Youth Reproductive Health and Pregnancy
0600-507.10 | Revision Date: 08/26/22
This policy provides guidelines for CSWs to address reproductive health care such as sexually transmitted infections (STIs) and pregnancy with minors/NMDs, including available resources and options for pregnant minors/NMDs.
TABLE OF CONTENTS
Reproductive and Sexual Health Care and Related Rights for Minors and NMDs
Pregnancy Prevention and Avoiding Sexually Transmitted Infections
Continuing the Pregnancy
Termination of Pregnancy
Safe Pregnancy and Healthy Baby
Collaborative Planning with a Public Health Nurse (PHN)
Nurse Family Partnership (NFP) Program
Expectant and Parenting Youth (EPY)
Expectant Parent Payment (EPP)
Documentation of Pregnancy and Parenting in CWS/CMS for Minors and NMDs
Entering Pregnancy Information as an Observed Condition
Entering Pregnancy Information as a Diagnosed Condition
Entering Parenting Information in CWS/CMS for Minors and NMDs
Cross Reporting to Law Enforcement
Prevention of Unintended Pregnancy for Minors and NMDs
Assisting a Pregnant Minor/NMD
Terminating a Pregnancy
Relinquishing an Infant for Adoption
Continuing a Pregnancy
Expectant and Parenting Youth (EPY) During a Minor/NMD's Pregnancy and Infant Supplement Following the Birth of a Child
Referenced Policy Guides
This policy guide was updated from the 02/04/19 version, to include information and procedures regarding the expectant parent payment that will be available to pregnant minors and nonminor dependents (NMDs) three months prior to the expected due date, per Assembly Bill (AB) 153. This payment will be in addition to the infant supplement payment, which begins the month of birth.
State law mandates social workers to inform a minor or NMD in foster care of their rights regarding sexual and reproductive health care to include as follows:
In addition to those rights outlined in the Foster Youth Bill of Rights, reproductive and sexual health care rights of minors and NMDs in out-of-home care should be given in a manner appropriate to the age and/ or development level of the minor or NMD upon entry into placement and at least every six (6) months thereafter. "A Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention" provides information on the roles and responsibilities of social workers in providing sexual health care information as well as guidance on addressing such matters with minors and NMDs.
See "Documentation of Pregnancy and Parenting in CWS/CMS for Minors and NMDs" documenting discussions related to the minor/NMD's reproductive rights and pregnancy.
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CSWs are permitted to distribute condoms to dependent DCFS minors/NMDs in foster care. CSWs should consult with the manager of their respective DCFS office on the availability of condoms for distribution to minors/NMDs and seek guidance from their assigned SCSW and PHN on how to provide an educational context for the minor/NMD receiving condoms. CSWs can also refer minors/NMDs to the condom project for free condoms.
DCFS and Department of Public Health (DPH) Public Health Nurses (PHNs) are available for consultation with the CSW, for direct consultation with the minors/NMD, and for joint response or collaborative planning regarding all reproductive health issues.
Any DCFS served minor/NMD can be seen at any of the Medical Hubs for Reproductive Health Information and Discussion of Available Birth Control Options. For additional information, see Overview of Youth's Rights for Sexual Health Services, Sexual Health Services Available at the Medical Hub Clinics and Reproductive Health Resources for Youth.
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A minor/NMD's choice to continue or terminate her pregnancy is a very personal decision and the CSW must support the minor/NMD's decision without expressing personal bias or attempting to influence her decision. Minors/NMDs should be directed to the Planned Parenthood, a Los Angeles County Health Clinic or an equivalent local family planning clinic for assistance in pregnancy testing and counseling/ education regarding her options. CSWs will ensure that the local, family planning clinic the minor/NMD is referred to provides counseling/education for a full range of options. These options include parenting, adoption, and pregnancy termination. A minor/NMD should also be encouraged to seek out people who will support her in making a decision, such as her partner, family, friends, clergy, or a professional counselor.
Revealing pregnancy information in the absence of a minor/NMD’s written consent is a violation of their right to privacy. The father’s written consent is necessary before documenting in the father’s case file that they are possibly going to be a father. This does not apply when documenting all non-reproductive/routine medical information in the minor/NMD’s case file or on CWS/CMS, or when sharing medical information with health care providers when appropriate. Refer to ACIN No. I-73-16 for guidance regarding how to document minor and NMD parents in CWS/CMS.
If a minor/NMD becomes pregnant, they have the right to continue their pregnancy, regardless of their age, marital status, or financial situation. All minors/NMDs in care are eligible to receive Medi-CalCalifornia's federal Medicaid program. and financial support to provide for themselves and their children.
It is important that a pregnant minor/NMD visit a doctor for prenatal care, including:
If a minor/NMD thinks they are pregnant, they should talk with their health care provider before taking any medications.
If a minor/NMD at any age does not want to continue a pregnancy, they have the legal right to terminate it. If the minor/NMD is under DCFS supervision, ensure that the minor/NMD's transportation needs are met, including transporting their, if necessary. No one has the legal right to force a minor/NMD to terminate or choose not to terminate the pregnancy, regardless of the minor/NMD’s age. Termination of pregnancy services are time sensitive. If the minor/ NMD's right to these services are being violated, the CSW shall ensure that the minor/NMD is able to obtain the services in a timely manner. For example, if a minor/NMD wishes to terminate their pregnancy and they are having trouble finding a medical provider who can assist them promptly, or if the minor/NMD needs transportation to their medical appointment and their housing provider/Resource ParentFamilies that have a foster care license and an approved family assessment that meets the State’s adoption standards. They are dually prepared to provide foster care and support family reunification; but, should reunification not occur, they are approved to provide an adoptive home for a child. is unable to assist them, the CSW shall assist the minor/NMD to help remove these barriers to accessing services.
Family planning clinic staff will answer questions about types of abortions, fees, and services available. The cost of abortion is covered by Medi-Cal. Counseling for minors/NMDs considering abortion is available at the Planned Parenthood or a Los Angeles County Health Clinic.
The CSW, and DPO if the minor/NMD receives dual supervision, must inform any minor/NMD of childbearing age of the Safe Haven law and provide them with the Safe Surrender Hotline number 877-BABY-SAFE. The law states that no parent/legal guardian who has custody of a minor child who is seventy-two (72) hours (three (3) days) old or younger may be prosecuted for child abandonment, if they voluntarily surrenders physical custody of the child to a designated employee at a public or private hospital emergency room. The law also allows for a fourteen (14) day “cooling off” period, during which the parent/legal guardian may return to reclaim the child.
Adoption can be an alternative for a minor/NMD who does not feel prepared to raise a child but does not want to have an abortion. Adoption is a legal process, during which the minor/NMD gives up all rights and responsibilities as a parent. Adoption is permanent and cannot be reversed.
There are two methods for legal adoption in California:
In both cases, the adopting family must be approved before the adoption process is final.
If the minor/NMD expresses an interest in adoption, CSWs should provide the minor/NMD with the DCFS Adoption Information/Intake number, (888) 811-1121 to seek assistance from an Adoption CSW to discuss adoption. CSWs should also provide the minor/NMD with their attorney's information so that they may get legal advice regarding adoption.
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When a youth/NMD chooses to continue a pregnancy and to become a parent, upon written consent, the CSW and a Public Health Nurse (PHN) co-located in the CSW’s office will have a collaborative planning meeting with the minor/NMD. Before signing the written consent, the minor/NMD should be advised that if desired, they are able to consult with their attorney prior to signing any release of information. At this meeting, the minor/NMD’s needs will be assessed and interventions to ensure a safe pregnancy and a healthy baby will be offered. These interventions may include, but are not limited to:
The goal of the collaborative planning meeting is to develop a plan that protects the minor/NMD and their child’s health and safety needs. During a CSW/PHN joint visit, the PHN will make skilled observations of the minor/NMD’s general health, nutritional, and developmental status through the use of the Home Visit Observations Attachment to the Home Visitation Guidelines. All health information will be entered into the minor/NMD’s Health and Education Passport.
When a home visit is indicated, the PHN and the CSW will meet at the minor/NMD’s placement to assess their health, safety, and health practices. During the joint visit, the PHN will:
A minor/NMD qualifies for the Nurse Family Partnership (NFP) program services if they meet all of the following criteria:
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The program provides home visiting services, beginning during the pregnancy and extending through the child’s first two (2) years of life. The PHNs who visit the minor/NMD’s home will focus on the new parent’s health and on their development as a parent.
If NFP is not an option, consider other home visitation resources, such as Welcome Baby, Partnerships for Families and Early Intervention programs, such as Early Head Start. The Los Angeles County Perinatal and Early Childhood Home Visitation Consortiums e-directory (Home Visiting E-Directory) can be utilized to find appropriate programs.
An Expectant and Parenting Youth (EPY) Conference (formerly Pregnant and Parenting Teen (PPT) Conference) is a voluntary proactive tool intended to identify and discuss issues related to pregnancy and early stages of child rearing for expectant or parenting minors/NMDs, including fathers. EPY Conferences focus on planning for healthy parenting, identifying appropriate resources and services, and preparing for a successful transition to independence.
The Child Welfare Health Services Section, Expectant and Parenting Youth (EPY) Conference Facilitators help promote the EPP as appropriate during EPY Conferences. The EPY Conference Facilitators are available for any questions regarding EPP. These staff can be reached at email@example.com and firstname.lastname@example.org.
Effective January 1, 2022, WIC 11465(e) authorizes a payment to be made directly to an expectant minor or NMD, approximately three (3) months prior to the minor/NMD’s due date. Prior to automation, this payment will be issued as a lump sum of $2,700; once automation has been finalized, an amount equivalent to the home-based foster care infant supplement will be paid monthly for the final three (3) months of a minor/NMD’s pregnancy. The payment will be the same regardless of placement type, and it will be paid directly to the expectant minor/NMD.
This expectant parent payment is available to meet the specialized needs of the pregnant minor/NMD, as well as prepare for the needs of the infant. Preparing for the birth of a newborn is expensive. Some potential expenses this payment could be used for are included below. Listed expenses are only examples, the expectant minor/NMD that receives the payment is not required to submit any accounting or receipts to show how the funds are utilized. All items bought with these funds are the property of the minor/NMD and go with them if/when they change facilities or age out.
Example uses of the payment include, but are not limited to:
CSWs need to discuss the availability of EPP funds with the pregnant minors/NMDs.
The EPP takes the place of the Early Infant Supplement (EIS) financial benefit that was previously provided to DCFS pregnant minor/NMD in placement in the 7th, 8th, and 9th months of pregnancy.
To implement the EPP benefit, CSWs are to obtain and submit a copy of an official medical record given directly to the pregnant minor/NMD from a qualified medical provider, containing both verification of pregnancy and the Expected Delivery Date. A determination of the 7th, 8th, or 9th month of pregnancy for the purpose of implementing the EPP payment(s) will be based on the Expected Delivery Date provided in the medical record. Minors/NMDs are eligible for the entire lump sum payment even if the EPP application is submitted after the 7th month of pregnancy.
If the pregnant minor/NMD does not have an official medical record from their health care provider containing the required information, the CSW may request a verification of pregnancy letter from the medical provider on formal letterhead with an Expected Delivery Date. Any verification and documentation procedure must abide by applicable confidentiality laws.
Eligible minors/NMDs must be in formal placement. Expectant parent payments are available to pregnant minors/NMDs who receive AFDC-FC or ARC payments, including those placed in Short Term Residential Therapeutic Placements (STRTPs), Supervised Independent Living Placements (SILPs), Transitional Housing Placements (THPP) or home-based foster care. Expectant parent payments are not available for minors/NMDs in the Adoption Assistance Program and the Kinship Guardianship Assistance Payment Program. Pregnant minors/NMDs residing in the home of one or both parents (HOP) are not eligible to receive EPP payments. However, they are eligible to receive financial assistance from the Department of Public Social Services (DPSS).The address provided on the EPP request must match the pregnant minor/NMD’s placement address as reflected in CWS/CMS. A verification of pregnancy letter from a qualified medical provider, reflecting the Expected Delivery Date, must be submitted as a part of the application.
Pregnant minors/NMDs residing in the home of one or both parents (HOP) are not eligible to receive EPP payments. However, they are eligible to receive financial assistance from the Department of Public Social Services (DPSS).
The infant supplement begins the month that the infant is born and continues as long as the non-dependent infant continues to reside with the minor/NMD parent in an eligible placement. As soon as the infant is born and is under the care of the now parenting minor/NMD, the CSW must initiate an Automated DCFS 280 request to start the official Infant Supplement payment of $900 per month, or $1,379 per month for group home/STRTP placements, and to begin Medi-Cal coverage for the infant.
Under the requirements of SB 794, data regarding pregnancy must be collected and reported. Pregnancy is a health condition which may be reported by the minor/NMD, their caregiver or physician. Due to the confidential nature of this information, conversations with minor/NMD about pregnancy-related topics should be handled with sensitivity and care to eliminate coercion regarding the disclosure of pregnancy status. Any disclosure regarding pregnancy requires the minor/NMD's written consent
There are two (2) ways to capture pregnancy information in CWS/CMS. Pregnancy information may be entered under the Observed Condition tab or under the Diagnosed Condition tab. The correct way to enter this data depends on whether the minor/NMD has consented to the release of information.
Discussions related to the minor/NMD's reproductive rights and pregnancy may also be documented in the CWS/CMS Case Notes (i.e. TItle XXs) with suggested language as follows:
Under the requirements of SB 528, complete and accurate data on parenting minor and NMD parents must be collected. The reported data must also include the parenting minor/NMD's county, age, ethnic group, placement type, time in care, number of children they have, and whether the children are court dependents.
When a CSW first learns that a minor/NMD is pregnant, the information should be entered into CWS/CMS via the Observed Condition tab. This will ensure that the information is not automatically populated on 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. and will keep the information private from caregivers and others such as school personnel, counselors, mentors and Foster Youth Services providers that receive copies of a minor/NMD's HEP. This information may not be relevant to the provisions of some types of services and supports and therfore need not be included in the HEP. Additionally, the minor/NMD should be consulted prior to the disclosure of any pregnancy-related information.
Entering the pregnancy as a diagnosed condition is necessary when the minor/NMD has been hospitalized as a result of the pregnancy. If a minor or NMD has been hospitalized for a health issue related to the pregnancy, such as a pregnancy complication or due to giving birth to a child, the pregnancy must be recorded as a diagnosed condition in order to allow for entering the hospitalization information. Pursuant to WIC section 16010(a), any hospitalization must be recorded in a manner in which the information would be entered into the minor/NMD's HEP.
If a minor/NMD is hospitalized for a pregnancy related issue, please follow the instructions listed under Assisting a Pregnant Minor/NMD that shows how to properly capture this information. Whenever possible, minors/NMDs should be consulted prior to the disclosure of any pregnancy-related information, including that of pregnancy related hospitalizations.
The All County Information Notice (ACIN) I-73-16, provides information on the state-required guidelines for entering parenting information into CWS/CMS. Prior to release ACIN I-73-16, guidelines had been established via ACIN I-60-15 to collect data on parenting minors/NMDs via CWS/CMS data entry. An FYI was issued (FYI 16-01) on how to document the state-required information into CSW/CMS and an update to FYI 16-01 was released via FYI 16-19.
CSWs should make a report to law enforcement in cases where the age difference is as described below, and any time there is a reasonable suspicion that the sexual activity was coerced or not voluntary (including sexual exploitation). In either case, the CSW must ensure that a child abuse report is made with DCFS and that a cross report is made to local law enforcement. In the absence of an emergency, prior to disclosure, the CSW must inform the minor that they will be disclosing this information and explain the reason for that disclosure.
Mandated reporters must report if they have a reasonable suspicion that:
Mandated reporters must report if they have a reasonable suspicion that intercourse with a minor was coerced, or in any other way not voluntary. As one example, sexual activity is not voluntary when the victim is unconscious or so intoxicated that they cannot resist. See Below, and see Penal Code sections 261 and 11165.1, for more examples.
Mandated reporters must report if they have a reasonable suspicion that a minor has been sexually trafficked or is being sexually exploited. Child pornography is sexual exploitation, as is the provision of food, shelter, or payment to a child in exchange for any sexual act described in Penal Code section 11165.1. See Penal Code section 11165.1 for more examples.
CSWs should make a report to law enforcement in cases where the minor reports that the sexual activity occurred under any circumstance where there is a reasonable suspicion that the sexual activity was coerced or in any way not voluntary These include, but are not limited to:
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A minor/NMD's pregnancy is confidential and thus without the minor/NMD's written consent, information entered into CWS/CMS and other documents, such as court reports, is not permitted except as described above under, "Entering Pregnancy Information as an Observed Condition" and "Entering Pregnancy Information as a Diagnosed Condition." Guidelines for documentation of each are described above under, "Assisting a Pregnant Minor/NMD."
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Discussion Questions for Pregnant Minors/NMDs
Expectant Parent Payment Memo
Expectant Parent Payment Toolkit
Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention
Know Your Rights for Sexual Health Services and Sexual Health Services Available at the Medical Hub Clinics <![CDATA[ ]]>
Overview of Adolescent Health Information Forms
Youth Brochure: Know Your Sexual and Reproductive Health Rights
ABCDM228, Applicant's Authorization of Release of Information
ABCDM228, (Sp), Applicant's Authorization of Release of Information
DCFS 174, Family Centered Referral and Services Form
DCFS 179-PHI, Authorization for Disclosure of Child's Protected Health Information (PHI)As defined by Health Insurance Portability and Accountability Act (HIPAA), is health (including mental health) information created or maintained by a health care provider that identifies or can be used to identify a specific individual. PHI relates to an individual’s health, health care or payment for care – in the past, present or future.
DCFS 179-PHI (Sp), Authorization for Disclosure of Child's Protected Health Information (PHI)
DCFS 565, Authorization for Disclosure of Medical Information for Participation in the Nurse Family Partnership Program
DCFS 5540, Special Payment Authorization/Request
Parenting Youth or Nonminor Dependent (NMD) Consent to Document and Share Her/His Non-Dependent Child's Health Information
0050-501.10, 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). and NeglectThe failure to provide a person with necessary care and protection. In the case of a child, the term refers to the failure of a parent(s)/guardian(s) or caretaker(s) to provide the care and protection necessary for the child's healthy growth and development. Neglect occurs when children are physically or psychologically endangered. The term includes both severe and general neglect as defined by Penal Code Section 11165.2 and medically neglected infants as described in 45 Code of Federal Regulations (CFR) Part 1340.15(b). Reporting Act (CANRA)
0050-502.10, Child Protection Hotline (CPH)
0070-520.10, Safely Surrendered BabiesPhysical custody of a minor 72 hours old or younger accepted by a person from a parent of the minor, who the person believes in good faith is the parent of the minor, with the specific intent and promise of effecting the safe surrender of the child. (SSB)
0070-548.01, Child and Family Teams
0070-560.05, Joint Response Referral: Consulting with PHN
0080-502.10, Case Plans
0100-510.40, Teen Parents in Foster Care and DPSS Services Assessment
0200-508.10, RelinquishmentThe action of a parent in which he or she surrenders custody, control and any responsibility for the care and support of the child. Currently, only an Adoption social worker or the court is qualified to process a relinquishment. Procedures and the Statement of Understanding
FYI 16-19 (May 16, 2016), CWS/CMS 7.4 CODE DROP SUMMARY
FYI 18-05 (February 9, 2018), Early Infant Supplement (EIS)
All County Information Notice (ACIN) No. I-73-16 (October 19, 2016) - Provides guidance regrading how to document minor and NMD parents in CWS/CMS.
All County Letter (ACL) 14-38 (June 16, 2014) – Summarizes the requirements as outlined in Senate Bill (SB) 528 regarding the rights of foster children, ages 12 and older, and NMDs in out-of-home care. SB 25 permits a social worker to provide dependent children and NMDs with age-appropriate, medically accurate information about sexual development, reproductive health, and prevention of unplanned pregnancies and sexually transmitted infections on an ongoing basis.
ACL 16-31 (April 22, 2016) - States that caregivers to use the reasonable and prudent standard, and defines the reasonable and prudent parent standard under federal law.
ACL 16-32 (April 28, 2016) – Summarizes the requirements as outlined in Senate Bill (SB) 794 regarding federal reporting requirements for the collection of data regarding the youth and NMDs in foster care that are pregnant or parenting in CWS/CMS.
ACL 16-82 (September 30, 2016) – Provides information and guidance related to legislative changes and existing law on the reproductive and sexual health care and related rights of youth and NMDs in foster care.
ACL 16-88 (October 12, 2016) – Provides guidelines that describe the duties and responsibilities in delivering unintended pregnancy prevention services and information to youth and NMDs.
ACL 18-44 (May 1, 2018) – Provides new resource materials and tools to support the sexual and reproductive health of youth and NMDs in foster care.
ACL 18-61 (June 20, 2018) – Authorizes social workers to inform a youth or NMD in foster care, beginning at age ten (10), of his/her rights regarding sexual and reproductive health care.
ACL 21-123 (October 8, 2021) – New expectant parent payment
Civil Code (CIV) Section 56.103 – Allows CSWs to receive Protected Health Information (PHI) related to service coordination, delivery, and treatment for foster youth.
Family Code (FAM) Section 6925 – A minor may consent to medical care related to prevention or treatment of pregnancy, except sterilization. A minor may receive birth control without parental consent.
FAM Section 6926 – A minor who is 12 years of age or older may consent to medical care related to the diagnosis, treatment, or prevention of a sexually transmitted disease.
FAM Section 6928 - A minor who is alleged to have been sexually assaulted may consent to medical care related to the diagnosis and treatment of the condition, and the collection of medical evidence with regard to the alleged sexual assault.
Welfare and Institutions Code (WIC) 369 – If a dependent child is 12 years of age or older, his or her social worker is authorized to inform the child of his or her right as a minor to consent to and receive those health services, as necessary. Social workers are authorized to provide dependent children access to age-appropriate, medically accurate information about sexual development, reproductive health, and prevention of unplanned pregnancies and sexually transmitted infections.
Welfare and Institutions Code (WIC) 16001.9 - States minor's and NMD's rights.
Welfare and Institutions Code (WIC) 16002.5 - States in part that complete and accurate data on parenting minor and NMD parents is collected.
Welfare and Institutions Code (WIC) 16521.5 - States in part that adolescents, including NMDs, are to receive age-appropriate pregnancy prevention information to the extent state and county resources are provided.
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