant

2. Other considerations may be identified that are not listed above and should be carefully reviewed prior to the placement of children. This is in accordance with the federal statute listed above

3. Private Providers may also utilize relative or kinship homes in this manner. In cases of a Private Provider wishing to utilize a relative or kinship home after taking certain approval requirements under consideration, the provider is solely responsible for the review and waiver of otherwise mandatory requirements. Private Providers may only utilize relative and kinship homes once they are fully approved.

D. Home Study Process

1. The home study process will begin with session one of PATH training. This involves the collection of the Resource Family Application for Parenting, CS-0688, the Authorization for Release of Information to DCS, CS-0668and the initial paperwork distributed during the orientation meeting.

2. The home study writer must conduct at least four (4) planned interviews with the prospective resource parents (three [3] if a lone applicant), including one (1) home consultation and individual interviews with each applicant. The interview process should begin immediately following PATH session three.

Note: Interviews with those adults (spouses, co-habitants, etc.) residing in the same home may be conducted during one visit. In other words, it is entirely possible that the four (4) required interviews could take place in three (3) visits if each adult inhabitant were interviewed separately in one visit.

3. Documentation of contacts by the home study writer identifying the progress and status of the study process will be entered on the Resource Home Recording Form, CS-0709 throughout the home study process and summarized in the home study narrative.

4. Each resource parent applicant and each member of the family must provide a medical report from a licensed physician, nurse practitioner or equivalent health care professional documenting the acceptable physical and emotional health of all household members, including freedom from communicable disease. Forms CS-0678, Resource Parent Medical Report and CS-0427,Child’s Medical Report may be used to document the applicant’s current medical status, as well as other adult, or child, household members.

Note: In cases where a child has had a physical examination for school, well-baby checks etc., within the last 12 months, the applicants may submit

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the documentation from that appointment, provided it speaks to the child being free of communicable disease.

5. Verifications of valid handgun carry permit, driver’s license, vehicle registration, current vehicle liability insurance, county vehicle inspection (if applicable), current marriage, any previous marriage annulments or divorces, births, adoptions and custody matters of children in the home, if applicable, must be provided. If the applicant is married, both members of the couple must be a party to the study process.

Note: Copies of valid driver’s license, (and if applicable; vehicle registration, current vehicle liability insurance, and proof of county vehicle inspection) must be obtained for any household member who might transport a child in care.

6. References must be obtained from three (3) individuals not related to the applicants, as well as one (1) relative reference from each of the applicants. The individuals providing references may not reside in the home of the applicants.

7. A decision on approval or denial regarding the home study should be made within ninety (90) days of the applicant’s completion of PATH and any additional required pre-service training for applicants to Private Provider agencies.

Exception: Pursuant to compliance with the Safe and Timely Interstate Placement of Children in Foster Care Act of 2006, the study, with a decision to approve or deny the resource home, should be issued within sixty (60) calendar days of the date of the ICPC referral.

8. If completion of the study or issuance of a decision regarding the ICPC resource home cannot meet the 60 day time line, the DCS home study writer or Private Provider agency personnel will document the reasons for the delay. They must also address action steps to be taken including a proposed date of completion in the current child welfare information system. Follow-up documentation must be included every 30 days until a decision is issued. Notice of the documentation is to be forwarded to the TN State Office, ICPC.

9. The home study approval date and the resource home approval date should be the same date. The decision regarding the home study is not valid until signed by the DCS Team Coordinator and Team Leader. The date the DCS Team Coordinator reviews and signs the home study is the official approval date.

10. In the case of Private Provider homes, the decision regarding the home study is not valid until signed by their Private Provider agency supervisor. The date the Private Provider agency supervisor reviews and signs the home study is the official approval date.

If approved, DCS or Private Provider staff shall:

a) Notify the applicants in writing using the Resource Parent Approval,CS-0702.

b) Enter the resource family into the ChiPFinS data system (DCS Only, excluding ICPC cases);

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c) Ensure the new resource home is entered into the resource home section of the current child welfare information system, including ICPC resource homes;

d) The REACT Family Entry Information Form, CS-0697 should be completed and placed in the case file when the resource parent(s) has expressed a willingness to adopt. This information should then be entered into the Resource Exchange for Adoptable Children in Tennessee (REACT) database, including ICPC resources.

11. DCS/Private Provider staff may not approve any applications that do not meet the standards outlined in this policy and DCS Policy 16.3, Desired Characteristics of Resource Parents. If a resource family is denied, the procedures outlined in DCS Policy 16.16, Denial or Closure of Resource Homes must be followed.

E. Mandatory Pre-Service Training

1. PATH should be co-led by DCS consortium or Private Provider staff person along with a trained DCS or Private Provider resource parent. Youth co-leaders should also be included in PATH Training Sessions five (5) and seven (7).

2. All resource parent applicants and/or any adults living in the household who will have a significant parenting role must complete PATH training.

3. A waiver request is not necessary for adults living in the resource home who have no significant parenting role. Clear documentation in the resource home record must be completed to explain why the individuals are exempt from the orientation session and PATH training and to justify the PATH waiver date recorded in the current child welfare information system.

4. Older birth or adopted children, and post custody children who are living in the home of the resource parents that turn eighteen (18) years old after the parents are approved, will not have to complete Parents as Tender Healers (PATH), unless they will have a significant parenting role.

5. Resource homes closed in good standing for less than two (2) years are not required to re-take initial PATH training. Those homes closed in good standing for a period in excess of two (2) years must re-take initial PATH training or some Departmentally-approved equivalent.

6. Those homes having completed PATH training but have remained in pending status for a period of more than one year must re-take PATH or some Departmentally-approved equivalent.

7. Please refer to the Protocol for Re-Activation or Re-Classification of Resource Homes when wishing to re-activate a home that has been closed regardless of the closure status.

8. Regions and Private Providers must consult with each other to exchange/share training and certification information.

9. In addition to the completion of PATH training, the following training must be completed prior to final approval as a resource parent:

CPR/First Aid (4 hours) non-certification class

Note: CPR certification due to employment (nurses, doctors,

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emergency medical personnel, etc,) can replace this requirement. The prospective resource parent must provide a copy of their current CPR/First Aid certification to the PATH trainer or the home study writer.

Medication Administration (4 hours)

Note: Medical personnel may take the modified version of Medication Administration for Medical Professionals provided by DCS nurses.

F. General Areas of Assessment

During the home study, the writer will assess at least the following areas with the applicants:

1. All areas outlined in DCS Policy 16.3, Desired Characteristics of Resource Parents,;

2. Understanding of core components of PATH;

3. Parenting strengths and abilities (see form CS-0895, Resource Family Strengths /Needs Checklist).

4. Resource home capacity (See DCS policy 16.46, Child/Youth Referral and Placement);

5. During the home consultation the writer must also assess safety and risk, documenting whether the prospective residence meets acceptable sanitary requirements utilizing the Home Safety Checklist, CS-0676. Although this list is not designed to be comprehensive, the following areas must beassessed and confirmed:

a) Physical facilities must meet the needs of children based on age, gender, sibling group status and any other special needs.

b) The residence is free of hazards.

c) The residence has an adequate water supply.

Applicants who rely on well water will need to provide documentation of its safety.

d) The residence has working toilet and bathroom facilities.

e) The residence has a working landline telephone.

f) The residence has adequate sewage disposal.

g) The residence has adequate sleeping space.

Unfinished attics, basements, hallways or other outbuildings may not be used as sleeping rooms.

Children should have their own bed.

It is preferable that no more than two (2) children share a sleeping room. Exceptions may be granted, in writing, by the Team Leader or Private Provider supervisory staff, if it becomes necessary for more than two (2) children to share a sleeping room.

Children three (3) years of age or older may not share the

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bedroom of the resource parent(s) except for brief periods of illness or emotional distress.

Children of the opposite sex shall not be allowed to share sleeping rooms, except in the case siblings where all siblings are age four (4) years old or under.

h) The residence has adequate storage space.

Individual space must be provided for each child’s personal possessions.

6. All family pets must be vaccinated as required by law. Documentation isrequired to verify that the vaccination is current.

7. The exterior of the residence must be inspected for hazards.

8. Resource parents who are gun owners must adhere to the following:

a. Resource Parents in possession of a Hand Gun Carry permit as per TN CODE ANNOTATED: 39-17-316 should provide DCS/Private Provider staff with a photo copy of the permit for the Resource Home File.

Each permit carrier will be responsible for the continual authorization of the permit every four (4) years.

The permit holder will provide DCS/Private Provide staff with a copy of the gun permit at time of renewal.

Resource Parents who do possess a Hand Gun Permit and choose to carry a weapon in the presence of the children in their care are expected to exercise extreme caution at all times.

Note: Refer to DCS Form CS-0670, Resource Parent Oath to Abide.

b. All firearms, bows and arrows, hunting knives and weapons of any variety must be housed and locked in a secure gun cabinet or other secure storage facility. Gun cabinets with glass enclosures or glass doors are not appropriate, unless specifically designed for the purpose of weapons display. Keys to the gun cabinet must be secured in a separate location. Trigger locks must be utilized on all firearms. Ammunition must be stored and locked separately.

9. Swimming pools must be secured in accordance with city and/or county safety ordinances.

G. Fire Safety 1. Prior to approval, resource homes must contain the following:

a) UL-approved, operational smoke detectors, and carbon monoxide detectors on every level of the home;

Smoke detectors and carbon monoxide detectors where children sleep are to be located in the child’s bedroom, or in the hallway adjacent to the child’s bedroom.

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b) A functioning fire extinguisher for each floor of the residence.

2. Applicants must prepare a floor plan of their home which identifies the location of all smoke detectors, carbon monoxide detectors and fire extinguishers and illustrates evacuation routes in case there is a fire in the home. This plan should be posted in a prominent location once the home is approved.

3. The home study writer may provide assistance in creating the floor plan. The home study writer will discuss a fire drill plan with the applicants during the home study process. Fire drill plan discussion should include:

a) How fire drills might be conducted in the family home;

b) How each family member would be made aware of the plan;

c) The location where all families members would meet after the home is evacuated;

d) Emergency phone numbers; and,

e) How family members with special needs might be assisted.

H. Assessment of Relationships

1. The home study writer must assess the quality of an applicant’s current and past relationships. The study must include an assessment of the prospective resource parent’s ability to build and maintain trusting and stable relationships with persons including their own children, family members, friends and others significant to the applicant. This assessment must include the following:

a) Reading the SAFE Questionnaire or resource parent’s autobiography;

b) PATH training;

c) Face to face interviews; and,

d) Contacting the references.

2. Significant relationships should be assessed based on duration as well as the number of relationships over time.

3. A conversation should be held with each member of the household to assess their attitude about sharing their home with children from the child welfare system.

4. A summary of these conversations must be included in the study narrative.

I. Background and Criminal Records Clearance

1. All adult household members must complete an Authorization for Release of Information to DCS, CS-0668 by the conclusion of the first PATH session. Criminal background checks must begin immediately following session one of PATH.

2. A criminal background check to include local Law Enforcement Agency records, TBI/FBI fingerprinting, an internet records check (see form CS-0687,Internet Records Clearance with results attached) and a DCS records review must be completed on each applicant. These checks must also beconducted for any other adult member of the household, and must also be documented in the resource home case record (see form CS-0845,Background Checklist and Results Summary) with results attached. Any changes identified from this search for which there is no disposition must be

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clarified by obtaining additional documentation from the court of jurisdiction.

3. All adults in the home must have the criminal records check include not only the current residence but extend to all residences for each individual for the previous five (5) years.

4. No applicant may be approved or waiver request made for anyone who has a felony conviction involving:

a) Child Abuse or Neglect;

b) Spousal Abuse;

c) A crime against a child or children (Including Child Pornography); or,

d) A crime involving violence including rape, sexual assault, or homicide.

5. No applicant may be approved or waiver request made for anyone who has a felony conviction in the last five years involving:

a) Physical Assault;

b) Battery; or,

c) A drug/alcohol related offense

6. Persons with other types of criminal charges/convictions may be considered as resource parents within the following parameters:

a) The conviction must not be for any of the criminal charges listed in paragraphs 4 or 5 above;

b) The conviction must have occurred at least five (5) years prior to the prospective resource parent applicant’s approval date with each offense addressed in detail within the home study;

c) Refer to Protocol for Requesting a Waiver of Criminal Charges/Convictions and complete Waiver of Criminal Charges/Convictions, DCS Form CS-0921.

7. An Internet Records Clearance, CS-0687, must be completed for all household members age eighteen (18) years or older which includes the following:

a) A Methamphetamine Offender Registry Clearance must be conducted for the prospective caregiver(s) and all adult household members using the Internet. The Internet Website address is: http://www.tennesseeanytime.org/methor

b) A Tennessee Sexual Offender Registry Clearance must be conducted for the prospective caregiver(s) and all adult household members using the Internet. The Website address for a TN search is: http://www.ticic.state.tn.us/SEX_ofndr/search_short.asp.

c) A National Sexual Offender Registry Clearance must be conducted for the prospective caregiver(s) and all adult household members using the Internet. The Internet Web site

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address for a national search is: http://www.nsopr.gov/

d) A TN Felony Offender Database Clearance must be conducted for the prospective caregiver(s) and all adult household members using the Internet. The Website address is http://www.tennesseeanytime.org/foil/search.jsp.

e) An Abuse Registry Clearance must be completed for the prospective caregiver(s) and all adult household members using the Internet. The Website address is http://health.state.tn.us/abuseregistry/index.html%20

8. A current child welfare information system person search and an inquiry to the Social Service Management System (SSMS) must be completed to determine if there is a past Child Protective Service (CPS) indication for any adult household member. If a record is found, it must be reviewed, on a case-by-case basis at Central Office, to assess the finding. Any involvement related to allegations of abuse or neglect must be considered in the assessment/home study process. If the applicant is an indicated perpetrator of sexual or severe physical abuse, approval will not be granted. A DatabaseSearch Form, CS-0741, must be completed to document search results.

9. Older birth, adopted, or post custody children, who are living in the home of the resource parents who turn eighteen (18) years old after the parents are approved, will have to have all criminal background clearances, including fingerprints, within six (6) months of their eighteenth birthday. Any home with adult children residing in the home who have not completed the background checks will not maintain approved status.

10. Internet Records Clearance and local background checks must be completed for all adults living on the resource parent’s property having the same mailing address. If any causes for concern are noted, fingerprinting must be completed on the individual(s) that prompted the concern.

11. A Driving Record Check/Moving Violation Record Check must be completed for each resource parent that provides transportation for DCS children.

J. Documentation and Home Study Requirements

1. The entire resource home study record, including the application, autobiography, all PATH forms and all supporting documentation (medical statements, criminal background checks/clearances, references, etc.) constitutes a completed study. This collection of information must become a part of the resource home case file (see DCS Policy 16.23, Resource Home Case Files) along with the home study writer’s recommendation. This file is then submitted to the Supervisor and Team Coordinator by the staff person completing the home study. The entire resource home study record will be reviewed for approval or denial. Private Provider agency’s home studies must also have two levels of supervisory review/approval upon submission.

a) A resource home study completed in response to an ICPC request must be child-specific to each child/youth identified on the Interstate Compact Placement Request (100A), CS-0525 and include a statement regarding the certification of the resource home as eligible under TN DCS standards for federal IV-E financial assistance.

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b) All resource homes should have form CS-0871, Resource Family Disaster Plan completed as a part of the home study.

2. All completed home study narratives must include a recommendation statement that clearly defines the age range, number and gender of children for which the family is approved to parent. The recommendation statement must also include information regarding the type of physical, emotional, behavioral and personality traits of children the family will be most successful in parenting. In cases where the study was initially intended for a kinship care placement, a statement regarding the family’s capability to meet that specificchild’s needs must also be included.

3. It must be documented, in the resource home record, that the discipline policy has been explained, and that the applicants agree to the discipline policyguidelines by signing the form Discipline Policy, CS-0553.

4. Resource home approval information must be entered into the current child welfare information system in a timely manner following the approval of the home study. In addition, any change that will affect the status of the home’s continued approval must be recorded in a timely manner both in the resource home record and in the current child welfare information system.

5. All applicants must agree to read and sign a Resource Parent Oath to AbideCS-0670, prior to approval.

6. The resource home record must contain a Resource Parent Approval, CS-0702, which indicates the number and type of children for whom the home is approved as well as the approval date.

The resource parent approval for a home studied under compliance with the Interstate Compact on the Placement of Children must also include a statement regarding approval of the specific child/youth identified in the ICPC documents and include a statement regarding the certification of the resource home as eligible under TN DCS standards for federal IV-E financial Assistance. In cases where the study was requested for an ICPC placement, a statement regarding the family’s capability to meet that specific child’s needs must also be included.

K. Home Study Maintenance

1. Once an applicant is approved as a resource family, the resource home study record must be maintained in accordance with DCS Policy 16.23, Resource Home Case Files .

2. In order to remain approved the resource family must maintain compliance with DCS Policy 16.8, Responsibilities of Approved Resource Parentsand all other DCS policy.

L. Types of Resource Homes Defined

1. Once all the above requirements are met, an approved resource family is permitted to accept placements for kinship care, foster care or adoption.

2. An approved resource family may also parent children who are adjudicated delinquent, provided they complete the specialized training requirements

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outlined in DCS Policy 16.8, Responsibilities of Approved Resource Parents.

3. An approved resource family may also be considered to serve as respite, mentoring, transportation, visitation or other resource services deemed necessary by DCS.

4. Anyone who applies to become a resource parent after the effective date of this policy wishing to provide therapeutic care or care for medically fragile children should make application to a Private Provider, unless an arrangement can be made in compliance with DCS Policy 16.11, Shared Resource Homes.

M. Resource Home Eligibility Teams

In order to ensure that federal IV-E safety requirements are met for funding purposes, the documentation used to support the initial resource home approval decision will be provided to the appropriate Resource Home Eligibility Team (RHET) New homes approved by private providers will submit the documentation to RHET overseen by Child Placement and Private Provider Unit (CPPP) in Central Office. New DCS resource home approvals by the various regions will submit the documentation to the appropriate Departmental Resource Home Eligibility Team (D-RHET) contact in the DCS Region’s Placement Services Division (see Departmental Resource Home Eligibility (D-RHET) Protocol andResource Home Eligibility Team (RHET) Protocol that are attached as collateral documents).

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Forms: CS-0431 Monthly Family Income and ExpendituresCS-0427- Child's Medical Record (for all children in the home)

CS-0553- Discipline PolicyCS-0668 - Authorization for Release of information (for all adults in the home)

CS-0670- Resource Parent Oath To AbideCS-0676 Home Safety ChecklistCS-0678 Resource Parent Medical ReportCS-0845- Background Checklist and Results SummaryCS-0741- Database Search ResultsCS-0871 – Resource Family Disaster PlanCS- 0688 – Resource Parent Application for ParentingCS-0687 Internet Records Clearance (for all adults in the home)

CS-0690 Resource Home Study Verifications ChecklistCS-0691 Fingerprint Card Information (for all adults in the home)

CS-0697- REACT Family Entry InformationCS-0702 - Resource Parent ApprovalCS-0709 - Resource Home RecordingCS- 0842- Substitute W-9 FormCS-0895- Resource Parent Strengths /Needs ChecklistCS-0921,Waiver of Criminal Charges/Convictions Note: Private Provider Agencies may use equivalent forms, provided the content of the forms capture the content of the forms listed above.

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Collateraldocuments:

Protocol for Reactivation or Re-Classification of Resource Homes

Protocol for Requesting a Waiver of Criminal Charges/Convictions

Departmental Resource Home Eligibility (D-RHET)Protocol

Resource Home Eligibility Team (RHET) Protocol

Resource Parent’s Bill of Rights

Eco Map

Parenting Strengths Checklist

Results from Police Records Checks

Reference Letters

Proof of all sources of income

Autobiography for each applicant/SAFE Questionnaire

Individual Interview (Work Aid)

Resource Parent Home Study Outline (Work Aid)

SAFE Family Home Study Outline (Work Aid)

Glossary:ParentingRole

The assumption of the primary responsibility for promoting and supporting the physical, emotional, social and intellectual development of a child from infancy to adulthood by an adult member/members of a household. Parenting refers to the activity of raising a child and is not specific to a biological connection. The nurturing parent can be an ancestor, step-parent, adoptive parent or guardian.

Driving Record Check/Moving Violation Record

Each region has designated specific Resource Parent Support Staff who are able to access the Moving Violation Records via an understanding with the Tennessee Department of Safety. This access provides DCS with driving records for each resource parent/ individual that provides transportation for DCS children. The report will show speeding and DUI charges and other moving violations. In an attempt to keep DCS children safe while in foster care, these reports will be completed during annual re-assessments of resource homes and should also be completed prior to approval of a new resource home.