When a child or youth in DFPS managing conservatorship is admitted to a facility operated or regulated by another state agency, such as juvenile detention, a state supported living center, or a hospital, the caseworker must provide the facility with the child’s history of sexual victimization and sexual aggression. When the caseworker is present at the time of admission to any of these facilities, the caseworker must provide the facility with the child’s sexual history report, Attachment A. If the child is admitted by the caregiver, the caregiver is responsible for the following:

• Notifying the facility of the child’s history of sexual victimization and aggression at the time of admission.
• Obtaining signatures on Form 2279b Certification of Receipt of Child Sexual Abuse or Child Sexual Aggression InformationWord Document.

Hospitals

When the caseworker is present at the time of admission, the caseworker must do all of the following:

• Provide the child’s sexual history report, Attachment A, to the hospital care coordinator or similar staff and attempt to obtain that person’s signature at the time of placement.
• Provide a copy for the hospital and ask the hospital care coordinator to include this report in the hospital’s physical chart.
• Upload the signed copy of the Attachment A into the Sexual History tab in One Case.

If the child is admitted by the caregiver, the caregiver is responsible for the following:

• Notifying the hospital of the child’s history of sexual victimization and aggression at the time of admission by providing Attachment A.
• Obtaining signatures on Form 2279b Certification of Receipt of Child Sexual Abuse or Sexual Aggression InformationWord Document from the care coordinator or similar hospital staff responsible for the child.

The primary caseworker must do the following immediately but no later than three business days after being notified about the admission:

• Ensure that the hospital care coordinator or similar hospital staff responsible for the child receives a copy of Attachment A and provide a blank copy of Form 2279b Certification of Receipt of Child Sexual Abuse or Sexual Aggression InformationWord Document.
• Attempt to obtain a signature on the Attachment A from the care coordinator or similar hospital staff. If the hospital care coordinator or similar hospital staff refuses to sign the document, the primary caseworker writes “Refused to Sign” on the signature line with the date that staff refused to sign.
• Upload the signed copy of Attachment A into the Sexual History Tab in OneCase.

Juvenile Detention and Other Facilities

The caseworker must provide a copy of the child’s sexual history report, Attachment A, to the admissions staff or person responsible for the oversight of the child or youth at the time of intake or admission, if that person is present. The caseworker must make every attempt to obtain the required signature on the Attachment A within three business days of being notified of admission. If a facility refuses to sign the document, the caseworker notes the refusal on the document by writing “Refused to Sign” on the signature line along with the date of refusal. The caseworker uploads Attachment A into the Sexual History Tab in OneCase. 

If the child is admitted by the caregiver, the primary caseworker must do the following immediately but no later than three business days after being notified about the admission:

• Ensure that the person responsible for the oversight of the child receives a copy of Attachment A.
• Obtain the signature of the admission staff or person responsible for oversight of the child or youth at time of admission on Attachment A. If the person responsible for the oversight of the child or youth refuses to sign Attachment A, the primary caseworker writes “Refused to Sign” on the signature line with the date that staff refused to sign. The caseworker uploads the signed copy of Attachment A into the Sexual History Tab in OneCase.

See 4133 Provide and Discuss the Placement Summary (Form 2279).