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.


Brewer-Porch Children's Center

James W. Thompson, Executive Director

The COA standards as applied to the operations at Brewer-Porch Children’s Center at The University of Alabama has given the administration an opportunity to examine best practice and improve the quality of care provided to clients.
read more>>


Child and Family Services promote child and family well-being, protect children’s safety, stablilize and strengthen families, and ensure permanency.

PA-CFS 13: Child Placement

When children are in need of out-of-home care they are connected with resource families or residential treatment programs that can best meet their needs for safety, permanency, and well-being, and best support their ties to family and community.

Interpretation: COA’s standards utilize the term “placement” in referring to the agency’s role in facilitating changes in children’s living environments; however it is valuable to look at this process as children joining resource families (or joining new communities in the case of residential treatment programs). Conceptualizing the process in this way helps workers humanize children and account for the emotional and physical toll to children, as opposed to discussing children being “placed” as if they were objects.
Interpretation: In instances where placements are made by the court rather than the agency, the agency is still expected to collaborate with the court to advocate for appropriate placement and promote placement stability, as emphasized throughout this core concept.  When an agency makes an emergency placement it must document efforts made to meet the standards given the emergency nature of the placement. Emergency placements involving an Indian child must comply with the emergency proceeding provisions set out in the Indian Child Welfare Act. Efforts should be made to identify emergency placements that comply with the placement preferences in ICWA so as to prevent future placement changes in the event that a full child custody proceeding is initiated 

Note:  Please note that this core concept addresses placement into foster care, kinship care, or residential treatment. See PA-CFS 28 for standards regarding relevant practices when arranging adoptions or guardianships.

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 service delivery 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
    • A description of services to support placement changes
    • Procedures for placement including: 
      1. Matching and joining children and out-of-home care providers
      2. Preventing and managing disruptions
    • Policy for giving preference to kin
No On-Site Evidence
    • Interview:
      1. Agency leadership
      2. Relevant personnel
      3. Children and families served
      4. Resource parents
      5. Residential treatment providers
    • Review case records
    • Review resource parent records

  • FP
    PA-CFS 13.01

    All available information is considered in order to identify the best living environment for each child and the process includes an assessment of children’s and potential caregivers’ strengths, needs, supports, and resources.

    Interpretation: The agency should ensure that the appropriateness of a potential living environment is assessed in line with the strengths, needs, and characteristics of each child. For example, when children pose a risk of harm to self or others, the agency must assess the level of risk when identifying a suitable family or treatment setting, and should develop plans for maintaining safety when necessary. Similarly, when children are victims of human trafficking or have a record of running away, potential caregivers or programs should be assessed for their capacities, competencies, resources, and willingness to provide effective care. The agency should also ensure that at least one primary caregiver can effectively communicate in a child’s language. When such a setting is not possible, assistance should be provided with translation and support and the agency should continue to identify a more suitable living environment. With regard to family settings, given that a potential caregiver’s ability to meet a child’s needs may be impacted if the caregiver is already caring for other children, the examination of characteristics and needs should also include attention to the needs of any other children currently residing in the potential caregivers’ home.   

    Interpretation: The information to be considered includes information obtained during intake, initial and comprehensive assessments, and case review, including information about previous placements/living environments, as well as information obtained during during assessments and annual reviews of resource parents. When children are separated from their families before comprehensive assessments are conducted the information available will obviously be more limited, but the agency should still consider all available information, including any information obtained at the time the children are separated from their families.

  • FP
    PA-CFS 13.02

    In order to ensure children are in the most family-like and familiar setting possible, the agency makes reasonable efforts to ensure children are:

    1. with siblings;
    2. with kin; and
    3. within reasonable proximity to their families and home communities.

    Interpretation: As noted in the Definition to PA-CFS, children should ideally join resource families, and should only be connected to residential treatment settings when no other appropriate and more family-like setting is possible.  Agency policy must require that preference be given to kin, and the agency must make reasonable efforts in accordance with applicable law and the requirements of the standard unless it is contrary to children’s well-being.  If children are not in the most family-like and familiar setting possible, the reason must be documented in the case record.  In the event that siblings cannot stay together, ongoing sibling contact, as addressed in PA-CFS 17, will be critical.
    Interpretation: Parenting youth and their children should always be living together, unless contraindicated, with caregivers who are willing, and have the competencies and resources, to provide support and care for both the youth and their children. Individuals or families exclusively seeking to become caregivers for infants are not appropriate resource families for parenting youth.

    Note: See PA-CFS 16.08 for more information regarding the importance of also helping children to maintain stability in their home schools, unless it is determined not to be in their best interest.

  • PA-CFS 13.03

    American Indian and Alaska Native children are placed according to the preferences specified in the Indian Child Welfare Act. 

    Interpretation: When the agency is working with American Indian and Alaska Native children and families, tribal representatives and service providers must be involved in placement decisions and placement changes in order to ensure compliance with the Indian Child Welfare Act, which requires that preference be given to placements in the following order: 

    1. a member of the child’s extended family;
    2. resource families licensed, approved, or selected by the child’s tribe;
    3. American Indian or Alaska Native families licensed or approved by an authorized non-Native licensing authority; and 
    4. an institution approved by an Indian tribe or operated by an Indian organization.
    Alternative placement preferences established by the child’s tribe may apply, and the court may also take into consideration the preferences of the child or his/her birth parents. Agencies should work closely with the child’s tribe to identify placement options within the tribal community. Families from all tribes to which the child has ties should be considered as placement options, and eligibility criteria should be consistent with the norms of the tribe.

    Research Note: The original language in the Multi-Ethnic Placement Act (MEPA) was updated by the Small Business Job Protection Act of 1996 to eliminate confusion about whether race, color, or national origin could be considered in making placement decisions. These amendments, known as Removal of Barriers to Interethnic Adoption, explicitly state that they have no effect on placement preferences for American Indian/Alaska Native children under the Indian Child Welfare Act (ICWA). The protection granted under ICWA is based upon the child’s political affiliation to the tribe and this is distinct and separate from the racial classifications outlined in the amendments. As such American Indian and Alaska Native children should be placed according to the placement preferences specified in ICWA.

  • PA-CFS 13.04

    The agency promotes the stability of children’s living environments and prevents the need for changes by:

    1. ensuring children, families, resource families, and residential treatment providers understand the steps involved in the process for a child joining a new living environment, and receive information and support throughout; 
    2. providing all legally permissible information about children’s characteristics, behaviors, histories, and permanency goals to prospective resource families or residential treatment providers; 
    3. ensuring that resource families and residential treatment providers make an informed decision to accept children into their care;
    4. arranging opportunities for children and parents to meet prospective resource families or visit residential treatment providers, when possible; 
    5. responding proactively to challenges that arise by assessing needs and providing necessary services and supports; and 
    6. facilitating workers’ abilities to spend more time with children, families, and resource families or residential treatment providers after children first come into new living environments or when challenges arise.

    Note: It is also essential to ensure that resource family recruitment, assessment, and training explain what resource families should expect when they accept children into their care; explore resource families’ strategies for managing challenges and keeping commitments; and emphasize the importance of permanence and stability for children. See PA-CFS 23, 24, and 25 for more information regarding resource family recruitment, assessment, and training.

    Research Note: The trauma of separating families, facilitating children joining a new living environment, and any subsequent changes in the living setting can be partially minimized through a sensitive and responsive matching and joining process. Effective planning requires sharing information to promote equal involvement in the process, and to allow all parties to do their job well. Birth and resource families need information about the process, visitation/family time, decision making timeframes, and expectations for involvement in meetings and ongoing communication.

    Research Note: Studies have shown that youth in foster care who have strong, supportive connections to their caregivers, and who have experienced fewer placement changes, are less likely to become pregnant at an early age.

  • FP
    PA-CFS 13.05

    Resource family homes are licensed or certified for no more than:

    1. five children in foster care and five total children; or 
    2. two children in treatment foster care and five total children.

    Interpretation: The total number of children includes all children under the age of 18 residing with the resource family, and includes any children residing with the family for overnight respite care. There should be no more than two children total under the age of two, and no more than four children total over the age of 13. Exceptions to the licensed or certified capacity may be made on a case-by-case basis to have children live with relatives, to keep siblings together, or for other extenuating reasons that directly support plans for children to be connected to relationships that are safe, nurturing, and intended to be enduring.

    Note: This standard is not applicable for unlicensed kinship caregivers.

  • PA-CFS 13.06

    The appropriateness of children’s living environments is reviewed regularly, and changes occur to support children’s best interests and permanency goals, as needed.

    Interpretation: The agency should make every effort to prevent any changes that are not in the best interest of children and their permanency goals. Changes that support children’s best interests and permanency goals may include moving from a foster family to an adoptive family, moving from a foster family to a kinship family, or other transitions that bring children closer to family or community.

    Research Note: Significant research has demonstrated the correlation between instability in children’s living environments and negative child outcomes including poor academic performance and social and emotional difficulties. Regardless of a child’s prior history of maltreatment or behavioral challenges, these negative outcomes increase following disruptions.

  • PA-CFS 13.07

    Children, families, and resource families or residential treatment providers receive additional support when children’s living environments will change, including: 

    1. sufficient advanced notice prior to the change; 
    2. formalized discussions of the reasons for the move or disruption, each party’s feelings about the change, and, as needed, interventions to address the reasons for the change;
    3. re-assessment of children’s strengths and needs in advance or at the time of the change, and identification of a resource family or other setting that can best promote safety, well-being, and permanency; and
    4. referral to additional services or supports.

    Interpretation: Whenever possible notice should be provided at least 14 days in advance of a move. 

Copyright © 2019 Council on Accreditation. All Rights Reserved.  Privacy Policy and Terms of Use