Youth Reproductive Health and Pregnancy
0600-507.10 | Revision Date: 7/23/2024

Overview

This policy provides guidelines for CSWs to address reproductive health care such as sexually transmitted infections (STIs) and pregnancy with minors/NMDs, including available resources and options for pregnant minors/nonminor dependents (NMDs).

Table of Contents

Policy

Procedure

Approvals

Helpful Links

Version Summary

This policy guide was updated from the 08/26/22 version, to address new legislation pertaining to the Supreme Court overturning Roe v. Wade, which allows states to ban abortions. The changes also address the termination of pregnancy for youth who are placed out of state and the accessibility of abortions in California, if desired. In addition, the information contained in FYIs 19-12, 20-02, and 23-02 were incorporated into this guide therefore cancelling those FYIs.

POLICY

State law mandates social workers to inform a minor or NMD in foster care of their rights regarding sexual and reproductive health care to include as follows:

  1. The right to receive medical services, including reproductive and sexual health care.
  2. The right to consent to, or decline, medical care (without need for consent from a parent, caregiver, guardian, social worker, probation officer, court, or authorized representative) for:
    1. The prevention or treatment of pregnancy, including contraception, at any age.
    2. Abortion, at any age.
    3. Diagnosis and treatment of sexual assault, at any age.
    4. The prevention, diagnosis, and treatment of STIs, at age twelve (12) and older.
    5. The right at age twelve (12) and older whenever feasible to choose their own health care provider for medical, dental, vision, mental health, substance abuse disorder services, and sexual and reproductive health care. This age group can also communicate with health care providers regarding treatment concerns and request a second opinion before undergoing invasive medical, dental, or psychiatric treatment.
  3. The right to access age-appropriate, medically accurate information about reproductive and sexual health care without discrimination or harassment, including but not limited to:
    1. The prevention of an unplanned pregnancy, including abstinence and contraception, at any age.
    2. Abortion care and other pregnancy services, at any age.
    3. The prevention, diagnosis, and treatment of STIs, including but not limited to, the availability of the Human Papillomavirus (HPV) vaccination, at age twelve (12) and older.
  4. Confidentiality Rights:
    • If the minor/NMD has the right to personally consent to medical services, such services shall be provided confidentially and maintained as confidential between the provider and the minor/NMD to the extent required by HIPAA. Disclosure of services may only be provided through written consent of the minor/NMD or through a court order.
    • When a minor/NMD has a right to consent to examinations and/or treatment by a medical provider must be private unless the minor/NMD specifically requests otherwise.
  5. The right to be provided transportation to reproductive and sexual health-related services in a timely manner.
  6. The right to obtain, possess and use contraception of their choice, including condoms.
  7. The right to storage space and to be free from unreasonable searches of their belongings. Contraception cannot be taken away as part of a disciplinary measure or for religious beliefs, personal biases and/or judgments of another individual.
  8. The right to independently contact state agencies, including the Community Care Licensing Division of the California State Department of Social Services (CDSS) and the State Foster Care Ombudsperson, regarding violations of rights.  The right to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints.
  9. Depending on the type of facility and age of the minor/NMD, to have personal rights posted and/ or explained in an age and developmentally appropriate manner, and provided to the minor/ NMD.

The Foster Youth Bill of Rights can be a very useful tool to facilitate a discussion with foster youth about their rights to reproductive health and sexual care. Foster youth have a right to receive a copy of the Foster youth Bill of Rights upon entry into foster care, every six (6) months, and at every replacement.  In addition to those rights outlined in the Foster Youth Bill of Rights, reproductive and sexual health care rights of minors and NMDs in out-of-home care should be given in a manner appropriate to the age and/ or development level of the minor or NMD upon entry into placement and at least every six (6) months thereafter. "A Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention" provides information on the roles and responsibilities of social workers in providing sexual health care information as well as guidance on addressing such matters with minors and NMDs.

See "Documentation of Pregnancy and Parenting in CWS/CMS for Minors and NMDs" documenting discussions related to the minor/NMD's reproductive rights and pregnancy.

Implementation of Senate Bill 89 Mandates

Senate Bill 89 went into effect in June 2017, resulting in the requirements listed below for child welfare agencies and those serving foster youth, related to the reproductive and sexual health care of youth in foster care.

Informing Youth of Their Rights and Removing Barriers

CSWs are to update case plans annually and document compliance with the mandates of SB 89 in all 6-month court reports (21.e, 21.f, .22, .26 reports) for youth in foster care, 10 years of age and older, including young adults in foster care, to indicate that the CSW has:
  1. Informed the youth or young adult that he or she may access age-appropriate, medically accurate information about reproductive and sexual health care, including, but not limited to, unplanned pregnancy prevention, abstinence, use of birth control, abortion, and the prevention and treatment of sexually transmitted infections.
  2. Informed the youth or young adult, in an age- and developmentally appropriate manner, of his or her right to consent to sexual and reproductive health services and his or her confidentiality rights regarding those services.
  3. Informed the youth or young adult how to access reproductive and sexual health care services and facilitated access to that care, including by assisting with any identified barriers to care, as needed.
  4. CSWs may refer to age-appropriate fact sheets when having this conversation with tweens, middle adolescents, and transition-aged youth.

Improving Access to Comprehensive Sexual Health Education (CSHE)

SB 89 requires DCFS to improve access to sexual health education. CSWs are required to document in the case plan and in all 6-month court reports (21.e, 21.f, .22, .26 reports) the following information:
  1. For all youth in foster care age ten (10) and older who are enrolled in middle school, junior high or high school, Children’s Social Workers (CSWs) are required to do the following:
    1. Review the case plan annually and update it, as needed, to indicate that the case-carrying CSW has verified that the youth or NMD has received CSHE that meets the requirements of the California Healthy Youth Act (CHYA), once in middle school and once in high school.
    2. Review the case plan annually and update it, as needed, to indicate that the case-carrying CSW has verified that the youth or NMD has received CSHE that meets the requirements of the California Healthy Youth Act (CHYA), once in middle school and once in high school.
  2. For youth and NMDs in foster care who have not met this requirement, SB 89 requires the CSW to document in the case plan how the Department will ensure that the youth/NMD receives the CHYA-compliant CSHE instruction at least once before completing junior high or middle school and once before completing high school.
    • Pending the youth being linked to and receiving an alternative CHYA-compliant CSHE, consider referring younger youth to AMAZE, a free online sexual health education resource that includes engaging, educational, and age appropriate sex education videos. The AMAZE website works best on County computers when using Goggle Chrome. Consider referring older youth and NMDs to a similar resource, BEDSIDER.
In order to verify that a foster minor/NMD has received or will receive instruction within the necessary timeframe, it is recommended that the Children Social Worker (CSW) communicate with school personnel working at the minor/NMD’s school. This will allow the CSW to determine if the youth/NMD will be able to meet this requirement through school attendance, or if the CSW will need to arrange an alternative way for the minor/NMD to receive the instruction.

The California Department of Education (CDE) website provides information about comprehensive sexual health education, including the curriculum requirements and a list of Frequently Asked Questions. The CSW can also reach out to staff from the Health Management Services Division –Child Welfare Health Services Section for further information on alternative comprehensive sexual health education. Although W&IC section 16501.1, subdivision (g)(20) does not dictate a specific year of middle school, junior high, or high school in which the curriculum must be delivered, it is recommended that CSWs connect a minor/NMD to comprehensive sexual health education as early as possible so that if it is determined that a minor/NMD will not receive this education through school attendance, there is sufficient time for the minor/NMD to receive it by some other means, prior to completing middle school, junior high, or high school.

If the youth has not received or is not scheduled to receive the required comprehensive sex education curriculum, the youth shall be provided access to the curriculum in an alternate way and document this both in the case plan and court report. The CSW may reach out to the Health Management Services Division - Child Welfare Health Services Section for assistance in locating free online sexual & reproductive health education courses.

Online courses are usually made available during the registration/enrollment period. The Child Welfare Health Services Section post announcements of online courses on LAKids Weekly News when they were informed that registration to online courses is open. 

If the youth declines or refuses to participate in the SB89 mandated sexual and reproductive health education course, the CSW should document this refusal in CWS/CMS Contact Notebook and consult with either the out stationed regional office County Counsel or the assigned trial County Counsel regarding next steps including informing minor’s counsel of the youth’s refusal. The youth’s reasons for refusal including efforts to offer alternative venues for the educational course should be documented in the next status review court report.  The youth’s reasons for declining cannot be disclosed if it pertains to protected health information.  For example if the youth says, “I do not want to take this course because it brings up trauma from when I was raped”.  That would be protected information that registration to online courses is open. 

If the youth declines or refuses to participate in the SB89 mandated sexual and reproductive health education course, the CSW should document this refusal in CWS/CMS Contact Notebook and consult with either the out stationed regional office County Counsel or the assigned trial County Counsel regarding next steps including informing minor’s counsel of the youth’s refusal. The youth’s reasons for refusal including efforts to offer alternative venues for the educational course should be documented in the next status review court report.  The youth’s reasons for declining cannot be disclosed if it pertains to protected health information.  For example if the youth says, “I do not want to take this course because it brings up trauma from when I was raped”.  That would be protected information that cannot be disclosed without consent.  Refer to SB 89 Quick Reference Guide on how to document SB 89 requirements.

Documenting SB 89 Compliance in Court Reports

As of January 1, 2023, compliance with the SB 89 mandates must be documented in court reports. When documenting in status review court reports for children in out-of-home care ten (10) years of age or older, information may be inserted under a new heading such as, “Compliance with SB 89 Mandates,” or “Reproductive Health Information”. Information shared in a court report should comply with confidentiality laws.

Reproductive Health Rights of California Foster Youth Placed Out-Of-State

All California youth placed in foster care (“foster youth”), including NMDs, have a right to access and receive reproductive health care including abortion care, should that be their decision. This holds true whether the youth are living in California or out of state. For any California foster youth placed in a state that has limited or banned the provision of any services related to sexual, reproductive or gender affirming health care (i.e., abortion services, hormone therapies, birth control, etc.), CSWs are to continue to ensure that these youth are able to receive health care services as required under California law. To help navigate the statutory challenges and to ensure a youth’s access to health care services continue, CSWs can contact their local county Medi-Cal office. For assistance in determining what services are available in the youth’s placement state, the CSW and the youth must reach out to their dependency attorney and the CSW must reach out to County Counsel, the Regional Administration Team, and/or the Health Management Services Division – Child Welfare Health Services Section (PPT_EPY_Conferences@dcfs.lacounty.gov), and the Regional Administration Team. CSWs can also refer to www.abortionfinder.org for a detailed breakdown of each state’s laws regarding what types of reproductive health care are legal in the youth’s placement state as well as assistance in locating health care providers in that state. For assistance in determining what services are available in the youth’s placement state, the CSW can reach out to the Health Management Services Division – Child Welfare Health Services Section (PPT_EPY_Conferences@dcfs.lacounty.gov),

If a youth expresses a desire or need for reproductive or gender affirming health care, the CSW should act with reasonable promptness to address this need in a timely manner as many of these services are very time sensitive. This includes any transportation needs. WIC Section 16001.9 describes the right to timely care and ACL 16-82 provides guidance on a youth’s right to be provided transportation to reproductive and sexual health-related services. Because abortion, gender affirming care and other reproductive health care laws are changing quickly, California youth living out of state can contact their dependency attorney to discuss their options.

The CSW has an ongoing duty to assist the youth. If the youth does not feel comfortable talking to their attorney, or has limited capacity (mentally or access) to make calls, search websites, etc. the CSW must assist the youth. CSWs can consult with their Regional Administration Team or the Health Management Services Division – Child Welfare Health Services Section for assistance on supporting the youth/NMD.

When a foster youth requires ongoing health care (e.g., hormone therapy or other gender affirming care) that is unavailable or difficult to access in the state where they are currently residing, an alternative placement may need to be considered by the case management team, including the youth’s attorney. The youth should be consulted when making any alternative placement decision and the youth’s written consent must be obtained prior to disclosing any health information. CSWs must honor the foster youth’s confidentiality as required by law.

CSWs are recommended to regularly provide youth who are placed out of state with a contact form or resource card with current information of their California support team including their CSW and Juvenile Dependency attorney to help them access any medical care or information they may need. If a youth placed out of state has a medical need that cannot be addressed in their placement area, transportation procedures should be arranged to ensure that their medical care can be addressed in a time-sensitive manner.

For information and resources, including but not limited to fees, lodging, and transportation to support reproductive health care access for minors/NMDs, CSWs can consult with their Regional Administration Team, County Counsel, or the Health Management Services Division – Child Welfare Health Services Section (PPT_EPY_Conferences@dcfs.lacounty.gov) for assistance. Refer to Management Directive, 14-02 Travel Policy, Travel Advance and Expense Reimbursement when requesting transportation and lodging for a child/youth/NMD. Please note that per the travel policy, “transportation of a child is a case work decision to be approved by the RA and does not require a court order.”

Pregnancy Prevention & Avoiding Sexually Transmitted Infections

CSWs may distribute condoms to dependent DCFS minors/NMDs in foster care. CSWs should make minors/NMDs aware of the availability of condoms and make them available. CSWs should consult with the manager of their respective DCFS office on the availability of condoms for distribution to minors/NMDs and, if appropriate, seek guidance from their assigned SCSW and Public Health Nurse (PHN) on how to provide an educational context (such as literature and educational materials) for the minor/NMD receiving condoms. If the youth wants condoms, they do not need or have to take a pamphlet, listen to an educational talk, etc. in order to receive condoms. CSWs can also refer minors/NMDs to the condom project, 211, 1degree.org, or DPH Health Centers for free condoms.

DCFS and Department of Public Health (DPH) PHNs are available for consultation with the CSW, for direct consultation with the minors/NMD, and for joint response or collaborative planning regarding reproductive health issues.

Any DCFS served minor/NMD can be seen at any of the Medical Hubs for reproductive health information and discussion of available birth control options. Some Medical Hubs offer birth control. Additionally, most Obstetrics/Gynecological doctors, family medical providers, and pediatricians can also discuss options for contraception with youth/NMD, provide services, and/or offer referrals for services. When calling for appointments, the CSW or caregiver would need to confirm with the provider’s office if there are age limits for whom they can see and whether they can provide contraception counseling and other reproductive health services.  For additional information, see Overview of Youth's Rights for Sexual Health Services, Sexual Health Services Available at the Medical Hub Clinics and Reproductive Health Resources for Youth.

Pregnancy

A minor/NMD's choice to continue or terminate their pregnancy is a very personal decision and the CSW must support the minor/NMD's decision without expressing personal bias or attempting to influence their decision. Minors/NMDs should be directed to the Planned Parenthood, a Los Angeles County Health Clinic or an equivalent local family planning clinic for assistance in pregnancy testing and counseling/ education regarding their options. CSWs will ensure that the local, family planning clinic the minor/NMD is referred to provides counseling/education for a full range of options. These options include parenting, adoption, and pregnancy termination. A minor/NMD should also be encouraged to seek out people who will support them in making a decision, such as their partner(s), family, friends, attorney, clergy, or a professional counselor. If a minor/NMD is exploring relinquishment of parental rights and placement of the baby for adoption, they may contact the DCFS Foster and Adoption Recruitment number, (888) 811-1121 or via email, Relinquishment@dcfs.lacounty.gov. CSWs should be aware of “crisis pregnancy centers” which do not provide a full range of reproductive health services. CSWs and minors/NMDs are encouraged to find a vetted clinic in California that provides a full range of reproductive health services: https://www.bedsider.org/find-health-care/clinics. If they are exploring this option, explain to the minor/NMD that they must discuss with their attorney the legal implications of adoption. Provide the minor/NMD with their attorney's name and the CLC main number (323) 980-1700. 

Revealing pregnancy information in the absence of a minor/NMD’s written consent is a violation of their right to privacy. The father’s written consent is necessary before documenting in the father’s case file that they are possibly going to be a father. This does not apply when documenting all non-reproductive/routine medical information in the minor/NMD’s case file or on CWS/CMS, or when sharing medical information with health care providers when appropriate. Refer to ACIN No. I-73-16 for guidance regarding how to document minor and NMD parents in CWS/CMS.

Continuing the Pregnancy

If a minor/NMD becomes pregnant, they have the right to continue their pregnancy, regardless of their age, marital status, or financial situation. All minors/NMDs in care are eligible to receive Medi-Cal and financial support to provide for themselves and their children.

It is important that a pregnant minor/NMD visit a doctor for prenatal care, including regular check-ups during pregnancy.  If a minor/NMD thinks they are pregnant, they should be encouraged to talk to their health care provider about medications they are taking

Safe Surrender

The CSW, and DPO if the minor/NMD receives dual supervision, must inform any minor/NMD of childbearing age of the Safe Haven law and provide them with the Safe Surrender Hotline number 877-BABY-SAFE and website: https://www.cdss.ca.gov/safe-surrender-baby. The law states that no parent/legal guardian who has custody of a minor child who is seventy-two (72) hours (three (3) days) old or younger may be prosecuted for child abandonment, if they voluntarily surrenders physical custody of the child to a designated employee at a public or private hospital emergency room, designated fire station, or other safe surrender site, as determined by the local County Board of Supervisors. The law also allows for a fourteen (14) day “cooling off” period, during which the parent/legal guardian may return to reclaim the child.

Adoption

Adoption can be an alternative for a minor/NMD who does not feel prepared to raise a child but does not want to have an abortion. Adoption is a legal process, during which the minor/NMD gives up all rights and responsibilities as a parent.  Adoption is permanent and cannot be reversed.

There are two methods for legal adoption in California:

  • Through a private or government agency, where the agency takes full responsibility for all legal matters involved
  • Independent adoption, where the parent locates an adoptive family on their own.

In both cases, the adopting family must be approved before the adoption process is final.

If the minor/NMD expresses an interest in adoption, CSWs should provide the minor/NMD with the DCFS Adoption Information/Intake number, (888) 811-1121 to seek assistance from an Adoption CSW to discuss adoption. CSWs should also provide the minor/NMD with their attorney's information so that they may get legal advice regarding adoption.

Safe Pregnancy and Healthy Baby

Expectant and Parenting Youth (EPY) Conference

A youth referred to an EPY Conference must have already considered and discussed their options with their parent(s)/legal guardian(s), attorney, or other trusted adult and decided to become a parent. All Expectant and Parenting Youth (EPY), whether a birthing parent or co-parent, shall be offered a voluntary EPY conference. An Expectant and Parenting Youth (EPY) Conference (formerly Pregnant and Parenting Teen (PPT) Conference) is a voluntary proactive tool intended to identify and discuss issues related to pregnancy and early stages of child rearing for expectant or parenting minors/NMDs, including fathers/co-parents. EPY Conferences focus on planning for healthy parenting, identifying appropriate resources and services, and preparing for a successful transition to independence. During EPY conferences, the facilitator should review the DCFS 229, Permission from Youth to Share Reproductive Health-Related Information form, including going over the youth’s right to disclose or not disclose information and their right to discuss it with their attorney.

The Child Welfare Health Services Section, Expectant and Parenting Youth (EPY) Conference Facilitators help promote the Expectant Parent Payment (EPP) as appropriate during EPY Conferences. The EPY Conference Facilitators are available for any questions regarding EPP. These staff can be reached at mendeh@dcfs.lacounty.gov and melenaa@dcfs.lacounty.gov.

Collaborative Planning with a Public Health Nurse (PHN)

When a youth/NMD chooses to continue a pregnancy and to become a parent, upon written consent, the CSW may disclose this information to the Public Health Nurse (PHN). Before signing the written consent, the minor/NMD should be advised that if desired, they are able to consult with their attorney prior to signing any release of information. The CSW and a Public Health Nurse (PHN) co-located in the CSW’s office will have a collaborative planning meeting with the minor/NMD. At this meeting, the minor/NMD’s needs will be assessed and interventions to ensure a safe pregnancy and a healthy baby will be offered. These interventions may include, but are not limited to:

  • A joint visit to the home, hospital, school, or office
  • Sending for medical records
  • Interpreting medical information
  • Referrals to appropriate community agencies

The goal of the collaborative planning meeting is to develop a plan that protects the minor/NMD and their child’s health and safety needs. Once the PHN receives the copy of the consent and disclosure and when a home visit is warranted, the CSW will work with the PHN to schedule and conduct the visit. During the CSW joint visit, the PHN will follow their Child Welfare PHN Policies & Procedures for completing their assessment for the minor/NMD and follow CWPHN documentation procedure. Refer to the section Documentation of Pregnancy and Parenting in CWS/CMS for Minor and Nonminor Dependents. 

When a home visit is indicated, the PHN and the CSW will meet at the minor/NMD’s placement to assess their health, safety, and health practices. During the joint visit, the PHN will:

  • Assist the CSW with the assessment of the home environment.
  • Identify actual and potential health needs of the minor/NMD and their child(ren) through observation and interviews.
  • Inform the CSW of any health and/or safety concerns. If the PHN raises concerns, the CSW shall employ a strengths-based approach to support the minor/NMD. The CSW shall ensure that the minor/NMD is referred to preventative services to address any concerns regarding the safety, health, or well-being of the child, and to help prevent, whenever, possible, the filing of a petition to declare a child a dependent of the juvenile court under WIC 300. The CSW shall ensure that the minor/NMD is provided access to services targeted at supporting and maintaining the parent-child bond and the minor/NMD’s ability to provide a permanent and safe home for the child.

Nurse Family Partnership (NFP) Program

A minor/NMD qualifies for the Nurse Family Partnership (NFP), if they meet all of the following criteria:

  • Is pregnant for the first time (subsequent pregnancies accepted in certain areas) 
  • Is under 28 weeks pregnant at the time of the referral
    • Some Service Planning Areas (SPAs) may accept referrals as long as the youth/NMD has not yet given birth – post-delivery, NFP program will refer the youth/NMD to other home visitation programs
  • Agrees to NFP program services

The program provides home visiting services, beginning during the pregnancy and extending through the child’s first two (2) years of life. The PHNs who visit the minor/NMD’s home will focus on the new parent’s health and on their development as a parent.

The CSW can refer minors/NMDs living in Los Angeles County to Nurse Family Partnership using the LA County Home-Visiting Confidential Referral Form.

If NFP is not an option, the CSW can still refer the minor/NMD to a home-visiting program using the LA County Home-Visiting Confidential Referral Form (hyperlink to form), which will allow the youth to be linked to Parents as Teachers or Healthy Families America. The CSW can also consider other home visitation resources, such as Welcome Baby, Partnerships for Families and Early Intervention programs, such as Early Head Start. The Los Angeles County Perinatal and Early Childhood Home Visitation Consortiums e-directory (Home Visiting E-Directory) can be utilized to find appropriate programs.

Partnerships for Families (PFF) Program

A minor/NMD is eligible for the Partnerships for Families (PFF) program as long as the minor’s children are not dependents of the court. A referral can be generated in the Family Centered Services Portal on LA Kids to refer an expectant mother and/or father. PFF’s home visitation services are provided by a master’s level staff. PFF provides and connects the youth to counseling, concrete supports including baby items and cribs, and other services and resources as needed.

In addition to thea home-visiting programs listed above, the CSW can refer the pregnant youth for a free doula if the youth would like a doula. A doula is a trained professional who provides expert guidance for the service of others and who supports another person through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such a dying. Youth identifying as Black or African American can be referred for a doula through the Black Infants and Families Program. CSWs can also refer pregnant youth of all racial identities for a doula through the Joy in Birthing Foundation. Youth placed out of county can access doula care through Medi-Cal. Youth may also access the Frontline Doula Hotline (Frontline Doulas). The Frontline Doula Hotline is a respectful "warm line" that allows youth to schedule a call-back time with a Doula. The Frontline Doula Hotline operates Monday through Sunday, 7 am–10 pm, PST.

Expectant Parent Payment (EPP)

Effective January 1, 2022, WIC 11465(e) authorizes a payment to be made directly to an expectant minor or NMD, approximately three (3) months prior to the minor/NMD’s due date. Prior to automation, this payment will be issued as a lump sum of $2,700; once automation has been finalized, an amount equivalent to the home-based foster care infant supplement will be paid monthly for the final three (3) months of a minor/NMD’s pregnancy. The payment will be the same regardless of placement type, and it will be paid directly to the expectant minor/NMD.

This expectant parent payment is available to meet the specialized needs of the pregnant minor/NMD, as well as prepare for the needs of the infant. Preparing for the birth of a newborn is expensive. Some potential expenses this payment could be used for are included below. Listed expenses are only examples, the expectant minor/NMD who receives the payment is not required to submit any accounting or receipts to show how the funds are utilized. All items purchased with these funds are the property of the minor/NMD and go with them if/when they change facilities or exit care.

Example uses of the payment include, but are not limited to:

  • Cribs, rocking chairs, changing tables or other infant related furniture.
  • Car seats, strollers, or infant carriers.
  • Clothes for the infant or maternity clothes for the pregnant minor/NMD.
  • Nursing bras, breast pumps, formula or other infant feeding necessities.
  • Diapers, pacifiers, bibs, and other miscellaneous infant items.
  • Birth preparation or parenting classes.

CSWs must discuss the availability of EPP funds with the pregnant minors/NMDs.

The EPP replaces the Early Infant Supplement (EIS) financial benefit that was previously provided to DCFS pregnant minor/NMD in placement in the 7th, 8th, and 9th months of pregnancy.

To implement the EPP benefit, CSWs must obtain and submit a copy of an official medical record given directly to the pregnant minor/NMD from a qualified medical provider, containing both verification of pregnancy and the Expected Delivery Date. A determination of the 7th, 8th, or 9th month of pregnancy for the purpose of implementing the EPP payment(s) will be based on the Expected Delivery Date provided in the medical record. Minors/NMDs are eligible for the entire lump sum payment even if the EPP application is submitted after the 7th month of pregnancy.

If the pregnant minor/NMD does not have an official medical record from their health care provider containing the required information, the CSW may request a verification of pregnancy letter from the medical provider on formal letterhead with an Expected Delivery Date. Any verification and documentation procedure must abide by applicable confidentiality laws. The CSW may use DCFS 6119, DCFS Expectant Parent Payment (EPP) Health Care Provider Request, which includes a signature line for the pregnant youth/NMD to authorize the health care provider to disclose the youth’s pregnancy and Expected Delivery Date. A verification of pregnancy letter from a qualified medical provider, reflecting the Expected Delivery Date, must be submitted as a part of the application. 

Expectant parent payments are available to pregnant minors/NMDs who receive AFDC-FC or ARC payments, including those placed in Short Term Residential Therapeutic Placements (STRTPs), Supervised Independent Living Placements (SILPs), Transitional Housing Placements (THPP) or home-based foster care. Los Angeles County will also issue an EPP for youth who are not in an approved placement but are otherwise eligible, through a Special Payment request for an Administrative Review Net County Costs (NCC). If the minor/NMD is not in an approved placement, the assigned CSW and SCSW should consult with their Regional Administration Team, assigned County Counsel, and/or a Health Management Services EPY Facilitator on the appropriateness of providing the EPP due to case considerations. Expectant Parent Payments are not available for minors/NMDs in the Adoption Assistance Program (AAP) and the Kinship Guardianship Assistance Payment Program (Kin-GAP). Pregnant minors/NMDs residing in the home of one or both parents (HOP) are not eligible to receive EPP payments. However, they may be eligible to receive financial assistance from the Department of Public Social Services (DPSS). The address provided on the EPP request must match the pregnant minor/NMD’s placement address as reflected in CWS/CMS.

The Child Welfare Health Services Section, EPY Conference Facilitators help promote the EPP as appropriate during EPY Conferences. The EPY Conference Facilitators are available for any questions regarding EPP. These staff can be reached at mendeh@dcfs.lacounty.gov, melenaa@dcfs.lacounty.gov, or PPT_EPY_Conferences@dcfs.lacounty.gov.

Infant Supplement

The infant supplement begins the month that the infant is born and continues as long as the non-dependent infant continues to reside with the minor/NMD parent in an eligible placement. As soon as the infant is born and is under the care of the now parenting minor/NMD, the CSW must initiate an FCSS Automated DCFS 280 request to start the official Infant Supplement payment of $900 per month, or $1,379 per month for group home/STRTP placements, and to begin Medi-Cal coverage for the infant. To begin Medi-Cal coverage for the baby, initiate an FCSS Automated 280 (Note: a hospital discharge summary or hospital certificate of birth may be needed to initiate the DCFS 280).

The infant supplement is an additional payment tied to AFDC-Foster Care, Kin-GAP and Approved Relative Caregiver (ARC) programs for children of parenting foster youth, when the child and parenting foster youth live in a foster care setting. Other parenting youth who are living with their non-dependent child are also eligible including youth under delinquency jurisdiction who are living in foster care, NMDs, and youth in non-related legal guardianships who are receiving AFDC-FC. An infant supplement payment is paid to the youth’s caregiver. NMDs living in a SILP receive their payment directly. A co-parent in foster care is entitled to the infant supplement if the newborn/young child is living with the co-parent at least part of the time. Infant supplements may only be used to provide for the care and supervision of the child of the eligible parent and are not intended to be additional compensation for the youth/NMD’s caregiver.

A NMD parent residing in a SILP with their non-dependent child, may enter into a Parenting Support Plan (PSP) with an identified and approved responsible adult mentor. The NMD parent may obtain the PSP rate of $200 (which is paid directly to the parenting NMD). Refer to PG 0100-510.40, Services for Minor and Nonminor Dependent (NMD) Parents for more information and procedures on how to obtain a PSP rate for the parenting NMD.

Termination of Pregnancy

If a minor/NMD at any age does not want to continue a pregnancy, they have the legal right to terminate it. If the minor/NMD is under DCFS supervision, the CSW must ensure that the minor/NMD's transportation needs are met, including transporting them, if necessary. No one has the legal right to force a minor/NMD to terminate or choose not to terminate the pregnancy, regardless of the minor/NMD’s age. Termination of pregnancy services are time sensitive. If the minor/ NMD's right to these services are being violated, the CSW must ensure that the minor/NMD is able to obtain the services in a timely manner (Planned Parenthood, a Los Angeles County Health Clinic). For example, if a minor/NMD wishes to terminate their pregnancy and they are having trouble finding a medical provider who can assist them promptly, or if the minor/NMD needs transportation to their medical appointment and their housing provider/Resource Parent is unable to assist them, the CSW shall assist the minor/NMD to help remove these barriers to accessing services. Each case needs to be addressed and evaluated on a case-by-case basis as to the logistics of transportation and lodging, and the CSW must consult with County Counsel, Regional Administration Team, and Child Welfare Health Services Section to avoid violating the state’s specific reproductive health laws. CSWs can also refer to www.abortionfinder.org for a detailed breakdown of each state’s laws regarding what types of reproductive health care are legal in the youth’s placement state as well as assistance in locating health care providers in that state. CSWs should inform the minor/NMD that Medi-Cal covers the cost of the termination of pregnancy, and refer to Management Directive 14-02, Travel Policy, Travel Advance and Expense Reimbursement when requesting transportation and lodging for a child/youth/NMD. For information regarding California protections for reproductive health care refer to https://www.gov.ca.gov/2023/09/27/california-expands-access-and-protections-for-reproductive-health-care/.

Documentation of Pregnancy and Parenting in CWS/CMS for Minors/NMDs

Under the requirements of SB 794, data regarding pregnancy must be collected and reported. Pregnancy is a health condition which may be reported by the minor/NMD, their caregiver or physician. Due to the confidential nature of this information, conversations with minor/NMD about pregnancy-related topics should be handled with sensitivity and care to eliminate coercion regarding the disclosure of pregnancy status. Any disclosure regarding pregnancy requires the minor/NMD's written consent.

Revealing pregnancy information in the absence of a minor/NMD's written consent is a violation of their right to privacy. The father's written consent is necessary before documenting in the father's case file that they are possibly going to be a father. This does not apply when documenting all non-reproductive/routine medical information in the minor/NMD's case file or on CWS/CMS, or when sharing medical information with health care providers when appropriate.

Under the requirements of SB 794, data regarding pregnancy must be collected and reported. There are two (2) ways to capture pregnancy information in CWS/CMS. Pregnancy information may be entered under the Observed Condition tab or under the Diagnosed Condition tab. The correct way to enter this data depends on whether the minor/NMD has consented to the release of information.

Discussions related to the minor/NMD's reproductive rights and pregnancy may also be documented in the CWS/CMS Case Notes (i.e. Title XXs) with suggested language as follows:

  • The CSW and the minor/NMD discussed topics of reproductive health.
  • The CSW provided resources regarding reproductive health.
  • The CSW offered to remove any barriers the minor/NMD may experience accessing reproductive health services.

Under the requirements of SB 528, complete and accurate data on parenting minor and NMD parents must be collected. The reported data must also include the parenting minor/NMD's county, age, ethnic group, placement type, time in care, number of children they have, and whether the children are court dependents.

When a CSW first learns that a minor/NMD is pregnant, the information should be entered into CWS/CMS via the Observed Condition tab. This will ensure that the information is not automatically populated on the Helath and Education Passport (HEP) and will keep the information private from caregivers and others such as school personnel, counselors, mentors and Foster Youth Services providers that receive copies of a minor/NMD's HEP. This information may not be relevant to the provisions of some types of services and supports and therfore need not be included in the HEP. Additionally, the minor/NMD should be consulted prior to the disclosure of any pregnancy-related information.

If a minor/NMD has been hospitalized for a health issue related to the pregnancy, such as a pregnancy complication or due to giving birth, the pregnancy must be recorded as a diagnosed condition in order to allow for entering the hospitalization information. Pursuant to WIC section 16010(a), any hospitalization must be recorded in a manner in which the information would be entered into the minor/NMD's HEP.

The All County Information Notice (ACIN) I-73-16, provides information on the state-required guidelines for entering parenting information into CWS/CMS.  Prior to release ACIN I-73-16, guidelines had been established via ACIN I-60-15 to collect data on parenting minors/NMDs via CWS/CMS data entry. An FYI was issued (FYI 16-01) on how to document the state-required information into CSW/CMS and an update to FYI 16-01 was released via FYI 16-19.

Cross Reporting to Law Enforcement

The CSW must ensure that a child abuse report is made with DCFS and that a cross report is made to local law enforcement in cases where the age difference is as described below, and any time there is a reasonable suspicion that the sexual activity was coerced or not voluntary (including sexual exploitation). In the absence of an emergency, prior to disclosure, the CSW must inform the minor that they will be disclosing this information and explain the reason for that disclosure. The CSW should notify the youth’s attorney of reports made to local law enforcement on behalf of their clients.

Age Difference

Mandated reporters must report if they have a reasonable suspicion that:

  1. A person fourteen (14) or older engaged in sexual intercourse with a minor under age of fourteen (14).
  2. A person twenty-one (21) or older engaged in sexual intercourse with a minor aged fourteen (14) or fifteen (15).

Sexual Activity that is Coerced or Not Voluntary

Mandated reporters must report if they have a reasonable suspicion that intercourse with a minor was coerced, or in any other way not voluntary. As one example, sexual activity is not voluntary when the victim is unconscious or so intoxicated that they cannot resist. See below, and see Penal Code sections 261 and 11165.1, for more examples.
 

Sexual Activity Involving Sexual Exploitation or Trafficking

Mandated reporters must report if they have a reasonable suspicion that a minor has been sexually trafficked or is being sexually exploited. Child pornography is sexual exploitation, as is the provision of food, shelter, or payment to a child in exchange for any sexual act described in Penal Code section 11165.1. See Penal Code section 11165.1 for more examples.

CSWs must make a report to law enforcement in cases where the minor reports that the sexual activity occurred under any circumstance where there is a reasonable suspicion that the sexual activity was coerced or in any way not voluntary. These include, but are not limited to:

  • While the minor was unconscious, intoxicated or lacked the mental, developmental or physical capacity to give legal consent; or
  • Was accomplished against the minor's will by means of force, violence or fear of immediate bodily injury; or
  • The minor is a victim of commercial sexual exploitation, or other sexual exploitation.
PROCEDURE

Informing Youth of Their Rights and Removing Barriers

CSW Responsibilities

  1. Communicate with DCFS youth, age 10 and above, about their reproductive and sexual health, and utilize the following resources:
  2. Document the required activities in the case plan utilizing the two (2) new Case Management Services, Service Categories: Inform Sexual and Repro Health Rights and Assist Access to Sexual/Repro Care Srvcs.
    • Since case plans are attached to court reports, the court will be kept apprised of CSWs meeting the mandates of having an annual conversation with youth age ten (10) and above regarding their reproductive health rights, accessing reproductive health services, and assisting in removing any identified barriers.
  3. Document the required activities in a contact in the case. Documentation should include any actions the CSW took to provide the youth/NMD with information, resources, and assistance to remove any barriers the youth/NMD may have in receiving sexual and reproductive health care. Confidential information about the youth/NMD receiving sexual and reproductive health care does not belong in the case documentation.

Improving Access to Sexual Health Education

CSW Responsibilities

  1. Submit DCFS 1726 DCFS School Records Request and ensure that Verification of Completion of Comprehensive Sexual Health Education (CSHE) is requested, through checkbox-marked on first page of the DCFS 1726.
  2. Upon receipt of the completed DCFS 1726, review the information provided by the youth’s school to ensure all requested information was given.
  3. If the required CSHE information was not provided, contact the youth’s school counselor to inquire if the youth completed the required CHYA-compliant CSHE. The attached Unified School Districts CHYA Matrix can be used as a tool to communicate with the school.
  4. If the youth has not received the CHYA-compliant CSHE at his/her school, refer to information provided by the school on the DCFS 1726, II. Availability of Alternative CHYA-compliant Comprehensive Sexual Health Education, on the possibility of the youth taking the class out of sequence, in independent study, or in summer school.
  5. With the youth’s agreement to participate, coordinate with the school to assist the youth in participating and completing the alternative CSHE. If the youth is not able, or does not wish, to participate during the proposed alternative time, document this information in the CWS/CMS Contact Notebook.
  6. If transportation is needed, explore the possibility of the caregiver assisting, or if the caregiver is unable to provide transportation, assist in facilitating transportation.
  7. If there is no alternative CSHE available through the school, notify the DCFS Child Welfare Health Services (CWHS) Section by emailing the Comprehensive Sexual Health Education InBox at CSHE@dcfs.lacounty.gov with the youth’s name, DOB, school name and grade level. The CWHS Section is tracking the need for youth to receive an alternative curriculum. This notification is required to assist DCFS in establishing an alternative to the youth receiving the CSHE once in Middle School and once in High School.
  8. Pending the youth being linked to and receiving an alternative CHYA-compliant CSHE, consider referring younger youth to AMAZE, a free online sexual health education resource that includes engaging, educational, and age appropriate sex education videos. The AMAZE website works best on County computers when using Goggle Chrome. Consider referring older youth and NMDs to a similar resource, BEDSIDER.
  9. Document the information obtained from the youth’s school in the Case Plan utilizing the Service Category, Sexual Health Education Services, and the two (2) Service Types, Sexual Health Education High School and Sexual Health Education Middle School.
    • Since Case Plans are attached to court reports, the Court will be kept apprised of the Department’s mandate to ensure that the case plan is reviewed annually and updated, as needed, to indicate that the CSW has verified that the youth/NMD has received the CHYA compliant CHSE, once in middle school and once in high school.
  10. Document the required activities in the CWS/CMS Contact Notebook. Documentation should include any actions the CSW took to obtain the required CSHE information.

Documenting SB 89 Compliance in Court Reports

CSW Responsibilities

  1. For all youth in placement, age 10 and above, document compliance with the mandates of SB 89 in all 6-month court reports (21.e, 21.f, .22, .26 reports). The following sample language may be used to avoid violating confidentiality rights:
    • Given the youth’s age, (s/he) was provided with information regarding reproductive/sexual health rights on (Date).
    • On (Date), the youth was provided information regarding reproductive/sexual health resources, as appropriate, and CSW discussed and removed any existing barriers to youth receiving reproductive/sexual health care.
    • Youth is currently attending ________________ Middle School and received the CHYA-compliant Comprehensive Sexual Health Education on (Date).
    • Youth is currently attending __________________ High School and received the CHYA-complaint Comprehensive Sexual Health Education on (Date).
    • Youth is unable to receive the CHYA-compliant Comprehensive Sexual Health Education (CSHE) at their school. CSW referred youth to an alternative CHYA-compliant Comprehensive Sexual Health Education program at _______________ on (Date).
    • Youth received the alternative CHYA-compliant Comprehensive Sexual Health Education program at __________________ on (Date).

Sexual and Reproductive Health for Minors and NMDs

CSW Responsibilities

  1. Personal biases and/ or religious beliefs will not be imposed upon the minor/NMD.
  2. Provide a copy of and explain in an age-appropriate manner the Foster Youth Bill of Rights upon entry into foster care and at least once every six (6) months at the time of scheduled contact and any change of placement.
  3. Inform the minor/NMD, in an age appropriate manner, of their rights to consent at any age to pregnancy-related care, including contraception, abortion, and prenatal care.  See FYI 22-19, Youth and Reproductive Health Rights.
    1. Reproductive and sexual health care.
    2. Unplanned pregnancy prevention, including abstinence, and use of birth control.
    3. Options regarding pregnancy, including abortion.
    4. Prevention and treatment of STIs.
  4. Inform the minor/NMDof their right to consent at age 12 or older to the prevention, diagnosis, and treatment of STIs.
  5. Inform the minor/NMD about their confidentiality rights regarding medical services and seek the youth/NMD's written consent prior to any disclosure of their sexual or reproductive health information. Also, inform the minor/NMD of their right to withhold consent to such disclosure(s.)
  6. Ensure the minor/NMD is up-to-date on their annual medical appointments.
  7. Ask the minor/NMD if they are facing any barriers in accessing reproductive and sexual health care services or treatment, and ensure any barriers are addressed in a timely manner.
  8. Use the reasonable and prudent parent stand to create normalcy and to support the healthy sexual development of the minor/NMD based on their individual needs. See the Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention.
  9. Providethe minor/NMD with the youth-friendly brochure, "Know your Sexual and Reproductive Health Care Rights."
  10. Provide resources such as Planned Parenthood, a Los Angeles County Health Clinic, and/ or a primary physician, information on condom availability, as well as other resources to address the sexual health needs of DCFS-served youth.
  11. Provide pregnant minor/NMD with Reproductive Health and Parenting Resources for Youth in LA County. The resources listed in this document are not exhaustive, but will serve as a starting point for locating resources appropriate for the individual youth/NMD.
  12. Document in the case plan any measures taken towards ensuring that items #1 through #7 were completed. All documentation needs to comply with existing confidentiality laws.

Assisting a Pregnant Minor/NMD

CSW Responsibilities

  1. Upon a minor/NMD’s disclosure they are pregnant:
    1. With the minor/NMD's written consent, immediately inform PHN about the pregnant minor/NMD.
    2. Document in the Health Notebook the pregnancy as an observed condition.
      1. Click on the Observed Condition page tab.
      2. To add an Observed Condition, click the "+" in the Observed Condition grid to create a new row, and complete all known and mandatory fields.
      3. Under Condition, select Physical Health from the Category dropdown list and Pregnant from the Health Problem dropdown list.
      4. Add any known contact information regarding the pregnancy related health care provider in the Description box under the Health Problem dropdown list.
      5. Any condition with the Alert box selected will populate in the Health and Education Passport (HEP).
  2. If the minor/NMD is hospitalized for a pregnancy related issue and has provided written consent, consult with the PHN to request for PHN review and documentation on CWS/CMS and assistance with any medical follow-ups, as needed.
    1. Submit a PHN consult referral (Pubic Health Nursing Consultation Request)
      • Under Request Reason, select “Input Medical Info into CWS/CMS”
  3. Advise the minor/NMD of the family planning options available to them, including:
    • Terminating the pregnancy
    • Continuing the pregnancy and relinquishing the baby for adoption
    • Continuing the pregnancy and keeping the baby
  4. Encourage the minor/NMD, if appropriate, to discuss their options with their parent(s)/legal guardian(s), attorney, or other trusted adult.
  5. Reassure the minor/NMD that they will receive CSW support no matter their choice.
  6. Provide the minor/NMD with a copy of Reproductive Health and Parenting Resources for Teens in LA County prior to closing the referral or promoting the referral to a case.
  7. Refer the minor/NMD to Planned Parenthood, a Los Angeles County Health Clinic and/or a primary physician to further discuss their family planning options.
    • If the minor/NMD is under DCFS supervision, ensure that the minor/NMD's transportation needs are met, including transporting them, if necessary. The CSW does not have to transport the minor/NMD; however, the CSW is responsible for ensuring transportation needs are met.
  8. Inform the minor/NMD of their right to confidentiality.
  9. If a DCFS-supervised minor/NMD decides to continue their pregnancy, inform them of the Nurse Family Partnership (NFP) program.
    • If they wish to participate and qualify, refer them for the services.
  10. If the minor/NMD has decided to carry their pregnancy to term and raise the baby, offer the minor/NMD an EPY Conference to assist with planning for healthy parenting, identifying resources and preparing for a successful transition to independence as a young parent.
    1. If the minor/NMD agrees, ask the minor/NMD to complete the DCFS 229, Permission from Youth to Share Reproductive Health-Related Information form and submit the DCFS 174 requesting the EPY Conference via the referral portal to "PPT/EPY." An EPY can request an EPY Conference before and after the baby is born.
    2. Email EPY facilitators Anita Melendez melenaa@dcfs.lacounty.gov & Hipolito Mendez mendeh@dcfs.lacounty.gov as well as the EPY email address, PPT_ EPY_Conferences@dcfs.lacounty.gov to confirm receipt of the referral.
  11. If a DCFS-supervised minor/NMD decides to continue their pregnancy, inform them of the Nurse Family Partnership (NFP) program.
  12. Inform the minor/NMD of the Safe Haven law.
  13. If the minor has an open referral, arrange for a joint response with a PHN.
  14. For DCFS-supervised minor/NMD, follow the relevant guidelines, depending on their decision:
  15. Document on the "Observed Condition" tab in CWS/CMS that:
    • Referrals were provided to the minor/NMD
    • The options for managing the pregnancy (family planning) were discussed prior to promoting the referral to a case, closing the referral, or on the open case.
    • Document in the Health Notebook information regarding the pregnancy and related medical treatment, including the name, address, and phone number of the physician providing prenatal care.
  16. If a Child and Family Team (CFT) meeting is held, advise the minor/NMD that their pregnancy will not be revealed during the CFT unless they authorize it.
  17. If a minor/NMD’s open referral is promoted to a case, incorporate financial and medical assistance, as well as expectant parent programs, into the case plan.
  18. If a placement decision must be made for a minor/NMD, their prenatal needs must be considered along with the permanency needs of their family unit, if the youth chooses to become a parent.
    • The minor/NMD should be advised that they have the right not to disclose their pregnancy status.
    • Discuss with the minor/NMD about the importance of informing the Resource Parent that they are pregnant so that they can help support them.
  19. Obtain the required verification once the pregnant minor/NMD is eligible and submit for the EPP (the pregnant minor/NMD can receive this payment even after the birth of the baby). Refer to Procedural Guide 0100-510.40, Services for Minor and Nonminor Dependent (NMD) Parents.
  20. At each subsequent home visit:
  21. Determine whether the minor/NMD and their family are using the referred resources.
  22. Document that information in the Contact Notebook.

Expectant Parent Payment (EPP) During a Minor/NMD's Pregnancy

CSW Responsibilities

  1. Discuss with the pregnant minor/NMD in placement the availability of EPP and the purpose of the funds, namely to assist the minor/NMD in preparing for the birth of the infant and to promote the purchase of necessary items for the arrival of the soon-to-be-born infant.
  2. Obtain an official medical record from the pregnant minor/NMD, containing both verification of pregnancy and the Expected Delivery Date.
    1. If such official medical record is not available, obtain the pregnant minor/NMD’s signature on the DCFS 6119, DCFS EPP Health Care Provider Request authorizing the health care provider to disclose the youth/NMD’s pregnancy and Expected Delivery Date.
  3. Submit the DCFS 6119, DCFS EPP Health Care Provider Request signed by the minor/NMD authorizing the health care provider to disclose the minor/NMD’s pregnancy and Expected Delivery Date to the health care provider via mail, email or fax.
  4. Complete the DCFS 5540, Special Payment Authorization/Request with a request to implement three (3) months of EPP payments at $900 each, for a total of $2,700. Complete all yellow- highlighted mandatory fields (refer to attached SAMPLE) and attach an official medical record containing verification of pregnancy and the Expected Delivery Date, or if unavailable, the completed DCFS 6119, DCFS EPP Health Care Provider Request, as well as the verification letter from the health care provider, and the History of Child Placements Report from CWS/CMS. Obtain approval of the DCFS 5540 from SCSW, ARA, and RA.
    • Submission of EPP payment requests will only be possible at the minor/NMD’s 7th month of pregnancy or beyond via the DCFS 5540. If for some reason the EPP has not been processed and received by the youth during the 7th, 8th, or 9th month of pregnancy they remain eligible to receive the total sum of $2700 after the baby is born.
  5. Scan and email the approved DCFS 5540, the official medical record containing verification of pregnancy and the Expected Delivery Date, and the History of Child Placements Report from CWS/CMS to the DCFS Special Payments Section In-box: SpecialPaymentRequests@dcfs.lacounty.gov.
  6. If the minor/NMD’s situation changes, (i.e., if the minor/NMD is no longer pregnant by the 7th month of pregnancy, no longer a dependent, or if there is a change in the minor/NMD’s address), notify the DCFS Special Payments Section in a timely manner by sending an email to the DCFS Special Payments In-box: SpecialPaymentRequests@dcfs.lacounty.gov.
  7. As soon as the infant is born and under the care of the now parenting minor/NMD, initiate an Automated DCFS 280 request to start the official Infant Supplement payment of $900 per month or $1379 per month for group home/STRTP placements, and to begin Medi-Cal coverage for the infant.
  8. If the minor/NMD is not in an approved placement, the assigned CSW and SCSW should consult with their Regional Administration Team, assigned County Counsel, and a Health Management Services EPY Facilitator on the appropriateness of providing the EPP and any case considerations.
    • Requests for EPP for a youth/NMD in a non-approved placement go through an Administrative Review Net County Costs (NCC).
    • Complete and gather the documents specified in #4. Consult with the EPY Facilitator and submit the required documents to the EPY Facilitator who will reach out to the program manager of Child Welfare Health Services Section for assistance. The program manager will draft a memo on behalf of the Regional Deputy Director explaining and justifying the EPP request and need for NCC funding. The memo will be sent to the Regional Deputy Director for their review/approval to then submit to the Finance Administrative Deputy III for approval.

SCSW Responsibilities

  1. Review the official medical record or verification letter with the Expected Delivery Date for accuracy of the DCFS 5540, based on the minor/NMD’s Expected Delivery Date.
  2. If accurate, approve the DCFS 5540 and forward it to the ARA and RA for review and approval.
  3. If the case is in the process of being transferred to another CSW, or in the absence of the CSW, if the youth’s situation changes, (i.e., if the minor/NMD is no longer pregnant by the 7th month of pregnancy, no longer a dependent, or if there is a change in the minor/NMD’s address) notify the Special Payment Section by sending a notification email to SpecialPaymentRequests@dcfs.lacounty.gov

Infant Supplement Following the Birth of a Child

CSW Responsibilities

  1. After the birth of the baby, if the non-dependent infant is residing with minor/NMD in an eligible placement (link to FYI), describe the availability of the Infant Supplement to the parenting minor/NMD.
  2. To request the infant supplement and begin Medi-Cal coverage for the baby, initiate an FCSS Automated 280. A hospital discharge summary or hospital certificate of birth may be needed to initiate the 280.

Continuing a Pregnancy

A minor/NMD's pregnancy is confidential and thus without the minor/NMD's written consent, information entered into CWS/CMS and other documents, such as court reports, is not permitted except as described above under, "Entering Pregnancy Information as an Observed Condition" and "Entering Pregnancy Information as a Diagnosed Condition." Guidelines for documentation of each are described above under, "Assisting a Pregnant Minor/NMD."

CSW Responsibilities

  1. Confirm that you have followed all of the steps in Assisting a Pregnant Minor/NMD.
  2. If the minor/NMD provides written consent and it has not been already completed, arrange for a collaborative planning meeting with a PHN.
  3. Engage the minor/NMD in a discussion of their feelings about going through pregnancy, the responsibilities of parenting, planning for education and finances, and other related questions for the youth/NMD to consider in making their decision.  See Discussion Questions for Pregnant Youth for additional guidance.  Document this conversation in the Contact Notebook.
  4. If not already offered and the minor/NMD agrees, refer the minor/NMD for an EPY Conference .
  5. Assess the minor/NMD’s need for health, financial, placement/housing, and education resources.
    • Document assessments in CWS/CMS Contact Notebook with the minor/NMD's consent
    • Document assessments on the "Observed Condition" tab of CWS/CMS when the minor/NMD's consent has not been given.
  6. If the minor/NMD decides to keep the baby, talk to them about the home visitation programs, doula services, and the Nurse Family Partnership (NFP) Program.  If they agree to participate and qualify for the program:
    1. Complete the NFP Referral Form.
    2. If the expectant parent is a nonminor dependent, they must sign a DCFS 565, Authorization for Disclosure of Medical Information for Participation in the Nurse Family Partnership Program.
    3. Give the completed form(s) to the PHN to submit. The NFP Program will send an enrollment status letter to the PHN.
  7. Consider referring the minor/NMD to the Adolescent Family Life Program (AFLP).
  8. Refer the minor/NMD and their caregiver to community resources, as needed or requested.
  9. If the minor/NMD resides with a parent or adult relative who is receiving CalWORKS, refer them and the parent/relative to the Department of Public Social Services (DPSS) to determine the minor/NMD’s eligibility for the Cal-Learn.
  10. Consult with the PHN to obtain the guidelines for appropriate prenatal care from the College of Obstetricians and Gynecologists, and to ensure that the youth/NMD receives appropriate prenatal care.
  11. Assist in supporting face-to-face contact between the pregnant minor/NMD and the biological parent if the minor/NMD requests assistance with this.
    • Document the contact or attempted contact in the Contact Notebook.
  12. If the other parent is a DCFS-Supervised minor/NMD, offer them an EPY conference and provide them with referrals to community-based programs such as AFLP.  If the other parent is a probation youth, provide referrals via the Deputy Probation Officer (DPO).
  13. If the minor/NMD is reluctant to disclose their pregnancy to their out-of-home caregiver, discuss with the minor/NMD about the importance of informing the Resource Parent that they are pregnant so that they can help support them. If the minor/NMD declines to disclose their pregnancy to the Resource Parent explore with the minor/NMD why they do not feel comfortable, while reassuring the minor/NMD that their decision to keep this information confidential will be respected.
  14. Inform and refer the minor/NMD to EPP and submit the application.
  15. Following the child's birth, initiate an Automated DCFS 280 request to start the Infant Supplement payment and to begin Medi-Cal coverage for the infant, even if the child is non-detained. The minor/NMD is eligible for this funding for their child until their case closes.
  16. Following the child's birth document parenting information into CWS/CMS utilizing the instructions in ACIN I-73-16.

Required Documentation

  1. Only after obtaining the minor/NMD's written consent document the pregnant minor/NMD referral in the CWS/CMS on the Special Projects page as follows:
    1. Pregnant Youth – Referred to the NFP Program
    2. Pregnant Youth – Status of referral to the NFP Program
      1. Client accepted into NFP
      2. Client was not accepted into NFP
        • Did not meet intake criteria
        • Refused
        • No NFP capacity in geographical area
    3. Pregnant Youth – Not referred to the NFP Program
      1. Does not meet eligibility criteria
      2. Referred to Prenatal Care provider (list provider name)
      3. Youth declined
      4. Referred to other home visiting program (list program name)
  2. Include the date when the action was taken or the notification was received on the Special Projects Page.
  3. List the provider’s name in the Comment section.

Terminating a Pregnancy

CSW Responsibilities

  1. Confirm that you have followed all of the steps in Assisting a Pregnant Youth.
  2. If the minor/NMD provides written consent and it has not been already completed, arrange for a collaborative planning meeting with a PHN.
  3. Encourage the minor/NMD, if appropriate, to discuss their options with their parent(s)/legal guardian(s), attorney, or other trusted adult.
    • Reassure the minor/NMD that they will receive your support no matter what choice they make.
  4. Ensure that the minor/NMD’s decision to terminate the pregnancy is based on their knowledge of the available options.
    • Document the conversation to terminate the pregnancy in the Contact Notebook.
  5. Refer the minor/NMD to Planned Parenthood or a Los Angeles County Health Clinic to further discuss and arrange for pregnancy termination services.
  6. If the minor/NMD or Resource Parent, in consultation with the youth, requests the abortion procedure.
    • Assist them in making adequate arrangements for the abortion procedure and adequate recovery time.
    • If the minor/NMD does not have other supportive people who can transport them to and from the location where the abortion procedure will occur, the CSW is to assist them by either making arrangements for their transportation or transporting the minor/NMD to and from the appointment. The CSW may request transportation per Management Directive, 14-02, Travel Policy, Travel Advance and Expense Reimbursement after consulting with County Counsel, the Regional Administration Team, or the Health Management Services Division – Child Welfare Health Services Section. This plan should be discussed with the minor/NMD in advance to ensure they are in agreement with the plan.
  7. Document information regarding the pregnancy and related medical treatment as well as conversations with the minor/NMD on the "Observed Condition" tab in CWS/CMS. Include the name, address and phone number of the treating physician.
  8. Provide post termination supportive services as needed, and ensure the minor/NMD’s attendance at follow-up medical appointments.
  9. Provide resources to the minor/NMD for family planning counseling and/ or sexually transmitted infection (STIs).

Relinquishing an Infant for Adoption

CSW Responsibilities

  1. Confirm that all of the steps in Assisting a Pregnant Minor/NMD have been followed.
  2. If the minor/NMD provides written consent and it has not been already completed, arrange for a collaborative planning meeting with a PHN.
  3. Inform the minor/NMD that adoption is a legal process, during which they give up all rights and responsibilities as a parent, and that once adoption procedures are completed, the decision is permanent and cannot be reversed.
  4. Explain to the minor/NMD that they must discuss with their attorney the legal implications of adoption. Provide the minor/NMD with their attorney's name and the CLC main number (323) 980-1700.
  5. If the minor/NMD expresses interest regarding adoption, with the minor/NMD's consent, request assistance from an Adoptions CSW by calling (888) 811-1121 or emailing Relinquishment@dcfs.lacounty.gov. The Adoptions CSW will engage the minor/NMD in a discussion of their feelings about going through pregnancy, the emotional impacts of adoption, adoption procedures, and other related questions for the minor/NMD to consider in making their decision.  See Discussion Questions for Pregnant Youth for additional guidance.  Document this conversation in the Contact Notebook.
  6. Inform the minor/NMD that there are two methods for legal adoption in California.
  7. Assist the minor/NMD in contacting the other parent and obtaining their consent for the adoption. 
    • If the baby’s other parent is known, the other parent is required to give consent to the adoption. 
  8. Create a Client Notebook for the infant.
    • If available, include the name, address, and phone number of the other biological parent in the infant’s Client Notebook.
  9. Provide the minor/NMD with the DCFS Adoption Information and Applicant Intake toll-free number (888) 811-1121.
    • Only the infant’s parents may decide to relinquish the infant and to call the Adoption Information and Applicant Intake section.
  10. Consult with PHN to obtain the guidelines for appropriate prenatal care from the College of Obstetricians and Gynecologists, and to ensure that the minor/NMD receives appropriate prenatal care.
  11. Inform the minor/NMD of doula services and home-visitation programs such as the Nurse Family Partnership (NFP) Program. If they agree to participate and qualify for the Nurse Family Partnership or other LA County Home-visiting program.
    1. Complete the LA County Home-Visiting Program Referral Form.
    2. If the expectant parent is a nonminor dependent (NMD), they must sign a DCFS 565, Authorization for Disclosure of Medical Information for Participation in the Nurse Family Partnership Program.
    3. Give the completed form(s) to the PHN to submit. The NFP Program will send an enrollment status letter and quarterly updates to the PHN.
  12. Refer the minor/NMD and their caregiver to community resources, as needed or requested.
  13. For dual supervised minors (DCFS and Probation) or for previous probation minors, refer to the Placement Permanency and Quality Assurance (PPQA) unit via the minor’s Deputy Probation Officer (DPO).
APPROVALS

SCSW Approval

  • Review and approve DCFS 5540

ARA Approval

  • Review and approve DCFS 5540

RA Approval

  • Review and approve DCFS 5540
HELPFUL LINKS

Attachments

California Expands Access and Protections for Reproductive Health Care

Discussion Questions for Pregnant Minors/NMDs

Expectant Parent and Parenting Support Hub

Expectant Parent Payment Memo

Expectant Parent Payment Toolkit

FFPSA Evidence Based Practices Desk Guide

Foster Youth Rights Handbook 

Guide for Case Managers: Assisting Foster Youth with Healthy Sexual Development and Pregnancy Prevention

If You Are in Foster Care, You Have Rights! (Middle Adolescents)

If You Are in Foster Care, You Have Rights! (TA/Young Adult)

If You Are in Foster Care, You Have Rights! (Teen/Early Adolescents)

Know Your Rights for Sexual Health Services and Sexual Health Services Available at the Medical Hub Clinics

Overview of Adolescent Health Information Forms

Referral to LA County Home Visiting Program

Reproductive Health and Parenting Resources for Teens in LA County

Resources for Parenting Foster Youth

SB 89 Quick Reference Guide – A DCFS Caseworker Toolkit

Youth Brochure: Know Your Sexual and Reproductive Health Rights

Forms

LA Kids

ABCDM228, Applicant's Authorization of Release of Information

ABCDM228, (Sp), Applicant's Authorization of Release of Information

DCFS 174, Family Centered Referral and Services Form

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

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

DCFS 229, Permission from Youth to Share Reproductive Health-Related Information

DCFS 565, Authorization for Disclosure of Medical Information for Participation in the Nurse Family Partnership Program

DCFS 5540, Special Payment Authorization/Request

FCSS Automated 280

Parenting Youth or Nonminor Dependent (NMD) Consent to Document and Share Her/His Non-Dependent Child's Health Information

REFERENCED POLICY GUIDES

0050-501.10, Child Abuse and Neglect Reporting Act (CANRA)

0050-502.10, Child Protection Hotline (CPH)

0070-520.10, Safely Surrendered Babies (SSB)

0070-548.01, Child and Family Teams

0070-560.05, Joint Response Referral: Consulting with PHN

0080-502.10, Case Plans

0100-510.40, Services for Minor and Nonminor Dependent (NMD) Parents

0200-508.10, Relinquishment Procedures and the Statement of Understanding

FYI 16-19, CWS/CMS 7.4 Code Drop Summary

FYI 20-17, Foster Care Search System Automated 280 (FCSS Auto 280 – Infant Supplement Update

FYI 22-03, Expectant Parent Payment (EPP)

FYI 22-19, Youth Reproductive and Sexual Health Rights

STATUTES AND OTHER MANDATES

All County Information Notice (ACIN) No. I-73-16 (October 19, 2016) - Provides guidance regarding how to document minor and NMD parents in CWS/CMS.

All County Letter (ACL) 14-38 (June 16, 2014) – Summarizes the requirements as outlined in Senate Bill (SB) 528 regarding the rights of foster children, ages 12 and older, and NMDs in out-of-home care. SB 25 permits a social worker to provide dependent children and NMDs with age-appropriate, medically accurate information about sexual development, reproductive health, and prevention of unplanned pregnancies and sexually transmitted infections on an ongoing basis.

ACL 16-31 (April 22, 2016) - States that caregivers to use the reasonable and prudent standard, and defines the reasonable and prudent parent standard under federal law.

ACL 18-61 (June 20, 2018) – Authorizes social workers to inform a youth or NMD in foster care, beginning at age ten (10), of his/her rights regarding sexual and reproductive health care.

ACL 21-123 (October 8, 2021) – New expectant parent payment

Civil Code (CIV) Section 56.103 – Allows CSWs to receive Protected Health Information (PHI) related to service coordination, delivery, and treatment for foster youth.

Family Code (FAM) Section 6925 – A minor may consent to medical care related to prevention or treatment of pregnancy, except sterilization. A minor may receive birth control without parental consent.

FAM Section 6926 – A minor who is 12 years of age or older may consent to medical care related to the diagnosis, treatment, or prevention of a sexually transmitted disease.

FAM Section 6928 - A minor who is alleged to have been sexually assaulted may consent to medical care related to the diagnosis and treatment of the condition, and the collection of medical evidence with regard to the alleged sexual assault.

Welfare and Institutions Code (WIC) 369 – If a dependent child is 12 years of age or older, his or her social worker is authorized to inform the child of his or her right as a minor to consent to and receive those health services, as necessary. Social workers are authorized to provide dependent children access to age-appropriate, medically accurate information about sexual development, reproductive health, and prevention of unplanned pregnancies and sexually transmitted infections.

WIC 16001.9 - States minor's and NMD's rights.

WIC 16002.5 - States in part that complete and accurate data on parenting minor and NMD parents is collected.

WIC 16521.5 - States in part that adolescents, including NMDs, are to receive age-appropriate pregnancy prevention information to the extent state and county resources are provided.