October 01, 2016

The Reasonable and Prudent Parent Standard

Heidi Redlich Epstein, Anne Marie Lancour

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

A new children’s attorney is asked by an older client if he can learn to drive. The client says his foster mother is teaching her son to drive and will teach him if it is allowed. It seemed a reasonable request so the attorney asked the child’s agency caseworker. “No, he is a foster child,” explained the caseworker. Not satisfied, the attorney pursued it up the chain of command, learning that foster children are not allowed to drive due to liability concerns. This made no sense. Foster children are told to do what they can to fit in and have a “normal” life, but many challenges impede that feeling of normalcy. A normal life would not include preventing a child from undertaking an age appropriate activity just because they are in foster care.” 

Federal Law Overview

The Sex Trafficking and Strengthening Families Act of 2014, Supporting Normalcy for Children in Foster Care provision,1 attempts to legislate normalcy for foster children. It requires caregivers use a “reasonable and prudent parent standard” when determining whether to allow a child in foster care to participate in extracurricular, enrichment, cultural, and social activities. Additionally, a “caregiver” must be appointed to apply the reasonable and prudent standard for children who reside in congregate or institutional care. 

Normalcy findings. At permanency hearings, the child welfare agency must provide the court with information that the reasonable and prudent parent standard is being followed. 

Although the law requires such findings only for children with a permanency goal of Another Planned Permanent Living Arrangement (APPLA), best practice is to make a finding for all children to uphold the intent of this law. The agency must verify for the court that the child is being given a chance to participate in age and developmentally appropriate activities.

Foster parent training. The move toward autonomous decision making by caregivers diverges from past practice, standards, and foster parent training. Recognizing this change, the law requires foster parents to be trained on this standard. Additionally, the Department of Health and Human Services must assist states with best practices to help foster parents apply a reasonable and prudent parent standard in a way that considers any concerns of the biological parents. However, trepidation by biological parents alone should not be the determining factor in decision making.

Liability protection. Liability policies must also be set by each state to protect caregivers who appropriately apply this standard when making daily decisions about approved activities for foster children. 

Older youth. This section also provides an additional $3 million (beginning in FY 2020) be made available each year under the Title IV-E Independent Living program. The goal is to promote age-appropriate activities for youth who are likely to remain in foster care until age 18. 

Purpose and Intent of Standard

Foster children need to develop life skills that will guide their development later on in life. One way these life skills are obtained is giving the foster child the same opportunities as children who are not in foster care. The reasonable and prudent parent standard calls for the foster parent to consider factors in making decisions on behalf of the child. Foster children should be given the same opportunities as children not in foster care. These could include:

  • Having an impromptu visit at a friend’s house
  • Playing in a pickup basketball game
  • Going on an out-of-state trip to a camp or dance event
  • Other activities that non-foster children participate in as part of growing up.

The foster parent needs to use their judgment in giving opportunities to the foster children and should not worry about being sued for allowing children to participate in normal activities based on the child’s age and developmental abilities. 

The reasonable and prudent parent standard should not infringe on parents’ rights. Parents should be included in decision making especially around education and health care. 

Need for Normalcy for Children

Congress recognized the need for normalcy and found the inability to participate in age or developmentally appropriate activities affects children’s healthy development and decision making. It also increases the likelihood that foster children will be victims of sex trafficking, become homeless, and have other negative outcomes in foster care.3

Children in foster care need to be able to participate in regular childhood activities and foster parents need to make daily decisions on issues such as: 

  • Afterschool clubs and activities
  • Reasonable and age-appropriate phone and computer use
  • Reasonable curfews and rules for dating and socializing
  • School or community-based sports
  • Civic activities, such as volunteering, Girl Scouts or Boy Scouts
  • Cultural activities—theatre, dance, or arts
  • Attending a community event such as a festival or holiday celebration
  • Social activities with friends and peers, including unsupervised social activities, such as:

    • Going to the movies
    • Trips to the mall
    • Athletic events
    • Dating
    • Visiting friends’ houses
  • Use of cell phones, internet and social media
  • Job opportunities
  • Travel, yearbook photos, driver’s licenses and learner’s permits

Healthy development. Adolescent brain research shows how important it is for youth to have experiences and relationships to become successful adults.4 Adolescent brains continue to develop and this growth is just as important as growth during early childhood.5 An adolescent’s brain is still developing; that development governs reasoning, planning, decision making, judgment, and impulse control.6 Adolescents are making their way into adulthood but are still experiencing mood swings and growing pains as they mature, try new experiences, and seek independence.7 It is important for foster parents to apply a reasonable and prudent standard as they help foster children in their care move through adolescence. 

Societal costs. The cost of not providing normalcy is high. Foster youth need to have life skills as they move toward adulthood. Without normal opportunities to grow and learn in a family setting, with reasonable limits, they may not have the skills to navigate adulthood. Youth also need to have permanent connections to adults; those connections may be adults the youth interact with in sports, the community, or other activities.

State Implementation

State legislation. Before the normalcy provision was enacted, some states had already passed similar requirements to achieve normalcy for foster children. Since its passage, 25 states have enacted legislation codifying the federal normalcy provision by statute or administrative code. Eight more states have legislation pending. Most states follow the federal law exactly. Other state statutes list additional factors for the caregiver to consider when using the reasonable and prudent parent standard, including: 

  • The child’s age, maturity, and developmental level while balancing the overall health and safety of the child.
  • The potential risks to the child or to others and the appropriateness of the extracurricular, enrichment, cultural or social activity or experience.
  • The best interest of the child, based on information known by the caregiver.
  • The importance of encouraging the child’s emotional and developmental growth.
  • The importance of supporting the child developing skills to successfully transition to adulthood.
  • The importance of providing the child with the most family-like living experience possible.
  • Any special needs or accommodations the child may need to safely participate in the activity or experience.
  • The child’s wishes, though not determinative, may also be considered.8

Case documentation. Many states require documentation in the child’s case plan about normalcy activities, especially for older youth. For example, Georgia’s statute states: 

… steps the state agency is taking to ensure that the child’s foster family home or child care institution is following the reasonable and prudent parent standard, and documentation that the child has regular, ongoing opportunities to engage in age or developmentally appropriate activities, including by consulting with the child in an age-appropriate manner about the opportunities of the child to participate in the activities.9

Caregiver support. Training and supporting caregivers is critical. “Recognizing the greatest opportunity for normalcy lies in the day-to-day decisions affecting the child’s activities, the child’s caretaker should be supported in making those decisions through the use of the reasonable and prudent parent standard.”10 Many states have legislated that training on this standard be mandatory for foster parents and have also created checklists and helpful guides.

Limitations on activities. As discussed earlier, the federal law provides examples of activities to include when considering what is reasonable and prudent parenting. Some states give examples of activities that should be encouraged while others place limits on those considered potentially harmful, such as hunting and riding an all-terrain vehicle. For example:

  • California’s normalcy provision states: “Nothing in this section shall be construed to permit a child’s caregiver to permit the child to engage in day-to-day activities that carry an unreasonable risk of harm, or subject the child to abuse or neglect.” Safety is paramount and requires the caregiver to make decisions with care.11 
  • Mississippi’s law specifies it is the caregivers’ responsibly to make sure the child has “…the safety equipment and any necessary permissions and training necessary to safely engage in each activity the child may participate in.” (Miss. Admin. Code 18-6:1.D-I)
  • Idaho Department of Health and Welfare forbids participating in high risk activities as outlined in Idaho’s Foster Care Recreation Standard. High-risk activities are never allowed, whereas moderate-risk activities may be allowed if certain safety precautions are met and mild-risk activities are presumptively allowed. High-risk activities include: White-water boating or rafting in waters with rapids rated at 3 or higher; rugged mountain or cliff climbing or climbing requiring ropes; hunting or target practicing with anyone other than the child’s parent or guardian; driving off-road motorized vehicles; kayaking; bungee jumping, base jumping, parachuting or sky diving. 12

Role of courts. One bill attempts to clarify and set limits on the role of the court by addressing the procedure for any questionable decision making by the caregiver. In Missouri, Senate Bill 979 proposes “No court shall order the division to provide funding for activities chosen by the caregiver. A caregiver’s decisions with regard to the child may be overturned by the court only if, upon notice and a hearing, the court finds by clear and convincing evidence the reasonable and prudent parent standard has been violated. The caregiver shall have the right to receive notice, to attend the hearing, and to present evidence at the hearing. …”

Agency policies. Some states have drafted internal agency policy, guidelines and tools, either in addition to or in lieu of statutes. Policies drafted to augment laws and guide child welfare agency staff can be helpful as this is a culture shift for many. Some policies are specific and establish clear guidelines on activities, including limiting the number of hours the foster child may be out of the foster home to no more than 24 - 48 hours and requiring notification, not preapproval, to the agency for out-of-state travel. New York published a 20-page administrative directive accompanied by three detailed tools that assist caseworkers gather information to support normative experiences, suggesting caregiver considerations when applying the reasonable and prudent parent standard and explaining what professionals and caregivers need to know before applying the standard. The state policy also addresses applying this requirement to different groups, such as children with a behavioral diagnosis and victims of sex trafficking.13

Following policy alone is typically not considered best practice, as agency policy without the force of a statute is rarely enforceable. Also, most jurisdictions have not defined the repercussions for the child welfare agency if a child is not provided opportunities similar to children not in foster care. 

Well-crafted legislation is needed to establish oversight and enforcement. Promoting Normalcy for Children and Youth in Foster Care, published by the Juvenile Law Center in 2015, suggests the following components of an effective normalcy law: 

  • Provide a right to engage in age or developmentally appropriate activities with an affirmative duty of the child welfare agency to provide these opportunities. 
  • Require including these activities in each child’s case plan and judicial oversight and a youth-friendly grievance procedure. 
  • Give youth a document describing their rights and grievance procedures.
  • Explain that normalcy for youth in foster care does not alter legal rights of biological parents. 
  • Ensure normalcy activities are provided in all group care settings. 
  • Codify the reasonable and prudent parent standard and clarify the scope of the decision-making authority.
  • Provide liability protections for foster parents and caregivers.14

Common Barriers to Implementation 

Culture shift. Promoting age-appropriate activities for foster children and supporting foster parents’ ability to make reasonable parenting decisions requires a culture shift. Clear guidelines and effective training are needed for foster parents and child welfare professionals. All participants must be informed of the specific training provided to foster parents to build the required trust in their decision-making ability. 

Costs. In addition changing the mindset of foster parents and child welfare professionals, this new standard has other potential implementation barriers. One major hurdle is who will pay for children’s activities. It is not expected that a new funding stream will be available in most states to make applying the reasonable and prudent standard practical so the solution will lie in the creativity of the players. As most parents quickly discover, it is not cheap to raise children and finding low-cost activities or creative ways to pay for activities is critical. Child Welfare agencies may want to consider contacting local organizations to see if they would be willing to provide low-cost activities to children in foster care.

The authors of Promoting Normalcy for Children and Youth in Foster Care (p.12) suggest possible funding strategies, including raising room and board rates for foster parents to cover the costs of participating in activities. These are arguably reimbursable under Title IV-E as a necessary expense under foster care maintenance payments. Another possibility is to draft state legislation requesting additional funds to support age-appropriate activities for foster children. For example, California recently proposed new legislation that would establish the California Foster Youth Enrichment Grant Program. This program would provide grants to foster youth to participate in activities that enhance their skills, abilities, self-esteem, or overall well-being. Examples of eligible activities include:

  • music, dance or drama lessons, 
  • school trips, 
  • college campus visits, 
  • advanced placement exam fees, 
  • test preparation courses or materials and books, 
  • summer camp attendance, 
  • sports league participation, 
  • school-sponsored formal dance attendance, and 
  • participation in school graduation activities.15

Safety and risks. Finally, it may help to provide detailed guidance to caregivers on making appropriate decisions, while not unreasonably limiting their decision-making authority. An example is a list of activities considered inherently risky and therefore requiring special consideration, such as Idaho’s list of high-risk activities referenced above.

Practice Tips 

Understand the normalcy provision and advise clients. Judges and attorneys need to be involved in promoting reasonable and prudent parenting, understand the provisions of the law, and share those provisions with clients.

Judges:

  • need training on the normalcy provisions and tools to help implement them. A judge’s checklist can help when reviewing courtroom findings regarding normalcy activities. (See “Questions to Ask at Permanency Hearings: Normalcy”).

Agency attorneys:

  • should review provisions of the law with casework staff and check to see if agency policies need to be updated.
  • should look into providing reduced rate liability insurance for foster parents for activities covered under normalcy provisions.

Parent attorneys:

  • should ensure their clients’ rights and concerns are considered. If there is a dispute, ask the court to make rulings if necessary. For example, if a parent objects to a child getting a job after school, the agency should consider the basis for the parent’s objection. 

    • Is there a safety issue? 
    • Will the child’s school work suffer? 
    • Is the work incompatible with the family’s religious preferences? 

  • If the agency and parent cannot agree on a resolution, the parent can ask for the issue to be reviewed in the next court hearing and have the court make findings based on the evidence presented.
  • Alternately, mediation may be used to resolve the issues between the caregiver and the parents. 

Children’s attorneys:

  • should advocate for their clients to be able to engage in age and developmentally appropriate activities. Consider working with local partners to arrange low-cost alternatives for foster youth wanting to engage in these activities.
  • should encourage their clients to come to court and advocate for their own normalcy activities. As courts see the impact of these activities on children, they will be more willing to encourage them in the future. (See sidebar, “Preparing Youth for Court”)

Be familiar with state practice and statutory guidelines. Some states have developed practice guidelines for legal practitioners with useful tools and information on implementing the normalcy provisions. Others have passed legislation.

  • The Florida Guardian ad Litem Program Dependency Practice Manual includes a section on how to help achieve normalcy for clients, a normalcy checklist, and a worksheet for GALs.
  • Nebraska passed legislation allowing foster parents to use their best judgment in making decisions about developmentally appropriate extracurricular, enrichment, cultural, and social activities for foster children.
  • Nebraska’s legislation recommends that: 

    • Foster parents consider various factors, including the child’s goals and input, parents’ input, and the child’s dopmental level, when making reasonable and prudent parenting decisions 
    • Children in foster care have the right to participate in normalcy activities 
    • The otherwise existing constitutional rights of biological parents are not impacted by the reasonable and prudent parenting standard.
  • Nebraska also suggested questions for judges when considering reasonable and prudent parenting standards, including: 

    • What extracurricular activities is the youth involved in?
    • What opportunities has the youth had to socialize with his or her peers?
    • Has the child traveled at all?
    • Does the young person have a job?
    • What activities does the child wish to participate in?
    • What barriers has the caregiver experienced connecting the youth to extracurricular and social activities?
    • Is the youth participating in all activities he/she would like to participate in? If not, why not?18

Prepare to handle disputes with parents over activities. The child’s biological parent may disagree with an activity identified for a child. While Louisiana statute does not specifically address legal disputes with parents around reasonable and prudent parenting, the Louisiana Pelican Center recommends courts, parties, and the legislature respect the legal rights and authority of the legal parent when the parent’s rights have not been terminated and the parent remains active in the child’s life. This includes keeping the legal parent reasonably informed about the child’s activities and seeking parental approval when possible and appropriate. The court should be involved if the foster parents and parents cannot agree. Disputes may include:

  • Parent objecting to an activity due to concern about safety         
  • Parent objecting to activity that might be against the family’s religious beliefs  
  • Parent objecting to an activity which may interfere with other activities that the parent believes are more important. 

When trying to resolve differences between parents and foster parents, Louisiana’s Pelican Center recommends courts assess:

  • The parent’s motives for objecting to the activity
  • The reasonableness of the parent’s concern
  • The prior history of the child and the family regarding this or other suggested activities
  • The child’s expressed interests
  • The parent’s reasonable and sincere objections

Conclusion

Foster children need to have the same opportunities as children who are not in care. Those opportunities will allow children the chance to develop bonds with other youth and adults; those adults may be the positive bonds that will help the youth become successful later on in life. The child welfare agency, foster parents, attorneys and the court should help the foster child participate in age and developmentally appropriate activities so the child can have as normal a life as possible. The reasonable and prudent parenting standard can help the foster child have a positive outcome in foster care and adulthood.

Heidi Redlich Epstein, JD, MSW, is the director of kinship policy and the assistant director of state projects at the ABA Center on Children and the Law. She provides legal training and technical assistance on kinship care, permanency issues and concurrent planning to judges, attorneys, and social service professionals. Heidi co-manages the Grandfamilies State Law and Policy Resource Center at www.grandfamilies.org. She was previously a law guardian for Legal Aid of Maryland and a residential social worker in upstate New York.

Anne Marie Lancour, JD, MAT is the Center’s Associate Director and Director of State Projects. She directs the Center’s award-winning Permanency Barriers Project and is a national expert on child abuse and neglect, termination of parental rights, adoption, and foster care. She provides training on legal ethics, system reform, permanency planning, and serves on several statewide policy reform workgroups in Pennsylvania.

This article was developed in collaboration with the Pelican Center for Children and Families, which administers the Louisiana Court Improvement Program under a sub-grant agreement with the Louisiana Supreme Court.

Endnotes

1. Pub. L. No 111. 

2. Sec. 111(a) (3)NOTE: 42 USC 671 note.

3. Committee Reports, 113th Congress (2013-2014), House Report 113-441.

4. Juvenile Law Center. Promoting Normalcy for Children and Youth in Foster Care, 2015, 5. 

5. Lawrence Steinburg, Ph.D. Age of Opportunity, 2014, 10-11.

6. Jim Casey Youth. The Adolescent Brain: New Research and its Implications, 2015, 20.

7. Jim Casey Youth, 2015, 11; “Beyond Raging Hormones.” Harvard Mental Health Letter, 2005.

8. 11 P.S. § 2644; La. Rev. Stat. § 46:283; Tex. [Fam.] Code Ann. §264.125; FL Stat Ann §39.4091(3)(b), 409.145 (3)(b)(2).

9. Ga. Code Ann., § 15-11-201.

10. La. Child. Code Ann. art. 675.

11. Cal. Welf. & Inst. Code §361.2.

12. Idaho Department of Health and Welfare. Idaho Foster Care Recreation Standard, 2015.

13. New York State Office of Children and Family Services, Administrative Directive, 15-OCFS-ADM-21, 2015. 

14. Juvenile Law Center, 2015, 3, 11-21

15. Assembly Bill 1984 (California, February 2016).

16. LB 746 (Nebraska 2015).

17. Ibid.

18. Nebraska Appleseed. Implementing the “Normalcy” Provisions in the Preventing Sex Trafficking and Strengthening Families Act (PL 113-183), A Guide for Court Stakeholders, October 2015.

Sidebar: Preparing Youth for Court

  • In what school and community activities is the youth participating? 
  • Is the youth getting to take part in such experiences as: 

    • Spending time with peers? 
    • Spending time with mentors? 
    • Afterschool employment, internships, or work experiences? 
    • Taking on more independence and responsibility in the home or placement, such as chores, later curfew, budgeting, etc.? 
    • Driver’s education and getting a driver’s license? 
    • Cultural activities? 
    • Activities or groups that support a youth’s ethnic, religious, or racial identity? 
    • Activities or groups that support a youth’s gender identity or sexual orientation? 
  • If the youth is in a family foster care setting: 

    • Is he or she able to participate in activities with the family, such as trips, celebrations, etc.? 
    • Have you discussed with the foster parents how they are adjusting to the new reasonable and prudent parent standard? Are they experiencing any challenges? Do they need any support to help facilitate the youth’s access to age or developmentally appropriate activities (e.g., information about activities, transportation, and funding)? 
  • If the youth is in a child care institution, including a congregate facility: 

    • Do you and the youth know how to ask the caregiver about participation in activities? 
    • Is the youth facing any challenges to making requests and getting permission that need to be addressed, such as timeliness? 
    • Have you discussed with staff at the child care institution whether they need any support to help facilitate the youth’s access to age or developmentally appropriate activities? Assistance could include things such as: information about activities, transportation, and funding.
  • Is normalcy discussed in case planning and included in the case plan goals? How is the youth being included? Are the biological parents being included? 
  • If the youth is not participating in age or developmentally appropriate activities— or not participating to the extent you believe is appropriate—what are the barriers? 

    • Have you discussed with the youth’s team how to address the barriers? 
    • Are you prepared to make ecommendations or propose orders to the court to address the barriers?
    • Is the youth prepared to respond to the court about normalcy? 
    • Have you helped the youth practice his or her response verbally or in writing? 
    • Have you explained to the youth what will happen in court and who will be present?
    • Do you need to make any special request or arrangements to ensure the youth is comfortable responding to questions about normalcy? 

      • Would the youth like to submit something in writing? 
      • Would the youth like to speak to the judge in chambers if allowed? 
      • Would the youth like a support person, like a therapist?

Reprinted from Pokempner, Jennifer. The Role of the Court in Implementing the Older Youth Provisions of the Strengthening Families Act, February 2016, ABA Center on Children and the Law Youth Engagement Project.

Sidebar: Questions to Ask at Hearings: Normalcy

If the youth is in family foster care, is he or she being provided regular and ongoing opportunities to participate in age or developmentally appropriate activities and experiences? 

  •  Can the youth describe these activities? 
  •  If opportunities are not being provided or taken advantage of, what are the barriers?

Does the child face barriers to participation because of a disability; special need; lesbian, gay, bisexual, transgender, or queer status (LGBTQ); parenting; or any other identified issue?

  • Are barriers related to cost of an activity or transportation? 
  • Does the child or caregiver need support or help addressing these barriers? Are there any orders the court can issue to address the barriers? 
  • If the youth is placed in a child care institution, is he or she receiving regular and ongoing opportunities to participate in age or developmentally appropriate activities and experiences? 

    • Can the youth describe these activities?
    • Does the child understand how to request permission to participate in activities from the designated caregiver?
    • If opportunities are not being provided or taken advantage of, what are the barriers?

Does the child face barriers to participation because of a disability, special need, LGBTQ status, parenting, or other identified issues?

  • Does the child or caregiver need support or assistance in addressing these barriers? 
  • Are there orders the court can issue to address barriers to participation? 
  • Is the reasonable and prudent parent standard being exercised? Has the caregiver received the required trainings? 
  • How are the child’s parents being involved in the child’s experience of normalcy?

Reprinted from Pokempner, Jennifer. The Role of the Court in Implementing the Older Youth Provisions of the Strengthening Families Act, February 2016, ABA Center on Children and the Law Youth Engagement Project.

Sidebar: How Can the Court Implement the Normalcy Provisions Effectively?

The court ensures the normalcy provisions are enforced by providing oversight and setting expectations. Implementing the normalcy provisions may mean significant culture change in many jurisdictions where permission of the agency or court is sought for every decision that is made with respect to a child’s activities. The court should be a leader and enforcer of these changes to help ensure that they are felt in the everyday lives of children.

The court can do this by:

  • Communicating the importance of normalcy to child well-being and permanency.
  • Making findings that the reasonable and prudent parent standard is being exercised.
  • Making findings of the regular and ongoing opportunities to engage in age or developmentally appropriate activities.
  • Issuing orders to eliminate barriers to youth participation in activities, such as:

    • Providing transportation, obtaining funding to make participation possible, or directing that planning meetings occur to discuss participation. 
    • Ensuring agency policies and practices are not at odds with new federal and state policy on normalcy.
    • Modeling collaborative decision making that facilitates youth involvement in age-appropriate activities and respects the roles of all parties, including the biological parents.

Because of these new provisions, the court should no longer be enmeshed in decisions about day-to-day social and recreational activities unless there is a conflict. Parties should no longer need to ask for hearings to get court approval to attend a camp or to take a school picture. Instead, the court can focus its time on areas of conflict regarding normalcy, and on permanency and well-being issues in general.

The court should set the tone about the importance of normalcy and what is expected in court reviews. 

Reprinted from Pokempner, Jennifer. The Role of the Court in Implementing the Older Youth Provisions of the Strengthening Families Act, February 2016, ABA Center on Children and the Law Youth Engagement Project.

 

Sidebar: Normalcy Resources

Pokempner, Jennifer et al. Promoting Normalcy for Children and Youth in Foster Care, May 2015, Juvenile Law Center.

Pokempner, Jennifer. The Role of the Court in Implementing Older Youth Provisions of the Strengthening Families Act, February 2016, ABA Center on Children and the Law Youth Engagement Project.

Promoting Well-Being through the Reasonable and Prudent Parent Standard, Center for the Study of Social Policy, 2014.

What Young People Need to Thrive: Leveraging the Strengthening Families Act to Promote Normalcy, Jim Casey Youth Opportunities Initiative, The Annie E. Casey Foundation, 2015.

Kids Central. Caregiver Guide to Normalcy, 2014. 

Washington State Department of Social and Health Services. Decision Making Department of Family and Protective Services: Normalcy Activities for Children, 2014.