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.


Rochelle Haimes, ACSW

Volunteer Roles: Commissioner; Peer Reviewer; Standards Panel Member; Team Leader

Rochelle is a Consultant working with a variety of private organizations to become accredited. Her primary area of expertise is in facilitating the development of PQI systems and activities. Her previous experience with both small and large organizations is the cornerstone for her long-standing volunteer activities as a Peer reviewer and as a Team Leader.
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Child and Family Services promote child and family well-being, protect children’s safety, stablilize and strengthen families, and ensure permanency.

PA-CFS 18: Physical and Mental Healthcare for Children in Out-of-Home Care

Children in out-of-home care receive comprehensive healthcare services within appropriate timeframes to promote optimal physical, mental, and developmental health.

Note: See PA-CFS 19 for additional expectations around healthcare provisions for expectant and parenting youth. 

Research Note: Children in foster care are more likely than other children to have significant medical and mental health needs. Research suggests that despite regulations and policies requiring the provision of comprehensive and routine healthcare, many children do not receive routine and specialized services.

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
    • Procedures for:
      1. Initial health screening
      2. Provision and coordination of physical and mental health screenings, assessments, and services
      3. Ensuring children obtain health-related information, services, and insurance prior to transfer from care
    • Documentation of the qualifications of health and mental health care professionals
    • Informational health and wellness materials provided to children
No On-Site Evidence
    • Interview:
      1. Agency leadership
      2. Relevant personnel
      3. Children served
      4. Resource parents
      5. Residential treatment providers
    • Review case records

  • FP
    PA-CFS 18.01

    Prior to or within 72 hours of initial entry into care children receive an initial in-person health screening from a qualified medical practitioner to:

    1. identify health conditions that require immediate or prompt medical attention; and
    2. identify health conditions that should be considered in making decisions about children’s living environments.

    Interpretation: The American Academy of Pediatrics recommends that the initial health screening occur within 24 hours of the initial separation from the family and entry into care.  When possible the screening should be performed by the child’s primary care physician who has knowledge of the child’s medical history or a physician that can serve as the child’s medical home while in out-of-home care.  The screening may be completed by a nurse practitioner, registered nurse, or physician’s assistant if a physician is unavailable.  The screening may be included in the assessment that occurs when a child is taken into custody following treatment at a hospital, clinic, or medical office.  The initial screening should include a developmental component to determine the need for further developmental assessment for children under six.
    Conditions that require immediate or prompt medical attention include, but are not limited to: acute illnesses, chronic diseases requiring therapy, signs of abuse or neglect, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances. 

    Note: While this standard is not required when children are in in the temporary legal custody of kin (and not the public agency), COA does still recommend that children with these living arrangements receive an initial health screening as per the standard.

  • FP
    PA-CFS 18.02

    Qualified professionals provide children with health services appropriate for their ages, including: 

    1. comprehensive medical examinations within 30 days of entry into care and according to well child guidelines; 
    2. dental examinations within 30 days of entry into care and every 6 months; 
    3. developmental screening within 30 days of entry into care and according to well-child guidelines to identify the need for further assessment;
    4. alcohol and drug abuse screenings within 30 days of entry into care and when indicated thereafter to identify the need for further diagnostic assessment; and 
    5. any services needed to address issues or conditions identified during health screenings, assessments, or examinations.

    Interpretation: See Recommendations for Preventative Health Care for children in foster care published by the American Academy of Pediatrics. Medical assessments should include, as appropriate to children’s ages and circumstances: lead exposure, tuberculosis testing, and HIV/STD risk assessment screening. 

    Interpretation: Dental exams should be provided for children over age three and occur every six months, and more frequently for children with dental issues based on clinical need. The agency can receive a rating of “2” if there is an annual preventive exam and evidence that recommendations from the dental care provider indicate children are not in need of more frequent care.

  • FP
    PA-CFS 18.03

    Children receive:

    1. mental health screenings within 30 days of entry into care, and when indicated thereafter, to identify the need for further diagnostic assessment; and
    2. diagnostic mental health assessments, as needed.

    Interpretation: Initial screenings can be conducted by trained caseworkers, but follow-up mental health assessments must be provided by qualified mental health professionals in accordance with applicable state or local regulations. Screenings should include attention to trauma exposure and symptoms, and trauma-focused assessments should be provided when needed, as noted in PA-CFS 7.05. When a child is in treatment foster care the diagnostic mental health assessment must occur within 30 days prior or subsequent to placement.

  • FP
    PA-CFS 18.04

    Qualified mental health professionals provide:

    1. any needed mental health services, including evidence-based psychosocial services and pharmacological treatments, as appropriate; and
    2. appropriate oversight of psychotropic medication use, including close supervision and monitoring of children receiving medications for off-label uses.

    Note: See PA-CFS 16 regarding additional expectations for connecting children who have experienced trauma to trauma-informed services.

    Note: High levels of collaboration and coordination, as addressed in PA-CFS 18.05, are necessary to ensure a comprehensive approach to the oversight of psychotropic medications.

    Research Note: Research suggests that children in foster care are prescribed psychotropic medications at a higher rate than the general Medicaid child population. Some literature cautions against the overuse of psychotropic medication for children, noting that pharmaceutical treatment is generally recommended when psychosocial treatment alone is not effective, or when pharmaceutical or concurrent treatment is more effective than psychosocial treatment. Concerning practices include prescribing too much medication, prescribing too many medications, and prescribing medication at too young an age.

  • FP
    PA-CFS 18.05

    Services are centrally coordinated for children to ensure: 

    1. continuity of care; 
    2. receipt of comprehensive services; 
    3. appropriate communication and coordination among healthcare providers, mental health providers, social service providers, other professionals, and children, families, and resource parents or residential treatment providers; and 
    4. that children, families, and resource parents or residential treatment providers receive needed information and support.

    Interpretation: The receipt of comprehensive services includes both healthcare and mental healthcare, as well as educational and support services that promote social and emotional well-being and development.  Children should have a medical home, or a health home as appropriate, where care is provided by professionals with expertise on the issues of children and adolescents in out-of-home care.

    Interpretation: When possible, American Indian and Alaska Native children should receive services from qualified professionals who have experience working with the tribe and knowledge of tribal customs and practices. An agency that has the responsibility for placing American Indian and Alaska Native children should be aware of services that the child may have access to through tribally contracted health facilities or through the federal Indian Health Services. The agency should work with the tribe or a local Indian organization to ensure they have access to needed medical information.

    Note: See PA-CFS 2 for more information regarding the importance of collaboration, coordination, and partnerships.

    Research Note: A study of resource parent retention suggests that the difficulty some resource parents have accessing medical providers and dentists who accept Medicaid contributes to resource parent turnover. Other research has demonstrated the challenges that kinship caregivers face in accessing medical care for the children in their care.

  • PA-CFS 18.06

    Relevant information about children’s health and mental health, including family history when available, is recorded in an efficient and secure system and shared with providers and resource parents or residential treatment providers, as appropriate.

    Note: See PA-CFS 2 for more information regarding the importance of collaboration, coordination, and partnerships.

  • FP
    PA-CFS 18.07

    Children receive age and developmentally appropriate support and education regarding: 

    1. proper nutrition and exercise;
    2. substance use and smoking;
    3. personal hygiene;
    4. safe and healthy relationships;
    5. sexual development;
    6. family planning and pregnancy options;
    7. pregnancy, prenatal care, and effective parenting;
    8. prevention and treatment of sexually transmitted infections/diseases; and
    9. HIV/AIDS prevention.

    Research Note: Research indicates that youth in the child welfare system have both higher rates of sexual activity and lower understanding of contraceptive methods. School-based sexual and reproductive health education may not be a dependable source of information for children in out-of-home-care, who are more likely to miss out on thorough sexual health education due to placement instability, which causes attendance and curriculum continuity issues, and/or cultural views of caregivers or caseworkers against receiving such education. Agencies should therefore assess and supplement, if appropriate, the sexual health awareness that an adolescent has received.
    Rates of sexual violence victimization are also especially high among youth involved with the child welfare system. Studies on the prevalence of sexual abuse and assault among youth in foster care have identified percentages ranging from 25 to 50 percent. As such, education on sexual and reproductive health should also address sexual violence including commercial sexual exploitation, sexual consent, incest, the consequences of perpetrating sexual violence, and reporting sexual violence.

  • PA-CFS 18.08

    Prior to transitioning from out-of-home care, children receive assistance to maintain or obtain: 

    1. health insurance; 
    2. health and mental health records, including the names and addresses of children’s doctors, as well as information regarding any special needs and appropriate treatment; 
    3. needed medical, dental, developmental, mental health, and substance use treatment services; and 
    4. needed medication.

    Interpretation: The agency should provide assistance to ensure access to coverage, including coverage provided through the child’s tribal affiliation when one has been established.  The agency should also work directly with state Medicaid agencies to connect eligible individuals to benefits, and it is recommended that direct service personnel be trained on their states’ Medicaid eligibility requirements and healthcare options for youth transitioning out of the foster care system. 

    Research Note: The Affordable Care Act (ACA) requires states to provide Medicaid coverage for individuals under age 26 who were in foster care at age 18 and receiving Medicaid. Youth are eligible for full Medicaid benefits which include Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services.

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