Cuyahoga County Department of Children and Family Services (CCDCFS) Policy Statement Policy Chapter: Child Health Care Policy Number: 9.00.01 Policy Name: Comprehensive Health Care for Children in Placement Approved By: Richard B. Werner, Interim Director Effective Date: 01/01/2006 Review Date(s): 06/15/2011 Revision Date(s): 07/18/2011 PURPOSE: To ensure that all children in the custody/placement of the Cuyahoga County Department of Children and Family Services (CCDCFS), receive triage examinations, comprehensive medical care/physical examinations, routine and non-routine health care consistent with the regulations set forth in Ohio Administrative Code (O.A.C.) Rule 5101:2-42-66.1 Comprehensive Health Care for Children in Placement. SCOPE: This policy applies to all children in CCDCFS Custody. POLICY A. All children while in CCDCFS custody/placement shall receive triage examinations, comprehensive medical care/ physical examinations, routine and non-routine health care pursuant to Ohio Administrative Code (O.A.C.) Rule 5101:2-42-66.1 Comprehensive Health Care for Children in Placement. B. It is the responsibility of the worker of record (WOR) to ensure that all health care required for children on his or her caseload be scheduled and completed in a timely manner. C. To prevent duplication of health care, the WOR is to document all provided treatment of the child within the State Automated Child Welfare Information System (SACWIS). D. Whenever possible, CCDCFS shall attempt to arrange for health care from the child s existing and previous medical providers as well as involve the parent, guardian, or custodian in the planning and delivery of health care services. E. A licensed medical provider (LMP) must provide health care services. A LMP is defined as: a. licensed physician/ psychiatrist b. an advance practice nurse 1
c. registered nurse d. licensed practical nurse e. physician assistant f. licensed/certified physical, occupational, or speech therapist g. licensed/certified nutritionist/dietician F. The WOR should make every effort to keep the parent(s), guardian, or custodian informed of the physical health care, mental health care, and developmental care provided to the child during the child s substitute care placement. Such information should be shared with the parent(s), guardian, or custodian, after triage, or when a medical emergency occurs at the time of the incident. All other treatment should be shared within one week depending on the severity, through face-to-face, or telephone contact. G. Also, the parent(s), guardian, or custodian should be updated on the child(ren)s health in writing no less than every six months, or at the time of each semiannual administrative review (SAR). It is the responsibility of the WOR to make every effort to ensure the parent(s), guardian or custodian are informed, consulted, and provide consent (if necessary) anytime a child in substitute care experiences a serious health, mental health, and/or medical emergency. H. The WOR should make every effort to provide a copy of a child s health care record, prepared pursuant to O.A.C. Rule 5101:2-42-66.2, to any and all medical personnel providing ongoing health care services to the child. I. In emergencies, seek medical attention at an emergency room of any hospital. PROCEDURES TRIAGE EXAMINATIONS A. Prior to placement, the WOR shall secure a triage examination (placement medical screening) of the child in order to prevent possible transmission of common childhood communicable diseases and identify any symptoms of illness, injury, or maltreatment. This triage examination is to be preformed by a LMP. Triage examinations shall occur each time a child in CCDCFS custody is moved to another placement, and/or there are concerns regarding the care of the child or being moved from cottage to cottage within a facility; unless the child is being released from or taken to a hospital/medical care facility. The WOR shall present the LMP with a copy of the Triage Report Form (available on the intranet under Health Care Forms) for completion by the LMP examining the child. 2
The WOR/PW is to receive a copy of this form from the provider, and follow all directions of the LMP. In instances where the child is taken into CCDCFS custody directly from a hospital setting, the WOR/PW should request a discharge summary from the LMP indicating what the child was hospitalized for, and any relevant medical issues. B. Health Care information about the child is to be documented in the case record within COMPREHENSIVE HEALTH CARE/ PHYSICAL EXAMINATIONS A. Within sixty (60) days of placement with a substitute caregiver, all CCDCFS children under age three (3) shall be referred by their assigned WOR to the Help Me Grow (HMG) program for a developmental screening. The purpose of the HMG developmental screening is to identify children needing further evaluation and/or services for developmental delays and disabilities. CCDCFS WOR shall refer all non-custody children under age three (3) for Help Me Grow services as well. B. The WOR shall be responsible for the supervision of comprehensive health care including a physical health examination, vision/hearing/dental assessments, as well as developmental and psychological assessments, for each child in their care or custody and placed in substitute care. Timeframes for comprehensive health care shall be pursuant to O.A.C. Rule 5101:2-42-66.1 or per the orders of the LMP. 1. The WOR shall arrange for and secure a comprehensive physical examination for each child no later than sixty (60) days after the child's placement into substitute care. CCDCFS shall secure an annual physical examination no later than thirty (30) days from the anniversary date of the child's last comprehensive physical examination. 2. The WOR shall arrange for and secure an initial vision assessment no later than sixty (60) days after the child's placement into substitute care. CCDCFS shall secure reexaminations per the timeframe recommended by the optometrist/ophthalmologist, or whenever a condition of visual impairment indicates a need for treatment; a licensed optometrist or ophthalmologist shall perform all treatment. 3. The WOR shall arrange for and secure an initial hearing assessment no later than sixty (60) days after the child's placement into substitute care. CCDCFS shall secure reexaminations per the timeframe recommended by the audiologist; or whenever a condition of hearing impairment indicates a need for treatment. All treatment shall be performed by a LMP or licensed audiologist. 4. The WOR shall arrange for and secure an initial dental assessment for a child over three years of age no later than one hundred and eighty (180) days after the child's placement into substitute care. CCDCFS shall secure annual dental reexaminations no later than thirty (30) days from the anniversary date of the child's last dental examination, or per 3
the timeframe recommended by the dentist. Treatment shall also be provided whenever a dental condition indicates a need for treatment. A licensed dental professional shall perform all dental treatment. C. For every child placed in substitute care, the WOR shall attempt to determine if the parent(s), guardian, or custodian has health care insurance coverage available to the child. If such insurance coverage is available, CCDCFS shall attempt to make use of this resource, as appropriate, to help meet the child's health care needs. D. Upon initial custody of the child (ren), the WOR must complete and submit a Healthy Start application to the CCDCFS Legal Department. In addition, within three (3) days of initial custody, the WOR must submit an IV-E application for the child (ren), to their supervisor for approval. The IV-E department is responsible to assess the child's eligibility for Medicaid, Title IV E, and supplemental security income, or other assistance programs that might provide financial assistance to help meet the child's health care needs. When CCDCFS petitions for custody, it shall also request financial support for comprehensive health care, if applicable. When a child has been determined Medicaid eligible and CCDCFS is unable to secure comprehensive health care by a Medicaid provider within the timeframe specified in (B) of this policy, the WOR shall remain responsible for securing comprehensive health care through an alternative provider and document why an alternative provider was used in the case record. E. WOR shall arrange for and secure appropriate immunizations for each child entering substitute care. If a child's record of previous immunizations is unavailable at the time of the comprehensive physical exam, and it is reasonable to assume that the child has received immunizations, WOR may postpone immunizing the child until a record of the child's immunizations is available for review. This postponement is not to exceed thirty (30) days from the physical examination, or the directions of a LMP. F. All infants age two and under shall receive required pediatric care as prescribed by a LMP according to the schedule recommended by the American Academy of Pediatrics, or per the directions of the current treating LMP. G. CCDCFS responsibility to providing health care pursuant to this rule is waived when a child leaves the placement within the sixty (60) day timeframe pursuant to paragraph (B) of this policy. H. The WOR shall work actively to involve the parent, guardian, and custodian or substitute caregiver in the planning and delivery of physical health examination, developmental and psychological assessments for children in custody. I. Health Care information about the child is to be documented in the case record within 4
ROUTINE HEALTH CARE A. All routine or minor office health care/treatment for children in CCDCFS custody shall be provide with the Consent for Routine/Minor Office Health Care/Treatment (ap144a) form. The ap144a pre-approves all routine or minor office health care for CCDCFS custody children; prior contact with CCDCFS is not needed at the time of the medical appointment. Also, the parent(s), guardian, or custodian should be updated on the child s health in writing no less than every six months, or at the time of each semiannual administrative review (SAR). Routine or minor office health care shall be defined as: physical exams; childhood immunizations (including influenza, H1N1, Hepatitis B and Tetanus shots); routine medications; short-term medications for non-acute/non-chronic conditions; birth control medications/devices/implants; routine laboratory work/testing; preventative/routine dental care and treatment; routine hearing services; routine vision services; and minor sutures/incisions/drainage. B. Health Care information about the child is to be documented in the case record within NON-ROUTINE HEALTH CARE A. All non-routine health care / treatment for children in CCDCFS custody require the prior written consent of CCDCFS. The Consent for Non-Routine Health Care/ Treatment (ap144b) form is used to provide written authorization in the event a CCDCFS child requires this type of care / treatment. Authorization for non-routine health care / treatment shall only be granted by CCDCFS personnel at the Senior Manager level or above, and by CCDCFS KIDS Hotline supervisors for authorizations required after regular business hours, or on weekends and holidays. Authorization should only be provided after receipt of the completed Surgical, Invasive, and NON-Routine form (available on the intranet under Health Care Forms) request form from a LMP. Also, the parent(s), guardian, or custodian should be updated on the child s health in writing no less than every six months, or at the time of each semiannual administrative review (SAR). Non-routine health care / treatment is defined as, but not limited to: all surgical, invasive and/or experimental procedures, procedures/treatments requiring sedation or general anesthesia, hospital admissions; treatment of acute, chronic conditions; all psychotropic, acute care, long-term, experimental, or high-risk medications; HIV/AIDS testing (SEE CCDCFS POLICIES ON HIV TESTING); extensive dental or orthodontia treatments; and subspecialty referrals or treatments. B. All children on psychotropic medications should have a psychological evaluation. (SEE CCDCFS Policy ON PSYCHIATRIC SERVICES) C. Health Care information about the child is to be documented in the case record within 5
RESOURCES Should the WOR or substitute caregiver need assistance with identifying a qualified LMP that accepts fee-for-service Medicaid, and/or with scheduling the comprehensive physical examination, the following numbers can be called for assistance this list is not inclusive: - University Hospitals Health System (216) 844-7553 (844) 552-8338 - The Metro Health System (216) 778-4700 (866) 260-5376 - St. Vincent Charity Hospital (216) 861-6200 (800) 451-8128 When calling the above numbers for assistance, the substitute caregiver should identify the child as being in the custody of CCDCFS. SEE ALSO: CCDCFS POLICIES: POLICY No. 5.02.01 Case Review Staffing & Semi Annual Administrative Review POLICY No. 9.00.02 Help Me Grow Services OHIO ADMINISTRATIVE CODE: 5101:2-42-66.1 Comprehensive Health Care for Children in Placement 5101:2-42-66.2 Documentation of Comprehensive Health Care for Children in Placement 6