Health and Education Passport (HEP)

0080-505.20 | Revision Date: 07/01/14

Overview

This policy guide provides direction on what information should be included in the Health and Education Passport (HEP)A document that is generated on CWS/CMS that contains a summary of a child's health and education information. The caregiver keeps a current copy of the Passport, along with the health and education forms in a binder provided by DCFS. This binder shall follow the child to all placements. The Passport shall accompany the child to all medical, dental and educational appointments. The Passport binder in its entirety is given to the child upon emancipation. when a child is being placed or replaced  in out-of-home care, when the child is a nonminor dependent (NMD), and when a child’s case is closed.

TABLE OF CONTENTS

Policy

Health and Education Passport (HEP)

HEP Categories

Court Report Headings

Documents Used to Collect HEP Information

Sensitive/Confidential Information

Providing the HEP Document to Out-of-Home Caregivers

Procedure

Child Initially Placed in Out-of-Home Care

Detaining CSW Responsibilities

Placement CSW Responsibilities

Child is in Out-of-Home Care

DI SCSW/Case-Carrying SCSW Responsibilities

DI CSW Responsibilities

Case-Carrying CSW Responsibilities

Writing a Court Report

CSW Responsibilities

Child is Replaced

Case-Carrying CSW Responsibilities

Court Terminates Jurisdiction/VFR Case is Closed

Case-Carrying CSW Responsibilities

APRD CSW Responsibilities

Youth Attains NMD Status

Case-Carrying CSW Responsibilities

Approvals

Helpful Links

Attachments

Forms 

Referenced Policy Guides

Statutes

VERSION SUMMARY

This policy guide was updated from the 07/22/13 version, as part of the Policy Redesign, in accordance with the DCFS Strategic Plan.

POLICY

Health and Education Passport (HEP)

The Health and Education Passport (HEP) document meets the State’s requirements for providing health and education information to out-of-home caregivers/foster parents. This applies to all cases, including court Family Maintenance (FM) and Voluntary Family Reunification (VFR)The foster care placement of a child by or with the participation of DCFS acting on behalf of CDSS, after the parent(s)/guardian(s) of the child have requested the assistance of DCFS and signed a voluntary placement agreement form. cases.

The HEP document must be attached to all court reports and must be updated whenever new significant health and/or education information has been entered into CWS/CMS. The HEP must be provided to out-of-home caregivers/foster parents, including information on the identity of the child’s Education Rights Holder, and the child’s school of origin.  In the case of nonminor dependents (NMDs), the NMD must give permission for the HEP to be attached to the Court Report.

The HEP must include (but is not limited to), the following information about the child:

• Names and contact information of the child’s health, dental, and education providers

• The child’s grade level performance

• The child’s school record

• The child’s progress, as demonstrated by factors like academic proficiency scores and credits earned toward graduation

• Assurances that the child’s placement in foster care takes into account proximity to the school in which the child was enrolled at the time of placement

• The child’s immunizations and allergies

• The child’s known current and past medical problems, current medications, and current and past hospitalizations

• The child’s relevant mental health history and medications

• Any other relevant mental health, dental, health, and educational information concerning the child as determined by the Director of Social Services

HEP Categories

Health Section – The HEP Health Section includes the following general categories:

• Child Information

• Current Health Information

• Alerts

• Allergies

• Current Health Issues

• Current Health Service Providers

• Developmental/Functional Limitations

• Immunizations

• Summary of Child’s Current Health Condition

• Well Child Exam

• Family Medical History

• Past Health Information

• Birth History

• Past Health Issues

• Past Health Service Providers

Education Section – The HEP Education Section includes the following general categories:

• Education Information

• Current

• Previous

See the attached HEP Checklist for a complete list of information that should be included in the HEP.

Court Report Headings

• Medical – An overview of the child/youth’s well-being including past and current health conditions, surgeries, allergies, and required specialized treatments. This includes well child exams, CHDP exams. HUB appointments, immunizations, and a report of the child’s height, weight, and Body Mass Index.

• Dental – A list of annual check-ups and specialized treatments including extractions, fillings, orthodontia treatment plans, follow-up care, and pending appointments.

• Developmental – An overview of child/youth’s developmental progress and significant milestones. This includes any early childhood assessments, Regional Center assessments/services, and therapeutic interventions.

• Mental and Emotional Status – A description of the child/youth’s mental health functioning and/or concerns, including a description of all psychological treatment plans including assessments, counseling, psychotropic medications, and the youth’s response to the treatment.

• Education – A list of the child/youth’s academic progress, concerns, and interventions, including the child/youth’s Education Rights Holder, any special education services, disciplinary actions, high school graduation prospective (credits completed, CAHSEE status), extracurricular activities, and individualized academic plans, e.g. IEP, SST, etc.

Documents Used to Collect HEP Information

Medical InformationAs defined by Civil Code (CIV) Section 56.05(g), is any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental or physical condition, or treatment. This does not include psychotherapy notes (notes made by the therapist about a private therapy session that are kept separate from the rest of the patient’s medical record). These notes are subject to additional privacy protections and cannot be disclosed by therapists even in situations where other PHI may be disclosed.:

• CSWs must use the Family Background (FB) #1, #2, and #3 to collect medical information. In cases where the DCFS 4344, Court Medical Consent – Medical Emergency Worksheet series forms were used to collect medical information, CSWs can refer to the DCFS 4434s to review previous medical information. All family medical history obtained from the FB #1, #2, and #3 must be entered into CWS/CMS by the DI CSW/Case-Carrying CSW, or by other designated staff.

• The JV-225, Health and Education Questionnaire is completed by the parent(s)/legal guardian at the initial hearing and included in the Jurisdictional/Dispositional Packet forwarded to the Regional Offices. This is only required in court cases. Once complete, it must be forwarded to the Public Health Nurse (PHN) who will enter all relevant medical information into CSW/CMS.

• Health care information is documented by the health care provider on the DCFS 561(a), Medical Examination Form, the DCFS 561(b), Dental Examination Form, and the DCFS 561 (c), Psychological/Other Examination Form. Documentation should include information on initial examinations, ongoing health care and health care provider authentication. The health care provider’s signature is required to document all office visits.

Mental Health Information:

• Mental health information is documented by the mental health provider on the DCFS 561 (c), Psychological/Other Examination Form. This includes information on all psychological services, mental health intake assessments/evaluations, psychological tests/exams, ongoing mental health care, and health care provider authentication.

• The JV-223, Order Regarding Application for Psychotropic Medication must be approved by the court. The D-Rate Unit enters this information in to CWS/CMS. This is only required in court cases.

Educational Information:

• CSWs must use the DCFS 1726, Request for School Report to collect educational information. The CSW can send the form out to the child’s school forty-five (45) days before the next court hearing date, and can request assistance from the relevant school support staff person before the required forty-five (45) day cut-off.

• The JV-225, Health and Education Questionnaire is completed by the child’s parent(s)/legal guardian at the initial hearing and included in the Jurisdictional/Dispositional Packet forwarded to the Regional Offices. This is only required in court cases. Once complete, it must be forwarded to the PHN who will enter all relevant medical information into CWS/CMS.

• Educational information can also be obtained from the following documents, and must be entered in to the Education Notebook by the CSW with primary assignment to the case or other designated staff: DCFS 1399, Notification to School of Pupil’s Foster Care Status and Request for Transfer of Pupil and Appropriate Records from the School of Origin to a New School, DCFS 179, Parental Consent and Authorization for Medical Care and Release of Educational Records, and JV-535, Findings and Orders Limiting the Right to Make Educational Decisions for the Child, Appointing an Educational Representative, and Determining the Child’s Educational Needs. This includes all reports from the school such as:

• Transcripts

• Grade/Progress Reports

• Attendance Records

• Individualized Education Plans (IEPs)

• Individualized Family Services Plans (IFSPs)

• California High School Exit Exam (CAHSEE) Student & Parent Reports

• Discipline Records

The PHN or other designated DCFS staff enters the information from the DCFS 561(a), (b), or (c) into the child’s Health Notebook or the Associated Services page of the Contact Notebook in CWS/CMS. Information entered in the Health Notebook populates into the HEP document. IQ scores must not be entered in the child’s Client Notebook or otherwise entered in the HEP. Information relating to IQ must be maintained in the Psychological/Medical/ Dental/School Records folder only and used for the sole purpose of accessing resources such as Regional Center services.

Sensitive/Confidential Information

Some medical/mental health information may be considered sensitive/confidential and therefore does not need to be included in the HEP (e.g. abortion records, results of sexual abuse forensic exams, sexually transmitted infections, etc.). PHNs or other designated staff review medical/mental health information to determine whether or not it is sensitive/confidential and then enter that information into CWS/CMS as a Contact in the Associated Service page. This information will not populate into the HEP document. Sensitive/confidential medical/mental health information should be shared with the caregiver and the medical provider in a confidential manner when the information is relevant to the provision of care of the child.

Providing the HEP Document to Out-of-Home Caregivers

• The HEP document must be provided to the out-of-home caregiver as soon as possible, and no later than thirty (30) calendar days after initial placement of a child into foster care.

• In addition, CSWs must provide the foster caregiver with blank forms for future health or mental health provider office visits.

• For each new placement, the CSW must provide the out-of-home caregiver with a current HEP within forty-eight (48) hours of replacement.

• A hard copy of the HEP document must be maintained in the HEP Binder and filed in the Psychological/Medical/Dental/School Records Folder.

• The caregiver must keep a current copy of the child’s HEP along with any other health and/or education documents that the HEP references in the HEP Binder.

• Psychological/psychiatric evaluation reports are not to be provided to the caregiver and should not be included in the HEP Binder. These reports must be kept exclusively in the case file.

Back to Policy

PROCEDURE

Child Initially Placed in Out-of-Home Care

Detaining CSW Responsibilities

1. At the time of removal, if possible, obtain the child’s personal and medical information (including immunization records, birth certificate, and information related to chronic illnesses or allergies), and any medical equipment from the parent or caregiver.

2. Gather family history information using the Family Background (FB) #1.

3. Provide the family with the FB #3 (also available in Spanish) along with a postage-paid envelope for the family to complete and return to the CSW.

4. Document attempts to obtain family information in the Contact Notebook.

5. Forward the documents to the assigned 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..

Placement CSW Responsibilities

1. Provide the caregiver with blank DCFS 561 series forms (with the top portion completed -- DCFS 561(a), Medical Examination Form; DCFS 561(b), Dental Examination Form; DCFS 561(c), Psychological/Other Examination Form).

1. Review and explain to the caregiver how to use the forms.

2. Complete the DCFS 1399, Notification to School of Pupil’s Foster Care Status, following instructions on page two (2) of the form.

3. Mail the DCFS 1726, Request for School Report to the child’s school of origin (the school the child was attending prior to his/her detention).

1. Place a copy of the DCFS 1726 in the Psychological/ Medical/ Dental/ School Records Folder.

2. Enter the name, address, and phone number of the school the child last attended in CWS/CMS.

4. Ensure that the following information is entered in CWS/CMS (if needed, ask the Public Health Nurse [PHN] or other designated person for assistance):

• Name, address, and phone number of the child’s doctor and dentist

• The child’s immunization history, prior health problems, and prior hospitalizations

• Any allergies and current or chronic health conditions

• Significant family medical conditions (if any)

5. Generate an initial Health and Education Passport (HEP) after all data has been entered into CWS/CMS.

6. Within thirty (30) days of initial placement, mail or give a copy of the HEP to the caregiver for inclusion in the HEP Binder.

7. Remind the out-of-home caregiver that the child’s health and education information is confidential and should only be shared with the CSW, Probation Officer, medical provider(s), and the educational provider.

8. Instruct the caregiver to take the HEP and the DCFS 561 series forms to all medical, dental, or psychological appointments.

1. Instruct the caregiver to ask the health care provider to use the DCFS series forms to document current information about the appointment and to authenticate with a signature and/or signature stamp.

Back to Procedure

Child is in Out-of-Home Care

DI SCSW/Case-Carrying SCSW Responsibilities

1. Upon receipt of the Jurisdiction/Disposition Hearing packet, make a copy of the JV225 and provide it to the Public Health Nurse (PHN).

1. Retain the original JV225 in the Court Documents Folder and forward it to the assigned DI CSW or Case-Carrying CSW.

2. Review the Family Background (FB) documents.

DI CSW Responsibilities

1. Prior to preparing the Jurisdictional/Dispositional Hearing Report, ensure that the JV225 has been filed in the Court Documents Folder.

2. Review the child’s health and education information in CWS/CMS to ensure it is complete.

• Ensure that any missing information is entered into CWS/CMS as soon as it becomes available.

3. Generate an updated Health and Education Passport (HEP).

4. Attach the HEP and the JV225 to the Jurisdictional/Dispositional Court Report.

Case-Carrying CSW Responsibilities

1. At the initial parent contact after the detention hearing:

1. Obtain additional educational and medical information from the parents (as needed), including immunization records, contact information for health care providers, allergies, chronic illnesses, and other information needed to ensure that the child’s health care needs are met.

2. Review Family Background (FB) #1 and #2.

1. Add additional information as provided by the parents.

2. Make sure that the parent(s)/caregiver was provided the FB #3 along with the postage-paid envelope to mail it back to the Office.

3. In cases where the DCFS 4344 series forms were used to collect medical information, review the DCFS 4344s for any relevant information to include in the HEP.

2. Ensure that the JV225 has been filed in the Court Documents Folder.

3. Review the child’s health and education information in CWS/CMS to ensure the child’s information is complete.

4. Ensure that updated medical and family history information is entered into CWS/CMS in the applicable Notebook(s).

5. During each contact with the child, collect completed DCFS 561 series forms if that child had a medical/dental treatment since the prior contact.

1. Review these forms with the caregiver to ensure all information is complete.

2. Collect any updated education records such as progress reports, report cards, disciplinary notices, and updated IEPs.

6. Give the completed originals of the DCFS series forms to the Public Health Nurse (PHN).

7. Confirm that all new medical, dental, or psychological/other information noted on the DCFS 561 series forms has been entered in to the applicable CWS/CMS Notebook(s).

8. Generate an updated Health and Education Passport (HEP).

9. Mail a copy of the updated HEP to the caregiver.

1. Remind the out-of-home caregiver that the child’s health and education information is confidential and should only be shared with the CSW, Probation Officer, medical provider(s), and educational provider.

10. When the school returns the DCFS 1726, provide the caregiver with a copy for inclusion in the HEP Binder and place the original in the Psychological/ Medical/ Dental/School Records Folder.

1. If the completed DCFS 1726 indicates that the child is receiving special education services, obtain a copy of the child’s Individualized Education Plan (IEP) from the school.

1. If the IEP is not current, make sure the child’s Education Rights Holder requests that the school hold an IEP meeting to update the IEP.

2. Provide the caregiver with a copy of the IEP for inclusion in the HEP Binder.

3. Place the original IEP in the Psychological/ Medical/ Dental/School Records Folder.

11. Enter any information regarding the IEP or special education information, along with the principal’s name and phone number in the child’s Education Notebook.

12. Review the child’s health and education information in CWS/CMS prior to preparing the Status Review Report.

13. Generate an updated HEP.

Back to Procedure

Writing a Court Report

CSW Responsibilities

1. Refer the Court to the Health and Education Passport (HEP) document under the following court report headings for each child:

• Medical

• Developmental

• Educational

• Mental and Emotional

2. If pertinent information that needs to be reported to the Court is missing from the HEP, provide a summary of that information under the appropriate heading. The HEP Checklist provides details on what needs to be included in the HEP.

3. Remove the child’s Social Security Number located under the heading “Child’s Information” on page two (2) of the HEP prior to printing the HEP and attaching it to the Court Report.

4. Attach the current HEP document to all Court Reports.

• When writing the Detention Report, if there is no information in the HEP document, provide a summary of the child’s information under the appropriate headings of the Detention Court Report.

Back to Procedure

Child is Replaced

Case-Carrying CSW Responsibilities

1. Provide an updated Health and Education Passport (HEP) to the caregiver within forty-eight (48) hours of the child’s replacement, each time a child is replaced.

2. Provide the caregiver with blank DCFS 561 series forms (DCFS 561(a), Medical Examination Form, DCFS 561(b), Dental Examination Form, DCFS 561(c), Psychological/Other Examination Form).

1. Review and explain how to use the forms.

3. Complete the DCFS 1399, Notification to School of Pupil’s Foster Care Status, following instructions on page two (2) of the form.

4. If required, ensure that the child is medically treated prior to replacement.

1. Bring the hospital/physician aftercare instructions, along with any prescribed medication, to the new placement.

2. Place these documents in the HEP Binder.

3. Attach copies to the Psychological/Medical/Dental/School Records Folder.

5. Ensure the health care provider completed the DCFS 561(a).

6. Document the nature of the illness or injury, the date of treatment and any treatment provided in the appropriate CWS/CMS Notebook(s).

Back to Procedure

Court Terminates Jurisdiction/VFR Case is Closed

Case-Carrying CSW Responsibilities

1. When the child is returned home, or the Court orders legal guardianship:

1. Provide the parent(s) or legal guardian(s) with a copy of the most current Health and Education Passport (HEP).

2. Place a copy of the most current HEP and the original DCFS Family Background (FB) forms in the Psychological/Medical/Dental/School Records Folder.

3. In cases where the DCFS 4344 series forms were used, attach a copy of the most recent HEP and the original DCFS 4344 III in the Psychological/ Medical/Dental/School Records Folder.

2. If the youth becomes a Ward of the Court and is placed under the supervision of the Probation Department, the child’s dependency jurisdiction is terminated. In this case, if the Probation Officer requests written reports on the child’s medical, mental health, and educational status, take the following steps:

1. Provide the Probation Officer with a copy of the most current HEP.

2. Place a copy of the most current HEP in the original DCFS FB forms in the Psychological/ Medical/Dental/School Records Folder.

3. In cases where the DCFS 4344 series forms were used, attach a copy of the most recent HEP and the original DCFS 4344 III in the Psychological/ Medical/Dental/School Records Folder.

3. If the youth transitions out of foster care provide the most current HEP to the transitioning youth.

• Psychological/psychiatric evaluation reports and/or IQ scores must never be given to the transitioning youth.

APRD CSW Responsibilities

1. If the child is adopted:

1. Provide the adoptive parent(s) with a copy of the most current Health and Education Passport (HEP).

2. Attach a copy of the most current HEP and the original DCFS Family Background (FB) forms in the Psychological/ Medical/Dental/School Records Folder.

3. In cases where the DCFS 4344 series forms were used, attach a copy of the most recent HEP and the original DCFS 4344 III in the Psychological/ Medical/Dental/School Records Folder.

Back to Procedure

Youth Attains NMD Status

Case-Carrying CSW Responsibilities

1. When the youth attains NMD status, provide the youth with his/her HEP.

2. If the youth is taking medication, advise him/her to check with his/her pharmacist or doctor for any interactions the medication might have with other medications, food or drink.

• If needed, seek assistance from the Public Health Nurse (PHN) in this discussion.

3. Inform the youth of his/her right to consent to treatment and for medication, including psychotropic medications.

4. Inform the youth that the information in the HEP will be kept confidential and cannot be released unless he/she signs the DCFS 6009, Nonminor Dependent Informed Consent form.

1. In the case of NMDs placed in licensed and approved settings, provide the information contained in the HEP to their caregiver.

1. Remind the caregiver that they cannot share the information with others without written consent.

5. Document all of the above in the Contact Notebook.

Back to Procedure

APPROVALS

None 

HELPFUL LINKS

Attachments

Health & Education Passport (HEP) Checklist

Forms

CWS/CMS

DCFS 561(a), Medical Examination Form

DCFS 561(b), Dental Examination Form

DCFS 561(c), Psychological/Other Examination Form

Family Background #1

Family Background #1 – SiblingA sibling is defined as a child related to another person by blood, adoption, or affinity through a common legal or biological parent. & RelativeFor the purpose of placement and foster care payments: An adult who is related to the child by blood, adoption or affinity within the fifth degree of kinship, including stepparents, stepsiblings, and all relatives whose status is preceded by the words, "great," "great-great" or "grand" or the spouse of any of these persons even if the marriage was terminated by death or dissolution. Addendum

Family Background #2

Family Background Addendum (Use with FB #1 and/or FB #2)

Family Background #3 – Medical and Social History Information about the Birth Mother/Father

Family Background #3 Coversheet

Health and Education passport

LA Kids

DCFS 1726, Request for School Report

DCFS 179, Parental Consent and Authorization for Medical Care (also available in Spanish)

DCFS 561(a), Medical Examination Form

DCFS 561(b), Dental Examination Form

DCFS 561(c), Psychological/Other Examination Form

DCFS 1399, Notification to School of Pupil’s Foster Care Status

DCFS 4158, Authorization for General Medical Care for a Child Placed by an Order of the Juvenile Court

Family Background #1

Family Background #1 – Sibling & Relative Addendum

Family Background #2 – DI

Family Background Addendum (Use with FB #1 and/or FB #2)

Family Background #3 – Medical and Social History Information about the Birth Mother/Father

Family Background #3 Coversheet

JV 225, Health and Education Questionnaire

JV 535, Findings and Orders Limiting Right the Make Educational Decisions for the Child, Appointing Educational Representative, and Determining Child’s Educational Needs

DCFS 6009, Nonminor Dependent Informed Consent

Referenced Policy Guides

0080-507.20, Concurrent Planning And The Concurrent Planning AssessmentAn assessment document as prescribed in Welfare and Institutions Code Sections 366.21(I), 366.22(b) and 361.5(g). The CPA is initiated by the case carrying Children's Social Worker and completed by the APRD CSW when adoption home study for attached children or matching/recruitment activities for unattached children are initiated. (CPA)

0100-510.61, Placement Responsibilities

0200-509.35, Adoptive Placements

0300-503.12, Health and Education Questionnaire

0500-501.20, Release of Confidential DCFS Case Record Information

0600-514.10, Psychotropic MedicationMedications used as tools for producing certain chemical and physiological effects in the central nervous system. They are usually classified according to the types of disorders they are primarily used to treat.: Authorization, Review, and Monitoring for DCFS Supervised Child

0700-504.20, Referring Children for Special Education or Early Intervention Services

Statutes

42 U.S.C. Section 675 (5) (D) – States that a child’s health and education record is reviewed and updated, and a copy is supplied to the foster parent/foster care provider with whom the child is placed, at the time of each placement. The copy is supplied at no cost when the child leaves foster care if the child is leaving by reason of having attained the age of majority.

All County Information Notice I-82-08 – Outcome Indicator on Health and Dental Assessments – Provides information to assist counties in following uniform data entry procedures for inputting health and education information on CWS/CMS.

Manual of Policies and Procedures, Division 31, Section 31-405 – States that CSWs must provide out-of-home caregivers with specific background information about the child including, but not limited to his/her health and education information. It also requires CSWs to ensure that the caregiver understands and supports the child’s case plan and is made aware of any changes to the health and education plan.

Welfare and Institutions Code (WIC) Section 16010(a) and (b) – States that a copy summary of the child’s health and education information must be attached to all court reports, and be maintained in the form of the Health and Education Passport (HEP).

WIC Section 16010(c) – States the required timeframes for delivering a child’s health and education summary to the out-of-home caregiver upon initial placement or replacement.

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