HIV/AIDS Testing and Disclosure of HIV/AIDS Information
0600-502.20 | Revision Date: 4/2/2015

Overview

This policy provides instruction for obtaining consent for HIV/AIDS testing and disclosure of that information for the purpose of providing coordination of care for children, youth and nonminor dependents under the care of DCFS.

Table of Contents

Version Summary

This policy guide was updated from the 07/01/14 version, to further clarify requirements that the CSW: consult with the SCSW and PHN prior to discussion of HIV/AIDS; obtain authorization to release information to the PHN; evaluate with PHN the need for the child to be transferred to the MCMS Unit and; request the child's Medical Team participate in the meeting with a clinical trial Principal Investigator.

POLICY

HIV/AIDS Services

HIV is a blood-borne virus.  It is most often transmitted via the blood and/or semen of an HIV-infected person.  HIV is not airborne.  The most common routes of transmission are:

  • Sexual activities involving exposure to the blood or semen of an infected person
  • Sharing needles used for intravenous (IV) injections
  • Tattooing and body-piercing with infected persons
  • Maternal transmission (i.e., from an infected mother to her fetus during pregnancy, birth or breast feeding)
  • Blood or blood products
  • Transfusions or organ transplants during the period from 1978 to June of 1985

HIV is Not Transmitted

From:

By:

Through:

Dishes

Coughs

Perspiration

Doorknobs

Hugging

Saliva

Drinking cups

Kissing on the lips

(if no open sores are present)

 

Eating utensils

Physical proximity

 

Insect bites

Shaking hands

 

Swimming pools

Sneezes

 

Toilet seats

   

It is safe to carry HIV-infected children in your arms, eat with them, transport them in your car, hug them, hold their hands, dry their tears, change their diapers, or give them a kiss on the cheek.  Protective clothing or devices are not needed, but Universal Precautions should be used.

The Public Health Nurse (PHN) is to be notified when there is a possibility that a child has been infected with HIV/AIDS.  PHN's are available to consult with the CSW at any point during the case, regarding the provision of HIV/AIDS services.

HIV Testing

In all instances of HIV testing of a child, consent is required, but the type of consent needed varies depending on the age of the child.

The following individuals can authorize HIV testing:

  • CSW may provide written consent for infants age 0-12 months when certain conditions are met.
  • Parent/Legal guardian or Conservator.
  • Youth, if (s)he is age 12 years of age or older.
  • Court, in the absence of parental consent, for a child who is 11 years old or younger.

No one else, including out-of-home caregivers, are permitted to authorize HIV testing.

CSW's must facilitate performance of testing under the following circumstances:

  1. Whenever it is known or reasonable to suspect that a child is an "At-Risk/High-Risk" child.
  2. The child is an infant, between the ages of 0-12 months, who meets all of the following criteria:
    1. Has been taken into temporary custody or has been and/or may be declared a dependent.
    2. Is being examined by medical personnel or receiving medical care and the attending physician determines that HIV testing is necessary to render appropriate care to the infant and have documented that determination.
    3. The attending physician must consider the infant's possible risk factors that are either known to them, or provided to them by the CSW.
    4. Factors to be provided by the CSW to the physician include, but are not limited to:
      1. The infant's parent has a history of behavior that places the parent at an increased risk of exposure to HIV
      2. The infant is a victim of sexual abuse that places the infant at risk of exposure to HIV.
    5. The CSW must make reasonable efforts to contact the parent or guardian for consent to care and is unable to do so.  The CSW must document his or her efforts to contact that person.
    6. The attending physician and the CSW must comply with all applicable state and federal confidentiality and privacy laws to protect the confidentiality and privacy interests of both the infant and the biological mother.
  3. The child has a parent whose personal history is either unknown or is known to include one or more of the high risk behaviors at the time of the child's conception or during the mother's pregnancy.
  4. A potential adoptive parent requests HIV testing as a prerequisite to adoption.
  5. After a discussion of their personal risk factors, a youth twelve (12) years of age or older, who is competent to give informed consent, expresses interest in being tested.
  6. The child's physician recommends testing.

If an infant, 0-12 months old, tests positive for HIV, the physician may determine that immediate HIV related medical care is necessary; this will be considered emergency medical care.  The CSW must follow existing DCFS policy for authorization of emergency medical care. Such care may be authorized by the CSW in writing without a court order.

  • The CSW must provide the physician with any contact information that is available for the biological mother in order to report the HIV infection to the local public health office.

Disclosing HIV/AIDS Information

All DCFS staff, including support staff, are required to maintain the confidentiality of HIV/AIDS status information, including prescribed medications and medical problems commonly associated with HIV/AIDS.  Negligent (e.g., direct or indirect release of information contained in any electronic records, paper documents and/or verbal communication), willful or malicious release of HIV/AIDS test results can result in civil penalties, misdemeanor conviction, fines as well as possible incarceration.

CSWs and all other staff can consult with the on-site or trial County Counsel with questions regarding specific cases that involve HIV/AIDS information.

Written consent or court order to disclose HIV/AIDS information should only be sought by the CSW when coordinating care of the child/youth; it must be made in a manner that is the most protective and discloses the minimum information necessary to coordinate the care of the child/youth.  The disclosed information must be limited to the fact that the child/youth is HIV positive or has AIDS, and should include a description of the medical needs of the child/youth.

No Written Consent/Court Order Required

The results of an HIV/AIDS test may be disclosed to any of the following people without the written authorization of the person tested:

  • The person who was tested, or that person's legal representative, conservator or to any person authorized to consent to the test.
  • The person's health care provider (e.g. medical doctor/pediatrician, dentist, psychiatrist, mental health practitioner, etc.) and to an agent or employee of that health care provider, who provides direct patient care and treatment.

In emergency situations, when there is imminent likelihood of transmission of HIV, disclosures must be limited to information needed to protect the health of the person involved.  The following information cannot be disclosed:

  • The HIV/AIDS status of the child/youth.
  • How or when the child/youth contracted HIV.
  • The identity of the child/youth's parent/legal guardian or siblings.

What can be communicated is that the individual should follow the universal precautions as to reducing the threat of infection via blood-borne pathogens.

Written consent or, in the absence of written consent, a court order must be obtained to disclose HIV/AIDS information of a child/youth's under the following circumstances:

  • When disclosing to any person not expressly listed above.
  • If the youth is 12 years of age or older, DCFS must defer to the youth's wishes if they want to personally inform their parent or legal guardian. 
  • If the youth is 12 years of age or older and has consented to the test, the sharing of their HIV test results can only be done with written consent from the youth or with a court order.
  • For youth who are 12 years of age or older who refuse or who are not competent to make medical decisions, a court order may be sought for testing, disclosure and treatment.
  • NMDs have the same legal decision making authority as any other adult, which includes invoking privacy regarding their medical conditions and consenting to receive treatment.  In all cases, written consent must be obtained from the NMD to share his or her HIV/AIDS information.  A court order may be sought when the NMD is not competent to make medical decisions for testing, disclosure and treatment.
  • For incompetent adults, a Probate Code Section 3200 petition is required to provide medical treatment.

A signed DCFS 450 or DCFS 451 must be on file for each person to whom HIV/AIDS information is to be released.  The signature of one parent of a child under 12 years of age is sufficient to provide valid consent, as long as that parent is legally permitted to do so.  When the release of HIV/AIDS information that was not previously authorized is now needed, a new written consent must be obtained.

Written consent or a court order is required prior to disclosing HIV/AIDS information to an out of home caregiver or group home administrator.

When the CSW seeks a court order for testing, the CSW should request authorization from the court to share the results with those parties that need to know (e.g., caregiver, etc.).  If the child/youth's HIV/AIDS status is known and consent for testing is not needed, then the CSW needs to obtain written authorization to share the information provided by the parent, legal guardian, or the child/youth, if 12 years or older.  If written authorization cannot be obtained, a court order should be sought.

The CSW must not to release HIV/AIDS status information to a child's/youth's school.  All school personnel are expected to use Universal Precautions during any medical emergency.

One or more of the following conditions must exist to obtain a court order for disclosure of HIV/AIDS information:

  • A child is 11 years of age or younger and their parent's/legal guardian's whereabouts are unknown (despite reasonable efforts by DCFS to locate them).
  • The parent/legal guardian has refused to give authorization for disclosure.
  • A youth who is 12 years of age or older is incompetent to give authorization.
  • A youth who is 12 years of age or older refuses to give authorization for disclosure.
    • In cases in which a youth refuses to provide authorization, and only when DCFS believes there is a compelling reason to disclose against the youth's wishes.

The disclosure of HIV/AIDS information must be made to prospective adoptive parents and documented in the AD 512 during the adoptive placements. Written consent for youth 12 years of age or older, or a court order to disclose the information must be on file prior to disclosing the information, even if the prospective adoptive parents have been the out-of-home caregiver.

PROCEDURE

Discussing HIV Testing with a Youth and his/her Parent(s)/Legal Guardian(s)

CSW Responsibilities

  1. Consult with the PHN and obtain a referral to a Medical Hub or certified testing location and provide to the youth, parent(s) or legal guardian.
  2. If the child or parent have immediate questions before going to the testing location, consult with SCSW and PHN prior to discussing any of the following issues:
    1. The person who performs the HIV test will discuss all the following issues with the child and/or parent.
      • An overview of HIV infection, AIDS disease, the importance of early detection and the need to seek counseling and medical support if there is a positive test result.
      • When there is a positive HIV test, or when a sexually active youth has been tested for HIV, post-test counseling will be made available by the testing physician.
      • How to cope and live with HIV/AIDS and the lifestyle changes that may be necessary (e.g., long-term medication use, consistent application of universal precautions, need for a healthy diet and an exercise program).
      • Possible discriminatory actions that may occur upon disclosure of HIV test results to insurance companies, employers/co-workers, schools, placements and/or friends/neighbors.
  3. Provide the parent/legal guardian/youth with information regarding who will need to be informed of the youth's health status.
    1. Results of the HIV test and any diagnosis must be given to the child's DCFS CSW. The CSW may provide this information to the child's:
  4. Document all contacts with the youth/parent(s)/legal guardian(s), physicians and/or collateral contacts in the Contact Notebook.

Obtaining HIV Testing Authorization

CSW Responsibilities

  1. When an infant, 0-12 months old is newly detained, indicate, in Section II of the Medical Hub Referral Form any known or potential HIV/AIDS information regarding the biological mother. Include any known HIV risk factors for either of the infant's parents. Factors include, but are not limited to:
    • The infant's parent has a history of behavior that places the parent at an increased risk of exposure to HIV, such as:
    • Sexual activities involving exposure to the blood or semen of an infected person.
    • Sharing needles used for intravenous (IV) injections.
    • Tattooing and body-piercing with infected persons.
    • Maternal transmission (i.e., from an infected mother to her fetus during pregnancy, birth or breast feeding).
    • Blood or blood products.
    • Transfusions or organ transplants during the period from 1978 to June of 1985.
    • The infant is a victim of sexual abuse that places the infant at risk of exposure to HIV.
  2. Follow current procedures for delivery of the Medical Hub Referral Form to the Medical Hub.
  3. Upon receipt of the Medical Hub/DCFS Infant HIV Test-Request/Authorization FAX form from the child's Medical Hub physician, discuss with the SCSW and confirm the following:
    • All of the criteria for consent for HIV Testing have been met
    • Efforts made to locate the parent have been unsuccessful and documented in CWS/CMS.
  4. With approval from the SCSW, provide written consent for HIV testing via the Medical Hub/DCFS Infant HIV Test-Request/Authorization FAX form.
  5. Document both the discussion with the SCSW and that written consent was provided to the infant's physician per the instructions for "Documenting and Filing HIV/AIDS Information".
  6. If the child is between 12 months and 11 years old, seek authorization from the child's parent/legal guardian and confirm that the child meets the criteria for testing.
    1. Collaborate with the PHN and jointly discuss with the child's parent or legal guardian the reasons why HIV testing would benefit the child and clarify or remind the parent why obtaining an early diagnosis of HIV infection is in the child's best interests.
    2. If the parent or legal guardian is not available or refuses to provide consent for HIV/AIDS testing, seek court authorization for HIV testing.
  7. If the youth is 12 years of age or older, is competent to give informed consent, and the youth meets the criteria for testing, seek authorization from the youth for their HIV testing.
  8. If the youth 12 years of age or older, has not requested HIV testing, discuss with the youth the reasons why HIV testing would be beneficial and why obtaining an early diagnosis of HIV infection is in their best interests.  Advise the youth of their right to consent to testing and receive treatment services.
    1. Arrange for a joint meeting with a PHN, if beneficial.
  9. Complete and process the DCFS 450, per the instructions included on the form.
  10. Discuss with the parent/legal guardian/youth why the individuals specified in Section III of the DCFS 450, need to know the results of the test and request that they sign and date the:  "Consent Signature for Disclosure" line in this Section.
    • The CSW may act as the witness of the parent(s)/legal guardian signature of the DCFS 450.
    • If the parent/legal guardian is not willing to sign the DCFS 450, if appropriate, move to obtain a court order. 
    • Sections I and II are to be completed after the youth has had an opportunity to have all their questions answered by the physician.
  11. If applicable, provide the parent/legal guardian the original form and a self-addressed stamped envelope and instruct them to give the form and the envelope to the physician/health care provider.
  12. If applicable, provide the parent/legal guardian with the name, address, and phone number of the child's physician for completing Sections I and II of the DCFS 450.
  13. Provide transportation access as needed (SFA funds, bus passes/tokens, or personally transport the child.
  14. Meet with the SCSW about how to handle case materials and documents (including whether testing was performed), all documentation related to testing, diagnosis and related services, and to whom the information can be released.

SCSW Responsibilities

  1. Meet with the CSW to discuss confidentiality protocols for handling case materials, documents related to HIV/AIDS (including whether testing was performed), all documentation related to testing, diagnosis and related services, and to whom the information can be released.

Obtaining Court Authorization for HIV Testing

CSW Responsibilities

  1. Seek court authorization if the child's/youth's physician states that HIV testing is recommended, the child/youth meets the criteria for testing and any one of the following is met:
    • The child is 11 years of age or younger and the parent's or legal guardian's:
    • Whereabouts are unknown (and the CSW has, despite reasonable efforts, been unable to locate them).
    • Are unable to meet with the child's physician.
    • Refused to give authorization for HIV testing.
    • The youth is age 12 years of age or older and (s)he is not competent to give their own consent.
    • Competency is determined by the youth's physician.
  2. Submit a DCFS 4225 to the court and check the box next to the Request for Authorization for HIV/AIDS Testing.
  3. Send the completed DCFS 4225 and any supporting documentation (e.g., 561(a) or 4158-2) to the Juvenile Court Services in a sealed envelope with the notation:  "Attention: Juvenile Court Services Liaison Office, Confidential Material Enclosed".
    • The child's name, court date, case number or court number must not appear on the envelope.
  4. Either upon notification from the Juvenile Court Liaison or upon receipt of a copy of the DCFS 4225, signed by the Hearing Officer, contact the child's physician and arrange for the test to be performed.
  5. Meet with the SCSW about how to handle case materials and documents (including whether testing was performed), all contacts related to testing, diagnosis and related services, and to whom the information can be released.

SCSW Responsibilities

  1. Meet with the CSW to discuss confidentiality protocols for handling case materials, documents related to HIV/AIDS (including whether testing was performed), all contacts related to testing, diagnosis and related services, and to whom the information can be released.

Placing a Child Diagnosed with HIV/AIDS

CSW Responsibilities

  1. Utilize the same placement priorities for placing children with HIV/AIDS as for all other children.
  2. Complete and submit a Level of Care (LOC)/Specialized Care Increement (SCI) rate request, for replacements.  (For initial placements, the request is automatic, thus no referral is needed.)
  3. Consult with the PHN to obtain assistance in:
    • Contacting the child's physician to determine if the child has special health care needs, after obtaining a medical release of information allowing the PHN to gather information.
    • Providing input to determine the appropriate LOC/SCI the caregiver should receive.
      1. Provide any information obtained to the LOC Unit.
    • Determining if the case qualifies to be evaluated for transferred to the MCMS Unit.
  4. Complete the DCFS 280 and in the "Priority #1 Placement" checklist, specify the information to be considered when assessing for a potential placement and child-caregiver match.  Check the:  "Other (Specify)" check-box and insert the following language:  "body fluid precautions".
    1. Submit the completed DCFS 280 to the TA/EW and obtain a list of potential placements.
  5. If there is difficulty locating a placement, contact the MCMS Unit during business hours, or the Accelerated Placement Team (APT), outside of business hours.  Emergency and after-hours placements of children known or reasonably suspected to have HIV/AIDS must utilize emergency shelter care resources.
  6. While interviewing a prospective caregiver, if the child has or it is reasonably suspected they have HIV/AIDS, advise the prospective caregiver verbally of the child's exact HIV/AIDS status without revealing the child's name:
    • Diagnosed as HIV-positive
    • Test results are pending or inconclusive
    • Known or believed to have been exposed (but not yet tested)
  7. Obtain informed consent from the caregiver prior to placement if the child has or it is reasonably suspected (s)he has HIV/AIDS.
  8. Inform the prospective caregiver that the foster care payment for a child with HIV/AIDS will be the LOC/SCI as determined by the LOC Unit.
    1. Advise the caregiver that if a child is placed with a higher LOC and/or SCI rate on the basis of reasonably suspected HIV/AIDS but it is later determined by the testing physician that the child does not have HIV/AIDS, the payment will be changed to the appropriate rate.
  9. In all placement related documents, use the language: "body fluid precautions".  Do not reference HIV or AIDS.
  10. Upon initial placement and with every placement change (including reunification) provide the new caregiver with a copy of the DCFS "Universal Precautions" instructions (Attachment A)
  11. Upon medical confirmation that the child is HIV-positive or has AIDS, contact the MCMS Unit and consult with the Medical Placement intake Coordinator to determine if the case qualifies to be transferred to the MCMS.

PHN Responsibilities

  1. Upon request, consult with the CSW to determine if the case qualifies to be evaluated for transferred to the MCMS Unit.
    1. Obtain all necessary information regarding the child's HIV/AIDS status from the CSW.
  2. Contact the child's physician and obtain their instructions regarding the child's HIV/AIDS status, and any special health care needs and/or placement requirements.
  3. As requested, provide input to the LOC Unit towards the completion of the LOC/SCI assessment, which includes the LOC Unit's completion of the DCFS 1696.

Locating Resources for HIV/AIDS Testing and Services

CSW Responsibilities

  1. As necessary, assist the child's parent/guardian or caregiver in locating resources for information, education, testing, counseling, legal and medical services or any other services related to the child's HIV/AIDS status.  Resources should be located as close to the caregiver's home as possible.
  2. Consult with the PHN, to locate appropriate resources.  The PHN can verify if the child is enrolled in Los Angeles County Public Health Department's California Children Services (CCS) and if not, the PHN can assist the CSW in facilitating the CCS referral on the child's behalf.
  3. For additional resources, contact the Los Angeles Family AIDS Network (LAFAN) which serves as an AIDS information clearinghouse.

Enrolling a DCFS Supervised Child in a Clinical Trial

CSW Responsibilities

  1. For more information on clinical trials and consent protocols click here.
  2. When the child/youth's physician recommends that the child/youth participate in a clinical trial, notify the parent/guardian/conservator or competent youth over 12 years of age and:
    1. Assist in arranging a meeting between the clinical trial Principal Investigator and the parent/guardian/conservator or competent youth over 12 years of age for consultation and/or consent.
    2. Request participation of the child's Medical Team (medical provider, PHN, CSW, SCSW, MCMS staff) in the meeting with the clinical trial Principal Investigator.
    3. Attend the meeting.
    4. Review the clinical trial consent form.
    5. Ask questions to clarify:
      • The trial protocol
      • Transportation needs
      • Possible emergencies due to side effects
    6. Request a copy of the consent form containing the parent/guardian/conservator or competent youth over 12 years of age signature and place in the child/youth's case file.
  3. If the parent/guardian/conservator or competent youth over 12 years of age is not available, or refuses to consent, seek authorization from the court per the following instructions:
    1. Submit a DCFS 4225, to the court addressing the following:
      1. In the "Recommended Treatment" section, describe as specifically as possible, the child/youth's medical status, the clinical trial and the potential beneficial, as well as, negative outcomes for the child/youth.  Include the name and telephone number of the clinical trial contact person and/or Principal Investigator.
      2. In the "Child's Parent(s)" section, write "See Attached" and attach a second page containing the italicized language below to request authorization for the child/youth's participation in a clinical trial.
      3. "It is respectfully requested that the Court authorize {insert child/youth's name}'s participation in the herein described clinical trial for HIV/AIDS treatment.  The child/youth's physician {insert name} has recommended that the child/youth participate in this clinical trial and the Principal Investigator, {insert name} has determined that this child is an appropriate candidate.  Further, it is requested that the physician and Principal Investigator be authorized to disclose the child/youth's participation in and response to the said treatment to the child's/youth's CSW and that the CSW be authorized to disclose the child/youth's participation in and response to the said treatment to the child's/youth's attorney, birth parents (unless their parental rights have been terminated), legal guardian, out-of-home care providers (if any), prospective adoptive parents (if any), and any licensed physician, dentist or mental health practitioner who is providing professional services to the child/youth, the nature of which creates a legitimate need to know the child/youth's participation in and response to the said treatment in order to serve the child's/youth's best interests."
    2. Attach an explanatory letter from the physician and a copy of the clinical trial consent form.
    3. Send the completed DCFS 4225 and all attachments to the Juvenile Court Liaison Office in a sealed envelope with the notation:  "Attention: Juvenile Court Services Liaison Office, Confidential Material Enclosed."
      • Do not put the child's name, court date, case number or court number on the envelope.

Releasing HIV/AIDS Information without Written Authorization or a Court Order

CSW Responsibilities

  1. Obtain SCSW approval before releasing HIV/AIDS information to:
    • Person tested
    • Legal Representative or person authorized to consent to the test:
    • Parent (unless parental rights are terminated) or legal guardian or; a youth 12 years of age or older does not want DCFS to disclose to the parents.
    • Court
    • Conservator of the person tested
  2. Discuss the importance of disclosing HIV/AIDS information to the persons listed above with:
    • Parent(s) of child under12 years old
    • Youth 12-17 years old
  3. If a youth, 12 years of age or older refuse to provide written authorization, obtain a court order.
  4. Document all contacts in the CWS/CMS Contact Notebook.

SCSW Responsibilities

  1. Upon request, or as needed, review and approve the release of HIV/AIDS information to appropriate parties.

Releasing HIV/AIDS Information with Written Authorization

CSW Responsibilities

  1. Consult with the SCSW and determine whether disclosure of a child/youth/NMD's HIV/AIDS status to the applicable person is appropriate or necessary.
  2. Upon determination that the disclosure is appropriate or necessary discuss the importance of disclosing HIV/AIDS information to the applicable person and the required written authorization with the:
    • Parent(s) of a child (under 12 years old).
    • Youth 12 years of age or older or an NMD.
      1. If a legally competent youth 12 years of age or older refuses or is unable to provide a written authorization, obtain a court order.
  3. Obtain the required written consent to disclose HIV/AIDS status as follows:
    • From the parent /guardian/conservator of a child under 12 years of age or legally incompetent youth under 18 years of age:
      1. Obtain the parent/guardian/conservator signature in Section III of the DCFS 450.
    • From a legally competent youth 12 through 17 years of age:
      1. Obtain the signature of the youth in Section III of the DCFS 451.
    • From a NMD or a nonminor participating in EFC:
    • Obtain the signature of a nonminor on the DCFS 6010.  Ensure that the box pertaining to release of HIV/AIDS information is checked.
      1. As applicable, complete file and submit the DCFS 450 or DCFS 451 form per the instructions included with the form.
  4. If a youth, 12 years of age or older refuse to provide written authorization, obtain a court order.
  5. Document all contacts in the CWS/CMS Contact Notebook.

SCSW Responsibilities

  1. Upon request, or as needed, review and approve the release of HIV/AIDS information to appropriate parties.

Releasing HIV/AIDS Information to an Out-of-Home Caregiver, Group Home Administrator, or School

SCSW Responsibilities

  1. Upon request, or as needed, review and approve the need to request a written authorization and/or release of HIV/AIDS information to appropriate parties.
  2. Review the DCFS 709 for the use of appropriate language regarding HIV/AIDS status prior to signing the form.

CSW Responsibilities

  1. When searching for a placement, ensure that written consent or a court order for disclosure of HIV/AIDS status is in the case file prior to discussing the child/youth/NMD's condition with a potential caregiver.
    1. If there is no written consent or court order on file, attempt to obtain one as soon as possible prior to disclosing the information.
    2. If an attempt or efforts have been made and the written consent or court order cannot be obtained in time to coordinate the care of the child/youth, discuss the child/youth's condition with the caregiver/group home administrator.
      1. As soon as possible thereafter, obtain the required written consent, and if unable to do so, obtain a court order for future sharing/disclosure.
  2. At initial placement of the child/youth:
    1. Complete and discuss the DCFS 709 with the caregiver.
    2. Complete the required placement agreement form and enter the phrase, "body fluids precautions" as appropriate.
  3. Do not inform the school of the child/youth/NMD's HIV/AIDS status.
    1. Do inform the school of any restrictions on activities prescribed by the child/youth/NMD's physician.
    2. Provide the school nurse with any medications that must be dispensed during the school day.
  4. Document all contacts in the CWS/CMS Contact Notebook.

Releasing HIV/AIDS Information in an Emergency

CSW Responsibilities

  1. Inform the appropriate parties to use Universal Precautions for protection from blood borne pathogens.
  2. Inform all parties to whom the child/youth/NMD's, parent's, or sibling's known or suspected HIV/AIDS status has been disclosed that they may not further disclose this information, except in an emergency.
  3. Document all contacts in the CWS/CMS Contact Notebook.

Obtaining a Court Order for Release of HIV/AIDS Information

CSW Responsibilities

  1. Consult with the SCSW and obtain approval to petition the court for authorization to release HIV/AIDS information.
  2. Submit a request for the calendaring of an appearance hearing (Set-On).
  3. Complete an "Ex Parte Application and Order" using a CWS/CMS template that, for confidentiality, has been saved as a Word document. Do not save to the CWS/CMS Database.
  4. Under the headings listed below, enter the suggested language indicated.
    1. Reason for Application:
      • "Request to seek authorization to disclose life threatening disease status."
    2. Reason for Recommendations:
      • "Court authorization is requested because" (state the reason(s) why it is necessary to make the disclosure and name the individual(s) to whom the information is to be released).
    3. Recommendations:
      • "It is respectfully recommended that the Child/youth's CSW be authorized to disclose the life threatening disease status of" (insert child/youth's name, the name of the person(s) to receive the information and his/her relationship to the child/youth).
  5. Photocopy the completed report (make enough copies for all parties in the matter).
  6. Staple together, the original signature page of the report and a copy of the signature page.
  7. Place the stapled signature set along with the other report copies and a completed DCFS 4153 in a manila envelope and seal it.
  8. Label the envelope, "Attention: Juvenile Court Services Liaison Office, confidential material enclosed."  Do not place the child/youth/NMD's name, case number, court date or court number on the outside of the envelope.
  9. Send the envelope to the Juvenile Court Services (JCS) Liaison Office per standard procedures.
  10. Obtain the court date from Juvenile Court Services and notice all parties.

Documenting and Filing HIV/AIDS Information

CSW Responsibilities

  1. Do not enter HIV/AIDS information into CWS/CMS or the child/youth/NMD's Health & Education Passport (HEP).  HEPs are attached to court reports and distributed to various parties including minor's counsel, parents and caregivers.
  2. Document all contacts in the CWS/CMS Contact Notebook.  Documentation must safeguard the confidentiality of the HIV/AIDS information by adhering to the following instructions:
    • Only the following information is permitted to be documented in CWS/CMS:
      1. Select the box for Sensitive Health and Medical Information located at the top of the Summary Page in the Health Notebook.
      2. In the Summary of Health Condition box enter the following language:  "life threatening illness" as it applies to the child/youth/NMD, their parents/legal guardians and or siblings.
  3. All other case information that makes reference to the fact that a child/youth/NMD, their parents/legal guardians and/or siblings have any HIV/AIDS involvement must remain confidential.
    • To ensure confidentiality when electronically documenting HIV/AIDS related information, do not save to the CWS/CMS Database.  Always save outside of CWS/CMS on your computer's hard drive as a Word document.
    • Manually document HIV/AIDS related information in the DCFS case file as appropriate.
  4. Label a 9x12 manila envelope:  "Privileged/Confidential Information."
    1. File all HIV/AIDS related documents in the:  "Privileged/Confidential Information" envelope and use as many envelopes as necessary.  These documents include, but are not limited to:
      • Placement Agreement form
      • DCFS 450, 451, DCFS 6010,709, AD 512
      • Medical, dental, psychological reports
      • Court petitions, reports
      • Computer flash/thumb drives
      • Other documents referencing a child/youth/NMD's HIV/AIDS status.
      • Documents that contain the phrases that are commonly used to allude to the presence of HIV/AIDS such as, "bodily fluid precautions" or "highly contagious life threatening illness."
    2. Close, fasten securely and file the envelope in the Medical Folder of the Master Case.  Add additional HIV/AIDS related documents to the envelope as necessary.  Close and secure it each time.

Submitting HIV/AIDS Information to Court

CSW Responsibilities

  1. Do not reference HIV/AIDS related information in court reports and/or petitions.
    • Do not specify the HIV status of the child/youth/NMD, their parent(s)/legal guardian(s) or sibling(s) in any court reports or petitions.
    • Do not include any reference that the CSW plans to authorize, has authorized; plans to seek or has sought written consent or court authorization for HIV testing or disclosure of HIV/AIDS status.
  2. Use non-specific language when referring to HIV/AIDS related information in court reports and or petitions.  The phrase "life-threatening illness" will inform the court of the child/youth/NMD's needs without violating any one's right to privacy.
  3. If referencing HIV/AIDS information cannot be avoided proceed as follows:
    • Place any documents or reports that refer to HIV/AIDS status of a child/youth/NMD, their parent(s) legal guardian(s) or sibling(s) in a sealed envelope.
    • Address the sealed envelope to the Hearing Officer.  Include the Hearing Officers name, Department number and an "Attention" line stating:  "Confidential Material Enclosed".
  4. Include the sealed envelope in the package with the court report and send to court per standard procedures.
APPROVALS

SCSW Approval

  • All existing Placement and F-Rate approval requirements
  • Releasing HIV/AIDS information
  • All existing Ex-Parte Application and Order approval requirements
HELPFUL LINKS

Attachments

Universal Precautions

Forms

LA Kids

DCFS 280, Technical Assistance Action Request

DCFS 450, Parent's/Guardian's Consent for HIV Test

DCFS 451, Child's Consent for HIV Test

DCFS 561(a), Medical Examination

DCFS 709, Foster Child's Needs and Case Plan Summary

DCFS 4153, Juvenile Court Calendar Set-On Slip Dependency

DCFS 4158-2, Physician Questionnaire

DCFS 4225, Report of Children's CSW with Recommendation of Authorization for Medical Care

DCFS 6009, Nonminor Dependent Informed Consent

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

Medical Hub/DCFS-HIV TEST-Request/Authorization

CWS/CMS

DCFS 709, Foster Child's Needs and Case Plan Summary

Ex Parte Application

REFERENCED POLICY GUIDES

0600-501.15, Consent for Emergency Medical Care

0200-509.35, Adoptive Placements

0300-306.05, Noticing Process for Juvenile Court Proceedings

0300-503.94, Set-On/Walk-On Procedures

0600-500.00, Medical Hubs

0600-500.10, Universal Precautions

0600-505.10, Placing Children with Special Health Care Needs

1000-504.10, Case Transfer Criteria and Procedures

STATUTES AND OTHER MANDATES

California Rules of Court 5.552 – Discusses confidentiality of records.

Family Code Section 6926(a)(b) – Outlines  the rights and responsibilities of a youth who is 12 years of age or older regarding consent to medical care related to the diagnosis or treatment of HIV/AIDS.

Health and Safety Code (HSC) Section 120975 – Outlines the provisions for privacy protection of individuals who are the subject of blood testing for HIV.

HSC Section 120980 – Provides information regarding penalties for negligently, willfully or maliciously disclosing HIV test results of an identified person and; penalty for disclosure that results in economic, bodily or psychological harm of an identified person.  Provides definitions regarding written consent and disclosure.

HSC Section 120990(c) – States in part that except as provided in subdivision (a), no person must administer a test for HIV infection unless the person being tested or his or her parent, guardian, conservator, or other person specified in Section 121020, which may be provided orally or in writing.

HSC Section 121010 (a-e) – Provides a listing of who may receive results of an HIV/AIDS test without written consent.

HSC Section 121020 – Provides a listing of who may consent to HIV/AIDS testing on behalf of a person not competent to consent on their own.  Includes circumstances under which a CSW may provide written consent for infants under twelve (12) months of age.  Also addresses obtaining court authorization.

Probate Code Section 3200 – Sets forth requirements regarding adult incompetency Petitions.

Superior Court Of California County of Los Angeles Local Rules 7.6 – Procedures for HIV/Aids Testing Of Dependent Child & Disclosure

Welfare and Institutions Code (WIC) Section 369 (a) – States under what circumstances the CSW may authorize medical care for a child in temporary custody and states the requirements for notification of the child's parent/guardian, and for court approval if parent/guardian objects.

WIC Section 369 (b) – States the requirements that must be met prior to court authorization of medical treatment for a child for whom a petition has been filed.

WIC Section 369 (c) – States the requirements that must be met prior to court order allowing the CSW to authorize general medical treatment for a child whom the court has placed into the care and custody of DCFS.

WIC Section 369 (d) – States the circumstances and requirements under which a child falling within WIC 369(a)(b)(c) who requires immediate emergency medical care may have treatment with CSW authorization and without a court order.

WIC 369(h) – States that dependent youth, 12 years of age or older, have the right to consent to and receive health and mental health services including treatment of infectious, contagious, or communicable diseases.  Additionally, the CSW is authorized to inform the youth of his or her right to consent to and receive those health services, as well as to provide the youth with access to age-appropriate, medically accurate information about sexual development, reproductive health, and prevention of unplanned pregnancies and sexually transmitted infections.

WIC Section 827 – Addresses confidentiality of Juvenile Court case files and lists who may inspect the case file and under what circumstances the case file may be inspected.

WIC Section 16001.9(a)(26) – States that dependent youth, 12 years of age or older, have the right to have access to age-appropriate, medically accurate information about the prevention and treatment of sexually transmitted infections.