Youth Reproductive Health and Pregnancy
0600-507.10 | Revision Date: 8/26/2022

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/NMDs.

Table of Contents

Version Summary

This policy guide was updated from the 02/04/19 version, to include information and procedures regarding the expectant parent payment that will be available to pregnant minors and nonminor dependents (NMDs) three months prior to the expected due date, per Assembly Bill (AB) 153. This payment will be in addition to the infant supplement payment, which begins the month of birth.

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.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:The prevention or treatment of pregnancy, including contraception, at any age.Abortion, at any age.Diagnosis and treatment of sexual assault, at any age.The prevention, diagnosis, and treatment of STIs, at age twelve (12) and older. The right to access age-appropriate, medically accurate information about reproductive and sexual health care without discrimination or harassment, including but not limited to:The prevention of an unplanned pregnancy, including abstinence and contraception, at any age.Abortion care and other pregnancy services, at any age.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.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, examinations and/ or treatment by a medical provider shall be private unless the minor/NMD specifically requests otherwise.
  2. The right to be provided transportation to reproductive and sexual health-related services in a timely manner.
  3. The right to obtain, possess and use contraception of his/ her choice, including condoms.
  4. The right to storage space and to be free from unreasonable searches of his/ her belongings. Contraception cannot be taken away as part of a disciplinary measure or for religious beliefs, personal biases and/ or judgments of another individual.
  5. 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, to speak to representatives of these offices confidentially, and to be free from threats or punishment for making complaints.
  6. 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.

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.

Pregnancy Prevention & Avoiding Sexually Transmitted Infections

CSWs are permitted to distribute condoms to dependent DCFS minors/NMDs in foster care. CSWs should consult with the manager of their respective DCFS office on the availability of condoms for distribution to minors/NMDs and seek guidance from their assigned SCSW and PHN on how to provide an educational context for the minor/NMD receiving condoms. CSWs can also refer minors/NMDs to the condom project for free condoms.

DCFS and Department of Public Health (DPH) Public Health Nurses (PHNs) are available for consultation with the CSW, for direct consultation with the minors/NMD, and for joint response or collaborative planning regarding all 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. 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 her pregnancy is a very personal decision and the CSW must support the minor/NMD's decision without expressing personal bias or attempting to influence her 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 her 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 her in making a decision, such as her partner, family, friends, clergy, or a professional counselor.

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
  • Following guidelines for nutrition during pregnancy
  • Getting enough rest
  • Regular exercise

If a minor/NMD thinks they are pregnant, they should talk with their health care provider before taking any medications. 

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, ensure that the minor/NMD's transportation needs are met, including transporting their, 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 shall ensure that the minor/NMD is able to obtain the services in a timely manner. 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.

Family planning clinic staff will answer questions about types of abortions, fees, and services available. The cost of abortion is covered by Medi-Cal. Counseling for minors/NMDs considering abortion is available at the Planned Parenthood or a Los Angeles County Health Clinic.

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. 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. 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

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 and a Public Health Nurse (PHN) co-located in the CSW’s office will have a collaborative planning meeting with the minor/NMD. 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. 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. During a CSW/PHN joint visit, the PHN will make skilled observations of the minor/NMD’s general health, nutritional, and developmental status through the use of the Home Visit Observations Attachment to the Home Visitation Guidelines. All health information will be entered into the minor/NMD’s Health and Education Passport. 

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) program services if they meet all of the following criteria:

  • Is receiving DCFS services
  • Is pregnant for the first time
  • Is no more than twenty-four (24) weeks pregnant
  • 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.

If NFP is not an option, 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.

Expectant and Parenting Youth (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. EPY Conferences focus on planning for healthy parenting, identifying appropriate resources and services, and preparing for a successful transition to independence.

The Child Welfare Health Services Section, Expectant and Parenting Youth (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 and melenaa@dcfs.lacounty.gov.

Expectant Parent Payment

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 that receives the payment is not required to submit any accounting or receipts to show how the funds are utilized. All items bought with these funds are the property of the minor/NMD and go with them if/when they change facilities or age out.

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.
  • Funds may also be used for a birth preparation or parenting class.

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

The EPP takes the place of 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 are to 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.

Eligible minors/NMDs must be in formal placement. 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. Expectant parent payments are not available for minors/NMDs in the Adoption Assistance Program and the Kinship Guardianship Assistance Payment Program. Pregnant minors/NMDs residing in the home of one or both parents (HOP) are not eligible to receive EPP payments. However, they are 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. A verification of pregnancy letter from a qualified medical provider, reflecting the Expected Delivery Date, must be submitted as a part of the application.

Pregnant minors/NMDs residing in the home of one or both parents (HOP) are not eligible to receive EPP payments. However, they are eligible to receive financial assistance from the Department of Public Social Services (DPSS).

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 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.

Documentation of Pregnancy and Parenting in CWS/CMS for Minor and Nonminor Dependents

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

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.

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.

Entering Pregnancy Information as an Observed Condition

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 Health 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.

Entering Pregnancy Information as a Diagnosed Condition

Entering the pregnancy as a diagnosed condition is necessary when the minor/NMD has been hospitalized as a result of the pregnancy. If a minor or NMD has been hospitalized for a health issue related to the pregnancy, such as a pregnancy complication or due to giving birth to a child, 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.

If a minor/NMD is hospitalized for a pregnancy related issue, please follow the instructions listed under Assisting a Pregnant Minor/NMD that shows how to properly capture this information. Whenever possible, minors/NMDs should be consulted prior to the disclosure of any pregnancy-related information, including that of pregnancy related hospitalizations.

Entering Parenting Information in CWS/CMS for Minors and NMDs

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

CSWs should make a report to 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 either case, 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 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.

Age Difference

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

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

Sexual Activity that is Coerced or in any Other Way 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 that Involves 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 should 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

Prevention of Unintended Pregnancy for Minors and NMDs

CSW Responsibilities

  1. Provide a copy of 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.
  2. 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.
  3. Reproductive and sexual health care.
  4. Unplanned pregnancy prevention, including abstinence, and use of birth control.
  5. Options regarding pregnancy, including abortion.
  6. Prevention and treatment of STIs.
  7. 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.
  8. Inform the minor/NMDof their right to consent at age 12 or older to the prevention, diagnosis, and treatment of STIs.
  9. Inform the minor/NMD about their confidentiality rights regarding medical services and seek the youth's and 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.)
  10. Ensure the minor/NMD is up-to-date on their annual medical appointments.
  11. Ask the 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.
  12. Personal biases and/ or religious beliefes will not be imposed upon the minor/NMD.
  13. 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.
  14. Providethe minor/NMD with the youth-friendly brochure, "Know your Sexual and Reproductive health Care Rights."
  15. 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.
  16. Provide pregnant minor/ NMD with Reproductive Health and Parenting Resources for Teens 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.
  17. Document in the Case Plan any measures taken towards ensuring that items #1 through -#7 under, "Reproductive and Sexual Health Care and Related Rights for Minors and NMDs" 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:
  2. With the minor/NMD's written consent, immediately inform PHN about the pregnant minor/NMD.
  3. Document in the Health Notebook the pregnancy as an observed condign.
  4. Click on the Observed Condition page tab.
  5. To add an Observed Condition, click the "+" in the Observed Condition grid to create a new row, and complete all known and mandatory fields.
  6. Under Condition, select Physical Health from the Category dropdown list and Pregnant from the Health Problem dropdown list.
  7. Add any known contact information regarding the pregnancy related health care provider in the Description box under the Health Problem dropdown list.
  8. Any condition with the Alert box selected will populate in the Health and Education Passport (HEP).
  9. If the minor/NMD is hospitalized for a pregnancy related issue, in the Health Notebook:
  10. Click on the Diagnosed Condition page tab.
  11. To add a Diagnosed Condition, click the "+" in the Diagnosed Condition grid to create a new row, and complete all known and mandatory fields.
  12. Under Condition, select Physical Health from the Category dropdown list and Pregnant from the Health Problem drop down list.
  13. Add a Health Problem Description.
  14. Click on the Hospitalization page tab.
  15. To add a Hospitalization, click the "+" in the Hospitalizations grid to create a new row.
  16. You will be prompted to Select Client Condition.
  17. Select the applicable Client Condition (Pregnant) from the Client Condition list.
  18. Click "Ok".
  19. Complete all known and mandatory fields.
  20. In the Hospitalization Comments, include information about the reason for the hospitalization. Examples may include severe morning sickness, premature labor, high blood pressure, or facts of the birthing including, but not limited tom if the youth gave birth via a caesarean section, any birthing complications and information about the baby (e.g. names, weight, length, date of birth, apgars, etc.), etc.
  21. 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
  22. Reassure the minor/NMD that they will receive CSW support no matter their choice.
  23. 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.
  24. Refer the minor/NMD to Planned Parenthood, a Los Angeles County Health Clinic and/or a primary physician to further discuss her 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.
  25. Inform the minor/NMD of their right to confidentiality.
  26. 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.
  27. 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.
    • If the minor/NMD agrees, submit the DCFS 174 requesting the EPY Conference via the referral portal to "PPT/EPY."
  28. Inform the minor/NMD of the Safe Haven law.
  29. If the minor has an open referral, arrange for a joint response with a PHN.
  30. For DCFS-supervised minor/NMD, follow the relevant guidelines, depending on their decision:
  31. 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.
  32. 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.
  33. If a minor/NMD’s open referral is promoted to a case, incorporate financial and medical assistance, as well as pregnant teen programs, into the case plan. Follow the procedures set forth in For a Pregnant Youth under DCFS Supervision.
  34. 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 not revealing her pregnancy status may lead to a placement move.
    • 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.
  35. Obtain the required verification and refer the pregnant minor/NMD for the Expectant Parent Payment.
  36. At each subsequent home visit:
  37. Determine whether the minor/NMD and their family are using the referred resources.
  38. Document that information in the Contact Notebook.

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 requests it:
    • Assist them in making adequate arrangements for the abortion procedure and adequate recovery time.
    • Transport them to and from the location where the abortion procedure will occur.
  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 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. 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. If the minor/NMD expresses interest regarding adoption, with the minor/NMD's consent, request assistance from a Resource Family Support Permanency Division CSW to 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.
  5. Inform the minor/NMD that there are two methods for legal adoption in California.
  6. 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 number of the main CLC number.
  7. Assist the minor/NMD in contacting the father and obtaining his consent for the adoption. 
    • If the baby’s father is known, the father 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 biological father 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 the Nurse Family Partnership (NFP) Program. If they qualify and agree to participate:
  12. Complete the NFP Referral Form.
  13. 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.
  14. 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.
  15. Refer the minor/NMD and her caregiver to community resources, as needed or requested.
  16. 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).

Continuing a Pregnancy

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 her 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 her 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 family for an EPY Conference .
  5. Assess the minor/NMD’s need for health, financial, placement/housing, and education resources.
  6. Document assessments in CWS/CMS Contact Notebook with the minor/NMD's consent
  7. Document assessments on the "Observed Condition" tab of CWS/CMS when the minor/NMD's consent has not been given.
  8. Once the minor/NMD decides to keep the baby, talk to them about the Nurse Family Partnership (NFP) Program.  If they agree to participate and qualify for the program:
  9. Complete the NFP Referral Form.
  10. If the expectant parent is a nonminor dependent, she must sign a DCFS 565, Authorization for Disclosure of Medical Information for Participation in the Nurse Family Partnership Program.
  11. 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 to the Adolescent Family Life Program (AFLP).
  13. Refer the minor/NMD and her caregiver to community resources, as needed or requested.
  14. 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.
  15. 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.
  16. Consult with the minor/NMD about identifying and contacting the father. If appropriate attempt to identify and locate the biological father. If identified, ensure that he is added to the family in the Client Notebook.
  17. With the pregnant minor/NMD’s consent, and if the biological father is willing, initiate face-to-face contact with them.
    • Document the contact or attempted contact in the Contact Notebook.
  18. If the father is a DCFS-Supervised minor/NMD, provide them with referrals to community-based programs such as AFLP.  If the father is a probation youth, provide referrals via the Deputy Probation Officer (DPO).
  19. 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.
  20. Refer the minor/NMD to EPP.
  21. Following the child's birth, ensure a referral is made for an Infant Supplement. The minor/NMD is eligible for this funding for their child until their case closes.
  22. Following the child's birth document parenting information into CWS/CMS utilizing the instructions in ACIN I-73-16.

PHN Responsibilities

  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:
  2. Pregnant Youth – Referred to the NFP Program
  3. Pregnant Youth – Status of referral to the NFP Program
  4. Client accepted into NFP
  5. Client was not accepted into NFP
    • Did not meet intake criteria
    • Refused
    • No NFP capacity in geographical area
  6. Pregnant Youth – Not referred to the NFP Program
  7. Does not meet eligibility criteria
  8. Referred to Prenatal Care provider (list provider name)
  9. Youth declined
  10. Referred to other home visiting program (list program name)
  11. Include the date when the action was taken or the notification was received on the Special Projects Page.
  12. List the provider’s name in the Comment section.

Expectant Parent Payment (EPP) During a Minor's Pregnancy and Infant Supplement Following the Birth of a Child

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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.

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
APPROVALS

SCSW Approval

  • Review and approve DCFS 5540

ARA Approval

  • Review and approve DCFS 5540

RA Approval

  • Review and approve DCFS 5540
HELPFUL LINKS
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, Teen Parents in Foster Care and DPSS Services Assessment

0200-508.10, Relinquishment Procedures and the Statement of Understanding

STATUTES AND OTHER MANDATES

All County Information Notice (ACIN) No. I-73-16 (October 19, 2016) - Provides guidance regrading 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.

Welfare and Institutions Code (WIC) 16001.9 - States minor's and NMD's rights.


Welfare and Institutions Code (WIC) 16002.5 - States in part that complete and accurate data on parenting minor and NMD parents is collected.

Welfare and Institutions Code (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.