V. D-10. Respite Care Policy

Respite care is the provision of periodic and/or intermittent, temporary care of the children who are in the care and custody of or adopted through the State of Maine Department of Health & Human Services. It is designed to provide relief from the stresses of constant responsibilities of providing out-of-home care. It is not used for regular child care situations when a parent would normally use ordinary child care, i.e., hiring a baby-sitter for an afternoon or evening outing. Respite care should be planned in advance, but may be used in emergency situations. Respite care may be utilized by licensed resource families for a daily, overnight or weekly basis.

Respite care should be used to maintain stable placements and allow caregivers opportunity to refresh, but should not be used to exclude foster children from ordinary and traditional family activities.

Resource families will be provided with a copy of Respite Foster Care Services (See Appendix 11) at the time of licensure.

Resource families should limit respite to two days per month to reduce disruption to the child. Additional respite may be needed in emergencies/crises or when a child is transitioning to a permanent placement. When a resource family is affiliated with a Child Placing agency the agency will be responsible for arranging respite.

Both regular and therapeutic resource families continue to receive their daily board rate and will arrange to pay the room and board portion of their reimbursement to the respite caregiver during periods of respite. In some situations, resource families may prefer to enter into informal agreements with other resource families and exchange provision of respite services, rather than exchange payment for respite. Regardless of the method of reimbursement worked out between resource parents, the child’s caseworker must be made aware of who is caring for the child whenever the child is placed in respite. Caseworkers will be responsible for tracking the number of units utilized by resource families.

When respite care is provided in emergency situations, caseworker will work with resource families and respite providers to help the child cope with any trauma or stress associated with the crisis.

Formal Respite: With the exception of emergency respite, resource families will inform the child’s caseworker of the need for respite. The Department of Health & Human Services staff and resource families will work together to select and initially screen the respite care provider to determine the most appropriate provider to meet the individual child’s needs. Respite providers should be familiar with the child’s daily routine, preferred foods and activities, and needed therapeutic or medical care. The respite provider will be made aware of and respect any issues related to culture, race/ethnicity, language, religion, and sexual orientation.

Respite will follow the existing licensing rules regarding number and ages of children in the home. All efforts will be made to ensure that once a respite provider is selected, the same respite provider is used on an ongoing basis to maintain the child’s sense of safety, consistency and security.

Informal Respite: Informal respite is encouraged and can be used on a regular basis. Informal respite often provides the same benefits as formal respite while maintaining a sense of normalcy for child. Informal Respite care providers may include previously licensed resource homes, extended family members or neighbors, or daycare providers. The name, address, dates of birth and telephone number shall be included in the case record. (Please see section on Qualifications of Respite Providers for specifics on approving informal respite.)

When a child is invited to a friend’s home for a sleepover or pajama party it is not considered respite and background checks do not need to be completed. Foster parents are trusted to make sound judgments regarding the safety and appropriateness of the home by meeting the parents, bringing the child to the home, and inquiring about the level of supervision. Foster children need to participate in normal childhood experiences without additional barriers.

When children are prescribed medication, the respite caregiver will be provided with the medication in its original container; with information about administering the medication; and with information about any possible side-effects which need to be reported to the child’s prescribing physician.

Resource parents shall prepare children for respite placement by arranging pre-placement visits (for planned respite care) and being sensitive to the child's needs. The resource parent shall provide the respite care provider with a copy of the Foster Child Identification and Information Sheet (See Appendix 10) and the child's MaineCare card. Periodically, the caseworker will discuss with the child his/her experiences in respite care to ensure they are receiving appropriate care and are safe in that environment.

Respite care providers will be reimbursed by the child’s resource caregiver at the daily board rate associated with the child’s current level of care. A regular resource family providing respite care to a child with a therapeutic level of care will be reimbursed at level B. In lieu of payment, it may be acceptable for resource parents to work out mutually agreeable exchange of respite services for one another.

3.	The caregiver will work out mutually agreeable financial reimbursement arrangements with informal respite care providers prior to the respite placement.

Only in rare circumstances will the Department fund both the primary placement and the respite placement. When in rare circumstances, a short term ( 3-5 days) clinical need for a secondary placement is identified, the child’s caseworker will complete an assessment of the situation to determine if the caseworker concurs that this need is justified, If the caseworker recommends approval of a short term secondary placement in order to prevent use of a crisis bed due to extreme disruptive behavior which could potentially disrupt the primary placement, the caseworker will seek approval for funding the secondary placement from the Program Administrator or from the Program Administrator designee.

At the time or prior to the time a worker is considering requesting that DHHS fund both the primary and respite placement, the worker will convene an emergency team meeting to address crisis planning and placement stability issues.

In order to provide formal respite, the home must be a licensed foster home. The Department must ensure that an informal respite provider is a safe caretaker and the home is an appropriate place for a child. An informal respite provider must meet the following safety requirements:

1.	A home assessment, to determine the suitability of the family’s home, resources, and capacity, by Department of Heath & Human Services staff.

3.	Criminal records, child/adult protective services checks and Bureau of Motor Vehicle checks to assure that the individual does not have a criminal or abusive background.

When respite care is to be provided within the foster home, the worker shall meet the potential respite provider and gather information to document their appropriateness to provide care for the child. The worker will request the provider sign a release to complete the above background checks. Regulations regarding smoking must be adhered to. Respite providers must use appropriate infant car seats, enforce use of seat belts and follow other transportation guidelines.

As new families are licensed licensing worker will inform foster parents of the benefits of periodic respite. Foster and kinship parents shall be encouraged to recruit individual respite care providers with whom the children in their home are familiar. Staff is also encouraged to recruit previously licensed foster and kinship parents who are no longer actively providing care for children, but left the agency in good standing. Waiting adoptive families may be a good resource well.

Individuals and families referred to the agency as potential respite care providers will complete the normal licensing approval process. If approved the respite care providers will be placed on a current, local list of respite providers. Resource families will be given a list of respite providers with updates on a regular basis.

If a child in respite care experiences an accident, health problem, or significant changes in appearance or behavior the information needs to be shared with both the resource parent and the Department of Health & Human Services caseworker for the child. Information should be reported to the caseworker as soon as possible during normal business hours. Any situations requiring emergency medical care, crisis intervention services, missing or runaway children, or police involvement need to be reported to the 24-hour emergency number.

Respite providers should have listed with the department an emergency contact and location of where they might go in the event of a disaster.

Special Medical/Mental Health needs or concerns (allergies, dietary restrictions, etc):

If a child in respite care experiences an accident, health problem, or significant changes in appearance or behavior the information needs to be shared with both the resource parent and the Department of Health & Human Services caseworker for the child. Information should be reported to the caseworker as soon as possible during normal business hours. Any situations requiring emergency medical care, crisis intervention services, missing or runaway child, or police involvement need to be reported to the 24-hour emergency number: 1-800-452-1999.

If upon returning a child to their resource parents you are concerned for the immediate safety of the child call the 24-Hour emergency number for assistance and if necessary contact your local police department. The emotional and physical safety of the child is vital and your intervention should seek to minimize the impact on the child.

You may call the local office during business hours or 1-800-452-1999 after-hours for any support/questions while providing respite.

Respite can be beneficial to resource families. It allows resource parents to take a break, which helps prevent burn out. Respite offers birth children of the foster home quality time with their parents. It also gives the foster children a break. Hopefully, the foster children will be spending a weekend with other foster children; children they can relate to.

Resource parents are encouraged to not use more than two days of respite days per month to minimize transitions for the child. Additional respite can be authorized in emergencies/crises or when a child is transitioning to a permanent placement. When a resource parent is affiliated with a Child Placing agency the agency will be responsible for assisting the resource parent in arranging respite. Both regular and therapeutic resource parents will continue to receive their daily board rate during periods of respite and will arrange to pay the room and board portion of their reimbursement to the respite caregiver during periods of respite. In some situations, resource parents may prefer to enter into informal agreements with other resource parents and exchange provision of respite services rather than exchange payment for respite. Regardless of the method of reimbursement worked out between the resource parents, the child’s caseworker must be informed of who is providing care for the child whenever the child is in respite..

When a child is invited to a friend’s home for a sleepover or pajama party this is not considered respite and background checks do not need to be completed. Resource parents are trusted to make sound judgments regarding the safety and appropriateness of the home by meeting the parents, bring the child to the home, and inquiring about the level of supervision. Foster children need to participate in normal childhood experiences without additional barriers.

A poorly planned respite weekend can cause more stress for everyone involved: resource family, respite provider, and the foster children. Here are some tips for having a successful respite weekend.

Contact your caseworker in advance of your respite date so he/she can have adequate time to assist you in identifying a respite family for you (with the exception of emergency respite). The caseworker will provide you with the contact information for the respite provider. If you find your own respite provider, let the caseworker know who you have chosen and make certain the respite is approved.

Do your foster children know the respite family? To avoid further trauma, try to have a visit with the respite family beforehand. Sometimes this is not possible especially in emergency cases, but highly recommended. Maintaining one consistent respite provider is encouraged to provide security and comfort for the child.

When contacting the respite family make sure to clarify the drop off and pick up dates and who is providing the transportation. Misunderstandings regarding the pick up date can cause confusion and stress for both the respite provider, and foster child/foster family.

During your first phone contact, don’t forget to mention any appointments or visits to the respite provider. If they are unable to make these appointments, you may choose to look for another provider, or speak with your caseworker on rescheduling the appointments. Visits are the heart of the reunification process and should not be missed or rescheduled, except for emergency situations.

Suggest activities your child enjoys to the respite provider that are appropriate for the, age, developmental abilities, physical abilities, interpersonal characteristics and any special needs of the child.

When packing for your foster children, be sure to include enough clean clothes. Don’t forget extra underwear and socks. For infants and toddlers too many diapers and wipes are better than not enough. Provide the child with a suitable overnight bag or backpack complete with their own toothbrush, toothpaste, and other preferred toiletries.

You may want to check with your respite provider about any activities they may be planning so you pack the needed items (swimsuit, sneakers, and snowsuit).

If appropriate have the children pick out a special toy or stuffed animal to help them at bed time. You may want to put together a small photo album. The kind with pages that you can just slip the pictures into would be easiest to prepare. Include pictures of birth family, foster family, friends and pets.

Make a respite packet. This is something you only have to make once and update as needed. Type or clearly write a list of needed information. Include a copy of the Respite Care Foster Child Identification and Information Sheet (included with this sheet) which lists your name and numbers, the caseworker's name and number, and an emergency contact number for where you can be reached during the respite period.

It is also helpful to have a list of the daily schedule, fears, likes and dislikes of the children. This is especially helpful for babies and toddlers. Make sure to note any allergies, and of course, any appointments scheduled during this respite period. The packet also should include the child's Maine Care card and "consent to treat" paperwork. Write out instructions for any medication, and include a medicine log so the respite provider can document when the medication was given. Make certain you pack enough medication to last throughout the respite period. When children are prescribed medication, the respite caregiver will be provided with the medication in its original container; with information about administering the medication; and with information about any possible side-effects which need to be reported to the child’s prescribing physician.

Preparation is the key to a great respite weekend. You can come back to the children relaxed and ready to get back to work serving your community, providing homes for children, and helping families heal.