REQUIREMENTS

The Division of Family and Children Services (DFCS) shall: 

1. Collaborate with hospitals or other facilities providing hospitalization or treatment to manage the medical or behavioral needs for any child in foster care or involved with child protective services (CPS). 
2. Provide the hospital or treatment facility social worker with the current phone number (including mobile) and email information for DFCS staff assigned to the child and family. 
3. Obtain the contact information for all hospital or treatment facility staff working with the child (e.g., social worker, nurse, treating physician). 
4. Be available and responsive to any hospital or treatment facility providing services to manage the health needs of children in foster care. 
5. Monitor the child’s health and medical care directly with the healthcare provider(s) to ensure the child receives appropriate care. 

6. Maintain communication with the hospital or treatment facility to prevent the child from being discharged to his/her parent/caregiver when seeking court intervention due to safety concerns. 

   NOTE: Physicians have a right to take temporary protective custody of the child without the consent of the parent/guardian (see policy 3.23 Intake: Special Circumstance Intakes Involving Temporary Protective Custody of a Child by Physician).  

7. For any child in foster care who is hospitalized: 
   1. Work continually and closely with the hospital or treatment facility during admission, treatment, and discharge to ensure full engagement and coordination throughout the child’s stay; 
   2. Notify the hospital or treatment facility of any restrictions on visitors; 
   3. Be immediately available to provide or facilitate authorization of necessary paperwork (e.g., admissions documents, consent forms, discharge documents, etc.); 
   4. Obtain the appropriate consent in accordance with policy 10.11 Foster Care: Medical, Dental and Developmental Needs and 10.12 Foster Care: Psychological and Behavioral Health Needs. 
   5. Advocate for the child in treatment team meetings; 
   6. Develop a plan for supervision of the child. 
   7. Ensure there is a solid plan for transitioning the child from the hospital or treatment facility to an approved placement setting, which includes, but is not limited to:
      1. Transportation arrangements upon discharge;  
      2. Completion of any medical training requirements for the parent or placement resource, if applicable; 
      3. Procedures for obtaining and administering any medication, supplies, or equipment the child may need post-discharge; 
      4. Coordination of any follow-up care recommended upon discharge.
   8. Be present at the specified date and time of a child’s discharge (including evenings, weekends, and holidays). 
   9. Adhere 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 children in foster care.
8. Obtain health records regarding the child’s diagnosis, treatment, medication, and discharge plans. 
9. Ensure the child’s health records are reviewed and updated, and a copy of the record is supplied to the foster parent or other placement resource, at the time of each placement of the child while in foster care. 
10. Incorporate the discharge plan into the Plan of Safe Care for any infant affected by prenatal exposure to substances (legal or illegal) or a Fetal Alcohol Spectrum Disorder (FASD) (see policy 19.27 Case Management: Plan of Safe Care for Infants Prenatally Exposed to Substances or a Fetal Alcohol Spectrum Disorder (FASD)). 
11. Ensure each region develops a protocol which aligns with this policy and is provided to the administrators, intake coordinators, social work department at hospitals/emergency departments, including Psychiatric Residential Treatment Facility (PRTF) and acute inpatient facilities/Crisis Stabilization Unit (CSU) in the region. The regional protocol must include: 
    1. The contact information for: 
       1. The Regional and County Director 
       2. The Child Protective Services Intake Communications Center (CICC) (1-855- GA-CHILD or 1-855-422-4453) 
       3. The on-call staff person for evenings, weekends, and holidays at each county office. 
    2. An escalation plan.  
    3. DFCS State Office resources that are available to county/regional staff and the hospital/facility (see Practice Guidance: DFCS State Office Resources). 
    4. Other information as needed.  
12. Document all activities in Georgia SHINES, including updating the Health Detail page and uploading health records to External Documentation within 72 hours of occurrence.

PROCEDURES

Screened-in Intake Report Involving a Child Currently in the Hospital 

The Social Services Case Manager (SSCM) will: 

1. Proceed to the hospital to begin the investigation and assessment of child safety (see policy 5.1 Investigations: Conducting an Investigation). 

   NOTE: When allegations of child abuse are reported regarding a child in a hospital in County A and it is determined that the primary caregiver resides in County B, the SSCM in County B (where the primary caregiver resides) shall be assigned. However, when distance precludes County B from making an immediate response, the SSCM in County A will be responsible for making face-to-face contact with the child to assess safety (see policy 3.1 Intake: Receiving Intake Reports). Communication must occur between the SSCM in County A and County B to ensure a coordinated response.

2. Contact the hospital social worker prior to or upon arrival at the hospital to: 
   1. Notify the social worker of arrival; 
   2. Obtain additional case information from the hospital;  

   3. Coordinate the face-to-face interview with the alleged victim child at the hospital to conduct the safety assessment; 

      NOTE: If there’s an impending discharge, it may be necessary to request the hospital delay discharge of the victim child until the SSCM arrives to assess the situation. 

   4. Obtain the contact information (cell phone number and email) for the hospital social worker, nurse, and treating physician; 
   5. Provide the contact information (cell phone number and email) for the assigned SSCM, SSS and County Director; 
   6. Provide the process for escalating issues or concerns beyond the SSCM level to the County Director within a time frame agreed upon with the facility; 
   7. Advise hospital staff to contact the Child Protective Services Intake Communications Center (CICC) 24 hours a day, seven days a week at 1-855-GA-CHILD (1-855-422- 4453) to identify the on-call staff person for each local DFCS office. 
3. Consult with the treating physician regarding the health and safety concerns of the child. Ask if the illness or injuries are a result of child abuse and obtain relevant documentation. 
4. Respond to the hospital’s/facility’s social worker inquiry about DFCS’ plan to ensure a safe discharge. Request the hospital adjust the discharge plan when the child is medically cleared, and safety concerns related to the discharge plan are identified. 

5. When informing parent(s)/caregiver(s) at the hospital or facility that their child will be removed from their legal custody and care: 

   1. Notify and coordinate with medical staff in advance, to allow them to make needed preparations to ensure the safety of all patients, families and staff, when possible. 
   2. Request the assistance of hospital staff in securing a private consultation room to address the matter with the family to ensure for the family’s privacy. 

   NOTE: The hospital staff is not responsible for informing parents/caregivers when their child has been removed from their custody. 

6. Discuss discharge plans with the hospital/facility staff, when appropriate, to include but are not limited to the following: 
   1. Will the child be discharged from this facility or transferred to another facility? 
   2. Will child and/or parent/caregiver education be required prior to discharge? 
   3. Will additional caregivers be needed to care for the child post-discharge? 
7. Respond timely to any request made by the staff relating to the care or concerns of the child.

When a Child in Foster Care is Hospitalized or Admitted to a Treatment Facility 

The SSCM will: 

1. Respond to the hospital/treatment facility within 24 hours or sooner based on the urgency of the circumstances.  
   1. If the hospitalization or admission is the result of alleged maltreatment, refer to policy 6.7 Special Investigations: Conducting Special Investigations of Child Death, Near Fatality or Serious Injury.
   2. . If the hospitalization or admission is the result of behavioral health crisis, refer to policy 10.12 Foster Care: Psychological and Behavioral Health Needs.
2. Visit the child at the hospital or treatment facility. Assess the situation and contact key participants, including but not limited to the placement resource, treating physician, and social worker. 
   1. Obtain the name and contact information for the hospital’s or treatment facility’s social worker, nurse and treating physician. 
   2. Consult with the treating physician regarding the health/behavioral and safety concerns of the child. Ask if the illness or injuries are a result of child abuse. 
   3. Provide the hospital/treatment facility the Foster Care Individual Child Medication Log, if applicable. 
   4. Obtain the anticipated discharge date and begin planning to ensure the child’s smooth transition back to his/her current placement or to a new placement. 
   5. Provide the social worker with the cell phone number and email contact information for the SSCM, SSS and the County Director. 
   6. Inform the hospital or treatment facility staff that if the SSCM cannot be reached, they should contact the SSS or the County Director. 
   7. Provide the process for the hospital or treatment facility to escalate issues or concerns beyond the SSCM level to the County Director within a time frame agreed upon with the facility. 
   8. Advise the hospital or treatment facility staff to contact CICC, 24 hours a day, seven days a week at 1-855-GA-CHILD (1-855-422-4453) to identify the on-call staff person for each local DFCS office. 

3. Notify the child’s parent(s) that the child has been hospitalized. 

   NOTE: If parental rights have been terminated, parental notification is not required. In such instances, consult with the Social Services Supervisor (SSS) and County Director before notifying the parent. 

4. Actively monitor a child’s hospitalization or in-patient treatment: 
5. Maintain an open line of communication with the treatment team to avoid delay in care: 
   1. Be immediately available or have a contingency plan for the possibility of emergencies. 
   2. Follow consent authorization procedures for surgery or psychotropic medication requests as outlined in policy 10.11 Foster Care: Medical, Dental and Developmental Needs and 10.12 Foster Care: Psychological and Behavioral Health Needs. 
6. Arrange visitation and/or supervision of the child during hospitalization or admittance to a treatment facility: 
   1. Obtain the hospital policy on visitation (e.g., ages of visitors, hours, length of visit, etc.). 
   2. Inform/remind the parent(s)/caregiver(s) of any court ordered restrictions on their visitation and advise of requirements for visitation. Address the rights of the family, including siblings, regarding visitation. 

   3. Inform the hospital staff of authorized visitors for the child. 

      NOTE: There may be court ordered restrictions on visitation, or supervised visitation may be agreed upon as part of a safety plan. 

   4. Arrange appropriate supervision when there are court ordered restrictions on unsupervised visitation; or based on an agreed upon safety plan. 

      NOTE: The hospital staff will not provide supervision of visitation with the child. 

   5. Provide or arrange for supervision for the child/patient with behavioral issues. A contracted provider may be used to ensure appropriate supervision of the child, when applicable. 

      NOTE: The medical hospital will not provide supervision for children with behavioral issues, however, if a child is in a treatment facility supervision should be provided.

Discharge Planning for a Child in Foster Care 

The SSCM will: 

1. Begin discharge planning at the time of admission. Identify placement options as soon as the child enters the hospital or treatment facility considering any special medical or behavioral health needs the child may have, when applicable (see policy 10.4 Foster Care: Selecting a Placement Resource).  

2. If the child has special medical or behavioral health needs, arrange for or ensure that the placement resource and any other designated caregivers of the child complete any needed training to appropriately address the child’s condition prior to the discharge. 

   NOTE: The hospital or treatment facility may also request that a secondary caregiver be trained to care for the child. 

3. Have a solid plan for transitioning the child from the hospital or treatment facility to an approved placement setting, including arranging transportation and obtaining any medication the child may need post-discharge. 
4. Obtain information from the medical/treatment care team regarding needed outpatient follow-up and share information with the placement resource. 
5. If adjustments are needed to the discharge plan, escalate the matter as follows:  
   1. County Director 
   2. Regional Director 
   3. DFCS Care Coordination Treatment Unit 
6. Be present at the specified date and time of a child’s discharge (including evenings, weekends, and holidays). 
7. Obtain copies of the discharge summary and any recommendations from the hospital/treatment facility regarding services and supports the child may need to be successful at home or in an out-of-home placement. 
8. Provide a copy of the discharge summary to the placement resource to maintain continuity of care.

Documentation of Hospital and Treatment Facility Care 

The SSCM will:  

1. Submit the release of information (ROI) request to the hospital’s or treatment facility’s medical records department. 
2. Obtain health records and copies of all documentation related to the child’s hospitalization. 
   1. Obtain written information on the child’s diagnosis and recommended treatment;  
   2. Enter the treatment provided in the child’s Health Log. 
   3. Share the child’s health information with the placement resource and document that it was shared.  
3. Document all activities in Georgia SHINES within 72 hours of occurrence. This includes updating Contacts and Summaries, the Health Detail and uploading health records to External Documentation. Include the following information: 
   1. Discharge planning activities and documents;
   2. . Recommendations from the hospital or treatment facility regarding needed services and supports the child may need to be successful.

PRACTICE GUIDANCE

Coordination with Caregivers During Hospitalization 

Caregiver involvement is essential throughout the hospitalization to ensure information sharing, success of treatment, appropriate post-hospital placement and provision of aftercare services. The SSCM should use every opportunity to gather information on the child and their caregiver while the child remains in the hospital. Ensure that sufficient time and opportunity is given to observe and evaluate the parent-child relationship. Observe the interaction between the child and the caregiver. Observe the caregiver’s response to the child, and their attention to the needs of the child. Assess the child’s vulnerability and parental capacity to maintain the child’s safety upon discharge from the hospital.

Coordination with Hospitals when Children are in Foster Care 

When children in foster care require short-term, specialized hospitalization services to manage critical or immediate health or behavioral needs, it is important that DFCS staff is available and responsive to the hospital and treatment team providing care to the child. In some cases, family members are not available to participate in treatment and support activities. Consequently, DFCS has the responsibility to fill in the gaps and ensure full engagement in the treatment process. 

Collaboration with hospitals and healthcare providers ensures a seamless continuum of care for the child. Upon admission of a child to the hospital, the SSCM should coordinate with medical staff, participate in treatment when appropriate, and begin discharge planning in advance of the anticipated discharge date. Delay in planning can result in a disruption to the continuum of care for the child. Ensuring an appropriate placement option is available upon the child’s release from the hospital is essential for a smooth transition from the hospital/treatment facility to the placement. Because a hospital setting is not intended to serve as a placement for a child, no child should remain in a hospital setting beyond the time that is medically necessary.

DFCS State Office Resources

Children’s Healthcare of Atlanta (CHOA) Liaison 

The unique partnership between DFCS and CHOA continues to strengthen the response to children who have been alleged to be abused. CHOA Liaisons work closely with hospital social workers, medical staff, and child advocacy physicians at the Stephanie V. Blank Center for Safe & Healthy Children. CHOA Liaisons can assist with the following:

1. Completing child abuse consultations; 
2. Conducting joint interviews of parents/caregivers and other witnesses at the hospital on cases; with concern for child abuse, including serious injury and child death;
3. Obtaining the child abuse consult report and providing a copy to county staff; 
4. Obtaining and providing DFCS history on consulting cases for assessment purposes; 
5. Observing the child advocacy medical exam and obtaining photographs of injuries; 
6. Discussing consult findings with medical staff and providing information to local DFCS and/or law enforcement, including immediate safety concerns; 
7. Facilitating communication between hospital social workers, physicians and local DFCS staff; 
8. Coordinating and/or participating in Patient Care Conferences; 
9. Providing expert case consultation on complex cases at county request; 
10. Helping to facilitate safety plans, removals, and kinship caregiver placements when county staff cannot be present; and 
11. Attending weekly Trauma Rounds and follow up on requests from Hospital Social Workers and Physicians.

Contact the CHOA Liaisons at: DHSDFCSCHOALiaison@gets.onmicrosoft.com

Care Coordination Treatment Unit (CCTU) 

The CCTU is a DFCS State Office team responsible for the facilitation and management of high-end, complex cases and system navigation of youth in foster care. CCTU empowers DFCS, its youth, families, and partners through education and collaboration; ensuring a holistic and systematic approach to address the behavioral, emotional, medical, and therapeutic needs of Georgia’s youth. CCTU was established to ensure the proper continuum of services were coupled with the identification of the most appropriate and least restrictive placement for children with "high-end" needs in foster care. Children considered in this population are identified as having severe medical, emotional, behavioral, psychiatric and developmental disorders. The CCTU staff are distinct professionals with a diverse array of clinical expertise and child welfare backgrounds which allows the ability to engage intensive practice guidance and consultation to field staff, inpatient treatment facilities and Room Board Watchful Oversight (RBWO) contracted providers on cases that require a meticulous level of insight to navigate the complexities within our state systems, policies and regulations. The CCTU operates on a 24/7 schedule, including weekends and holidays. Specific functions of the CCTU includes: 

1. Placement Intervention/Guidance 
2. Emergency Response and Assistance 
3. RBWO Program Designation Assessments 
4. PRTF & Acute Hospitalizations 
5. Emerging/Dependent Adults with Intellectual and/or Developmental needs, Severe Mental and Behavioral Health 
6. Severe Medically Fragile 
7. Physical Health Hospitals  
8. Technical Assistance, Training and Development 
9. Data Tracking and Trend Analysis 
10. Care Coordination & Service Consultation (healthcare services, medical interventions, clinical treatment) 
11. Community Based Services Consultation, and System(s) Navigation 
12. Monitoring of inpatient behavioral/physical health facilities DFCS entries and exits 
13. Stakeholder Engagement

CCTU Staff include: 

1. Behavioral Support Specialist (BSS) provides oversight and consultation of behavioral management issues for children in the custody of DFCS. Also, guides field staff in the identification of appropriate placement resources for children categorized as high-end with complex needs. In addition, provides additional support and oversight to RBWO providers to ensure that children are benefitting from therapeutic interventions and moving towards less restrictive placements. 
2. Therapeutic Support Specialist (TSS) are licensed professionals with the ability to engage the field in intensive practice guidance and consultation on cases that require a meticulous level of insight to navigate the complexities within our state systems, policies, and regulations. Responsible for immediate and on-going assessment of medical necessity, treatment, and discharge planning of inpatient admissions to psychiatric residential treatment facilities, crisis stabilization units, and other acute inpatient behavioral or physical health facilities.

As soon as a child with no transitional placement resource identified is admitted to a hospital, the SSCM should make a referral to CCTU for discharge planning/placement assistance. CCTU will assist in coordinating services within the community, locating an appropriate placement for the child and can support hospital personnel in contacting Regional and/or County staff. 

1. County staff should contact their Regional TSS to inform them of the inpatient admission and need to assist in hospital coordination of their child and submit a Universal Application with any other supplemental documents for assignment to the BSS Team if placement guidance is needed through GA+SCORE. The referral submission portal is located on the GA+SCORE website www.gascore.com under the State Office CCTU Link. The information will be triaged and assigned to a BSS for review and assist with placement efforts. 
2. Hospital staff may email cctu.support@dhs.ga.gov for assistance in contacting regional and county staff, and for assistance in coordinating discharge planning if county personnel are unresponsive. The email should include: 
   1. The point of contact (phone number, email address) and brief synopsis of the referral 
   2. The child’s first and last name, date of birth and County

Wellness Programming, Assessment and Consultation (WPAC) Unit 

The WPAC Unit partners with child welfare staff to provide practice support, consultation, tracking and quality monitoring of physical and moderate behavioral health needs of children and youth in foster care and family preservation. Wellness Specialists work closely with the designated CMO and other community-based healthcare providers to ensure timely and comprehensive care coordination. 

WPAC should be contacted when the SSCM has difficulty obtaining medical care and treatment following hospital discharge, or in coordinating services with Amerigroup. Contact WPAC at: healthmatters@dhs.ga.gov.