Purpose 

The purpose of this Child Welfare Services Manual Transmittal (CWSMT) is to announce a new policy section in the Child Welfare Policy Manual regarding the handling of requests for end of life decisions for children in foster care.

Discussion 

The Georgia Division of Family and Children Services (DFCS) is responsible for the safety, permanency and wellbeing of the children served. On rare occasions, children in foster care face life’s most serious circumstances. When there are signs that death is imminent for a child in foster care, requests may be received from medical personnel or organ procurement organizations regarding decisions pertaining to the child’s end of life.Immediate communication with DFCS’ leadership is essential to ensure that such requests are handled timely and appropriately. This new policy section includes provisions for the handling of requests to forgo or discontinue life sustaining procedures, orders for do not resuscitate, and organ donation for children in foster care. The following are highlights of the new policy section and other impacted policies:

10.28 Foster Care: End of Life Decisions for Children in Foster Care 

1. New policy section that outlines provisions for handling of requests for forgoing or discontinuing life sustaining procedures, orders for do not resuscitate, and requests for organ donation for children in foster care. 
2. Requires the immediate notification to the Division Director or General Counsel whenever a request is received regarding forgoing or discontinuing life sustaining procedures, orders for do not resuscitate, or organ donation. 
3. Requires gathering and providing information to DFCS leadership regarding the child and the circumstances.
4. Requires maintaining ongoing and timely communication with DFCS leadership, medical/hospital personnel and parents of a child in the temporary custody of DFCS. 
5. Provides procedures for escalating requests. 
6. Provides practice guidance on Removal of Life Support and How DFCS May Receive Requests.

19.29 Case Management: Coordination of Care with Hospitals 

1. Adds a requirement to refer to policy 10.28 Foster Care: End of Life Decisions for Children in Foster Care for guidance when requests are received from hospitals regarding end of life decisions for a child in foster care.  
2. Updates the contact information for the Children’s Healthcare of Atlanta (CHOA) liaisons. 
3. Discontinues the Coordination of Care with Hospitals Protocol from Forms and Tools to minimize redundancy as the components for the regional protocol is already included in the requirements section of the policy.

Implementation 

This policy update is effective upon the release of this manual transmittal and is available on the Online Directives Information System (ODIS) at http://odis.dhs.ga.gov/. Regional and County Leadership shall provide opportunities for staff to review and discuss the updated policy to ensure implementation. Please refer to policy 1.3 Administration: Access, Distribution and Review of Child Welfare Policies for the applicable requirements and procedures for policy review. 

Please direct questions regarding this policy release to the Field Program Specialist in your region. Regional staff shall submit questions to the Policy and Regulations Unit at .PPPDUnit@dhs.ga.gov