AFCARS and Placements

1. AFCARS and Placements Angelina Palmiero, MSW Children’s Bureau

2. Placements • General Considerations regarding what AFCARS calls a placement and what your agency calls a placement. • Remember AFCARS is an administrative data set using generic terms. • Remember that AFCARS was issued in 1993 but was written beginning in the late 1980s. • So, what does that mean for us? • When designing the method you will use to collect information, it is best to use your agency’s terminology when possible and not the AFCARS terms. Sometimes the AFCARS terms work and sometimes they are not descriptive enough. • Your terms are to be mapped to AFCARS and more than one item may need to be mapped to a single AFCARS term.

3. FC #41, Current Placement Setting • This element asks that you report where the child resides as of the end of the report period. Or, if the child was discharged from foster care during the report period, where the child was residing prior to the discharge. • The AFCARS options are: • Pre-Adoptive Home • Foster Family Home, Relative • Foster Family Home, Non-relative • Group Home • Institution • Supervised Independent Living • Runaway • Trial Home Visit

4. How are placements counted in AFCARS? • Are all placement moves counted for AFCARS purposes? • In general, yes but there are some exceptions. • If the placement is a temporary absence from an ongoing placement, then these are not included in the placement count (foster care element #24). • The exceptions are: • Visit with siblings • Day or Summer camps • Respite placements • Acute Care Hospitalizations • Runaway • Trial Home Visits • Another exception that isn’t part of the above condition of temporary absences from an ongoing placement is moves from one cottage to another that are located on the same campus. • All stays in a locked facility are to be counted regardless of how long the child is in the facility. • Hospital stays that are for non-acute care must be counted. The agency and CB will need to discuss what timeframe constitutes an acute care stay.

5. Placement count versus the placement date • Are there special circumstances where the date may change but not the placement count? • Yes. On the prior slide, the list of exceptions included “runaway” and “trial home visit.” • If at the end of the report period – • The child is placed back home and the agency still has placement and care responsibility of the child, the child is still in the AFCARS reporting population with an open removal episode (no discharge date in foster care element #56 and no discharge reason in element #58). Therefore, the date of the placement (FC #23) is the date the child returned home, the placement count does not change, and the current living arrangement (foster care element #41) is “trial home visit.” • A child has run away from his/her foster care placement. The date the child ran away would be reported for element #23 and the placement count does not change. The current living arrangement reported in element #41 is “runaway.”

6. Placement Count versus Placement Date • Runaway The date a child runs away from his/her placement setting would be reported for element #23. The placement count does not change. The current living arrangement reported in element #41 is “runaway.” • Example - Report period ending 3/31/12: • Child was living at the Smith foster home as of January 1, 2012. • On March 28, 2012 the child ran away from the home. FC #23 = 3/28/12 FC #24 = 1 FC #41 = Runaway

7. Placement Count versus Placement Date • Runaway, Continued • Example - Report period ending 9/30/12: • Child was living at the Smith foster home as of January 1, 2012. • On March 28, 2012 the child ran away from the home. • On April 5, 2012 the child is picked up and returned to the Smith FH. FC #23 = 1/1/12 FC #24 = 1 FC #41 = Foster Home, non-relative

8. Placement Count versus Placement Date • Runaway Example - Report period ending 9/30/12: • Child was living at the Smith foster home as of January 1, 2012. • On March 28, 2012 the child ran away from the home. • On April 5, 2012 the child is picked up and taken to the Heritage Group Home. FC #23 = 4/5/12 FC #24 = 2 FC #41 = Group Home

9. Counting Placements - Hospitals When considering hospital placements, you need to be able to distinguish between an acute care stay and one that is non-acute care. The agency and CB will discuss what you will use for the length of time to differentiate between the two. For many of the States we have used their Medicaid Plans as a reference. For the examples listed in this presentation, we will consider anything hospital stay over 15 days as a non-acute care stay.

10. Example – Hospital Placements • Below is an example of how to count placements when the child’s hospital stay is not for acute care. This is for a child who has been in foster care. • First placement is with a foster family – the Jones – April 2, 2012 • Hospitalized on May 1, 2012 • Discharged from the hospital on August 15, 2012 and returns to the Jones Foster Home • 2012B Report Period (9/30/12) • FC #23 = 8/15/2012 • FC #24 = 3 • Jones, Hospital, Jones

11. Example – Hospital Placements • Below is an example of how to count placements when the child’s hospital stay is for acute care. This is for a child who has been in foster care. • First placement is with a foster family – the Jones – March 12, 2012 • Hospitalized on April 1, 2012 • Discharged from the hospital on April 10, 2012 and returns to the Jones Foster Home • 2012B Report Period (9/30/12) • FC #23 = 3/12/12 • FC #24 = 1

12. Example – Hospital Placements • Below is an example of how to count placements when the child’s hospital stay is for acute care but the child goes to a different foster home. This is for a child who has been in foster care. • Placement with the Jones foster family April 30, 2012 • Hospitalized on June 1, 2012 • Discharged from the hospital on June 10, 2012 and is placed in the Smith Foster Home • 2012B Report Period (9/30/12) • FC #23 = 6/10/12 • FC #24 = 2 • If the hospital stay had been for more than 15 days: • FC #24 = 3 (Jones, Hospital, Smith)

13. Placements • Remember: • A child’s physical location should always be recorded in the system. This is regardless of the type and funding source for the placement. • Licensed or unlicensed foster home • Relative foster home • Private Providers’ settings • Group Homes, Child Care Institutions, etc. • Hospital • Locked Facility • Runaway • Respite, Visits, Camp • Own Home

14. AFCARS Reporting Population (Refresher) • Previously we discussed certain removal situations that also affect the reporting of placements. • Child’s only placement is a hospital or locked facility: these records are not included in the reporting population. • Child’s first placement location is a hospital or locked facility and then the child moves to a foster care setting. • Child is on runaway status when the agency receives care and placement – include the record and placement count = 0

15. Resources • AFCARS Webinar “Diagnosed Conditions”, Tuesday July 10, 2012 - Email nrccwdt@cwla.org for registration information • Join the Tribal IV-E Tribes and Grantees Groupsite: http://tribalcwdata.groupsite.com • NRC-CWDT Website: http://www.nrccwdt.org/ • Federal AFCARS Information: http://www.acf.hhs.gov/programs/cb/systems/index.htm#afcars • AFCARS Technical Bulletins: http://www.acf.hhs.gov/programs/cb/systems/afcars/techbulletin/index.htm

16. THANK YOU !!