What Is CTFC?

Children’s Therapeutic Foster Care (CTFC) is a Medicaid service offered through the Waiver for Serious Emotional Disturbance (SEDW). It is an intensive community-based mental health service alternative to inpatient treatment facilities (acute psychiatric hospitals, Hawthorn Center, and crisis residential centers). Treatment is temporary, typically 6-9 months. CTFC is not a foster care placement and has specific mental health treatment criteria required for eligibility.

All referrals should be made directly to Community Mental Health (CMH) agency for assessment for SEDW and CTFC medical necessity. Referrals to CTFC are most appropriate when home-based services have not been successful, or when a youth is exiting a highly restrictive institutional or group care setting. Children and youth referred to CTFC must be eligible for the SEDW and meet CTFC relevant treatment criteria, including having an identified committed caregiver/permanent guardian (“Aftercare Family”) participant in the family treatment component. Youth’s identified Aftercare Family must be concurrently involved in CTFC treatment and be available to receive the youth in their home immediately upon exiting CTFC services at any point, including premature exit from CTFC. There is no transfer of guardianship; the CMH and the Therapeutic Home will never act in a guardianship capacity for youth receiving CTFC services. Any situation where a permanent Aftercare Family cannot be identified is not appropriate for CTFC.

Treatment Foster Care (TFC) is a placement option for children supervised by MDHHS with a documented psychological or psychiatric diagnosis and/or are stepping down from residential or psychiatric hospitalization and require an expertly trained foster home setting to meet their behavioral health needs. TFC services are family-based and provides individualized treatment for children and families. TFC services are directed towards diverting children from placement in a residential setting or assisting a child after discharge from a residential setting. The treatment foster family is viewed as the primary focus of intervention with children in their care. It is a family setting that seeks to integrate with, rather than replace treatment services provided outside of the home. Treatment will be delivered through service interventions provided by treatment foster care program staff and external resources with the child, identified permanent placement, and treatment foster parents.

The length of TFC will be variable and at all times be determined on an individual, case-by-case basis relative to each child’s specialized needs and service plan. Discharge planning shall begin at the time of placement within the treatment foster home.

TFC shall not be used as a long-term placement option but should be an intervention, which serves to meet a child’s specific treatment needs until he/she is able to step down to a lower level of placement as determined by the family’s MDHHS service plan and the child’s treatment plan.

The CMH providing CTFC is the provider of mental health treatment intervention for youth enrolled in CTFC in accordance with the Michigan Medicaid Provider Manual and Michigan Mental Health Code. The CMH will never act in the capacity of a foster care agency. For example, for youth involved in child welfare, the CMH is not responsible for emergency/ afterhours placements, and there is no foster care record kept.

CMHs have a Child Placing Agency designation so they can license and oversee Therapeutic Homes; however, they are considered “non-contracted/non-DHHS programs.” There is no transfer of guardianship in CTFC. This means guardians retains all rights and responsibilities regarding:

• Treatment plan and decisions around clinical treatment
• Participation in Wraparound
• Medical and dental appointments, including emergencies
• Last minute returns home (if Therapeutic Parent is not able to continue providing treatment)
• Education, including Individual Education Plan and school enrollment
• Decisions about where the kid spends the night (sleep overs, vacations)

Therapeutic Homes are licensed and trained providers of CTFC Medicaid Services. Therapeutic Homes are specifically trained and contracted as providers of Medicaid mental health services and will never be available for traditional foster care or Treatment Foster Care under their contract with CMH. As such, Therapeutic Parents are considered contractual employees of the CTFC/TFCO agency, not foster parents. Only one youth receives care in a Therapeutic Home, no other non-relative youth are permitted to reside in the home.

Therapeutic Homes are considered providers of Medicaid services and members of the clinical treatment team, participating in weekly clinical team meetings guided by a mental health treatment plan. Therapeutic Parents, as members of the treatment team, do not communicate with the youth’s guardians/committed caregivers. All communication about mental health treatment flows through the lead CTFC clinician.

There is no transfer of guardianship while a youth is in CTFC, and Therapeutic Parents do not make any guardianship decisions (such as medical, educational, mental health decisions). Specifically, Therapeutic Homes have no oversight or decision making capabilities regarding:

• Treatment plan and decisions around clinical treatment
• Medical and dental appointments: No medical/ dental responsibilities outside transport to/from routine care, emergency care, and administration of medication. Aftercare family is driving medical needs of child. Release forms will be signed for Therapeutic Parent to access emergency care as needed, and administer medication if applicable.
• Education, including Individual Education Plan and school enrollment
• Decisions about where the youth spends the night (sleep overs, vacations)

Children and youth referred to CTFC must have an identified committed caregiver/permanent guardian (“Aftercare Family”) participant in the family treatment component. An Aftercare Caregiver can be the youth’s biological family, adoptive family, pre-adoptive family, or a kinship placement, as long as they are able to assume the required active role in treatment and act as the youth’s guardian. In the case of a pre adoptive home, an open room is required should the youth need to exit treatment at any time, and the foster care agency (not the CMH) would be responsible for the youth upon exit from treatment. Specifically, the Aftercare Caregiver must be able to assume all responsibility for the youth, including:

• Treatment plan and decisions around clinical treatment
• Participation in Wraparound
• Handle all medical and dental appointments, including emergencies
• Last minute returns home (if Therapeutic Parent is not able to continue providing treatment)
• Education, including Individual Education Plan and school enrollment
• Decisions about where the kid spends the night (sleep overs, vacations)

CTFC is a treatment model, not a foster care placement. The youth’s Aftercare Family must be available to receive the youth in their home immediately at any point, including premature exit from CTFC. There is no transfer of guardianship; the CMH and the Therapeutic Home will never act in a guardianship capacity for youth receiving CTFC services. Any situation where a permanent Aftercare Family cannot be identified is not appropriate for CTFC.