2023-10-19 15:44:22
This recent instruction dated September 20, 2023 aims to strengthen therapeutic family care places in all regions for children and adolescents. The text specifies the modalities for implementing this reinforcement and recalls the framework of this mode of care, which relies in particular on family assistants.
Article L. 3221-1-1 of the Public Health Code (CSP) specifies that psychiatric activity is carried out in particular in the form of therapeutic family care (AFT). It is one of the possibilities for full-time care in psychiatry.1. According to article L. 421-2 of the Social Action and Families Code (CASF), l’assistant familial is the person who, for remuneration, habitually and permanently welcomes minors and adults under 21 years of age into their home. Its activity is part of a child protection system, a medico-social system or an AFT service within a health establishment. It is this last method of reception and care which is the subject of measure 15 of the Mental Health and Psychiatry Conference, with the aim of offering children, for
for whom returning home is not possible, an alternative to hospitalization and allow them to engage in a phase of rehabilitation or acquisition of a certain autonomy in a family environment in which they will be able to build social and emotional bonds2.
In 2019, the number of infant-juvenile therapeutic family reception places was 721, representing 107,212 days of hospitalization, without uniformity across the territory, with certain departments concentrating a high density of places, such as Normandy which has 140. Let us remember that to strengthen and develop this modality of care in the territories, measure 15 of the Mental Health and Psychiatry Conference proposes the creation of 100 additional AFT places for children and adolescents. Two years following the meeting, the ministerial instruction of September 20, 2023 specifies the terms of this reinforcement: additional places, homogenization of places in the territory, consolidation of existing places, with a dedicated envelope of 5 million euros.
Pour permettre d’accompagner le renforcement de l’accueil familial thérapeutique, une enveloppe de crédits pérennes dédiés de 5 M€ est prévue en 2023 au sein du compartiment « Transformation » du nouveau modèle de financement de la psychiatrie. Le coût d’une place en accueil familial thérapeutique a été évalué à environ 50 k€ (rémunération de la famille d’accueil et renforcement de l’équipe soignante dédiée).
To strengthen therapeutic family care in their territories, the ARS will have to put in place calls for expressions of interest in order to select the projects carried out by the most relevant health establishments, with the aim of creating AFT or strengthening the existing. The ARS must ensure that the projects are carried out by establishments which will be authorized in psychiatry for the child and adolescent psychiatry mention. The projects must be selected by November 30, 2023. An informative return to the DGOS is expected by January 31, 2024 at the latest.
Although the AFT service projects concerned by this instruction are carried out by health establishments, it is appropriate that the departmental councils be informed and involved in the process, taking into account both the status of family assistants (subject to approval of the departmental council) as well as children and adolescents who may be covered by the ASE.
1- See Instruction No. DGOS/R4/2022/257 of December 2, 2022 relating to the implementation of the reform of
authorizations for psychiatry activity.
2- Order of 1is October 1990 relating to the organization and operation of therapeutic family reception services.
• Instruction no. DGOS/R4/2023/142 of September 20, 2023 relating to the strengthening of therapeutic family care (AFT) for children and adolescents, OFFICIAL HEALTH BULLETIN (no. 2023.18, published on 09/29/2023) .
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