Santa Clara County Social Services Agency

Santa Clara County Social Services Agency

Agency Memorandum #08-21

August 20, 2008

DFCS Staff

Reminders and Revised Procedures Concerning the Health and Education Passport

Overview

/ This memorandum provides reminders concerning existing Health and Education Passport (HEP) procedures and revisions to those procedures in the following areas:
·  Delivery of the HEP binder to the caregiver within 30 days of initial placement[1]
·  Delivery of the HEP binder to the caregiver within 48 hours of second and subsequent placements1
·  Ensuring that Health Contact forms and other medical/dental information is received by the Child Health and Disability Prevention (CHDP) Unit for data entry into the child’s CWS/CMS case
The memorandum also provides information to clarify when well-child physical and dental examinations should be scheduled according the CHDP Periodicity Schedule, typical medical insurance eligibility timeframes for examinations and the best practice that children age 2 years and older have annual physical examinations. It remains a high priority to work with caregivers to ensure that well-child examinations occur as required.
The revised policies and procedures outlined in this memorandum become effective August 25, 2008.

Overview of Existing and Updated Roles and Responsi-bilities

Overview of Existing and Updated Roles and Responsi-bilities / OPP Chapter 15-1 – Health and Education Passport (HEP) has been updated in regards to the responsibilities of:
·  ER Emergency Response (ER) or any other Social Worker assigned at the time a child is initially taken into temporary custody
·  Dependent Intake (DI) Social Workers
·  All Social Worker at the time of second and subsequent placements
·  Health and Education Passport Clerical Support Staff
·  CHDP Unit Public Health Nurses (PHNs)
New / The ER Social Worker or any Social Worker assigned at the time the
child is initially taken into temporary custody must:
·  Document allergies, injuries, diseases, disabilities, medications, and medical and dental providers on the “Your Child’s Health and Education” form (JV-225)
·  Complete and obtain parents’ signatures on the “Authorization for Use and Disclosure of Protected Health Information” form (SCZ 244) in order to obtain the child’s medical records.
·  Ensure that the JV-225 with this critical information is in the HEP binder provided to the child’s initial caregiver at the time of placement.
New / The DI Social Worker is responsible for completing the other items on
the JV 225 with the parent or, in the absence of the parents, with relatives or other persons who have knowledge of the child’s health and education information (HEP
Clerical Support Staff may assist - see below).
All social workers responsible for the second or subsequent placement of a child must ensure that the HEP binder accompanies the child to the new placement.
HEP Clerical Support Staff assist Social Workers, caregivers and the Health and Disability Prevention Program’s Public Health Nurses (CHDP PHN) by:
·  Attending initial detention hearings to interview parents to complete the JV-225.
o  Note: The DI Social Worker remains primarily responsible for ensuring that these documents are completed if the HEP Clerical Support Staff cannot obtain a completed JV 225 at the Initial Detention Hearing.
·  Sending for and tracking the receipt of all medical records identified on the SCZ 244.
o  / New / If a record is not received within 10 business days, HEP
Clerical Support Staff follow-up with the medical provider to obtain the record.
·  Forwarding Health Contact forms and medical records to the CHDP PHN Unit for review and entry of information into CWS/CMS.
·  Researching immunization records on the Bay Area Immunization Registry-CAIR.
·  Entering of information from the JV-225 and immunization records into the child’s CWS/CMS case.
·  Mailing the CWS/CMS Health and Education Passport document to the current caregiver:
o  / New / No later than 25 days after the child was initially placed and
again if necessary, after all medical records identified on the SCZ 244 are received and entered into CWS/CMS by the CHDP PHNs.
o  At the request of the CHDP PHNs, Social Worker or caregiver.
o  / New / Within 30 calendar days of the child’s 6 month court review
hearing.
The Public Health Nurses of Child Health and Disability Prevention Program Unit provide consultation to the Social Workers, caregivers and HEP Clerical Support staff; expedite referrals to health care providers; and, review and enter medical information into the child’s CWS/CMS case. A more complete overview of the CHDP PHN’s role is at the end of the memorandum.
Required Actions: First 30 Days of Initial Placement / Procedures were revised to ensure that caregivers are provided critical basic medical information about the child in the HEP binder at the time of initial placement and all available medical information within 30 days of the initial placement.
Required / Step / Action / Who

Actions: First 30 Days of Initial Placement (continued)

/ 1.  / a.  Prior to the initial placement, minimally completes Items 1 -6 on the JV-225 form with the parents. (Completes all items prior to initial placement, if circumstances allow.)
Note: If the parents are not available, diligent efforts must be made to obtain this information from relatives or other persons who have knowledge of the child’s medical history and current health condition.
b.  Prior to the initial placement, completes the “Authorization for Use and Disclosure of Protected Health Information” form (SCZ 244) with the parent(s) to identify health care providers and to obtain parents’ signature(s) authorizing release of the medical records to DFCS.
Note: If the parent is unable or unwilling to provide authorization to request medical record, it is necessary to obtain court authorization to obtain the medical records.
c.  Makes a copy of the JV-225 and places it in the HEP binder to be given to the caregiver[2] at the time of the child’s initial placement.
Note: By August 25th, binders will be available in supply areas at the W. Julian St. office, the Assessment Center, the Family Resource Centers, and in South County at the Rosanna St. and Tomkins Ct. offices.
d.  Sends a copy of SCZ 244 to HEP Clerical Support Staff, 5th Floor, 373 West Julian.
e.  Files the original SCZ 244 in the child’s case file. / ER Social Worker or Social Worker assigned at the time of the child’s being taken into temporary custody
2.  / b.  Completes the remaining items on the JV-225 with the parent(s). When the form is completed, makes 3 copies:
i.  Retains one copy in the child’s file.
ii.  Forwards one copy to the HEP Clerical Support Staff.
iii.  Sends the original copy of the JV-225 to the County Clerks Office to be filed in the child legal file. / Dependent Intake Social Worker (with assistance from the HEP Clerical Support Staff)
3.  / a.  Enters medical and education information from the JV-225 into the Existing Health, Existing Education and Existing Education Provider notebooks in the CWS/CMS Client Case Management Section.
b.  Sends copies of SCZ 244 to medical providers and / HEP Clerical Support Staff
Required / Step / Action / Who
Actions: 1st 30 Days of Initial Placement (continued) / 3. (con’t) / requests medical records
c.  Tracks receipt of medical records and follows-up with providers to obtain pending medical records after 10 business days if a report is not received, until all initially medical reports identified on the SCZ 244 are received.
d.  Forwards a copy of medical record to CHDP PHN Unit.
·  Flags last medical record received that is listed on the SCZ 244 for CHDP PHNs.
e.  Forwards original medical records for review and filing to current primary Social Worker.
f.  Checks Bay Area Immunization Registry-CAIR database to obtain records and enters immunization records into CWS/CMS.
g.  Generates and sends the Passport to the current caregiver identified in CWS/CMS within 25 days of the child’s initial placement.
h.  Sends another Passport to the current caregiver, if necessary, after additional medical records identified on the SCZ 244 are received and forwarded to the CHDP PHN Unit for review and information is entered into CWS/CMS. / HEP Clerical Support Staff
/ 4.  / a.  Enters medical information from initial medical records identified on the JV-225 into the Existing Health notebook in the CWS/CMS Client Case Management Section
·  Notifies HEP Clerical when information from the flagged last medical record received is entered into CWS/CMS
b.  Forwards original medical record to the assigned social worker for review and filing. / CHDP Public Health Nurses
/ 5.  / a.  Within 31 days of the initial placement, confirms with the caregiver that the updated Passport document has been received, and follows-up as necessary to ensure that the caregiver has an initial Passport document and understands how to use the contents of the HEP binder
b.  Files medical records in the child’s case folder / Dependent Intake Social Worker

Required Actions Within 48 Hours of Subsequent Placements

/ Existing procedures in OPP Chapter 15-1 – Health and Education Passport (HEP) specify that the HEP binder shall accompany the child to each subsequent placement and the new caregiver shall receive the binder within 48 hours of the child’s placement... The Placement tracking team enters educational information related to the new placement from information provided by the Social Worker on the “Placement/Address Change Form” (SCZ 17) and sends out an updated CWS/CMS HEP document to the new caregiver.
Health Contact Forms and Other Medical and
Dental Information / Health Contact Forms
Existing procedures in OPP Chapter 15-1 – Health and Education Passport (HEP) require caregivers to ensure that the Health Contact Form [SC 1702(c)] is completed by all health providers and returned to the CHDP PHN Unit, while maintaining a copy of the SC 1702(c) in the HEP binder. There is no change in procedures for caregivers. In the near future, caregivers receive a letter from the Department reminding them to use the envelopes provided to mail the SC 1702(c) forms to CHDP c/o the Department.
New / Revised procedures require that if a caregiver asks the Social Worker to
take the completed SC 1702(c) form to the Department, the Social Worker forwards the copy to the HEP Clerical Support Staff and files the original SCZ 1702(c) (white copy) in the child’s case folder. HEP Clerical Support Staff will forward the copy to the CHDP Unit for review and data entry.
Other Medical Records
All other medical records are also sent to the CHDP c/o the Department where the CHDP PHNs review and enter the information into the child’s Passport and forward the record to the social worker for filing.
New / If the Social Worker directly obtains a medical record from a health care
provider, the caregiver or another source, the Social Worker forwards a copy to the HEP Clerical Support Staff and file the medical record in the child case folder. HEP Clerical Support Staff will forward the copy to the CHDP Unit for review and data entry.
Well-Child Physical and Dental Examinations
Well-Child Physical and / Well-Child Physical Examinations
Well-child physical examinations must be accomplished according to the Periodicity Schedule for Health Assessment Requirements by Age Groups. The Schedule contains guidelines regarding the recommended intervals between examinations based on the child’s age.
Social Services Program Managers are provided weekly Well-Child Exam Reports to distribute to staff as a tool to determine when examinations are needed.
New / The methodology for this report will be revised in the near future to list
the “Exam Eligibility Date” according to typical medical insurance payment guidelines (including Medi-Cal) and “Overdue Exam Date” according to the periodicity table. Previously, the methodology for determining the overdue date for children age 4 years and older resulted in overdue examinations if more than one year had passed since the last exam, per DFCS policy calling for required yearly examinations for children age 4 years and older. (The periodicity schedule requires that the interval between physical examination be 12 months for children 2 and 3 years of age.)
DFCS policy continues to emphasize that it is best practice for children age 4 years and older to have yearly physicals. Although no longer required, yearly physical examinations for older children are strongly encouraged because the health and development of foster children is often impacted negatively by adverse life experiences. The Overdue Exam Date for children age 4 years and older will be set in the Well-Child Exams Reports according by the longer intervals recommended in the Periodicity Schedule for Health Assessment Requirements by Age Groups.
Dental Examinations
(continued) / Periodicity Schedule for Health Assessment Requirements by Age Groups.
Infants
Under 1 mo. / 1-2 mo. / 3-4 mo. / 5-6 mo. / 7-9 mo. / 10-12 mo. / 13-15 mo. / 16-23 mo.
Interval Until Next Exam / 1 mo. / 2 mos. / 2 mos. / 2 mos. / 3 mos. / 3 mos. / 3 mos. / 6 mos.
Toddlers and Older Children
2 yr. / 3 yr. / 4-5 yrs. / 6-8 yrs. / 9-12 yrs. / 13-16 yrs. / 17-20 yrs.
Interval Until Next Exam / 1 yr. / 1 yr. / 2 yr.
(Best Practice is once a year) / 3 yr.
(Best Practice is once a year) / 4 yr.
(Best Practice is once a year) / 4 yr.
(Best Practice is once a year) / None*
(Best Practice is once a year)
*The new Well-Child Examination Report, which is still being developed, will have information about “Exam Eligibility Date” for social workers, caregivers and older youth to use in planning for emancipation.
Note: CDSS Manual of Policy and Procedures, Division 31-405(n)(1) requires that “Each child in placement shall receive a medical and dental examination, preferably prior to, but not later than, 30 days after every placement.”
Annual Dental Examinations
Beginning at age 3, all children must receive a dental examination annually. Denti-Cal and many dental plans allow examinations every 6 months.
General Reminders for Social Workers / Social Workers are reminded of their responsibilities to:
·  Review the Health and Education Passport with the child’s caregiver during each and every monthly contact with the caregiver, whether in person or by telephone.
o  Confirm with the caregiver has received and filed Passports, Health Contact Forms, and educational materials in the HEP binder.
·  Plan with the caregiver for necessary medical and dental care for the child, including well-child physical and dental examinations that should be scheduled at the intervals recommended above, , as well as within 30 days of every placement.
Overview of the Role of CHDP Public Health Nurses
Overview of the Role of CHDP Public Health Nurses (continued) / The role of the Public Health Nurses in the Child Health and Disability Unit include the following tasks and responsibilities:
·  Maintains and updates the list of CHDP doctors and Medi-Cal dentists.
·  Assists Resource Families to obtaining timely comprehensive physical and dental exams.
·  Consults with Resource Families and Social Workers regarding the health needs of foster care children in their care.
·  Monitors completion of required preventive exams by checking the weekly Well Child Exam list.
·  Reviews health information forms to identify and follow-up on diagnosed conditions of foster care children.
·  Documents complex medical conditions and interventions on CWS/CMS Health Notebook.
o  Once reviewed, forwards uncomplicated medical forms to clerical staff for entry.
·  Reviews medical records received as a result from attaining medical consent (SCZ 244).
o  Forwards to the assigned Social Worker
·  Expedites referrals to specialty medical providers, dentists, developmental services, and community programs.
·  Interprets health care records for Social Workers as needed.
·  Collaborates with the Social Worker to ensure that necessary health care information is available to those persons responsible for providing health care for child.
·  When confidential health information is received on a health form:
o  In CWS/CMS, PHNs will check the box:
§  "Sensitive Health and Medical Information is on File for this Person" which is locate on the Summary Page of the Health Notebook.
§  SW will receive hard copy of the information.
·  Provides training for Social Workers and Resource Families/Caregivers on the preventive and special health needs of children in foster care.
·  Coordinates health services for children in out-of-county placements with the assistance of the statewide network of Foster Care PHNs and CHDP services.
Updated
OPP, HEP Binders, and Forms / The DFCS OPP will be updated to include revisions described in this memorandum. “Your Child’s Healthy and Education” forms (JV-225), “Authorization for Use and Disclosure of Protected Health Information” forms (SCZ 244) and HEP binders are available in the forms cabinet areas.

Reviewed by: