Private Organization Accreditation

Lutheran Social Services of New England is a high-performing nonprofit organization. LSS is a powerful difference maker and go-to resource, driving ourselves to constantly anticipate futures that are different from the past. For 140 years, LSS has been caring for people in need in New England.


Children's Foundation of Mid America

James W. Thurman, President/CEO

Children’s Foundation of Mid America has been accredited through COA since 1983. The process of accreditation ensures that we meet or exceed the highest standards in the industry.
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The agency’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.

PA-BSM 6: Documentation and Debriefing

The agency assesses restrictive behavior management incidents and effects to reduce future preventable occurrences and untoward consequences.

NA The agency prohibits the use of restrictive behavior management interventions.

Rating Indicators
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
  • A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  
  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
  • A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Please see Rating Guidance for additional rating examples. 

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
    • Debriefing procedures
    • Documentation of behavior management/incident reviews
    State Administered Agency (Regional Office)
    • Documentation of behavior management/incident reviews
    All Agencies
    • Documentation of debriefing
    • Behavior management logs
    All Agencies
    • Interview:
      1. Agency Leadership
      2. Supervisory/management personnel
      3. Persons served
      4. Parents/legal guardians
    • Case record review

  • PA-BSM 6.01

    The use of restrictive behavior management interventions is documented, including:

    1. the justification, use, circumstances, and length of application in the individual’s case record; and
    2. names of the service recipient and personnel involved, reasons for the intervention, length of intervention, and verification of continuous visual observation in a log.

  • FP
    PA-BSM 6.02

    Debriefing occurs in a safe, confidential setting within 24 hours of the incident and includes the service recipient, appropriate personnel, the foster parents, and parents or legal guardian to:

    1. evaluate physical and emotional well-being;
    2. identify the need for counseling, medical care, or other services related to the incident;
    3. identify antecedent behaviors and modify the service plan as appropriate; and
    4. facilitate the person’s reentry into routine activities.

    Interpretation: When agencies serving youth in the juvenile justice system use mechanical restraints to prevent escape during transport, rather than in response to an incident, it may not be relevant to identify antecedent behaviors and modify the service plan, as referenced in element (c) of the standard. However, elements (a), (b), and (d) are still relevant.

    Interpretation: The agency ensures the service recipient’s participation in the debriefing process.  In situations where the service recipient initially refuses to participate, the agency should make continued attempts to involve the individual.

    Note: Agencies serving youth involved with the juvenile justice system should refer to the Interpretation to PA-BSM 2.01 regarding the involvement of youths’ parents or legal guardians.

    Note: Following each incident of restrictive intervention, Medicaid requires that a physician or other qualified clinician conducts and documents an initial face-to-face assessment and summary review within one hour of the intervention to evaluate the health and safety of client, the appropriateness of the intervention, and necessary changes to the treatment plan.  Agencies should review state Medicaid plans for their state’s definition of a qualified clinician and a list of specific elements to be included as part of the assessment.

  • FP
    PA-BSM 6.03

    Personnel and foster parents involved in the incident are debriefed to assess:

    1. their current physical and emotional status;
    2. the precipitating events; and
    3. how the incident was handled and necessary changes to procedures and/or training to avoid future incidents.

    Interpretation: When agencies serving youth in the juvenile justice system routinely use mechanical restraints to prevent escape during transport, rather than in response to an incident, it may not be relevant to assess precipitating events or address how future incidents might be avoided, as referenced in elements (b) and (c) of the standard.

  • FP
    PA-BSM 6.04

    Any other person involved in or witness to the incident is debriefed to identify possible injuries and emotional reactions.

    Interpretation: Debriefing can include a discussion of factors that led up to the incident and other appropriate responses for future situations. Emphasis should be placed on returning the environment to pre-incident condition and resuming the normal program routine.

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