Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0070-516.15 | Revision Date: 12/11/20

Overview

This policy guide provides guidelines on the provision of mental health services to children under the supervision of DCFS, including the referral of cases to the Coordinated Services Action Team (CSAT).

TABLE OF CONTENTS

Policy

Child Welfare Mental Health Screening Tool (MHST)

Consent for Mental Health Services and Releasing Information

Coordinated Services Action Team (CSAT)

CSAT Roles and Responsibilities

Procedure

Initiating a Mental Health Screening

ER CSW Responsibilities

ER CSW Responsibilities for ER Referrals Under Investigation

ER CSW Responsibilities for Newly Detained Children

ER CSW Responsibilities When Providing Ongoing Services (Court or Voluntary)

ER SCSW Responsibilities for Newly Opened Non-Detained Child Under Court Ordered FM, VFM, or VFR

MAT+SLS Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

Continuing Services CSW Responsibilities for Newly Detained and Non-Detained FM, VFM, or VFR

Dependency Investigator (DI) Responsibilities

Linking to and Engagement with Mental Health Services

Continuing Services CSW Responsibilities

Working with DMH Specialized Foster Care (SFC) for MHST Screenings and Mental Health Service Linkage

Continuing Services CSW Responsibilities

CSAT Team Responsibilities

DMH Specialized Foster Care (SFC) Responsibilities

Approvals

Helpful Links

Attachments

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version to update the CSAT referral process, including new responsibilities of the Multidisciplinary Action Team (MAT)+Services Linkage Specialist (SLS) staff, and instructions on how to work with DMH SFC for mental health screenings and service linkage.

POLICY

Child Welfare Mental Health Screening Tool (MHST)

The Child Welfare Mental Health Screening Tool (MHST) is a quick tool intended to be used primarily by non-mental health professionals to rapidly screen and identify children and youth who should be referred for a mental health assessment. There are two (2) screening tools: one (1) for children 0-5 years; one (1) for children 5 years-adult. Both tools may be accessed through the Referral Portal on DCFS's LA Kids Website.

Emergency Response Children's Social Workers (ER CSWs) will complete a MHST for children in conjunction with the promotion of an emergency response referral to a case. This will initiate the start of ongoing child welfare services to the family (both court and voluntary cases).

No MHST is required for emergency response referrals where it has been determined that child welfare services will not be provided.

The Child Welfare Mental Health Screening Tool (MHST) will be administered by the Continuing Services CSW for children on an open case who meet the following criteria:

• The child is not receiving mental health services at the time of the case plan update.

• The child presents with a behavioral indicator for which they previously screened negative.

• Results of the MHST are defined as follows:

• A positive MHST screen is when any item other than “no” is checked on the MHST and comments indicate a need for mental health services.

• A negative MHST screen is when items are not checked or marked “no” only on the MHST and indicates no need for mental health services.

• For all children who screen negative, an annual re-screening from the date of the last negative screen will be required unless they are receiving mental health services.

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Consent for Mental Health Services and Releasing Information

A parent/guardian must provide consent by signing a DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental ServicesServices provided by the Regional Centers, which include diagnostic evaluation, coordination or resources such as education, health, welfare, rehabilitation and recreation for persons with developmental disabilities. Additional services include program planning, admission to and discharge from state hospitals, court-ordered evaluations and consultation to other agencies., before mental health and/or developmental assessments and services can commence.

• If the parent is unavailable or declines to sign the DCFS 179-MH, the Court must give authorization. Children 12 years or older, who are mature enough, and legal guardians may also give authorization if it is more expedient.

• Authorization to release and exchange protected health information (PHI) may be obtained either by the parent’s signature on the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information, or by a court order at the time consent for mental health treatment is requested. Authorization for the release of protected health information depends on who provided consent to treatment. If the parent/legal guardian provided consent, they would authorize the release of the PHI. However, if the minor consented to their own mental health treatment, then the minor's authorization is needed.

• Nonminor dependents (NMDs) may consent to their own treatment.

If a child is under court ordered DCFS supervision, a health care provider is allowed by law to disclose protected medical or mental health information without the child’s or parent/guardian's authorization to DCFS in order to coordinate the health and mental health treatment of the child. The Department of Mental Health (DMH) Specialized Foster Care (SFC) staff may share (PHI) consistent with DMH policy and the requirements of the federal Health Insurance Portability and Accountability Act (HIPAA)Passed in 2003, the Health Insurance Portability and Accountability Act (HIPAA) is designed to give patients more control over their health information, set boundaries on the use and disclosure of health information, institute safeguards to protect privacy of health information, create accountability, civil and criminal penalties, and establish a balance between individual privacy and the public good. In cases where the law of California is more restrictive than HIPAA, the State law must be followed. Conversely, if HIPAA is more restrictive than State law, then HIPAA must be followed unless there is a legal exception. and Confidentiality of Medical Record Act (CMRA).

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Coordinated Services Action Team (CSAT)

The primary function of the CSAT is to provide a regionally based, clinical management team to assist the Children's Social Worker (CSW) in coordinating services for the family and aim to reduce the number of agencies from which the family will receive services.

CSAT establishes specific protocols in each regional office regarding division of labor in order to ensure that staffing and programmatic resources in each regional office are utilized as fully and efficiently as possible.

• Each regional CSAT office has various staffing resources and needs to adapt accordingly.

• The composition of the CSAT may vary depending on the nature of the family’s/children’s needs and the status of the child’s placement.

• CSAT has numerous lead positions, including but not limited to, the Public Health Nurse (PHN), Residential Care Liaison (RCL), Level of Care/Child and Adolescent Needs and Strengths (LOC/CANS) CSW, DMH Specialized Foster Care (SFC), Education Specialist, Parents in Partnership (PIP), and Community Based Liaison (CBL).

• The lead position within the team may also vary depending on the program status of the case.

A secondary function of the CSAT is to manage and enter necessary data into CWS/CMS. Automated reports are then produced to track the completion of tasks and the utilization of resources, related to the services provided and the County’s compliance with the terms of the Katie A. Settlement Agreement. In addition, the CSAT:

• Assists to quickly identify a family’s strengths/needs and matches those needs with available community based resources

• Provides office-based expertise to expedite and ensure service linkage, and

• Manages or directly completes tasks associated with the completion of the following:

• Documenting initial medical examinations for newly detained children

• Documenting completion of developmental screens and services

• Documenting children’s enrollment in school and Regional Center status

• Assistance with the completion of the Child Welfare Mental Health Screening Tool (MHST), as required

• Obtain consent and authorization for release of information and determine existing financial eligibility

• Referral/Linkage for assessment and treatment, as needed

• Resource Management

CSAT Roles and Responsibilities

The primary role of the Multidisciplinary Assessment Team (MAT)+Service Linkage Specialist (SLS) Children Services Administrator (CSA) is to ensure that all children with an open case are screened, assessed, and linked to mental health services as needed. In particular, the MAT+SLS CSAs ensure that each eligible newly detained child receives a mental health screening, a MAT assessment, a MAT Summary of Findings (SOF) meeting and report, and is linked to mental health treatment, as needed. Additionally, the MAT+SLS CSAs will:

• Complete specific tasks, including data entry associated with the completion of the Medical Hub (Hub) examination, MHST, consent, benefits establishment and referral to a DMH MAT provider for all newly detained children.

• Complete administrative activities associated with the Medical Hub such as receiving the results of the Hub’s initial medical examination, ensuring the Hub results are distributed to the MAT Provider, and documenting the information in CWS/CMS.

• Perform similar administrative duties related to other points of service along the screening, assessment and service linkage continuum.

• Provide case support on cases brought to the attention of management in the Bureau of Clinical Resources and Services (BCRS).

• Facilitate Child and Family Team Meetings (CFTMs) or staffing for high risk cases, as needed.

• Invite CSAT members to attend CFTMs based on the child and family's needs.

• Develop the safety plan, identifying the child's strengths and needs, as well as interventions.

• Complete the service linkage in coordination with the DMH SFC and the CSW.

• Consider referring cases with expectant and parenting youth to a DCFS Expectant and Parenting Youth (EPY) Conference.

• An EPY Conference is a voluntary, proactive tool intended to identify and discuss issues related pregnancy and early stages of child rearing for the expectant or parenting youth, including fathers. EPY Conferences focus on planning for healthy parenting, identifying appropriate resources and services, and preparing for a successful transition to independence.

• Assist the CSW with re-establishing eligibility for a child deemed ineligible for Temporary Aid for Needy Families (TANF).

• Serve in a leadership and support role to the CSAT team members, including the: Educational Specialist, PHNs, LOC/CANS, etc.

• Manage the coordination of all CSAT activities.

• Enter required data and to produce regular reports for analysis in compliance with Katie A. data tracking requirements.

The Residential Care Liaison (RCL) supports the Regional CSAT. RCLs are assigned as the CSAT lead for certain high-needs children on existing cases who require an extraordinary amount of the CSW's time. In particular, the RCL in each regional office:

• Brings the child's team together to assist the CSW in identifying and ensuring the most appropriate placement and services provided for the child/youth, and

• Coordinates staff meetings/teleconferences

The DMH Specialized Foster Care (SFC) Staff, co-located in DCFS offices, triage, assess and link children and families to mental health services. DMH resources and procedures allow staff to attend Child and Family Team Meetings (CFTMs) meetings acting as a mental health representative on the team. DMH staff are also tasked with following up on the MHST and consultations for ER investigations and open cases on high risk children.

The DMH Specialized Foster Care (SFC) Supervisor (or his/her designee) is the primary point of contact for mental health issues on the CSAT team. The DMH/SFC Supervisor:

• Reviews and screens all referrals that come to the co-located programs

• Assigns cases to clinicians within the program

• Oversees the tracking of case disposition

The CSAT Centralized Unit supports the CSAT process, by serving as the central coordination point to support MAT+SLS CSAs. The centralized unit clerk will process and track all completed MHSTs from the CSWs and Hubs, monitor the CSAT in-box, and provide clerical and data entry support for the MAT+SLS CSA.

The DCFS Eligibility Verification Staff assists the CSAT team in resolving problems with Medi-CalCalifornia's federal Medicaid program. eligibility that interfere with the child’s access to services. Staff will refer families to resources to assist in the benefits establishment process (i.e. CalWORKS /GAIN).

The DPSS Linkages GAINGreater Avenues for Independence - CalWORKs services may include GAIN services (Welfare-to-Work Program). GAIN is mandatory for parents aided on CalWORKs, unless there is an exemption (e.g., parent has a child under a year old, temporary incapacity, participant is over age 65). Social Workers (LGSWs) are co-located at DCFS offices that have implemented Linkages. The LGSW:

• Facilitates a referral for families from DCFS via the DCFS 5122 form to DPSS where the identified goal is family reunification.

• Helps CSWs to verify and ensure Medi-Cal, specifically “full scope” Medi-Cal.

• In the screening and assessment of non-detained children, works with the MAT+SLS to expedite the verification and processing of Medi-Cal for families who may be eligible but not already receiving Medi-Cal.

• Attends CFTMs when needed, to assist in streamlining supportive services, or prescreening for potential services eligibility for mutual families and caregivers.

Additional staff may be called upon, on a case by case basis, to join the team as needed. This may include:

• Staff from the Permanency Partners Program (P-3)

• Staff from the Resource Family Approval (RFA) program

• Educational Liaisons

• WraparoundWraparound is a multi-agency initiative. The Wraparound approach is a family-centered, strengths-based, needs-driven planning and service delivery process. It advocates for family-professional partnership to ensure family voice, choice and ownership. Wraparound children and family teams benefits children by working with the family to ensure Permanency. Wraparound is funded through Title IV-E funds. The average length of involvement with the program is 8 months. The primary focus of the program is to keep children out of residential placements and maintain them safely in their family and community. Liaisons

• Public Health Nurses (PHNs)

• Residential Care Liaison (RCL)

• DMH Intensive In-Home staff

• DMH Family Preservation (FP) Liaisons

• Specialized Foster Care (SFC)

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PROCEDURE

Initiating a Mental Health Screening

ER CSW Responsibilities

1. Complete the appropriate (0-5 years) or (5 years-adult) Mental Health Screening Tool (MHST) form in conjunction with the promotion of an emergency response referral to a case and start of ongoing child welfare services to the family via the Referral Portal link on DCFS LA Kids website.

• ER CSWs are not required to complete a MHST unless the referral will be promoted to a case and ongoing DCFS services will be provided.

• The MHST provides guidance on screening for mental health needs.

2. Read and review the MHST mental health follow up response from DMH as indicated via email. CSWs are to consult with DMH SFC staff regarding their findings and next steps to ensure a child's timely linkage to mental health services per DCFS and DMH's shared agreement to work collaboratively and team on an ongoing basis.

ER CSW Responsibilities for ER Referrals Under Investigation

1. If, within the course of investigating an emergency response referral, a child is assessed as pre-acute (suicidal/danger to self or others), contact ACCESSLos Angeles County Department of Mental Health's (DMH) 24 hour, 7 (seven) day a week hotline: Emergency psychiatric services are coordinated through ACCESS. ACCESS offers information regarding all types of mental health services available in Los Angeles County. CSWs may request a joint response with FRO by contacting ACCESS at (800) 854-7771./PMRT at (800) 854-7771 immediately and wait with the child until ACCESS arrives for an in-person response. Refer to Procedural Guide 0070-547.14, Expedited Joint Response Protocol with the DMH Field Response Operations (FRO). If you believe a dangerous sitation exists or the child feels threatened, call 911 for immediate assistance.

2. If while assessing a referral for existing mental health threats, a mental health concern is noted within the last 24 hours, contact the CSAT Team immediately for a consultation and to formulate a plan to address those needs, based upon the Regional OfficeThe DCFS office that is responsible for providing services to the child, youth, dependent, or nonminor dependent. Usually, the office where the child's CSW is located. CSAT team protocol for responding to ER referrals.

• Mental health concerns include, but are not limited to, unusual behaviors, child seems disconnected, depressed, or in danger of being removed from preschool, daycare, school or home due to behavior, has experienced abuse or neglect, or has a parent with a mental health or substance/alcohol abuse problem). 

ER CSW Responsibilities for Newly Detained Children

1. Complete the MHST.

2. Refer the child for an initial medical and/or forensic examination, at the Medical Hub.

3. Work with the MAT Coordinator to obtain consent for mental health treatment, authorization for release of protected health information, and benefits establishment.

4. Upload the necessary documents to the MAT Coordinator or CSAT Screening Clerk.

5. At the time of the initial placement, the CSW will initiate a request for Medi-Cal on the DCFS 280, Technical Assistance Action Request. The TA will generate the Medi-Cal verification letter.

6. Respond to requests for additional information from members of the CSAT within two (2) business days.

7. Document your discussion/plan for services in the Contact Notebook.

ER CSW Responsibilities When Providing Ongoing Services (Court or Voluntary)

1. Complete the appropriate MHST (0-5 years) or (5 years-adult) form in the Referral Portal and upload the appropriate consent.

• The CSAT email in-box will receive an email alert that the MHST has been submitted and the MAT+SLS will complete follow-up actions to ensure and track the completion of the MHST.

ER SCSW Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

• At the time of promotion of the referral to a case, confirm that an MHST has been completed for each child on the case.

MAT+SLS Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

1. Respond to requests for additional information from members of the CSAT within two (2) business days.

• Timelines to refer to Specialized Foster Care:

• Acute - same day of the MHST

• Urgent - within one (1) calendar day of the MHST

• Routine - within 10 calendar days of the MHST

2. Complete follow-up actions to ensure and track the completion of the MHST.

Continuing Services CSW Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

1. Complete the MHST (0-5 years) or (5 years-adult) in the following situations:

• At the time of the first case plan update following the implementation of CSAT.

• For children who screen negative. Annual re-screening from the date of the last negative screen will be required unless they are receiving mental health services.

• When a behavioral indicator is identified.

2. Complete the MHST for a child placed outside of Los Angeles County.

• If the CSW indicates that the child is placed outside of LA County, the MHST is automatically forwarded to the AB1299 Unit.

• For courtesy supervision provided by another agency, contact the caregiver (and child if appropriate) and complete the MHST based on feedback from the caregiver, child and social worker performing courtesy supervision.

• For a CSW who is providing courtesy supervision for a child in Los Angeles County, complete the MHST according to regular frequency.

3. Complete the MHST and upload the appropriate consent for children involved in inter-county transfers into Los Angeles County at the time of case assignment, unless the child is receiving mental health services at the time and has received them in the past 60 days.

4. Where a behavioral indicator is identified and an MHST has previously been administered and was positive, consult with the SCSW, MAT+SLS, or co-located DMH staff.

5. Respond to requests for additional information from members of the CSAT within two (2) business days.

6. Document your discussion/plan for services in the Contact Notebook.

Dependency Investigator (DI) Responsibilities

1. When the DI is assigned to investigate a probate legal guardianship, and there is no CSW assigned to the case, the DI will be responsible for completing the MHST following the DI’s first contact with the child.

• If there is both a DI and a CSW assigned to a probate legal guardianship case, then the Continuing Services CSW must complete the MHST.

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Linking to, and Engagement with, Mental Health Services

Continuing Services CSW Responsibilities

1. Maintain regular telephone/email contact with the service providers and request written progress reports.

2. Incorporate pertinent information provided by the service provider(s) into the case plan and court reports.

3. Document all contacts with service provider in the Service Providers Contact Notebook.

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Working with DMH Specialized Foster Care (SFC) for MHST Screenings and Mental Health Service Linkage

Continuing Services CSW Responsibilities

1. Complete the MHST and upload consents in the Referral Portal when a child in an existing open case is experiencing a mental health crisis or determined to be in need of mental health services.

2. Review DMH's feedback on MHSTs for the assignment of the DMH SFC Clinician and recommendation for mental health service linkage.

3. Review the Clinical Feedback form for the final determination of a child's mental health services.

CSAT Team Responsibilities

1. Review the MHST submitted by the CSW in the Referral Portal.

2. Upload the child's documented history reports (court reports, Screener Narrative, Investigative Narrative, etc.) and Medi-Cal eligibility information (Medi-Cal letter and/or MEDS-lite report).

3. Determine if the MHST is for the Multidisciplinary Assessment Team (MAT) or CSAT SFC.

4. Submit all CSAT MHSTs to DMH SFC.

5. Enter MHST feedback from DMH SFC in CWS/CMS.

6. Review the Clinical Feedback forms from DMH to refer Child AbuseThe non-accidental commission of injuries against a person. In the case of a child, the term refers specifically to the non-accidental commission of injuries against the child by or allowed by a parent(s)/guardian(s) or other person(s). The term also includes emotional, physical, severe physical, and sexual abuse as defined in CDSS MPP Section 31-002(c)(9)(D). Prevention and Treatment Act (CAPTA) children (aged 0-3 years old) with positive developmental screens for Regional Center Services.

DMH Specialized Foster Care (SFC) Responsibilities

1. Send receipt to DCFS when an MHST is received.

2. Assign the MHST to a DMH SFC clinician.

3. The DMH SFC Clinician completes the feedback portion of the MHST to inform the CSAT Team and CSW/SCSW of the assigned clinician's contact information and one of the clinical recommendations below:

• Outpatient treatment

• Intensive Care Coordination (ICC)

• Assessment

4. Submission of Clinical Feedback form to DCFS CSAT.

• The Clinical Feedback form is the final document from DMH that identifies the clinical outcome of a case after the submission of the MHST, which can provide details of the child's assessment or mental health service linkage or challenges linking the child to services.

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APPROVALS

None

HELPFUL LINKS

Attachments

Mental Health Assessment Behavioral Indicators

Forms

LA Kids

Child Welfare Mental Health Screening Tool (MHST) (Child 0-5 Years)

Child Welfare Mental Health Screening Tool (MHST) (Child 5 Years-Adult)

DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental Services

DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information

DCFS 280, Technical Assistance Action Request

Referenced Policy Guides

0070-548.01, Child and Family Teams

0600-500.00, Medical Hubs

0600-500.05, Multidisciplinary Assessment Team (MAT) Assessments and Meetings

0600-501.09, Consent for Mental Health Treatment and/or Developmental Assessments and Services

Statutes

Welfare and Institutions Code (WIC) 11203 (b)(1) – When out-of-home services are used with the goal of family reunification, the case plan shall provide, in part, for the continuation of CalWORKs services, under specified circumstances, when a child has been removed from a home, and is receiving out-of home care.

Katie A., et.al vs. the State of California – A 2002 class action lawsuit filed against the State and County alleging that children in contact with the County’s foster care system were not receiving the mental health services to which they were entitled. In July 2003, the County entered into a settlement agreement resolving the County-portion of the lawsuit.

LA Co. DMH SFC Guidelines Manual, ML No. 5 – Provides guidelines and protocols for DMH Specialized Foster Care Staff.

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