Private Organization Accreditation

CSS Healthcare Services provides Community based health services to the young, the elderly and to Individuals with Developmental Disability. Founded in 1997, we have the ability to offer a variety of quality community-based services to our clients, which has greatly contributed to our growth and success.


Audrey Coleman, RN-MSN

Volunteer Roles: Military Reviewer; Peer Reviewer; Team Leader

My first experience with COA was in 1999 with what was a NC Area Program. I started as a peer reviewer in 2005, doing two to four site visits a year. I am also a team leader and have recently been approved to be a military reviewer.
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Guardianship Services for Minors support the establishment of a court-appointed, long-term, living arrangement with a committed caregiver that ensures safety and increases stability and child well-being.

GSM 7: Pre-Guardianship Services

Pre-guardianship services prepare the child, prospective guardian, and birth parents for transfer of custody.

Interpretation: Extended family members may be included in pre-guardianship services if their involvement is appropriate.

Interpretation: When the case involves an American Indian or Alaska Native child, resources offered by the tribe or local Indian organizations should be considered and prioritized.

Rating Indicators
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (HR 6.02) and training (TS 2.03); or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • A number of client records are missing important information  or
  • Client participation is inconsistent; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • A description of Pre-Guardianship Services
    • Informational materials provided to birth parents
    • Orientation and informational materials provided to prospective guardians
    • Interview:
      1. Program director
      2. Relevant personnel
      3. Service recipients
    • Review case records

  • GSM 7.01

    Age appropriate services that prepare the child for transfer of custody include:

    1. counseling to understand and cope with separation and family loyalty issues; and
    2. support to cope with changing roles and relationships.

  • FP
    GSM 7.02

    Birth parents are prepared for transfer of custody through services that include:

    1. education about their legal rights, including visitation;
    2. education about the importance of permanency and a stable home for the child;
    3. planning for participation in the legal process when it is appropriate and desired;
    4. discussion about a visitation plan that is in the best interests of the child; and
    5. discussion of changing roles and relationships.

  • FP
    GSM 7.03

    Prospective guardians participate in an orientation that includes the following:

    1. the importance of permanency and a stable home for the child;
    2. the impact of guardianship on birth parent rights;
    3. the process for completing the transfer of custody;
    4. their responsibility to maintain a visitation plan and supervise birth parent visitation, as necessary;
    5. circumstances under which guardianship can be terminated or modified, including their right to petition the court; and
    6. the availability of guardianship subsidies and the impact they could have on receipt of federal, state, or tribal benefits.

    Interpretation: A guardianship subsidy can be considered income and could impact the child’s eligibility for other benefits such as Medicaid, Supplemental Security Income, or subsidized child care. Organizations should be aware of the regulations in their state and with local tribes.

    Interpretation: The orientation should explore the caregiver’s capacity to provide permanency over time for the child. This material can cover the need for additional support; circumstances that may adversely impact the caregiver’s ability to care for the child, for example, age or presenting medical issues; and plans for the child if the caregiver is unable to provide care, such as the establishment of a successor guardian. See GSM 8.05 for more information on the establishment of a successor guardian.

    Interpretation: The prospective guardian should be fully informed of their right to petition the court to adopt the child at a later time and the impact this will have on birth parent rights. Guardians of American Indian and Alaska Native children should be informed of alternatives to adoption such as tribal customary adoption, which must be approved or adjudicated by the tribal court.

  • GSM 7.04

    Prospective guardians are prepared for the transfer of custody through education, training, information, and support that address the following, as appropriate:

    1. attachment and bonding;
    2. possible impacts of guardianship on the family;
    3. changing roles and relationships, including sibling relationships;
    4. the importance of maintaining connections with the child’s family, community or tribe, as appropriate;
    5. child development and parenting techniques including special considerations for a child’s transition into adolescence;
    6. raising a child of a different race, ethnicity, culture, or religion;
    7. caring for a child with special needs;
    8. helping a child cope with separation and loss;
    9. a history of maltreatment;
    10. financial impact on the family;
    11. issues of independent living; and
    12. available support services.


    • Revised Interpretation - 10/31/17
      The interpretation was revised to include additional training criteria around the Indian Child Welfare Act. 

    Interpretation: Information about available support services should include an overview of any services that will be lost once the guardianship arrangement is finalized, as well as the availability of services in other states, tribes, or Indian organizations if the family plans on moving out of state in the future.

    Interpretation: Pre-guardianship services should be tailored to the age range, cultural background, and needs of the child and adjusted accordingly when the child is already living with the prospective guardian.

    With regards to elements (d) and (f), training must include educating prospective guardians on the Indian Child Welfare Act, its impact on placement and permanency for American Indian and Alaska Native children, and the guardians’ responsibilities for supporting the child’s cultural identity and facilitating connections to their tribe.

    Research Note: A preliminary study suggests that the organization consider the readiness of each prospective guardian, rather than relying only on the completion of training or other tasks.

    Research Note: Contact with tribal relatives is commonly practiced among tribal communities and is believed to support the child’s cultural identity and an improved sense of belonging.

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