This policy guide was updated from the 07/01/14 version in order to update the activities which may be performed by a Public Health Nurse (PHN) as a result of the passage of Senate Bill (SB) 319.

POLICY

Public Health Nurses (PHNs)

Existing law (WIC 16501.3) requires that a public health nursing program be established and maintained for the provision of ensuring that the health, mental health, and health-related needs of children and youth under the supervision of DCFS are met in an appropriate and timely manner. Senate Bill (SB) 319 expanded the law to include additional activities that may be performed by a Public Health Nurse (PHN) for the purpose of coordinating health and mental health care services and medical treatment to children and youth under the supervision of DCFS. PHN activities include, but are not limited to, acquiring medical information directly from health care providers and reviewing documentation for the purpose of assisting in arranging follow-up care, as applicable; sharing information related to screenings, assessments, and laboratory test results necessary to monitor the administration of psychotropic medication; and , upon request, assist Nonminor Dependents (NMDs) in making informed decisions regarding his/her health care.

DCFS has an established public health nursing program which utilizes PHNs from both DCFS and the Department of Public Health (DPH)/Health Care Program for Children in Foster Care (HCPCFC). CSWs and PHNs work in collaboration to facilitate appropriate health and mental health care services for children under the supervision of DCFS.

Roles and Tasks of DPH/HCPCFC PHNs

DPH/HCPCFC PHNs work within DCFS to coordinate appropriate health care services for children in out-of-home care under the supervision of the Court. They provide comprehensive health care consultation to CSWs and to Probation Officers to prevent illness and to promote and maintain the health of children, youth, and nonminor dependents (NMDs) in foster care.

DPH/HCPCFC PHNs act as consultants to CSWs for children placed in any of the following:

Adoptive Home Not Finalized

ER referrals where the child has been detained

Foster Family Agency (FFA)A non-profit organization licensed by the State of California to recruit, certify, train, and provide professional support to foster parents. Certified Home

Foster Family Home (FFH)

Group Home

Legal guardian’s home with open court jurisdiction

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./nonrelative extended family member home

Small Family HomeAny residential facility in the licensee's family residence, which provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. WIC 11400(e)

Tribal Court-Specified Homes

Critical Incidents, Media Alerts, Near Fatalities, and Fatalities

A DPH/HCPCFC PHN may assign themselves as a secondary assignment on a referral or case or his/her supervisor may do so in order to assist the CSW in identifying the PHN assigned to the case/referral.

DPH/HCPCFC PHNs are responsible for tasks that include, but are not limited to, the following:

Evaluation and Assessment

Identify chronic physical, developmental, dental, and mental health conditions in a child.

Review and assess medical, dental, developmental, and mental health care documents, including the Health and Education Passport (HEP), to:

Identify a child’s appropriate health care needs

Determine appropriate referrals and services needed for the child

Evaluate the health status of a child in out-of-home care

Assist in making Specialized Care Increment (SCI) F-Rate eligibility recommendations.

Evaluate and prioritize his/her caseload according to the PHN Practice Manual guidelines.

Consultation and Collaboration

Serve as a bridge between foster families, CSWs, Probation Officers (POs), and health care providers to facilitate referrals to health and mental health care providers.

Identify appropriate health care services and community resources for a child.

Collaborate with community agencies, health and mental health care programs, and caregivers to maintain a child’s continuity of care.

Assist CSWs and POs in obtaining additional services to help caregivers provide services to a child with special needs.

Provide education about the role of DPH/HCPCFC PHNs and medical topics, upon request, to caregivers, community providers, and CSWs.

Provide all follow-up reports and relevant documentation for critical incident, media alert, near fatality, and child fatality meetings.

Provide sexual and reproductive health education to foster youth over the age of twelve (12), including but not limited to, providing resources as well as condoms, as requested or as needed.

Provide sexual and reproductive health education, including resources and condoms, to CSWs for the purpose of educating youth regarding sexual and reproductive health.

Coordination of Services

Timely coordination of primary and specialty health care needs.

Coordinate medical services for a medically fragile child.

Coordinate necessary medical follow-ups by reviewing E-mHub exam resultsand other available documentation.

Assist in providing monitoring and oversight of psychotropic medication for children in out of home care.

Documentation

Document 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. Authorizations (PMSa) for any prescribed psychotropic medication in the HEP in the CWS/CMS Health Notebook.

Provide bi-hospital log updates regarding the status of a hospitalized child placed in out-of-home care.

Review and update the HEP in the CWS/CMS Health Notebook based on medical information obtained from CSWs, medical hubs, and providers. This includes, but is not limited to, any diagnosed medical conditions, prescribed medications, and any recommended or existing treatment.

Complete a Nurse to Nurse (N2N) report of the child’s health care coordination status when transferring a case to another DPH/HCPCFC or DCFS PHN.

Participation

Participate in joint home, office, school, and hospital visits, as needed.

Participate in Child and Family Team (CFT) meetings, as needed, to establish a plan of care.

Upon request, assist NMDs in making informed decisions regarding his/her health care by, at a minimum, providing educational resources and materials.

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Roles and Tasks of DCFS PHNs

DCFS PHNs are responsible for responding to requests for PHN consultations from CSWs regarding children living in any of the following settings:

With a parent, including during an ER investigation, or Voluntary Family Maintenance (VFM), or Family Maintenance (FM)

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.

Probate/Non-court probate case

Post Adoption Services (PAS) case

Kin-Gap

DCFS PHNs are responsible for tasks that include, but are not limited to, the following:

ER Referrals

Consult with ER CSW about the child’s medical and developmental problems as part of the Joint Response Referral process during the investigative phase for children with known or suspected problems.

Participate in joint face-to-face visits with the CSW in the home, office, school, or hospital and obtain and review the child’s medical condition with the CSW, including reviewing medical records and, if applicable, mental health records. Consult with the medical provider, as needed.

Provide recommendations about the child’s medical, developmental, and mental health needs, as needed and requested.

Document medical information and, if applicable, mental health information related to prescribed psychotropic medication, in the CWS/CMS Health Notebook. This includes, but is not limited to, any diagnosed medical conditions, prescribed medications, and recommended or existing treatment.

Assist in the coordination of necessary medical and, if applicable, mental health, follow-up.

Open VFM, FM, VFR, and Non-Court Probate Cases

Consult with the CSW for a child with known or suspected medical or developmental conditions as part of the Joint Response Referral process.

Post-Adoption Services Cases and Kin-Gap Cases

Review medical information to determine eligibility for Specialized Care Increment (SCI) – F-Rate criteria.

Children with Special Health Care NeedsAssembly Bill 2268, defines children with special health care needs as those children who are either temporarily or permanently dependent upon medical equipment or in need of other specific kinds of specialized in-home health care, as determined by the child’s physician. See "medically fragile."

Review the medical records and, if applicable, mental health records, for children with serious and/or chronic medical and developmental conditions, in order to assist CSWs in making informed decisions and arranging and planning services with regard to screening, assessment, and treatment of the child's condition.

Assess the child’s medical condition for Medical Case Management Services Unit transfer criteria and for Specialized Care Increment (SCI) – F-Rate criteria.

Participate in CFT meetings and/or other multidisciplinary team conferences for children.

Hospitalized Children

Provide weekly tracking and monitoring updates to DCFS PHNs and CWSs to:

Provide current updates

Assess the child’s readiness for hospital discharge

Ensure all necessary services are in place to facilitate discharge

Assess the caregiver’s capacity for the following during joint home visits with the CSW post-hospitalization of a child:

To meet the child’s ongoing medical needs and continuity of care

To assist in coordinating necessary medical, and if applicable, mental health, follow-up.

Critical Incidents, Medical Alerts, Near Fatalities, and Child Fatalities

Conduct a joint home visit with the CSW to assess the medical, developmental, and mental health needs of all children residing in the home.

Assist in obtaining current and past medical and, if applicable, mental health,information on the child and his/her siblings.

Consult with medical providers regarding the child’s medical condition as well as mental health providers when psychotropic medication has been prescribed and administered.

Assist in coordinating necessary medical and mental health services for the child.

Provide a written summary medical report to the DCFS Medical Director.

Additional Responsibilities

Review E-mHub exam results, and document the results in the Health and Education Passport (HEP).

Review and document forensic exam findings in the Health Notebook.

Clarify and explain findings and results to the CSW, as needed.

Assist in coordinating medical and, if applicable, mental health, follow-up appointments, as needed.

Provide trainings to CSW Academy trainees on the role of the PHN.

Provide F-Rate training to foster parents, relatives, and caregivers.

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PROCEDURE

Making a Secondary Assignment for a PHN

DPH/HCPCFC PHN Responsibilities

Prior to assigning yourself as a secondary:

Determine the case status based on the DPH/HCPCFC PHN caseload assignment guidelines.

Consult with PHNs if unable to determine if the case belongs to his/her caseload assignment or unit.

Upon receiving consultation from the CSW or the SCSW, or if temporarily covering for another DPH/HCPCFC PHN, assign yourself as a secondary.

See CWS/CMS Assignment Page: Assigning a PHN as a Secondary Assignment for instructions on how to make a secondary assignment.

Enter an end date for a secondary assignment as soon as the required data entry has been completed in CWS/CMS only when:

Transferring a case to an DPH/HCPCFC or DCFS PHN

Working on a case or referral while temporarily covering for another DPH/HCPCFC PHN.

Complete a Nurse to Nurse (N2N) report prior to transferring a case.

DCFS PHN Responsibilities

Assign yourself as secondary on CWS/CMS under the following situations:

Upon receipt of any of the following:

DCFS 5646-1, Public Health Nursing Consultation Request, from either the CSW or the SCSW

A Nurse to Nurse (N2N) report from a PHN

Any medical documents for children on your caseload

Critical incident, child fatality, and media alerts on your caseload

For all hospitalized children on your caseload

As assigned by the PHN Supervisor or Nurse Manager

See CWS/CMS Assignment Page: Assigning a PHN as a Secondary Assignment for instructions on how to make a secondary assignment.

Enter an end date on the secondary assignment in the following situations:

A case is transferred to another PHN

Upon completion of the review and documentation of all available medical, dental, developmental, and, if applicable, mental health, problems that require PHN follow-up or assistance.

Complete a Nurse to Nurse (N2N) report prior to transferring a case.

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APPROVALS

None

HELPFUL LINKS

Attachments

CWS/CMS Assignment Page: Assigning a PHN to a Secondary Assignment

Forms

LA Kids

DCFS 5646-1, Public Health Nursing Consultation Request

Referenced Policy Guides

0050-504.25, Recording Child Fatalities and Near Fatalities

0070-548.01, Child and Family Teams

0070-560.05, Joint Response Referral: Consulting with PHN

0080-502.25, Family Maintenance Services for Court and Voluntary Cases

0080-505.20, 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.

0100-520.35, Kinship Guardianship Assistance Payment (KIN-GAP) Program

0600-500.00, Medical Hubs

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

0600-507.10, Youth and Reproductive Health and Pregnancy

0600-514.10, Psychotropic Medication: Authorization, Review, and Monitoring for DCFS Supervised Child

1000-504.10, Case Transfer Criteria and Procedures

0900-522.11, Specialized Care Increment (SCI)A rate paid in addition to the basic care rate for the care of children/youth with special needs. – F-Rate

Statutes

WIC Section 16501.3(b) - States, in part, that a foster care public health nurse (PHN) shall work with CSWs to coordinate health care services and serve as a liaison with health care professionals and other providers of health-related services. Further, the foster care PHN shall have access to a child's medical, dental, and mental health care information in order to perform their duties.

WIC Section 16501.3(c) - States, in part, that the duties of a foster care PHN include, but is not limited to, the following: (1) Documenting initial and follow up health screenings; (2) Collecting and interpreting health information to determine the need for mental health, health, and other necessary health-related services; (3) Participating in medical care planning and coordinating health and mental health assessments for the purpose of case planning and coordination, facilitating the acquisition of any necessary court authorizations for procedures or medications, and monitoring and oversight of psychotropic medications; (4) Providing follow up contact to assess a child's progress in meeting treatment goals; (5) At the request of, and under the direction of a nonminor dependent (NMD), assist the NMD in accessing and coordinating physical health and mental health care, and assisting the NMD in making informed decisions about his or her health care by, at a minimum, providing educational materials, and assisting the NMDin assuming responsibility for his or her ongoing health and mental health care management.

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