Back to Top ^

Health Care > Specialized Services and Treatment > Placing Children with Special Health Care Needs

Placing Children with Special Health Care Needs

0600-505.10 | Revision Date: 04/23/19

Overview

This policy guide provides instructions on how to place children with special health care needs, including instructions on how to transport children with special health care needs.

TABLE OF CONTENTS

Policy

Children with Special Health Care Needs

Special Health Care Needs

Medical Conditions Requiring Specialized In-Home Health Care

Individualized Health Care Plan (IHCP) 

IHCP Team

Placement Selection

Placement Capacity for a Child with Special Health Care Needs

Supervision of a Child with Special Health Care Needs

Non-Emergent Transportation

Procedure

Making an Initial Assessment

CSW Responsibilities

Placing a Child with Special Health Care Needs

CSW Responsibilities

Transporting a Child with Special Health Care Needs in Non-Emergencies

CSW Responsibilities

SCSW Responsibilities

MCMS CSW Responsibilities

MCMS ARA Responsibilities

MCMS Division Chief Responsibilities

ERCP Duty SCSW/ARA Responsibilities

ERCP Designated ARA Responsibilities

Supervising a Child in Placement with Special Health Care Needs

MCMS or Regional CSW Responsibilities

MCMS SCSW Responsibilities

Supporting a Child when Family Reunification or Family Maintenance Services are Court Ordered

CSW Responsibilities

Approvals

Helpful Links

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 04/02/15 version to reflect the updated instructions on how to transport children with special health care needs and reflect current terminologies or programs.

POLICY

Children with Special Health Care Needs

DCFS-supervised children with special health care needs are entitled to placement in the least restrictive, most family-like setting in close proximity to their parent’s home. Caregivers must be trained by health care professionals to manage the special health care needs of the child.

 

The Medical Case Management Services (MCMS) Units specifically serve the needs of DCFS-supervised children with special health care needs. For further information on MCMS, refer to Policy 1000-504.10, Case Transfer Criteria and Procedures.

Special Health Care Needs

A child with special health care needs meets the following criteria:

Medical Conditions Requiring Specialized In-Home Health Care

Specialized in home health care includes those services identified by the child’s primary physician and/or pediatric specialist. Specialized in-home health care may be required for a child with a medical condition if the child is dependent on one or more of the following:

Back to Policy

Individualized Health Care Plan (IHCP)

The Individualized Health Care Plan (IHCP) is prepared for a child with special health care needs prior to his/her placement.  It includes the plan of the child's physician for the child's in-home health care.  It may include the identification of any available and funded medical services that are to be provided to the child in the home. Services may include, but are not limited to, assistance from the following individuals:

 

The IHCP outlines:

 

When required, specialized in-home health care must be arranged prior to the placement of a child with special health care needs. DCFS typically documents the IHCP using the DCFS 416, Individual Health Care Plan (IHCP).

IHCP Team

The Individualized Health Care Plan (ICHP) Team develops an IHCP for a child with special heath care needs placed in a specialized foster care home. The Team is convened by the CSW, by phone or in-person, to discuss the specific responsibilities of the person(s) providing in-home health care, based on the IHCP.

 

The IHCP Team includes the following individuals:

Back to Policy  

Placement Selection

A child who meets criteria for special health care needs may be placed in the following placements:

 

State regulations specify standards that must be met in each of these environments:

 

No child with special health care needs may be placed in any group home, STRTP or combination of group homes or combination of STRTPs for longer than a short-term placement of 120 calendar days. The short-term placement in the group home or STRTP must be on an emergency basis for the purpose of arranging a subsequent placement in a less restrictive setting (e.g., with the child’s parents, relatives, foster parent, FFA or another appropriate person or facility). A child with special health care needs must not be placed in a group home or STRTPunless the CSW has determined and documented that the group home or STRTPhas a program that meets the specific needs of the child and there must be a commonality of needs with the other children in the group home or STRTP.

Placement Capacity for a Child with Special Health Care Needs

No more than two (2) foster care children may reside by law in a specialized foster care home. The exception is in the case of a home that has a third child with or without special health care needs and where the licensed capacity is not exceeded. In such a case all of the following conditions must be met:

 

New determinations must be made and documented each time there is an increase or turnover in foster care children and the two (2) child capacity limit is exceeded. For further information on how to obtain a capacity exemption, refer to Placement Capacity.

Back to Policy

Supervision of a Child with Special Health Care Needs

Specific standards exist for a parent/caregiver supervising a child with special health care needs. Child welfare and safety issues must be addressed that pertain to the parents and the Juvenile Court.

 

Children with special health care needs should be supervised by the MCMS Unit. For further information on MCMS Case Transfers, refer to Policy 1000-504.10, Case Transfer Criteria and Procedures.

Non-Emergency Transportation

If the child appears to need immediate emergency medical attention, contact 911 for assistance and for an ambulance to transport the child to the nearest hospital emergency room.

A CSW should not transport a child with special health care needs.  The caregiver is expected to provide this service after completing the child specific training. If that is not possible, a request for non-emergency transportation through MCMS will be made by the CSW. Non-emergent transportation should only be requested if no other transportation options are available (i.e., initial placements and replacements).


All non-emergent transportation requests must be coordinated by MCMS Intake Staff. It is important to initiate all non-emergent transportation requests as soon as a need is identified since it can take several hours for an ambulance to respond. If transportation is required before a child has undergone a PHN assessment, the MCMS ARA and Intake Coordinator may make the determination that he/she has special heath care needs for the purposes of transportation only.

 

For Interstate Compact for the Placement of Children (ICPC) replacements requiring out-of-state transportation, the child must be accompanied by an adult who has received child-specific training and/or by a qualified health care professional.

 

For all court appearances, contact the child’s attorney to determine if the child’s appearance can be waived prior to making a transportation request through MCMS.

Back to Policy  

PROCEDURE

Making an Initial Assessment

CSW Responsibilities

  1. While conducting the safety assessment, determine if the child has special health care needs.

 

  1. If the child exhibits special health care needs, consult with the Public Health Nurse (PHN) and determine if a joint home visit with the PHN is necessary.
  1. Collect information from the parent(s) on the child’s condition using Family Background #1. Identify the medical services that he/she has already utilized.
  1. Obtain the signed DCFS 179, Parental Consent and Authorization for Medical Care and Release of Education Records, or DCFS 179-PHI, Authorization for Disclosure of Child's Protected Health Information from the parent(s).
  1. If it is not possible to get the DCFS 179 or DCFS 179-PHI signed, obtain a court order to access the child’s medical records and obtain services, as necessary.

 

  1. Obtain the following from the PHN:

 

  1. Consult with the Bureau of the Medical Director, as needed, at (213) 351-5614 or askthedoctor@dcfs.lacounty.gov.

Back to Procedure  

  1. Complete a referral to the Regional Center, if appropriate.

Back to Procedure  

  1. Document all contacts with the family, collateral contacts, and the PHN in the Contact Notebook.

Placing a Child with Special Health Care Needs

CSW Responsibilities

  1. If a child appears to have special health care needs, consult with the Public Health Nurse (PHN) and MCMS Intake Coordinator to:
  1. Verify that the child meets the criteria for the medical conditions requiring specialized in-home health Care.
  1. Obtain assistance from the MCMS Intake Coordinator in identifying and facilitating an appropriate placement.
  1. If applicable, collaborate with the PHN and MCMS Intake Coordinator to discuss any needed training for the out-of-home caregiver who will be caring for that child.

 

  1. Prior to placement, obtain written verification of completion of child-specific training administered by an R.N. or M.D to the caregiver(s) and, if applicable, the assistant caregiver(s). The training should be documented on the DCFS 6079 and signed by the trainer and caregiver(s).

 

  1. Initiate the DCFS 149 & 149A, Medical Care Assessment & Medical Care Assessment Cover letter.

 

  1. Consult with the PHN regarding the child with potential special health care needs and the F-Rate documentation. Complete the DCFS 1696, F-Rate and Regional Center (ARM) Rate Indicators.

 

  1. Obtain a copy of the DCFS 416, Individual Health Care Plan (IHCP).

 

  1. Ensure that the selected caregiver has the following necessary documents prior to the child’s placement:

 

  1. If appropriate, refer the child to a Medical Hub.

 

  1. After consulting with the MCSW Intake Coordinator and after it has been determined that the child meets the criteria for transfer to a MCMS Unit, prepare the child’s case by meeting all case transfer criteria.

Back to Procedure  

Transporting a Child with Special Health Care Needs in Non-Emergencies

CSW Responsibilities

  1. Consult with the SCSW to determine whether the request to transport the child is appropriate.

 

  1. If the SCSW agrees to the request, complete the DCFS 6099 Patient Transportation Request Form and obtain SCSW signature. Document the child’s transportation needs and clearly document the rationale for the request.

 

  1. Forward the completed form to the MCMS Intake Coordinators at MCMS_Intake@dcfs.lacounty.gov or 626-332-5634 (Fax). The form should be submitted as much in advance as possible.

  1. For after-hours non-emergent transportation requests, contact ERCP at 213-639-4500 or 213-763-1440..

  2. The CSW must meet the transportation company at the pick-up and drop-off location or may be required to ride along with the youth. At minimum, the CSW must be present at pick-up and drop off location. In some cases, the transportation company will require the CSW to also accompany the youth..

  3. If child refuses to cooperate with the transportation, work with the child to persuade them to cooperate. The transportation company will remain on standby for 60 minutes prior to canceling the transportation.

  4. Confirm with MCMS Intake that the transportation was successful or report any problems that occurred.

SCSW Responsibilities

  1. Determine whether the transportation request is appropriate for the child. Consult with the PHN when necessary.

  2. If appropriate, sign the DCFS 6099, Patient Transportation Request Form and return to CSW.

MCMS CSW Responsibilities

  1. Upon receipt of a Patient Transportation Request form, consult with The EMS Agency’s Central Dispatch Office (CDO) to determine the appropriate type and level of medical transportation based on the child’s medical needs and obtain a quote for services if needed.

 

  1. Forward the request to the MCMS ARA for pre-approval of transportation services. If the expected cost is over $500, forward the request to the MCMS Division Chief for pre-approval.

 

  1. Upon receipt of the ARA and/or DC pre-approval, submit a completed DCFS 6099 Patient Transportation Request Form to CDO to arrange a patient transportation services in advance whenever possible. Advise CDO of any behavior concerns.

 

  1. If the request is approved, contact the requesting CSW and inform him/her of the approval for the transportation and provide information regarding the transportation arrangement. If the request is denied, contact the requesting CSW and inform him/her of the denial for transportation and the reason for it.

 

  1. If the request is denied, the CSW must make his/her own transportation arrangements. This could be the caregiver, Court transportation, CSW, outside resources (Medi-Cal Transportation, 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.) or even calling 911 if it appears to be an emergency. It will only be denied if the request does not fit the criteria for Non-emergent Transportation for a child with special health care needs.

 

  1. Confirm and/or verify delivery of transportation service and document on the DCFS 6099 Patient Transportation Request Form as such.

MCMS ARA Responsibilities

  1. Review the request, and approve or deny it.

 

  1. Inform the Intake Coordinator of the decision.

MCMS Division Chief Responsibilities

  1. If the expected cost is over $500, review the request and approve or deny it.

 

  1. Inform the Intake Coordinator of the decision.

ERCP Duty SCSW/ARA Responsibilities

  1. Upon receipt of a DCFS 6099 Patient Transportation Request Form, review the request, and approve or deny it.

 

  1. Consult with the EMS Agency’s Central Dispatch Office (CDO) to determine the appropriate type and level of medical transportation based on the child’s medical needs and obtain a quote for services if needed.

 

  1. Submit a completed DCFS 6099 Patient Transportation Request Form to CDO to arrange a patient transportation services in advance whenever possible. Advise CDO of any behavior concerns.

 

  1. If the request is approved, contact the requesting CSW and inform him/her of the approval for the transportation and provide information regarding the transportation arrangement. If the request is denied, contact the requesting CSW and inform him/her of the denial for transportation and the reason for it.

 

  1. Confirm and/or verify delivery of transportation service and document on the DCFS 6099 Patient Transportation Request Form as such.

 

  1. Forward the completed DCFS 6099 Patient Transportation Request form (indicate the decision made) to the MCMS Intake Coordinators at MCMS_Intake@dcfs.lacounty.gov, and inform the MCMS Intake Coordinator of the decision.

ERCP Designated ARA Responsibilities

  1. If the expected cost is over $500, review the request and approve or deny it.

 

  1. Inform the Intake Coordinator of the decision.

Transporting a Child with Special Health Care Needs from Law Enforcement

CSW Responsibilities

  1. If the child appears to need immediate emergency medical attention, contact 911 for assistance and for an ambulance to transport the child to the nearest hospital emergency room.

 

  1. If appropriate, enlist the parent/caregiver to assist in transporting the child to the nearest emergency room hospital to meet the foster parent.

Supervising a Child in Placement with Special Health Care Needs

MCMS or Regional CSW Responsibilities

  1. Provide services to children with special health care needs as set forth in the case plan.

 

  1. When considering split of sibling case, follow the procedure.

 

  1. Collaborate with the Regional CSW regarding sibling visitation if appropriate, parental status and visitation, and court reports.

 

  1. Make monthly contacts in the foster home, and monitor the care provided to ensure that the child’s health and welfare needs are met, including his/her educational, emotional, and mental health needs.

 

  1. Document contacts in the Contact Notebook.

 

  1. Verify and document that the child is monitored at a frequency determined by a primary pediatrician and/or medical team that specializes in the area of the child’s major medical problem.

 

  1. Ensure that the child has a current and completed DCFS 416, Individual Health Care Plan (IHCP).

 

  1. Review the (SCI) F-Rate documentation every six (6) months and between intervals if the child’s medical, developmental, and/or psychological status changes.

 

  1. For children in long-term care (LTC) placements that are paid through Medi-Cal, ensure that LTC Medi-Cal is established.

 

  1. Request that the Facility Director of the child’s placement complete the LTC Medi-Cal application online.
  1. If the Facility Director has questions or needs assistance with the application, instruct the Facility Director to contact the MCMS Intake Coordinator.
  1. If the Facility Director refuses to complete the application, consult with PHN.

MCMS SCSW Responsibilities

  1. Instruct the Regional CSW to follow the above process when the case has not yet been transferred to the MCMS Unit and needs an immediate LTC Medi-Cal application.

Back to Procedure  

Supporting a Child when Family Reunification or Family Maintenance Services are Court Ordered

CSW Responsibilities

Prior to returning a child home:

 

  1. Assess for all SDM child safety issues, including parental compliance with all court orders.

 

  1. Complete the required SDM tools.

 

  1. In consultation with the medical provider and/or the PHN:
  1. Complete an updated IHCP and document the child’s current health care needs.
  1. Provide the parent(s) with a copy of the Health and Education Passport.
  1. Arrange for the parent(s) to receive the child-specific training required to meet the child’s special medical needs.
  1. Consult with a PHN if needed.
  1. Verify that the parent(s) received and successfully completed the training.
  1. Coordinate the parent’s attendance at necessary appointments, including medical, therapy, educational etc.

 

  1. Document all information in the Contact Notebook and Health and Education Notebook.

 

Once the child has returned home and is receiving Family Maintenance services:

 

  1. Involve the PHN, as needed, in making a joint home visit to assess the health of the child and the parent’s interactions with the child.

 

  1. If needed or as ordered by the child’s medical provider, arrange for a visiting nurse to further instruct the parent(s) and to monitor the child’s progress in the home.

 

  1. Ensure that all required appointments (medical, educational, etc.) are made by the parent(s) on behalf of the child.

 

  1. If a child is also supervised by the Regional Center, coordinate a plan for the child with the Regional Center.

 

  1. Document all contact and activities in the Contact Notebook and Health and Education Notebook.

Back to Procedure  

APPROVALS

ARA Approval

ERCP ARA Approval

MCMS ARA Approval

MCMS Division Chief Approval

RA Approval

SCSW Approval

Back to Approvals 

HELPFUL LINKS

Forms

LA Kids

ABCDM 228, Applicant's Authorization For Release of Information

DCFS 149 & 149A, Medical Care Assessment & Medical Care Assessment Cover letter

DCFS 179, Parental Consent and Authorization for Medical Care and Release of Education Records

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

DCFS 280, Technical Assistance Action Request

DCFS 416, Individual Health Care Plan (IHCP)

DCFS 709, Foster Child Needs and Case Plan Summary

DCFS 1696, F-Rate and Regional Center (ARM) Rate Indicators

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

DCFS 4366, Children Services Case Transfer Sheet

DCFS 6079, Medical Training Confirmation

DCFS 6099, Patient Transportation Request Form

Family Background #1

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

Family Background #3 - Coversheet

Referenced Policy Guides

0070-516.10, Assessing a Child's Development & Referring to a Regional Center

0070-528.10, Assessing Children with Special Needs in ER Investigations

0070-560.05, Joint Response Referral: Consulting with PHN

0080-503.00, Contacts with the Child Support Services Department (CSSD)

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.

0100-510.10, Placement Capacity

0100-510.60, Placement Considerations for Children

0100-510.61, Placement Responsibilities

0100-525.10, Interstate Compact on the Placement of Children (ICPC)

0300-306.80, Transportation Requests to Bring Children/Youth to Court

0600-500.00, Medical Hubs

0600-500.20, Health and 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.

0600-501.10, Medical Consent

0600-505.12, Identifying and Documenting a Client’s Disability and Need for Special Services

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

0900-511.12, Dual Agency Rates

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

1000-504.10, Case Transfer Criteria and Procedures

Statutes

Health and Safety Code (HSC) 1501.1 – States in pertinent part, that when placing children in out-of-home care, particular attention should be given to the individual child’s needs, the ability of the facility to meet those needs, the needs of other children in the facility, the licensing requirements of the facility as determined by the licensing agency, and the impact of the placement on the family reunification plan.

 

HSC Section 1507.5 – States, in part, that in-home medical care as well as home and community-based services may be provided by a licensed home health agency to a child with special health care needs in foster family homes, when deemed medically appropriate by the State Department of Health Services.

 

United States Code Section 1396d(a)(4)(B) of Title 42 - Provides a definition for "early and periodic screening, diagnostic, and treatment services".

 

Welfare and Institutions Code (WIC) Section 11400(e) – Defines, in pertinent part, small family home.

 

WIC Section 17730, 17731, 17732, 17732,1, 17733, 17734, 17735, 17736 – States, in part, rules and placement requirements for children and youth who have special health care needs and who are staying in a specialized foster care home placements. Also states the county documentation and reporting requirements

 

WIC Section 17739 - States the priority consideration for placement of a medically fragile child.

Back to Helpful Links