4517. Health Care Services for Children Placed in Out-of-Home Care

Original Date: September 27, 1995

Revised Date: July 1, 2024

Sunset Review Date: July 31, 2028

Approved by: Vickie Ybarra, Assistant Secretary for the Partnership, Prevention, and Services Division

Purpose

This policy provides guidance on verifying children and youth in out-of-home placement receive routine and necessary health care to meet their health and well-being needs, including, but not limited to:

Initial Health Screens to identify and address emergent medical needs at the time of placement.
Required Early and Periodic Screening, Diagnosis and Treatment (EPSDT) visits.
Immunizations.
Mental health services.
Substance Use Disorder (SUD) services.
Dental examinations.

Scope

This policy applies to DCYF child welfare employees.

Laws

RCW 9.02.110 Right to have and provide

Chapter 13.34 RCW Juvenile Court Act-Dependency and Termination of Parent-Child Relationship

RCW 13.34.060 Shelter care-Placement-Custody-Duties of parties

RCW 13.34.069 Shelter care-Order and authorizations of health care and education records

RCW 13.34.315 Health care-Evaluation and treatment

RCW 74.14A.050 Identification of children in a state-assisted support system-Program development for long-term care-Foster care caseload-Emancipation of minors study

42 CRR Part 441(B) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21

Policy

Caseworkers must:
1. Prior to the shelter care hearing:
  1. Inform parents or guardians, before authorizing evaluations and treatment for children’s and youth’s routine and necessary health care appointments, i.e., Initial Health Screens, physical or emotional health, emergency care, and dental, unless they cannot be reached.
  2. Provide parents and guardians the opportunity to attend any health care appointments, unless prohibited by a court order.
2. Throughout the life of the case:
  1. Make reasonable efforts to allow parents and guardians an opportunity to attend health care appointments, unless prohibited by a court order.
  2. Identify and address the children’s and youth’s health care needs and appointments, including, but not limited to their:
    1. Physical health.
    2. Mental health. Youth age 13 and older:
      1. May obtain mental health treatment on their own.
      2. Must provide consent for DCYF to access their mental health records.
    3. Substance use disorder (SUD) treatment:
      1. Youth 13 and older may obtain SUD treatment on their own.
      2. Children and youth of any age must provide consent for DCYF to access their SUD records.
    4. Dental care
    5. Treatment recommendations
Child health and education tracking (CHET) screeners must follow, the:
1. CHET handbook for notification to caseworkers of the child’s or youth’s scheduled health appointments
2. CHET policy for the required EPSDT visits for children and youth when they are placed in out-of-home care.

Procedures

Caseworkers must complete the following for children and youth when they are placed in out-of-home care:
1. Inform parents and guardians:
  1. At the time of removal, they:
    1. Will be notified of health care appointments scheduled for their children or youth prior to the shelter care hearing.
    2. May attend appointments until the shelter care hearing, unless prohibited by a court order.
  2. How they may attend and participate in health care appointments throughout the life of the case, unless it is prohibited by a court order or law enforcement investigation, or it is unsafe.
  3. Of the dates, times, and locations of health care appointments, by:
    1. Phone
    2. Email
    3. Mail, when they cannot be reached through phone or email.
2. Consult with the assistant attorney general (AAG) if there are safety concerns related to the parent or guardian attending health care appointments.
3. Obtain physical health, mental health, dental, and immunization history from their:
  1. Parents or guardians using the Family Genetic and Medical History DCYF 13-041 form.
  2. Health care providers and document following Procedures Section 5.
4. Follow the DCYF Administrative 6.04 Supporting LGBTQIA+ Individuals policy when children and youth are seeking gender-affirming medical services.
5. Identify health care needs. If they have:
  1. An emergent health care need, verify they are taken to urgent care or the emergency department immediately to be evaluated.
  2. A non-emergent illness, chronic health issue, injury, or health concern verify they are taken to their health care provider for an Initial Health Screen to be evaluated, no later than five calendar days of entering out-of-home care. These children and youth must still have their required EPSDT within 30 days to complete the CHET requirement.
  3. No known medical needs, coordinate with CHET screeners to schedule the required EPSDT as soon as possible.
6. Obtain consent from:
  1. Parents or guardians using the Consent DCYF 14-012 form for children or youth that are not legally-free and under age:
    1. 13, for psychotropic medications.
    2. 18, for:
      1. Medical treatment requiring surgery, except for surgeries related to abortions as no consent is required.
      2. Anesthesia.
  2. Court order if the parents or guardians are not:
    1. Available to provide consent.
    2. In agreement with the health care provider’s recommendation and unwilling to provide consent.
7. Follow the Consent Decision Tree DCYF CWP_0006 publication to obtain or release children’s and youth’s protected health information.
8. Collaborate with health care providers, parents or guardians, and caregivers to verify health care needs are followed up on and met.
9. Provide caregivers with their known health care information, per the Notification of Court Hearings, Providing Reports to Court, and Information Sharing with Out-of-Home Caregivers policy.
10. Verify they are current on their immunizations. If they are not, caseworkers must:
  1. Coordinate with the children’s or youth’s caregiver and health care provider to get current with their vaccinations.
  2. Complete the following if the parents or guardians do not want them immunized:
    1. Refer them to RCW 28A.210.090.
    2. Contact the AAG to discuss whether a court order is needed.
General Medical Appointments
Caseworkers must:
1. Follow the Placement Out-of-Home policy for documentation requirements for emergent and non-emergent placements of children and youth to initiate:
  1. The CHET process.
  2. Apple Health Core Connections (AHCC) or Fee-For-Service (FFS) Medicaid coverage.
2. Collaborate with CHET to verify the required EPSDT visit is completed within 30 calendar days of being placed in out-of-home care, per the CHET policy.
3. Verify children or youth:
  1. Participate in their ongoing EPSDT visits, per the EPSDT schedule.
  2. Obtain medical treatment as needed and that all recommended treatments and medical appointments occur.
4. Obtain medical records or visit summaries.
5. Provide parents, guardians, and caregivers the medical records or visit summaries.
6. Assist parents, guardians, and caregivers with:
  1. Obtaining recommended services for the children and youth.
  2. Utilizing the Medicaid managed care plan for children and youth as needed to:
    1. Locate providers.
    2. Receive care coordination related to physical or behavioral health needs.
7. Follow the recommendations from the Ongoing Mental Health (OMH) Screening Report DCYF 15-434 form. OMH is a follow up screening to the CHET that occurs for eligible children and youth that have been in out-of-home care for at least six months.
Dental Examinations
Caseworkers must complete the following for children and youth in out-of-home care:
1. Coordinate with CHET screeners to verify dental appointments are scheduled within the first 30 calendar days of out-of-home care. The initial exam must occur no later than their 60th day of placement, unless CHET screeners obtain dental records showing they had their routine dental exam within six months of their out-of-home placement, then their next dental appointment may be scheduled six months from their last dental exam.
2. Verify they receive dental visits every six months beginning at one year of age or at the eruption of their first tooth, whichever comes first.
3. Obtain dental exam results following each appointment and follow recommended treatments.
4. Provide parents, guardians, and caregivers dental examination results and assist them in obtaining recommended services for the children and youth.
5. Follow the Meeting Dental Treatment Needs for Children and Youth in Out-of-Home Placement document.
Consent for other than Routine or Necessary Medical Treatment
Caseworkers must complete the following for children and youth that are not legally-free:
1. Assist health care providers in obtaining a signed consent from the parents or guardians for medical needs other than routine or necessary emergency care. Including, but not limited to:
  1. Surgery, except for surgeries related to abortions.
  2. Anesthesia.
  3. Medical procedures.
2. When parents or guardians are not available or unwilling to provide consent:
  1. Obtain a statement from the health care provider detailing the risks and benefits of the procedure or anesthesia.
  2. Request a court hearing.
  3. Provide the court the health care provider’s statement, for the court to determine whether the procedure or anesthesia will occur.
Documentation
1. Caseworkers must:
  1. Follow the Documentation policy for documentation timeframe requirements.
  2. Document:
    1. Efforts made to inform the parents or guardians of health care appointments in case notes.
    2. The following for children and youth on the Health/Mental Health Pages in FamLink and in the court report:
      1. Dates of all physical health, mental health, and dental appointments
      2. Physical health, mental health, and dental conditions or diagnoses.
      3. Results of EPSDT visits and other physical health, mental health, and dental appointments.
  3. Verify the CHET and EPSDT information is documented in a Shared Planning Meeting.
  4. Upload received physical health, mental health, and dental records into FamLink.
2. CHET screeners must:
  1. Document the EPSDT visit that occurs within the first 30 days of out-of-home placement on the Health/Mental Health Pages in FamLink.
  2. Upload the EPSDT visit summary into FamLink.

Forms

Family Genetic and Medical History DCYF 13-041

Consent DCYF 14-012

Foster Care Initial Health Screen DCYF 13-843 (located on the DCYF forms repository)

Ongoing Mental Health (OMH) Screening Report DCYF 15-434

Resources

Access to Baby and Child Dentistry (ABCD)

Apple Health Core Connections (AHCC) will help you connect with appropriate providers to meet the child or youth’s physical and behavioral health care needs.

Phone: 1.844.354.9876, then press 1 and enter extension 6102194 (8am-5pm M-F) or

Email AHCCTeam@coordinatedcarehealth.com (anytime)

AHCC 24 hour Nurse Line 1.844.354.9876, dial 2 for Member Services and listen for the Nurse Advice option

CHET handbook (located on the DCYF intranet under Programs and CHET)

Child Health and Education tracking (CHET) policy

Consent Decision Tree DCYF CWP_0006 publication

Court Report policy

DCYF Administrative 6.04 Supporting LGBTQIA+ Individuals policy

Documentation policy

Health Care Authority (HCA) Foster Care Medical Team (FCMT) 1.800.562.3022 or

Fostering Well-Being Unit 360.725.2626 or fwb@dshs.wa.gov

Meeting Dental Treatment Needs for Children and Youth in Out-of-Home Placement (located on the DCYF intranet under Programs and Health Care Services & Programs)

Notification of Court Hearings, Providing Reports to Court, and Information Sharing with Out-of-Home Caregivers policy

Ongoing of Mental Health

Placement Out-of-Home policy

Psychotropic Medication Management policy

Shared Planning Meeting policy

WAC 182-534-0100 EPSDT