Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)
0070-516.15 | Revision Date: 9/6/2023

Overview

This policy guide provides guidelines on the provision of mental health services to children under the supervision of DCFS, including the referral of cases to the Coordinated Services Action Team (CSAT).

Table of Contents

Version Summary

This policy guide was updated from the 12/11/20 version to provide instructions for the CSAT Mental Health Referral (MHR) process and the usage of the Child and Adolescent Needs and Strengths (CANS) as the new screening tool for children and Non-Minor Dependents (NMDs). This also includes new responsibilities of the Multidisciplinary Assessment Team (MAT) + Services Linkage Specialist (SLS) Children Services Administrator (CSA) and instructions on how to work with Department of Mental Health (DMH) Specialized Foster Care (SFC) for mental health screenings and service linkage and with DMH MAT Coordinators for MHR/CANS screenings and DMH MAT provider case assignments.

POLICY

Mental Health Referral/Child & Adolescent Needs & Strengths (MHR/CANS) Screenings

The Mental Health Referral (MHR) is a coversheet located on the Referral Portal on DCFS’ LA Kids Website that instructs users to attach the Child & Adolescent Needs & Strengths (CANS) Screenings. The CANS replaced the Child Welfare Mental Health Screening Tool (MHST) as the tool to screen and identify children and youth who should be referred for a mental health assessment.

The CANS assessment replaced the following: MHST, Family Strength and Needs Assessment (FSNA), and Child Strengths and Needs Assessment (CSNA). The Children’s Social Worker (CSW) uploads the appropriate CANs from CWS-CARES as an attachment to the MHR on the DCFS Referral Portal.

Emergency Response (ER) CSWs will complete the MHR for children in conjunction with the promotion of an emergency response referral to a case. This will initiate the start of ongoing child welfare services to the family (both court and voluntary cases).

The MHR is not required for emergency response referrals that will not be promoted to a case.

Continuing Services CSWs will completed the MHR for children on an open case who meet the following criteria:

  • The child is not receiving mental health services at the time of the case plan update.
  • The child presents with a new behavioral indicator.
  • Results of the MHR are defined as follows:
  • An MHR/CANS screen is designated as Urgent based on a score of three (3) in the Behavioral or Risk Factor Domain on the CANS tool, with clear documentation from the CSW in the comment field of the MHR indicating the reason for “urgency.” Urgent screens will be prioritized by co-located Department of Mental Health (DMH) Specialized Foster Care (SFC) staff.
  • All other MHR/CANs screens are designated as Routine.

Before mental health and/or developmental assessments and services can commence, a parent/guardian must provide consent by signing a DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental Services.

  • If the parent is unavailable or declines to sign the DCFS 179-MH for a detained child, the CSW must request authorization from the Court.  If a parent declines to sign for a voluntary non-court involved child, then the CSW is to sign the DCFS 179-MH, indicating that the parent declined to sign.  Children 12 years or older, who are mature enough, and legal guardians may also give authorization using the service provider's consent forms, if it is more expedient.
  • Authorization to release and exchange protected health information (PHI) may be obtained either by the parent’s signature on the DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information, or by a court order at the time consent for mental health treatment is requested. Authorization for the release of protected health information depends on who provided consent to treatment. If the parent/legal guardian provided consent, they would authorize the release of the PHI. However, if the minor consented to their own mental health treatment, then the minor's authorization is needed.
  • If DCFS is assisting a nonminor dependent with obtaining treatment, the NMD may consent to their own treatment through the usage of the DCFS 6009, Nonminor Dependent Informed Consent and DCFS 6010, Nonminor Dependent 2-Way Authorization for Sharing Information. NMDs must sign consent for treatment with the service provider.

If a child is under court ordered DCFS supervision, a health care provider is allowed by law to disclose to DCFS protected medical or mental health information without the child’s or parent/guardian's authorization to DCFS in order to coordinate the health and mental health treatment of the child. The Department of Mental Health (DMH) Specialized Foster Care (SFC) staff may share (PHI) consistent with DMH policy and the requirements of the federal Health Insurance Portability and Accountability Act (HIPAA) and Confidentiality of Medical Record Act (CMRA).

Coordinated Services Action Team (CSAT)

The primary function of the Coordinated Services Action Team (CSAT) is to provide regionally-based, clinically-focused collaboration with the CSW and the Child and Family Team (CFT), with the goal of coordinating services to address the mental health, emotional well-being, and developmental needs of system-involved youth, and ensuring alignment of the various providers who serve the family.

Each regional office has various staffing resources and needs. The composition of the CSAT may vary depending on the nature of the family/children’s needs and the status of the child’s placement. The CSAT team may be comprised of various members, including but not limited to, the Public Health Nurse (PHN), Residential Care Liaison (RCL), Level of Care (LOC) CSW, DMH Specialized Foster Care (SFC), Education Specialist, Parents in Partnership (PIP), and Community Based Liaison (CBL). Shared responsibilities (and the lead position) may also vary depending on the needs of the case and the Child and Family Team. The CSAT team provides office-based expertise to identify a family’s strengths/needs and ensure linkage to community-based resources.

A secondary function of the CSAT is to manage and enter necessary data into CWS/CMS. Automated reports are then produced to track the completion of tasks and the utilization of resources, related to the services provided and the County’s compliance with the terms of the Katie A. Settlement Agreement. CSAT is responsible for the following documentation:
  • Screening and referral information from MHR
  • Upon feedback from DMH, Intervention and Plan Detail information from the MHR
  • Completion of developmental screens for children ages 0-3

CSAT Roles and Responsibilities

The primary role of the Multidisciplinary Assessment Team (MAT)+Service Linkage Specialist (SLS) Children Services Administrator (CSA) is to ensure that all children with an open case are screened, assessed, and linked to mental health services as needed. In particular, the MAT+SLS CSAs ensure that each eligible newly detained child receives a mental health screening, a MAT assessment, a MAT Summary of Findings (SOF) meeting and report, and is linked to mental health treatment, as needed. Additionally, the MAT+SLS CSAs ensure that each eligible newly detained child receives a mental health screening, a MAT assessment, a MAT Summary of Findings (SOF) meeting and report, and is linked to mental health treatment, as needed. Additionally, the MAT+SLS CSAs will:

  • Upon electronic receipt of the MHR/CANs from the CSW, complete MHR-specific tasks, including uploading consent, court report/investigative narrative, and Medi-Cal eligibility, for all children in an open case and documenting the information on CWS/CMS.
  • Ensure medical Hub results are distributed to the MAT Provider.
  • The CSAT Team may be able to assist the CSW with completing the coversheet of the MHR on a case by case basis for MAT cases.
  • Provide case support on cases brought to the attention of management in the Bureau of Clinical Resources and Services (BCRS).
  • Facilitate Child and Family Team Meetings (CFTMs) or staffings for high risk cases, as needed.
  • Invite CSAT members to attend CFTMs based on the child and family's needs.  Inform the CFT of services and supports that promote stabilization and overall well-being. 
  • As part of the CFT, collaborate with the team in developing the safety plan, identifying the child's strengths and needs, as well as interventions.
  • Provide guidance on requests involving 1:1 behavioral aides, psychological testing, and specialized services.
  • When possible, participate in Psychiatric Hospitalization Discharge Planning Teleconferences and 241.1 Teleconferences.
  • Complete a Regional Center referral when recommended on the Medical Hub exam or MAT Summary of Findings (SOF) report.
  • Complete the service linkage in coordination with the DMH SFC and the CSW.
  • Consider referring cases with expectant and parenting youth to a DCFS Expectant and Parenting Youth (EPY) Conference.
    • An EPY Conference is a voluntary, proactive tool intended to identify and discuss issues related to pregnancy and early stages of child rearing for the expectant or parenting youth, including fathers. EPY Conferences focus on planning for healthy parenting, identifying appropriate resources and services, and preparing for a successful transition to independence.
  • Serve in a leadership and support role to the CSAT team members
  • Manage the coordination of all CSAT activities.

The Residential Care Liaison (RCL) supports the Regional CSAT. In particular, the RCL team:

  • Assists regional CSWs with referral packets for a Qualified Individual (QI) Assessment by DMH, to determine whether a Short Term Residential Therapeutic Program or Family Based Setting with services and supports can best meet the youth’s needs. Refer to FYI #21-17 for the RCL’s role in assisting CSWs with QI referrals (add hyperlink).
  • Coordinates Psychiatric Hospital Discharge Planning Teleconferences for youth on 5585 psychiatric holds
  • Monitors and completes JV224 Psychotropic Medication Progress Reports to court for youth placed in STRTPs
  • Assists with cases previously eligible for D-Rate funding.

The DMH Specialized Foster Care (SFC) staff, co-located in DCFS offices, triage, assess and link children and families to mental health services. DMH staff can attend Child and Family Team Meetings (CFTMs) acting as a mental health representative on the team. DMH staff are also tasked with following up on the urgent MHR/CANS and consultations on ER investigations and open cases.

The DMH Specialized Foster Care (SFC) Supervisor (or his/her designee) is the primary point of contact for mental health issues on the CSAT team. The DMH/SFC Supervisor:

  • Reviews and screens all referrals that come to the co-located programs
  • Assigns cases to clinicians within the program
  • Oversees the tracking of case disposition

The CSAT Centralized Unit supports the CSAT process, by processing and tracking all completed MHR/CANS from the CSWs and Hubs, monitoring the CSAT in-box and providing clerical and data entry support for the MAT+SLS CSA.

The DCFS Eligibility Verification staff (Technical Assistants) assist the CSAT team in resolving problems with Medi-Cal eligibility that interfere with the child’s access to mental health services. 

Additional staff may be called upon, on a case by case basis, to join the team as needed. This may include:
  • Staff from the Permanency Partners Program (P-3)
  • Staff from the Resource Family Approval (RFA) Program
  • Educational Liaisons
  • DMH Wraparound Liaisons
  • Public Health Nurses (PHNs)
  • Residential Care Liaison (RCL)
  • DPSS Linkages GAIN Social Workers (LGSWs)
  • DMH Intensive In-Home staff
  • DMH Family Preservation (FP) Liaisons
  • Specialized Foster Care (SFC)
PROCEDURE

Initiating a Mental Health Screening

ER CSW Responsibilities

  1. Complete the appropriate MHR/CANS (0-5 years) or (5 years-adult) form in conjunction with the promotion of an emergency response referral to a case and start of ongoing child welfare services to the family via the Referral Portal link on DCFS LA Kids website.
    • ER CSWs are not required to complete a MHR/CANS unless the referral will be promoted to a case and ongoing DCFS services will be provided.
    • The MHR/CANS provides guidance on screening for mental health needs.
  2. Read and review the MHR/CANS mental health follow up response from DMH as indicated via email. CSWs are to consult with DMH SFC staff regarding their findings and next steps to ensure a child's timely linkage to mental health services per DCFS and DMH's shared agreement to work collaboratively and team on an ongoing basis.

ER CSW Responsibilities for ER Referrals Under Investigation

  1. If, within the course of investigating an emergency response referral, a child is assessed as immediate (suicidal and/or danger to self or others), contact ACCESS/PMRT at (800) 854-7771 immediately and wait with the child until ACCESS arrives for an in-person response. Refer to Procedural Guide 0070-547.14, Expedited Joint Response Protocol with the DMH Field Response Operations (FRO). If you believe a dangerous situation exists or the child feels threatened, call 911 for immediate assistance.
  2. If while assessing a referral for existing mental health threats, a mental health concern is noted within the last 24 hours, contact the CSAT Team immediately for a consultation and to formulate a plan to address those needs, based upon the Regional Office CSAT team protocol for responding to ER referrals.
    • Mental health concerns include, but are not limited to, unusual behaviors, child seems disconnected, depressed, or in danger of being removed from preschool, daycare, school or home due to behavior, has experienced abuse or neglect, or has a parent with a mental health or substance/alcohol abuse problem). 

ER CSW Responsibilities for Newly Detained Children

  1. Complete the MHR/CANS.
  2. Refer the child for an initial medical and/or forensic examination, at the Medical Hub.
  3. Work with the MAT Coordinator to obtain consent for mental health treatment, authorization for release of protected health information, and benefits establishment.
  4. Upload the necessary consent and CANs documents to the MHR on the Referral Portal.
  5. At the time of the initial placement, the CSW will initiate a request for Medi-Cal on the DCFS 280, Technical Assistance Action Request. The TA will generate the Medi-Cal verification letter.
  6. Respond to requests for additional information from members of the CSAT within two (2) business days.
  7. Document your discussion/plan for services in the Contact Notebook.

ER CSW Responsibilities When Providing Ongoing Services (Court or Voluntary)

  1. Complete the appropriate MHR/CANS (0-5 years) or (5 years-adult) form in the Referral Portal and upload the appropriate consent.
    • The CSAT email in-box will receive an email alert that the MHR/CANS has been submitted and the MAT+SLS will complete follow-up actions to ensure and track the completion of the MHR/CANS.

ER SCSW Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

  • At the time of promotion of the referral to a case, confirm that an MHR/CANS has been completed for each child on the case.

MAT+SLS Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

  1. Respond to requests for additional information from members of the CSAT within two (2) business days.
    • Timelines to refer to DMH Specialized Foster Care:
      • Immediate or Intensive Action Needed - same day or within one (1) calendar day of the MHR/CANS
      • Routine - within ten (10) calendar days of the MHR/CANS
  1. Complete follow-up actions to ensure and track the completion of the MHR/CANS.

Continuing Services CSW Responsibilities for Newly Detained and Non-Detained Children Under Court Ordered FM, VFM, or VFR

  1. Complete the MHR/CANS (0-5 years) or (5 years-adult) in the following situations:
    • At the time of the first case plan update following the implementation of CSAT.
    • When a behavioral indicator is identified.
    • For 2PEN cases from ERCP.
    • MART is responsible for completing the initial MHR/CANS.
  2. Complete the MHR/CANS for a child placed outside of Los Angeles County.
    • If the CSW indicates that the child is placed outside of LA County, the MHR/CANS is automatically forwarded to the AB1299 Unit.
    • For courtesy supervision provided by another agency, contact the caregiver (and child if appropriate) and complete the MHR/CANS based on feedback from the caregiver, child and social worker performing courtesy supervision.
    • For a CSW who is providing courtesy supervision for a child in Los Angeles County, complete the MHR/CANS according to regular frequency.
  3. Complete the MHR/CANS and upload the appropriate consent for children involved in inter-county transfers into Los Angeles County at the time of case assignment, unless the child is receiving mental health services at the time and has received them in the past sixty (60) days.
  4. Where a behavioral indicator is identified and an MHST has previously been administered, consult with the SCSW, MAT+SLS, or co-located DMH staff.
  5. Respond to requests for additional information from members of the CSAT within two (2) business days.
  6. Document your discussion/plan for services in the Contact Notebook.

Dependency Investigator (DI) Responsibilities

  1. When the DI is assigned to investigate a probate legal guardianship, and there is no CSW assigned to the case, the DI will be responsible for completing the MHR/CANS following the DI’s first contact with the child.
    • If there is both a DI and a CSW assigned to a probate legal guardianship case, then the Continuing Services CSW must complete the MHR/CANS if a case plan is required.

Linking to, and Engagement with, Mental Health Services

Continuing Services CSW Responsibilities

  1. Maintain regular telephone/email contact with the service providers and request written progress reports.
  2. Incorporate pertinent information provided by the service provider(s) into the case plan and court reports.
  3. Document all contacts with service provider in the Service Providers Contact Notebook.

Working with DMH Specialized Foster Care (SFC) for MHR/CANS Screenings and Mental Health Service Linkage

Continuing Services CSW Responsibilities

  1. Complete the MHR/CANS and upload consents in the Referral Portal when a child in an existing open case is experiencing a mental health crisis or determined to be in need of mental health services.
  2. Review DMH's feedback on MHR/CANS for the assignment of the DMH SFC Clinician and recommendation for mental health service linkage.
  3. Review the Clinical Feedback form for the final determination of a child's mental health services.

CSAT Team Responsibilities

  1. Review the MHR/CANS submitted by the CSW in the Referral Portal.
  2. Upload the child's documented history reports (court reports, Screener Narrative, Investigative Narrative, etc.) and Medi-Cal eligibility information (Medi-Cal letter and/or MEDS-lite report).
  3. Determine if the MHR/CANS is for the Multidisciplinary Assessment Team (MAT) or CSAT SFC.
  4. Submit all CSAT MHR/CANS to DMH SFC.
  5. Enter MHR/CANS feedback from DMH SFC in CWS/CMS.
  6. Review the Clinical Feedback forms from DMH to refer Child Abuse Prevention and Treatment Act (CAPTA) children (aged 0-3 years old) with positive developmental screens for Regional Center Services.

DMH Specialized Foster Care (SFC) Responsibilities

  1. Send receipt to DCFS when an MHR/CANS is received.
  2. Assign the MHR/CANS to a DMH SFC clinician.
  3. The DMH SFC Clinician completes the feedback portion of the MHR/CANS to inform the CSAT Team and CSW/SCSW of the assigned clinician's contact information and one of the clinical recommendations below:
    • Outpatient treatment
    • Intensive Care Coordination (ICC)
    • Assessment
  4. Submission of Clinical Feedback form to DCFS CSAT.
    • The Clinical Feedback form is the final document from DMH that identifies the clinical outcome of a case after the submission of the MHR/CANS, which can provide details of the child's assessment or mental health service linkage or challenges linking the child to services.
APPROVALS
None
HELPFUL LINKS

Attachments

Mental Health Assessment Behavioral Indicators

Forms

LA Kids

Mental Health Referral (MHR)

CANs (CANS) (Child 0-5 Years)

CANs (CANS) (Child 5 Years-Adult)

DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental Services

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

DCFS 280, Technical Assistance Action Request

DCFS 6009, Nonminor Dependent Informed Consent

DCFS 6010, Nonminor Dependent 2-Way Authorization for Sharing Information

REFERENCED POLICY GUIDES

0070-548.01, Child and Family Teams

0600-500.00, Medical Hubs

0600-500.05, Multidisciplinary Assessment Team (MAT) Assessments and Meetings

0600-501.09, Consent for Mental Health Treatment and/or Developmental Assessments and Services

1200-500.80, Service Linkages between the Department of Public Social Services (DPSS) and DCFS

FYI 21-17, New Procedures for Placement in a Short-Term Residential Therapeutic Program (STRTP).

FYI 18-04, Guidelines for Convening Child and Family Team (CFT) Meetings


STATUTES AND OTHER MANDATES

Welfare and Institutions Code (WIC) 11203 (b)(1) – When out-of-home services are used with the goal of family reunification, the case plan shall provide, in part, for the continuation of CalWORKs services, under specified circumstances, when a child has been removed from a home, and is receiving out-of home care.

Katie A., et.al vs. the State of California – A 2002 class action lawsuit filed against the State and County alleging that children in contact with the County’s foster care system were not receiving the mental health services to which they were entitled. In July 2003, the County entered into a settlement agreement resolving the County-portion of the lawsuit.

LA Co. DMH SFC Guidelines Manual, ML No. 5 – Provides guidelines and protocols for DMH Specialized Foster Care Staff.