Joint Response Referral: Consulting With PHN
0070-560.05 | Revision Date: 7/1/2014


This policy guide helps identify which referrals require consultation with PHN and their role in the investigation.

Table of Contents

Version Summary

This policy guide was updated from the 02/08/11 version as part of the Policy Redesign, in accordance with the DCFS Strategic Plan. 


Referrals regarding serious medical problems are identified as a Joint Response Referral (JRR) which requires the CSW to consult with the Public Health Nurse (PHN) to assess the health needs of the child and family to determine the most appropriate course of actions to meet the health and safety needs of the referred child(ren).  The CSW must consult with a PHN within three (3) calendar days of receiving the referral.  If there is a difference of opinion between the CSW and PHN, the SCSW and PHN Supervisor will assist them in making the decision. 

The medical problems include but are not limited to:

  • Diabetes
  • Shaken baby syndrome
  • Failure to thrive
  • Allegations of severe neglect
  • A child has a known or suspected medical problem or developmental condition

The PHN assistance can include but are not limited to:

  • A joint CSW/PHN visit
  • Obtaining additional medical information
  • Setting up a medical exam for the child
  • A referral to a specialty provider or agency
  • Interpreting medical information

PHN assistance does not include any direct medical services such as taking vital signs, giving injections, bandaging wounds, or medically diagnosing any condition and/or health problem.

A joint visit with the PHN may not be required if the child has a recent HUB or other medical evaluation, unless there is a new medical condition that has been identified.


Consulting With PHN on JRR

CSW Responsibilities

  1. Upon identifying the referral to be a JRR, complete the DCFS 5646-1, Public Health Nurse Consultation Request form and submit to PHN.
  2. After consultation with the PHN, if a joint home call is decided upon, make the visit in separate cars.
    • For ERCP Staff: PHNs are available for consultation by telephone only for referrals received after hours.  After consultation via telephone with the SCSW and on-call PHN, and a joint home visit is indicated, the ERCP CSW will respond to the referral according to established policy and procedures.  If the children are not detained, the referral is forwarded to the assigned regional office (ER CSW) for follow-up and a joint home visit with the PHN assigned in the region.
  3. If the PHN does not respond to a written request for a joint visit, document on Case Notes and confer with your SCSW.  Continue with the rest of the investigation
  4. Document the results of your investigation.
  5. Complete all required cross-reports as set forth in Procedural Guide 0070-548.18, Notice of Report to the Child Abuse Central Index.

PHN Responsibilities

  1. Upon receiving the DCFS 5646-1, respond by email to the CSW and SCSW and set up a consultation.
  2. Collaborate with the CSW and determine the appropriate course of action.
  3. If interventions other than a home visit are determined to be the appropriate course of action, assist the CSW in carrying them out. 
  4. If a joint visit is to take place, drive there separately. 
  5. Observe the general health, nutritional and developmental status of each child in the referral through the use of the Home Visit Observations Attachment to the Home Visitation Guideline.  Conduct interviews as necessary to identify actual and potential health and/or safety concerns and inform the CSW of those concerns during the visit.
  6. Follow up on any child’s health issues and medical problems
  7. Document each joint visit/consultation in the Contact Notebook and enter acquired pertinent medical information in the child(ren)’s Health Notebook.



Case Notes

DCFS 5646-1, Public Health Nurse Consultation Request

Investigation Narrative


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

0070-548.18, Child Abuse Central Index (CACI) Review Hearings


California Department of Social Services (CDSS) Manual of Policies and Procedures (MPP) Section 31-125 – sets forth requirements when conducting an emergency response investigation.