Assessing Children with Special Needs in Emergency Response (ER) Investigations
0070-528.10 | Revision Date: 4/3/2026

Overview

This policy guide helps the CSW identify abuse or neglect of special needs children and identify their special needs.

Table of Contents

Version Summary

This policy guide was updated from the 07/01/2024 version to align with timeframes in the Medical Hub policy for initial medical exams and medical clearances.  The policy was also updated to reflect current practice and terminologies.  Further, a section was added to assess special developmental needs. 

POLICY

Children with disabilities and other special needs are especially vulnerable for abuse, neglect and/or exploitation due to the additional support they may require. Some examples of disabilities and other special needs include:

  • Medical disability, medical fragility or chronic health conditions
  • Emotional/mental/behavioral disorders
  • Special educational needs
  • Intellectual and developmental disabilities
  • Autism spectrum disorder
  • Physical disabilities (e.g., mobile impairments, cerebral palsy)
  • Sensory impairments (e.g., vision or hearing impairments)
  • Communication disorders (e.g., speech or language impairments)
  • Learning disabilities

It is important to assess a child’s special needs during the investigation of child abuse or neglect and consider the family as a unit to determine whether the special needs of the child are being met.

Continued child welfare services are not appropriate for children with special needs when the CSW's assessment has concluded that there is no abuse or neglect involved. Services listed below are provided as possible resources the family can access at their discretion or choice, as appropriate, in the event the family is not aware of or receiving them.  This list is not exhaustive.



Special Medical Needs

Some medical needs are temporary and others are chronic.  Children with temporary disabilities (burns, broken bones, temporary colostomies, or children with surgical wounds, etc.) require medical assistance only for a specified period of time.  However, those children who suffer from chronic disabilities such as asthma, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), and diabetes, require ongoing assistance managing their disabilities.  Those conditions which depend on technologies such as wheelchairs, braces, tracheotomies, internal feeding tubes, cardio-respiratory monitors, ventilators or dialysis, also require assistance from family members for an indeterminate period of time.

Another group of children within this population are those who are considered medically fragile.  Typically, these are infants or children under three (3) years of age that are prone to re-hospitalizations.  The risk of deterioration, resulting in permanent injury or death, persists, even though all procedures and ministrations are correctly performed.  Examples of this may include children diagnosed with acquired immunodeficiency syndrome (AIDS), congenital or hereditary defects (e.g., hydrocephalus, sickle cell anemia, or cystic fibrosis), severe burns, epilepsy and complications from prenatal exposure to drugs and/or alcohol.

Medical Hubs are now available to provide the state-required initial medical exams for newly detained children as well as forensic exams when appropriate. Refer to the Medical Hubs policy for more information, including the timelines and requirements for initial medical examinations (IME) referrals.  If a child is being served by the Medical Case Management Services (MCMS) section, indicate that the medical hub referral form is being submitted for consultation only.

The office of the Medical Director is available to answer all questions regarding general medical, dental, mental health and substance abuse for all DCFS children and families via email at askthedoctor@dcfs.lacounty.gov.

All Children’s Social Workers (CSWs), including CSW's from Emergency Response Command Post (ERCP) are required to immediately consult with a Public Health Nurse (PHN) regarding children with a known or suspected medical condition.  This applies to new Emergency Response (ER) referrals, open ER referrals, and cases. 

Back to Policy  

Special Mental Health Needs

Extreme behavior patterns frequently place children in conflict with parents, siblings, caregivers, teachers, peers and society at large.  Diagnostic impressions may vary, but most revolve around depression and anxiety, pervasive developmental disorders, such as autism spectrum disorder, psychosis, lack of social skills, disruptive or aggressive disorders, traumatic stress, and/or attention deficit/hyperactivity disorder.  These children are usually serviced through mental health clinics, psychiatric hospitals or therapists, and may be prescribed psychotropic or other medications. These children may also be in special education programs or receive accommodation at school.

When working with a mentally ill child, a CSW must assess the safety of all siblings in the home.  This is particularly relevant when the mentally ill child presents with acts of violence, rage, fire setting, or sexually acting out behaviors.

The origin of psychological problems in children may be organic and/or environmental.  A CSW should investigate and assess the environmental factors such as neglect and/or physical or sexual abuse as contributory factors these types of behaviors in children.  For example, a parent’s/caregiver's failure to follow through on prescribed treatment and medication can exacerbate a child’s mental illness.  In contrast, a parent/caregiver may have complied with all recommendations and exhausted all private and community resources, but still is unable to protect their child from harm due to the child’s propensities or special needs.

A CSW should be alerted to the depressed and/or suicidal child, especially for pre-teens, as the behaviors and symptoms of depression are initially less discernable. 

Back to Policy  

Special Educational Needs

Many children with special medical needs or emotional/mental/behavioral disorders require special education services as well.    These include children from infancy (early intervention services for children 0-3 and their families), pre-school age (3-5), and school age (5-22) who due to their impairment, require specially designed instruction or services to receive free appropriate public education (FAPE). These services are to be provided in the least restrictive environment (LRE) and are documented in the student’s Individualized Education Program (IEP).

Special education may be provided for children with disabilities in the following areas:

  • Hearing impairment (including deafness)
  • Visual impairment (including blindness)
  • Speech or language impairment
  • Orthopedic Impairment
  • Traumatic brain injury
  • Intellectual disability
  • Autism
  • Serious Emotional Disability
  • Developmental delays (children three (3) - nine (9))
  • Multiple Disabilities 
  • Specific learning disabilities:  
  • Other Health Impairment (limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome, and adversely affects a child's educational performance.)

A child is not eligible for special education or services if the child does not otherwise meet the eligibility criteria and their educational challenges are primarily due to limited English proficiency; a lack of instruction in reading or mathematics; temporary physical disabilities; social maladjustment; or environmental, cultural, or economic factors.

Children and youth with impairment who do not qualify for special education may still be eligible for educational accommodations and supports through Section 504 of the Rehabilitation Act of 1973, commonly referred to as a “504 Plan”. The 504 plan outlines the special services, accommodation, and modifications that will be used by the LEA to assist students. 

Children aged three (3) years old and above should be referred to receive an assessment through their LEA and CSWs should work with the Education Specialist assigned in their office.

Infants and toddlers ages 0-3 should be referred to Early Start and connected to their local regional center. An additional resource is Help Me Grow LA (http://publichealth.lacounty.gov/mch/helpmegrow/index.html), a program of the Los Angeles County Department of Public Health (LACDPH) that helps families find services that can support their child’s development, including early intervention services.

Special Developmental Needs

Developmental delay means a child is behind in developing skills expected for their age and is not reaching age-expected milestones in one or more areas of development, such as:

  • Communicative (limited/no words, not imitating sound, speech is difficult to understand)
  • Physical (not moving independently [crawling/cruising/walking], falls a lot, difficulty with small objects/use of fingers)
  • Cognitive (difficulty problem solving, learning new skills is limited, not interested/does not attempt to know the use of toys/objects – intended for age)
  • Adaptive (difficulty breathing, sucking, swallowing, not able to hold a bottle, does not pick up or bring food to mouth, difficulty with dressing, eating, toileting, self-direction)
  • Social (limited/avoids interaction with same-age peers or adults, limited/avoids eye contact when name is called, limited imaginative play, inappropriate use of toy or other objects)

Some children with developmental delays catch up over time, especially with early intervention. 

Developmental disability is a broader, lifelong condition that impacts development in areas such as:

  • Self-care (affects personal hygiene, grooming, feeding)
  • Receptive and expressive language (significant difficulty understanding a simple conversation, needing information to be repeated, significant difficulty following directions)
  • Learning (poor academic level, information retention and reasoning)
  • Mobility (fine and gross motor skills, [e.g., difficulty using scissors, utensils, writing, kicking, pushing, pulling, holding or balancing items])
  • Self-direction (affects emotional development, personal judgement, interpersonal relationship)
  • Capacity for independent living (difficulty performing age-appropriate, simple household tasks, does not have age-appropriate capacity to be left unsupervised)
  • Economic self-efficiency (individual lacks the capacity to participate in vocational training or to obtain and maintain employment without significant support, difficulty with job finding).

Examples of developmental disabilities are autism spectrum disorder, intellectual disability, cerebral palsy, and epilepsy. While developmental disabilities are lifelong conditions, the individuals can still make progress and thrive with the right support and services. 

 

Developmental delays may be temporary setbacks or could be early signs of a permanent developmental disability. Early detection and intervention are both crucial to improve outcomes.

 

Regional Centers (RC) are private, non-profit organizations that are under contract with the California Department of Developmental Services (CDDS) to coordinate and provide community-based services to people with developmental disabilities. Clients of Regional Centers are called consumers. Regional Centers develop, purchase and manage services for their consumers and their families.

The DCFS Regional Center Support unit RegionalCenterSupport@dcfs.lacounty.gov is available to answer all questions regarding screening for developmental delays and disabilities, RC eligibility criteria and RC eligibility status for all DCFS children and their parents/caregiver.

All CSWs, including the CSW’s from Emergency Response Command Post (ERCP), are required to immediately screen all children for developmental delays and disabilities immediately and refer those with suspected qualifying conditions to the Regional Center. This applies to new ER referrals, open ER referrals, and cases. If it is not possible for the ER/ERCP CSW to make the RC referral due to inability to obtain proper consents from the Education Rights Holder (ERH) or the case being transferred less than seven (7) business days of suspecting delay/disability from the screening and/or information gathered, the ER/ERCP must alert the next assigned CSW at the time of the DCFS referral/case transfer that an RC referral is needed, including the reasons why a referral is needed and why they were not able to submit the referral.  Refer to Assessing a Child’s Developmental & Referring to a Regional Center policy for more information.

PROCEDURE

Identifying Abuse or Neglect of Special Needs Children

CSW Responsibilities

  1. Obtain a diagnosis and a treatment plan if possible, from the parent/caregiver, doctor, and/or any professional that has this information. 
  2. Identify the nature of the child's special needs that must be met.
  3. Identify what resources are being used or should be used to meet the child’s special needs.
  4. Conduct the investigation per policy.
  5. Determine the parents/caregivers’ responses to their child's special needs.
    1. Is there neglect (e.g., medical) problems such as parental/caregiver’s substance abuse, mental illness, developmental delay, inability to meet the child's needs, etc.?
    2. Is there unintentional neglect due to parental or caregiver:
      1. Lack of knowledge?
      2. Inability to access resources (lack of transportation, child care, medical insurance)?
      3. Limited ability (illiterate, unable to follow complex medical directions)?
    3. Are the available resources insufficient to meet the special needs, such as children with severe mental illness or conditions that cannot be controlled/resolved with the usual medical, psychological, and/or educational interventions? Consider the totality of the family’s circumstances and information gathered to determine whether there is neglect.
    4. Are there indications that the neglect is purposeful or willful?
  6. Determine if the siblings are being appropriately cared for.
  7. Assess the stress levels and coping skills of the parents/caregiver.
  8. Determine if the parent/caregiver is willing and able to provide for the needs of all of the children in the household.
  9. Determine what support systems are available to the family.
  10. Provide referrals as needed.
  11. Document your findings in the Contact Notebook.  (Include the child’s strengths and needs in your findings.)

Back to Procedure 

Referrals for Special Medical Needs

CSW Responsibilities

  1. Consult with the Public Health Nurse (PHN) for any joint response referrals with the PHN.
  2. When a referral is received with the designation of MCMS (Medical Case Management Services) on the Screener Narrative in the Referral Folder, consult the Public Health Nurse regarding the identified medical condition. Refer to the Case Transfer Criteria and Procedures policy.
  3. Interview parents/caregiver and obtain:
    1. Child’s health history
    2. Information related to child’s health condition, equipment, medications, supplies, and all doctors treating the child and their phone numbers.
    3. Consent to release of information
    4. Determine source of health insurance, if any
  4. Contact school personnel and obtain:
    1. Medication provided at school
    2. Known health problems
    3. Special education needs
    4. Current IEP/504 plan (with parent’s consent)
    5. Attendance record
    6. Health/immunization record
  5. Interview siblings to determine how well they are able to cope with the effects of the medical needs of the identified child.  
  6. Obtain information from collateral contacts.  Include teachers, counselors, community agencies, babysitters, and current and previous healthcare providers.
  7. Initiate medical record request.
  8. Conduct the investigation, per policy
  9. Document your findings in the Contact Notebook. Include the child’s strengths and needs in your findings.

Back to Procedure 

PHN Responsibilities

  1. Assist CSW by explaining the condition(s). The medical provider has the primary responsibility of explaining medical conditions to patients. 
    1. Upon request, provide additional health related resources to the parent(s)/caregiver to increase the level of providing care or to reinforce things previously learned.  
    2. Upon request, the PHN will assist with providing resources to locate a medical provider.
    3. Consult with school personnel, as needed
    4. Consult with hospital personnel and discharge planner as needed
    5. Request medical records when necessary
    6. Call community agencies for various resources.
  2. Document any findings and actions taken in the Health Notebook.
  3. Follow all other applicable steps for a joint response referrals.

Back to Procedure 

Assessing Special Mental Health Needs

CSW Responsibilities

  1. When assessing for a potential emotional/mental/behavioral disorder, consider:
    1. Acts or threats of violence, such as, threats to harm self or others, self-mutilation, harming of animals, outburst of rage, excessive verbal or physical aggressiveness,
    2. A pattern of stealing, lying, fire-setting, or sexual acting out
    3. Sleep difficulties or depression, (including depression or anxiety linked to stigma or lack of support, bullying, harassment or family rejection)
    4. A history of enuresis or encopresis
    5. Impairment in reality testing, judgment, or communication
    6. Visual and or auditory hallucinations
  2. Consult the Coordinated Services Action Team (CSAT) team and/or the Department of Mental Health (DMH) Specialized Foster Care (SFC) on duty clinician if mental health concerns exist. If the Child is an immediate danger to self or others contact ACCESS (Psychiatric Mobile Response Team) immediately at 1-800-854-7771.  
  3. Assess the safety of all members of the household.
  4. Utilize the Child and Adolescent Needs and Strengths (CANS) Assessment
  5. Provide referrals and assist the family with accessing all available assistance as appropriate.
  6. Determine if all of the child’s special needs are being met.
  7. Conduct the investigation, per policy.
  8. Document your findings in the Contact Notebook.  Include both positive and negative findings.

Back to Procedure 

Assessing Special Educational Needs

CSW Responsibilities

Conduct the investigation, per policy, with a focus on:

  1. Obtaining information from the child’s school regarding the nature of the child’s special educational needs including any assessments and IEP or 504 plans, if applicable
  2. Consult with the designated office Education Specialist to review the information received from the school.
    1. Submit requests for consultation through the Education Specialist Referral System (ESRS) on LA KIDS.
  3. Evaluate the parent’s/caregiver’s ability and willingness to work with the school on behalf of their child. Alone, a parent's inability or unwillingness to work with the school is not enough to substantiate allegations of abuse or neglect. However, the inability or refusal to work with the school could be part of the assessment and determination that there is some form of abuse or neglect. 
  4. Advocating on behalf of the parent/caregiver and child in terms of either requesting and/or participating in an Individual Educational Plan (IEP) or development of a 504 plan.
  5. Providing referrals as appropriate. 
  6. Documenting your findings in the Contact Notebook.  Include the child’s positive and negative aspects.
    1. The child’s academic strengths and needs
    2. Any services the school provides
    3. Any additional recommendations to support the youth’s academic stability and growth
  1.  

Assessing Special Developmental Needs

CSW Responsibilities

  1. Screen for developmental delays and disabilities by reviewing pertinent documents (birth history, medical records, school records [including IEPs, if applicable] discipline reports, psychological assessments, mental health records, MAT assessments, etc.).
  2. Use the 0-5 Developmental Milestones Checklist to screen children under age three (3) years old, or the DCFS Screening Guide for RC Referrals for Children Three Years & Older for developmental delays and disabilities and refer to RC as appropriate.
  3. Follow procedures in Assessing a Child’s Development & Referring to a Regional Center.
APPROVALS
None
HELPFUL LINKS

Forms

CWS/CMS

Medical HUB Referral

LA Kids

DCFS 561(b), Dental Examination Form

DCFS 561(c), Psychological/Other Examination Form

DCFS 149 and 149A, Medical Care Assessment Cover Letter/DCFS149A, Medical Care Assessment 

DCFS 149A (sp), Medical Care Assessment & Cover Letter

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

DCFS 179 (sp), Parental Consent and Authorization for Medical Care and Release of Health and Education Records

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

Medical HUB Notice to Caregivers (Spanish)

Medical HUB Referral Form

Suicide Prevention Fact Sheet (Spanish)

REFERENCED POLICY GUIDES

0070-516.10, Assessing a Child’s Development and Referring to a Regional Center

0070-516.15, Referring Children for Mental Health Services and the Coordinated Services Action Team (CSAT)

0070-548.10, Investigation, Disposition and Closure of Emergency Response Referrals

0070-548.24, Structured Decision Making (SDM)

0070-548.26, Child and Adolescent Needs and Strengths (CANS) Assessment

0700-500.10, Education of DCFS-Supervised Children

0070-560.05, Joint Response Referrals: Consulting with PHNs

0600-500.00, Medical Hubs

0600-505.10, Supervising and Placing Children with Special Health Care Needs

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

1000-504.10, Case Transfer Criteria and Procedures

STATUTES AND OTHER MANDATES

Education Code (EDC) Section 504 – Provides the provisions of 504

EDC 56026 – Provides the definitions for “individuals with exceptional needs”

EDC Section 56441.11 – Special Education Program for Individuals with Exceptional Needs Between the Ages of Three and Five Years, Inclusive.

Penal Code 11165.2, Provides the definition for neglect and severe neglect.

Penal Code 11165.3 Provides the definition for willful harming or injuring of a child or the endangering of the person or health of a child.