4517. Health Care Services for Children Placed in Out-of-Home Care

Original Date: 

Revised Date: October 20, 2022

Sunset Review Date: October 31, 2026

Approved by:  Frank Ordway, Chief of Staff

Policy Update Memo Effective July 1, 2023

Purpose 

Ensure children in out-of-home placement receive routine and necessary health care to provide for their health and well-being needs, including but not limited to:

  • An Initial Health Screen (IHS) to identify and address any emergent medical concerns at the time of placement.
  • Initial as well as on-going Early and Periodic Screening, Diagnosis and Treatment (EPSDT).
  • Immunizations
  • Dental examinations.

Scope

This policy applies to DCYF child welfare employees.

Laws

 

Chapter 13.34 RCW Juvenile Court Act-Dependency and Termination of Parent-Child Relationship

RCW 13.34.315 Health care-Evaluation and treatment.

42 CFR Part 441(B) Services: Requirements and Limits Applicable to Specific Services

Policy

  1. When a child is placed in out-of-home care under a court order, DCYF has the authority to authorize evaluations and treatment for the child’s routine and necessary medical, dental, or mental health care, and all necessary emergency care.
  2. To identify a child’s physical, behavioral and dental health care needs, the caseworker must complete all of the following:
    1. Obtain the child’s medical, dental and immunization history from the child’s parent or legal guardian or medical and dental providers.
    2. Provide caregivers with the child’s known physical, behavioral and dental health care history per the Notification of Court Hearings and Information Sharing with Out-of-Home policy.
  3. Informed consent of a parent or a court order is required for children younger than age 18 to undergo medical treatment that requires surgery, or anesthesia. Parental consent is required for psychotropic medications for children younger than 13 unless the child is legally-free.
  4. When a child has not had their recommended immunizations, caseworkers must verify a child is taken to a health care provider for immunizations. If a parent or legal guardian does not want their child immunized, caseworkers must complete the following:
    1. Refer the parent or legal guardian to RCW 28A.210.090 Immunization Program—Exemptions.
    2. Contact the local assistant attorney general (AAG) to discuss whether a court order is needed.
  5. Caseworkers will support a parent or legal guardian attending and participating in medical and dental appointments when it is safe and reasonable.
  6. Children, ages birth to 18 years of age, in out-of-home placement must have:
    1. An IHS within five calendar days of entering out-of-home placement by a qualified medical provider to identify and address any medical concerns.
    2. An EPSDT examination within 30 calendar days of entering out-of-home placement.
    3. Ongoing EPSDT examinations according to the schedule in the Procedures section.
    4. An initial dental examination scheduled within the first 30 calendar days of placement. The exam must occur within the first 60 days of placement unless the child is an infant and has not had their first tooth eruption.  
    5. At least one dental examination every six months.
  7. Caseworkers must follow DCYF Administrative 6.04 Supporting LGBTQIA+ Individuals policy when children and youth are seeking gender-affirming medical services.
  8. Document health information and records in FamLink.

Procedures

  1. IHS
    Caseworkers must:
    1. Verify children who enter out-of-home placement receive an IHS by their last known or other qualified medical provider as soon as possible but no later than five calendar days of original placement date (OPD). Qualified medical providers include:
      1. Medical Doctor (MD)
      2. Advanced Registered Nurse Practitioner (ARNP)
      3. Physician’s Assistant (PA)
    2. Only permit exceptions to the IHS requirement when children are:
      1. Released from a hospital (in-patient or emergency) directly into out-of-home care.
      2. Receiving healthcare services through a Pediatric Interim Care center (PIC).
      3. Receiving an IHS or scheduled to receive an IHS through a Child Advocacy Center (CAC) or sexual assault clinic.
      4. Receiving an EPSDT within five calendar days of entering out-of-home care. 
    3. Provide all known health information about the child to the caregiver and medical provider prior to the IHS.
    4. Provide the IHS information and recommendations to the caregiver and document:
      1. The information in the FamLink health/mental health pages under the "health" tab and insert a new "medical/dental/exam" within the required placement documentation timeframes.
      2. Reasons for any exceptions to the IHS requirement in a case note. 
    5. Verify children receive necessary follow-up healthcare as specified by the medical provider.
  2. EPSDT Examinations
    Caseworkers must:
    1. Verify children in out-of-home placement receive EPSDT examinations according to the schedule below:
      1. Within 30 calendar days of out-of-home placement
      2. Five examinations during a child's first year of life.
      3. Three examinations for children between one and two years of age
      4. Annual examinations for children between three and 20 years of age.
    2. Children entering out-of-home placement who received an EPSDT examination within 30 calendar days before placement, do not need another EPSDT unless:
      1. Medically indicated, or
      2. There are allegations of abuse or maltreatment that require medical examination.
    3. Obtain a copy of the EPSDT results and determine if recommended treatments or follow-ups have or need to occur for the child.
    4. Provide the child's caregiver all EPSDT results and assist them with obtaining any recommended services for the child.
  3. Dental Examinations
    Caseworkers must:
    1. Contact the child's dental provider within the first 30 calendar days of placement to schedule a dental exam. The initial exam must occur no later than the 60th day of placement.
    2. Verify children in out-of-home placement receive dental visits every six months.
    3. Obtain a copy of the dental exam and determine if recommended treatments and follow-ups have or need to occur for the child.
    4. Provide the child's caregiver all dental examination results and assist them in obtaining any recommended services for the child.
    5. Documentation
      1. Document the dates and results of all dental examinations in the FamLink health/mental health pages under the "health" tab and insert a new "medical/dental/exam" within the required placement documentation timeframes.
      2. Review and record the child's dental information at Shared Planning Meetings and in the report to the court.
  4. Consent for other than Routine or Necessary Medical Treatment for children who are not legally-free
    Caseworkers must:
    1. Assist the medical provider in obtaining informed parental consent for other than routine or necessary emergency care, including surgery, anesthesia, or gender-affirming medical care.
    2. If a parent is not available to provide consent or is not in agreement with the recommended medical treatment, obtain a statement from the medical provider that details the risks and benefits of the procedure or anesthesia. Request a court hearing and provide the court with the statement in order to enable the court to make an informed decision and issue the resulting order.
  5. Documentation
    1. Document child's health condition, the dates, and results of all EPSDT examinations including those that occur after the initial 30 day EPSDT.
    2. Document exams and health conditions in the FamLink health/mental health pages under the "health" tab within the required placement documentation timeframes.
    3. CHET screeners will document the initial EPSDT examination date and results on the Health/Mental Health Pages in FamLink.
    4. Review and record the child's EPSDT information at Shared Planning Meetings and the court report.
    5. Upload received medical records into FamLink.

Forms

Foster Care Initial Health Screen DCYF form 13-843

Resources

Access to Baby and Child Dentistry (ABCD)

Health Care Authority (HCA) Foster Care Medical Team (FCMT) – 1.800.562.3022Aging and Long-Term Support Administration (ALTSA) Fostering Well-Being Unit – 1.800.422.3263 ext. 52626 Apple Health Core Connections (AHCC) 1.844.354.9846

AHCC 24-HR Nurse Advice Line 1.844.354.9876, dial 2 for Member Services and listen for the Nurse Advice option

DCYF Administrative 6.04 Supporting LGBTQIA+ Individuals policy