INSTRUCTIONS TO STAFF 340:75-6-88
Revised 12-1-10
1. (a) Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) schedule. The purpose of the EPSDT is to prevent and identify conditions that may interfere with a child or youth's natural growth and development.
(1) The schedule of frequency for EPSDT provides:
(A) six health screenings during the child's first year of life;
(B) two screenings in the child's second year of life;
(C) one screening yearly for the child age two through five years; and
(D) one screening every other year for the child age six through 20 years.
(2) Eligible children may receive dental screening services once every 12 months.
(3) More frequent screening services are allowed when a medical condition is suspected.
(b) Documentation of medical services. The Child Welfare (CW) worker and placement provider ensure the continuity of medical services and records while a child is in out-of-home care.
(1) These records are made:
(A) part of the child's paper case record and Life Book; and
(B) available to the parent(s), any subsequent provider, and youth leaving care for independent living.
(2) The CW worker updates the:
(A) appropriate KIDS screens no later than 30 days after each child's appointment for medical, dental, or behavioral health services;
(B) child's immunization and prescriptions records and KIDS Service Log; and
(C) KIDS AFCARS screens when the child receives a specific diagnosis by the physician or therapist.
2. Initial health and developmental screening. The CW worker is responsible for ensuring, in coordination with the placement provider and parent(s), when applicable, that a child in out-of-home care timely receives all needed routine and specialized medical care, including medical, dental, visual, and counseling needs. The CW worker schedules initial health and developmental screening for children:
(1) under the age of three years, no later than 30 days after the child's removal from the home;
(2) age three years and over, no later than 90 days after the child's removal from the home; and
(3) placed in foster care, within 30 days after placement.
3. SoonerStart. When the child is younger than three years of age, the CW worker:
(1) refers the child to SoonerStart via Form 04MP021E, Child Welfare SoonerStart Referral, no later than 15 working days after the child's initial placement in out-of-home care, excluding shelter and emergency foster care;
(2) notifies the parent(s) and placement provider of the referral to SoonerStart;
(3) informs the placement provider that cooperation is required with SoonerStart in the provision of any service recommended for the child;
(4) updates KIDS Contacts screen with purpose type – SoonerStart Referral;
(5) notifies SoonerStart of any change in placement of the child by providing copy of Form 04KI025E, Change in Placement Notification, within two working days when the screening, evaluation, or both, have not been completed by SoonerStart;
(6) discusses the information provided by SoonerStart with the parent(s), within 15 working days of receipt;
(7) documents SoonerStart information in KIDS Medical screen;
(8) includes SoonerStart information in KIDS Family and Child Strengths and Needs Assessment screens;
(9) files SoonerStart information in the child's paper case record; and
(10) completes Form 04AF022E, Report of Violation of Rules in an OKDHS Resource Home, when notified by SoonerStart of the placement provider's lack of cooperation or follow through with recommendations.
4. Human Immunodeficiency Virus (HIV)-related services. When requested by a placement provider, OKDHS provides examinations or tests regarding HIV on the child based on the Centers for Disease Control guidelines for time and frequency of testing. Refer to OAC 340:75-1-115 for HIV testing.
5. Healthcare for child placed in parent(s)' home. A child in OKDHS custody living in the parent(s)' home may continue to be eligible to receive financial assistance from the Oklahoma Health Care Authority for necessary medical services. The parent(s) of a child, in emergency or temporary OKDHS custody who is living in his or her own home, has the primary responsibility to provide and arrange for the medical needs of the child. Refer to OAC 340:75-13-62 for medical coverage when the child resides with the parent(s).
6. Unavailable local medical care. When a child in out-of-home placement needs medical care outside the county of residence, the attending physician makes the recommendation and referral. When the physician recommends treatment he or she cannot provide, but does not make the referral, the CW worker in the county where the child is receiving care makes the appointment.
7. Notification of injury or medical treatment.
(1) When medical attention for accidental or non-accidental injury is sought or required for a child in OKDHS legal custody in out-of-home placement, OKDHS notifies the:
(A) court of jurisdiction;
(B) child's parent(s);
(C) parent(s)' attorney;
(D) child's attorney;
(E) district attorney;
(F) court-appointed special advocate; and
(G) tribe, when applicable.
(2) Form 04MP027E, Notice of Injury to Child Requiring Medical Examination or Treatment, is completed by the CW county of placement worker when a child in OKDHS custody requires medical treatment as a result of an accidental or non-accidental injury to advise the parties of the:
(A) nature of the injury;
(B) date of occurrence; and
(C) medical care provided or planned to meet the child's needs.
(3) All injuries, other than normal minor childhood scrapes and bruises, such as small bruises to the knee or shin, are made known to CW staff.
(4) Any injury to the child, even when accidental, is immediately reported per OAC 340:75-3-6, when the injury involves the face, head, neck, stomach, or genitals, burns, broken bones, deep bruises or wounds, or any type of injury requiring medical attention.
8. (a) Transporting medication. The CW worker ensures the child's medication is transported with the child when the child is moved from one placement to another.
(1) The CW worker completes Form 04MP012E, Receipt and Release of Prescription and Over-the-Counter Medication(s), Section I, Receipt of Prescription and Over-the-Counter Medication(s) (OTC), with the parent(s) or placement provider prior to the removal of a child from own home or out-of-home placement.
(2) Upon completing Form 04MP012E, the CW worker provides a copy to the parent(s) or placement provider. Form 04MP012E, is not required when the child is discharged from a hospital setting.
(3) The CW worker obtains the appropriate medication or prescription(s) to be filled and provides a copy of the discharge summary to the parent(s) or placement provider. The copy provided by the hospital is filed in the paper case record.
(b) Medication not transported. When the CW worker is provided medication(s) in any of the ways described in (1) through (5) of this subsection, the CW worker leaves the medication(s) with the parent(s) or placement provider and documents the action on Form 04MP012E, in Section II, Medication(s) Not Transported. A copy of completed Form 04MP012E is given to the parent(s) or placement provider. If medication was prescribed, the CW worker contacts the prescribing physician immediately to have the physician call in a new prescription(s) to a local pharmacy. The worker picks up the new medication prior to placing the child in the new location. The CW worker does not transport medication(s) when the medication is supplied to the worker:
(1) in plastic sacks or any other container that is not the original prescription bottle or packaging;
(2) with multiple types or dosage strengths of medication in a single prescription bottle;
(3) with an expired prescription;
(4) with more medication than the amount indicated on the prescription label or OTC package information, such as combining two containers of medication; or
(5) with the prescription label or OTC packaging altered.
(c) Releasing medications. Form 04MP012E, Section III, Release of Prescription and Over-the-Counter Medication(s), is completed with parent(s) or new placement provider when releasing medication.
(d) Psychotropic medications. When the CW worker transports a child, who has been prescribed psychotropic medication, from acute or residential inpatient treatment, the CW worker inquires whether the discharging physician will monitor the medication. When the discharging physician will not, the CW worker arranges, as soon as possible, for the child to be assessed by another physician so that the child's continued need for medication can be determined or monitored.
9. Medication disposal. A person responsible for medication disposal is designated by each county director and signs Section III of Form 04MP012E, Receipt and Release of Prescription and Over-the-Counter Medication(s), when medication prescribed to a child in OKDHS custody requires disposal. Prior to requesting disposal of the medication the CW worker verifies the medication:
(1) is no longer prescribed for the child;
(2) cannot be properly administered;
(3) has expired; or
(4) is not accepted by the child's placement.
10. Reasonable attempts to locate parent or legal guardian. The CW worker makes reasonable attempts to secure parental consent for extraordinary medical services provided to a child in OKDHS custody. A reasonable attempt includes attempts to contact the parent or legal guardian by phone to inform them of necessary medical services.
(1) When the parent or legal guardian cannot be reached by phone, the CW worker attempts personal contact at any known address for the parent(s) or legal guardian. Attempts to locate the parent or legal guardian include contacts with relatives or other persons knowledgeable about the family.
(2) When services are provided at a medical facility or by a medical practitioner, the parent is required to contact the facility or practitioner directly. The CW worker facilitates contact, when needed.
11. (a) Separate and specific written consent for medical care or treatment or the administration of psychotropic medications. Each child or youth has unique needs that require individualized treatment planning. It is the intent that children in care receive necessary medical care and treatment and behavioral health care, including psychotropic medication, in a rational and safe manner.
(1) Psychotropic medication decisions are based upon adequate information, including psychiatric history and assessment, medication history, medical history, including known drug allergies, and consideration of the individual's complete current medication regimen, including non-psychoactive medications, such as antibiotics.
(2) Psychotropic medication is integrated as part of a comprehensive treatment plan including:
(A) appropriate behavior planning;
(B) symptom and behavior monitoring; and
(C) communication between the prescribing clinician, the youth, parents, legal guardians, foster parents or other placement providers, CW specialists, therapist(s), pediatricians, and any other relevant members of the child or youth's treatment team.
(b) Definitions related to requests for separate and specific written consents.
(1) "Separate and specific consent" means, for the purposes of this instruction, a written consent requested by a physician or medical facility to provide specific treatment or medication.
(2) "Informed consent" means, for the purposes of this instruction, voluntary written consent from a person who has received full, accurate, and sufficient information and explanation about a child's medical condition, medication, and treatment to enable the person to make a knowledgeable decision without being subjected to any deceit or coercion. Informed consent for medical care and treatment or administration of psychotropic medication that requires a separate and specific written consent may only be given by:
(A) a parent whose rights are intact;
(B) a legal guardian of the child; or
(C) an OKDHS representative, after a reasonable attempt to locate a parent or legal guardian has failed, and after consideration of a sufficient explanation by a physician regarding the risks involved in the proposed treatment.
(4) "Sufficient explanation" means, for the purposes of this instruction, information provided and explained in plain language by the prescribing physician or physician's representative to the consent-giver, including, but not limited to the:
(A) medical care and treatment or the medication;
(B) reason for prescribing the treatment or medication and its purpose or intended results;
(C) side effects, risks, and contraindications, including effects of stopping a medication;
(D) method for administering the treatment or medication and dosage range when applicable;
(E) potential drug interactions;
(F) alternative treatments;
(G) behavioral health or other services used to complement the use of psychotropic medication, when applicable; and
(H) other treatment interventions considered by the physician that may include, but are not limited to, medical, mental health, behavioral, counseling, or other services.
12. (a) Requests for separate and specific written consent for medical care and treatment or the administration of psychotropic medication. When a child in OKDHS voluntary, emergency, or temporary custody has been prescribed treatment or medication requiring a separate and specific consent, such as for psychotropic medication, the CW specialist makes reasonable attempts to locate the parent or legal guardian of the child to obtain consent. When the parent or legal guardian is located, the CW worker:
(1) advises the parent or legal guardian of the physician's recommendation for treatment or medication;
(2) provides the parent or legal guardian contact information for the physician;
(3) upon request, facilitates a telephone call or appointment between the parent or legal guardian and prescribing physician; and
(4) advises the parent or legal guardian that the medical provider is seeking consent to provide treatment or medication.
(b) Consent by OKDHS when the child is in OKDHS permanent custody or the parent or guardian declines to authorize, withdraws consent, or cannot be located to authorize the administration of psychotropic medication. When a child is in OKDHS permanent custody or the parent or legal guardian declines to authorize or withdraws consent, or cannot be located for the administration of psychotropic medication, a county director, assistant county director, or person left in charge may provide consent for the administration of psychotropic medication when a separate and specific consent is requested. The CW worker completes and submits Form 04MP036E, Request for Consent for Psychotropic Medication, to the county director, assistant county director, or person left in charge with the separate and specific consent request.
(c) When consent is not required for the administration of psychotropic medication. Consent for the administration of psychotropic medication is not required when:
(1) a parent, legal guardian, or OKDHS has previously consented to the administration of psychotropic medication and the medication is continued or the dosage of the same medication is changed; or
(2) the prescribing physician or medical facility does not require a separate and specific consent.
(d) Consultation prior to consent for the administration of psychotropic medication. The county director, assistant county director, or person left in charge obtains a sufficient explanation or consultation as necessary to provide informed consent for the administration of psychotropic medication by contacting the prescribing physician or the psychiatric hotline at APS Healthcare at 877-845-7468 during business hours to arrange a consultation with a physician.
(e) Emergency medical care and treatment or administration of psychotropic medication. Emergency medical care and treatment or psychotropic medications may be provided or administered in advance of parental or OKDHS authorization when the child's attending physician determines an emergency exists. The CW worker notifies the parent or legal guardian, when applicable, as soon as possible after receiving notification of the emergency.
13. Use of psychotropic medication for chemical restraint. Use of psychotropic medications as a means of control, punishment, or discipline of children, for staff convenience, or for chemical restraint is strictly prohibited.
14. Monitoring children prescribed psychotropic medication.
(1) Children taking psychotropic medications are seen by the prescribing physician as directed by the physician.
(2) Children in acute settings, displaying unsafe behavior, experiencing significant side-effects, not responding to a medication trial, or in an active phase of medication trial are seen as directed by the physician.
(3) Monitoring the use of psychotropic medication provided to a child in OKDHS custody is a joint responsibility among the prescribing physician, caregiver, CW worker, and CW supervisor. The CW worker and the placement provider have joint responsibility to:
(A) assure the physician's directions and intent for the medication are implemented;
(B) contact the prescriber immediately when a child's condition becomes unstable; and
(C) arrange for medical evaluations and required laboratory tests to monitor therapeutic levels of a medication or to monitor potential organ system damage from a medication. Laboratory tests are performed according to the physician's directions.