Presentation on theme: "WELCOME HEALTHWORKS TRAINING:"— Presentation transcript:
1WELCOME HEALTHWORKS TRAINING: TOHEALTHWORKS TRAINING:DCFS Mandated Healthcare Services for Children in Foster Care
2INTRODUCTION DCFS Presenter HealthWorks Presenter Trainees Please Interrupt anytime with QuestionsShare your Views, Issues and CommentsQUESTIONS: HOW MANY OF YOU ARE DCP?HOW MANY OF YOU ARE FOLLOW UP?HOW MANY OF YOU ARE PRIVATE AGENCY WORKERS?HOW MANY OF YOU ARE WORKERS FROM OUTSIDE OF COOK?
3LEARNING OBJECTIVES: SOME OF THE TOPICS WE’LL COVER WE HOPE THAT EVERYONE WILL LEAVE WITH A BETTER UNDERSTANDING OF1. All the Healthcare Services Mandated for Children in DCFS care and the specific Timeframes for these Services2. How to Access these HealthCare Services3. The crucial role that Caseworkers and Caregivers play in the healthcare process4. HealthWorks and how (HW) can be a valuable asset to caseworkers – help is only a phone call away5. The important role that HW CARE COORDINATORS play in DCFS Healthcare System – in the initial 45 days of a case6. Lastly, (where the buck stops) who is ultimately responsible for insuring that children get timely and appropriate Healthcare services?. It is the caseworker of course who is ultimately responsible
4MODULE 1 sf GIVES AN OVERVIEW OF THE HEALTHCARE SERVICES THAT ARE MANDATED BY DCFSSPECIFIC TIMEFRAMES FOR THESE SERVICES TO BE COMPLETED
5HEALTHWORKS IS A PARTNERSHIP Almost every thing that we talk about today is going to be in one way or another about “HEALTHWORKS”(1) HealthWorks, first and foremost is a partnership.HealthWorks Is the lead partner – in an associationWith Hospitals, clinics, doctors, who serve our childrenWith caseworkers & With foster parents(2) This Partnership is about insuring Accessto ALL DCFS Childrenfor ALL DCFS Required Healthcare Services(3) This Partnership is also about DOCUMENTATION: A CRUCIAL RESPONSIBILITY OF HEALTHWORKS.DCFS needs to know if children have in fact received the necessary health services to insure their well beingMore about documentation later slide 38WHAT DO YOU THINK I AM TALKING ABOUT WHEN I SAY “HEALTHWORKS” ?Back in 1986 when I started working for DCFS, no one used the word “ HealthWorks”Children came into DCFS care, we placed them in a foster home and gave the SCG the temporary medical card. And that was the beginning and end of HealthCare for that child unless the child got sick. There was no Initial Health Exam, there was no comprehensive Health Exam. There was no annual physical, vision, hearing, dental etc.
6HOW CHILDREN COME INTO DCFS CARE: sf (1) Through Protective Custody (PC)By the policeBy DCP/InvestigatorBy a physician(2) Custody by means other than Protective Custody(a) Temporary Custody or Guardianship given by a Juvenile Court judge (w/o PC being taken)(b) Disrupted Guardianship or Adoption cases(c) Dependency and Voluntary Placement Agreement casesThere were 17,772 Children in DCFS care 7/2505 (51, )Monthly about 180 kids are PC’d; 53% in Cook26.75 are 0 to 5 years old28 % are 6 to 12 years old45.3% are 13 years and olderAny Investigators in the class? Or on call downstate caseworkers who can take custody?You will hear all kinds of Legal Terminology: PC = Protective Custody… Who can take Protective Custody??TC= Temporary CustodyHow does DCFS get Temporary Custody??How long does an investigator have to obtain Temporary Custody?TC: TR= Temporary Custody with rights to Major MedicalTC: TW= Temporary Custody without rights to Major MedicalSome Statistics:There were 17,772 Children in DCFS care 7/2505 (51, )Monthly about 180 kids are PC’d; 53% in Cook26.75 are 0 to 5 years old28 % are 6 to 12 years old45.3% are 13 years and older
7WHICH ARE THE HEALTHCARE SERVICES MANDATED BY DCFS? sf 1. An Initial Health Screening (IHS)2. A Comprehensive Health Evaluation (CHE)3. Enrollment with a HW Primary Care Physician4. Age-appropriate Well Child Exams and Immunizations5. Annual Health, Vision and Hearing, screen from age 3 to 216. Oral/Dental exam from age two (2)7. All Referrals to Specialty & follow up services8. Also mandated, Documentation of health services in HW central file and child’s case file1 to 3 Some mandated Services are because of the ACLU suit and resulting Consent Decree…In 1994, as part of the Consent Decree HealthWorks was implemented to provide Health Services CONSISTENT WITH pediatric standards ser forth by Feds in EPSDT.4 to 6 : Because many of the health Services are paid for through the Medicare Program they must comply with EPSDT Guidelines. Early and Periodic Screening, Diagnostic and Treatment = special program of preventative and comprehensive health services designed to provide early discovery and treatment of health problems of children In Illinois EPSDT = The Healthy Kids program
8TIMEFRAMES WITHIN WHICH THESE HEALTHCARE SERVICES MUST BE DONE 24 HOURS: INITIAL HEALTH SCREENING (IHS): completed within 24 hours of custody for every “NEW” Custody case21 DAYS: COMPREHENSIVE HEALTH EVALUATION WITHIN 21 DAYS AFTER Temporary Custody45 DAYS: Enrollment with a HealthWorks Primary Care Physician (PCP) within 45 days of DCFS custodyON-GOING : WELL CHILD EXAMSChildren under 2:(according to schedule based on good medical practice:Children 2 and older: Annual physical, vision, hearing and dentalIMMUNIZATIONS(according to schedule :24 Hours: Consent Decree ACLU21 Days: Consent Decree… 21 Calendar Days45 days:On-Going well child exams: These exams are schedule by Am Ac of PedAnnual exams: DCFS PolicyImmunization:
9WHY ALL THESE HEALTHCARE SERVICES FOR CHILDREN IN FOSTERCARE? sf (FIRST REASON)Children in foster care are uniquely disadvantagedAre more likely to have a high rate of acute and chronic health problemsMay have had prenatal exposure to drugs and alcohol and all the related medical problemsmore likely to have developmental delays & behavioral problems.DCFS as surrogate parent has the obligation to provide for the well being of children in care
10THEN THERE’S THE BH CONSENT DECREE sf (SECOND REASON)Lawsuit filed by the American Civil Liberties Union (ACLU) on behalf of children in DCFS careTo raise the standard of care across-the-board (including HealthCare) for children in foster careConsent Decree laid out certain standards of Health Care that DCFS agreed had to be metBecause of this Consent Decree, DCFS has to insure that children get adequate, timely and professional HealthCare Services
11DCFS DIVISION OF SERVICE INTERVENTION: HEALTH SERVICES sf HEALTH SERVICES is an office within DCFS (not to be confused with “HealthWorks”)HW is a private organization- the partnership of hospitals/doctors we spoke about earlier:DCFS Office of HEALTH SERVICES IS responsibleFor developing health policiesFor monitoring HealthWorks to make sure it meets all the expectations and responsibilities as laid out in its contract with DCFSFor providing assistance to ALL (POS/DCFS) Caseworkers in matters of HealthCareFor providing consultation through DCFS Nurses for children with complex medical conditions
12ACCESS TO HEALTH CARE: THE PURPOSE OF HEALTHWORKS aka LEAD AGENCIES To make Health Services a reality for DCFS childrenDCFS implemented HealthWorks (HW) Program in September of 1993HW was To address barriers that prevented DCFS children from receiving Healthcare services.Barriers were:Lack of Access to HealthCare ServicesLack of Access to To Qualified professional providersLack of Documentation of HealthCare Services that were provided.Physicians in HW network have to meet professional standardsBoard certified in Pediatrics, Family Practice, Internal Medicine, Obstetrics-GynecologyThey have also agreed to document HealthCare services by completing DCFS Health forms and returning them to HealthWorksRepeat in slide 36
13HANDOUTS sf PART ONE OF THE HANDOUTS - IS THE SLIDE SHOW 2 SLIDES TO A PAGESLIDE NUMBER BOTTOM RIGHTPART TWO - COPIES OF HEALTHWORKS FORMS /DOCUMENTSALSO A LIST TELEPHONE NUMBERS YOU MIGHT FIND USEFUL
14MODULE 2 sfThis section is all aboutInitial HealthScreening (IHS)
15WHAT IS AN IHS & WHY IS IT NEEDED? An IHS is an Unclothed physical examination for every child coming into DCFS custodyIHS - To assess the health needs of the child requiring immediate attentionTo check for any infectious diseaseTo look for any signs of abuse or neglectTo make an informed decision about appropriate placement.IHS should be done preferably PRIOR to placement.
16WHAT IS THE TIMEFRAME FOR AN INITIAL HEALTH-SCREENING EXAM (IHS) sf IHS must be done within 24 hours whenever there is a NEW CUSTODY case (1) Protective Custody By DCP, By police, By a physician(2) Custody by means other than Protective Custody:e.g.. Temporary Custody or Guardianship (without PC being takenReopening a closed case without regard to the shortness of time between closing and reopening(e.g. Child is returned home, but custody taken again the following day)
17WHAT FORMS MUST BE USED FOR AN INITIAL HEALTH SCREENING EXAM - sf Encounter Form (sections 1-4NB. Check Arrival/Departure timeConsent for Ordinary and Routine Medical and Dental Care (for examination & for Release of informationLOOK AT BACK OF THIS FORM.LIST OF 8 RISK FACTORS WHICH IF ANY PRESENT, DCFS REQUIRES THE CHILD TO BE TESTED FOR HIV.If any child on your caseload falls within these guidelines & has not been tested for HIV; child should be testedYOU DO NOT NEED A NY OTHER SPECIAL CONSENT FORM FOR HIV TEST. THIS FORM IS SUFFICIENT.3. LOOK AT DIFFERENT “CONSENT FOR THE RELEASE OF INFORMATION” FORM (P 39)4. Temporary Medical Card5. NEW: CFS: 655 Initial Child Health History Form DCP is to gather as much health information as possible on taking Protective Custody of a child and take this info to IHS.
18THE HEALTHLINE: 1-800-KID-4345 In COOK County:In all NEW CUSTODY cases, the HealthLine must be called to arrange an Initial HealthScreening exam.Why call The HealthLine? The Health Line operator will helpTo select an IHS siteTo arrange for an IHSTo inform HealthWorks of new custody caseSo HW’s Care Coordinator can begin data search of prior medical records and begin Interim Case management for the first 45 daysOutside of Cook CountyCaseworker usually calls the HealthCare Provider that DCFS has relationship with OR child’s prior PCP if known
19ACCESS TO THE INITIAL HEALTHSCREENING EXAM: INITIAL HEALTHSCREENING SHOULD BE AT ONE OF THE SITES BELOW:Because HealthWorks has an Agreement with IHS Sites:(1) IHS completed within one hour of arrival(2) use of DCFS forms supplied by Healthworks(3) copy of IHS to Case Worker & copy is sent to HealthWorks3 Preferred Sites for IHS Cook CountyLaRabida Hospital: East 63rd St and Lake MichiganERC Maryville Clinic: 810 West MontroseSt. Anthony’s Hospital: West 19th Street8 other Sites for IHS in Cook CountyCook County Children’s Hospital: 700 S Wood StreetMt. Sinai Hospital: S CaliforniaLoretto Hospital: 645 South Central AvenueMichael Reese Hospital: S Ellis AveProvident Hospital : 500 E 51st StreetRoseland Hospital: 45 W 111th StreetBethany Hospital: West Van Buren StreetSt. Alexius Medical Center: 1555 N Barrington Road
20DOCUMENTING THE IHS(IF IT’S NOT DOCUMENTED, IT DIDN’T HAPPEN!) The documentation of health services is of critical importance.IN COOK COUNTY: The IHS Provider & the DCFS/POS Worker FAXES ALL IHS RECORDS TO HEALTHWORKS ( )When Police take PC; or PC is taken of a hospitalized child: The Hospital Discharge Exam IS the equivalent of an IHS.Get at the time of Discharge. Don’t Wait…more difficult when documents are sent to Medical RecordsFax it to HealthWorks for their central file
21WHOSE RESPONSIBILITY IS IT TO HAVE THE IHS DONE? EXPECTATIONS OF THE DCFS/POS WORKER FOR INITIAL HEALTH SCREENING EXAM? sfWHOSE RESPONSIBILITY IS IT TO HAVE THE IHS DONE?DCP is responsible for IHS when they take PCFollow-up/Permanency Worker is responsible for having the Initial Health Screening Exam done:In an INTACT/DISRUPT CaseWhen Judge gives DCFS Temporary Custody or Guardianship w/o PC being takenEach time a child’s case is opened or RE-OPENED. (Closed and reopened regardless of shortness of time in between it is a NEW custody cases)CASE ASSIGNMENT PROTOCOL1. Private Agencies shall not accept HMR cases directly from DCFS employees other than CAPU staff.2. Private Agencies shall not accept traditional foster care cases directly from DCFS employees other than CAPU staff3. A placement team is not responsible for case management services until it is contacted by CAPU4. CASE ASSIGNMENT PAYMENT UNIT must always be sent a packet of info when a new child case is either opened when PC is taken; or when a case is to be screened for court intervention. Only CAPU cam assign a case5. 6. When a new SCR report results in placement of additional children on active cases open to DCFS teams,a. the DCFS follow up worker is responsible for Health Screens, the placement of children and the provision of the Medicaid card.b. When the need for placement arises after hours and on weekends or holidays the DCP worker is responsible for these activities (p. 20)7. When a new SCR reports result in placement of additional children on active cases open to private agencies,a. the DCP worker is responsible for health screens, the placement of children and the provision of Medical cards.b. DCP is responsible for placing the child after working hours.8. 9. Intact to Placement Cases: (without DCP involvement)a. The screening worker (CPS or POS) prepares the screening documentsb. A packet is routed immediately to CAPUc. CAPU will offer the case to the team that served the intact familyd. Screener is responsible for IHS etc.10. Intact to Placement Cases: (DCP involvement) When DCP takes PC of children involved with child protection services/intact cases (CPS), DCP must inform CAPU immediately for assignment and placement. Only CAPU can assign a case. A placement team is not responsible for case management services until it is contacted by CAPUa. c CPS Intact Worker responsibilities (p 50)b. Contact the HealthLine to schedule an IHSc. Fill out the portions of the Encounter Formd. Provide the Medicaid carde. Complete the Family Assessment Worksheet CFS 144011. Placement Worker responsibilities:a. Among other responsibilitiesb. Instruct the SCG to call the Healthline to schedule CHEc. Select a PCP12. New Cases - assigned only by CAPU not by other DCFS employeesa. When PC is taken: Prior to placing a child in a foster home, DCP must have completed an IHS, have a temporary medical card to give the SCG. If a traditional agency is receiving the case at PC the agency should meet DCP at IHS exam and then transport the child to SCG
22POS WORKERS & ACCESS TO MEDICAL CARDS sf HOW DOES POS WORKER GET A “TEMPORARY” MEDICAL CARD?During Business Hours:CALL the DCFS Liaison for your agency.Call Medical Card Hotline (9am – 4p) They will fax a letter w official letterhead, child’s name, ID, IDPA number and eligibility date.After Hours (also weekends, emergencies):Call ERC (Emergency Shelter)NEEDED: Order for Temporary Custody or Guardianship from CourtNote(1): “Permanent” monthly Medical Card – not in the mail call Medical Card HotlineNote (2) Medical Card for children placed out-of-state. Contact Interstate Compact:To get out of state Medical Card (1) call INTERSTATE COMPACT-Carolyn Gephardt for Medical Card out of state(2) call Payment Unit
23WHAT DCFS EXPECTS OF EVERY WORKER WHO PLACING A CHILD IN a Foster Home WHAT DCFS EXPECTS OF EVERY WORKER WHO PLACING A CHILD IN a Foster Home? (with SCG) sfWE EXPECT CASEWORKERS TO -1. GIVE SCG copies of ALL the IHS Documentation2. Make SCG aware of any Health Issues, Medication, Medical Equipment child needs3. Give copy of Asthma Action Plan if child is Asthmatic & Study Home environment for Asthma triggers4. VERY IMPORTANT: CASEWORKER MUST CALL & INFORM HEALTHWORKS WHERE THE CHILD IS BEING PLACED: NAME, ADDRESS AND ESPECIALLY A CURRENT TELEPHONE NUMBER OF FOSTER PARENT5. Inform Foster Parent to call and cooperate with HealthWorks: The bottom line is that HW needs to get in touch with SCG As Soon As PossibleTo schedule the Comprehensive Health Evaluation in 21 days ( calendar days: If HW unable to contact SCG = lost time)To assist in selection of Primary Care Physician (PCP) for the child
24MODULE 3 INTEGRATED ASSESSMENT: THE ILLINOIS MODEL MODULE 3 IS ALL ABOUTINTEGRATED ASSESSMENT: THE ILLINOIS MODEL
25INTEGRATED ASSESSMENT (IA) sf There are Three (3) phases of the Integrated Assessment Process (Illinois Model):FIRST PHASE: Initial Assessment of DCP - Prior to case opening, DCP collects info related to immediate safety, ongoing potential of risk and ends with transitional visit. CPSW does same for child welfare cases/ no PC casesSECOND PHASE: A Clinical Screener and Caseworker have joint interviews with child. Parents, SCG resulting in Integrated Assessment Report (IAR) – basis for Service Plan. (w/i 45 days of placement.THIRD PHASE: ALL the on-going assessments by CPSW: collecting, analysing info > updating IAR and >497 until the case is closed.WHICH CASES ARE TARGETED FOR INTEGRATED ASSESSMENT?All standard Cases –new placement cases – no addon; no disrupted intact cases(Trigger Cases) Multiple Placement Disruption: 3rd placement in foster home or HMR after 2 placements in 18 monthsSo I/A Process provides CPSW with front end assistance for coordinating all info & used to identify strengths and needs of child and family systems. It is the basis for 497.Integrated Assessment Report: drafted in 30 days by clinical screener. CW, Supervisor, Clinical Screener review report: Findings, recommendations/services best suited to address child’s needs, prognosis for permanency; begin to develop with family Comprehensive Service Plan. Family Meeting on day 40. I/A report and Client Service Plan presented to Juv. Court day 45
26WHAT IS A COMPREHENSIVE HEALTH EVALUATION (CHE)? CHE EXAM MUST BE “COMPREHENSIVE”: IT INCLUDESA physical exam, A vision, and hearing screen (3 yrs and older) and oral health screening (2 yrs and older) Asthma ScreenLab tests: TB, anemia, lead, sickle cell, urinalysis, HIV test per DCFS guidelines ( if no prior test)Clinical screener & CW must complete a behavioral or mental health interview with child, SCG and parentIntegrated Assessment Report drafted by Clinical Screener (= Social History)WHAT’S NEEDED FOR CHE: CHILD’S PRIOR MEDICAL HISTORY(CFS 656) Child and Family Health History by the DCFS/ POS worker and faxed to HealthWorks 5 days prior to CHEThe 7 page Comprehensive Health Profile: a compiled by HW from all the prior health records HW found: (birth history, immunization records; school health records) for CHE provider to review and complete at time of CHE The CHE MUST BE completed in 21 Calendar Days from TC
27THE PURPOSE OF THE COMPREHENSIVE HEALTH EVALUATION ? Every worker involved with any case must have the best understanding possible of all the child’s needs/strengths: physical, mental, developmental, behavioral, (must take into account the child’s and family’s strengths)Those needs/strengths must then be addressed by putting in place the most appropriate services for this child and family in the Client Service Plan (497)The hope is with a better understanding of the needs and strengths, the child/family will be better served, there will be less placement disruption, and child will be better prepared to adapt successfully after return home or after emancipation
28THE EXPECTATIONS OF HEALTHWORKS’ CARE COORDINATORS (CC) (Let’s talk about what DCFS expects of some key actors CC; CW; & SCG)HW Care Coordinators (CC) work every case for the first 45 daysBEFORE THE CHE: To do their job HW C C NEEDScurrent information about the child’s foster parent from the worker placing the child, in order to schedule the CHE.Health Information:ALL IHS Records with the CFS 655 from InvestigatorThe CFS 656 From CaseworkerAll Known prior Medical Records from a Data Search (IDPA/ Cornerstone/ Birth Hospital/School)CC then Compiles these Records in the 7 page “Comprehensive Health Profile” for the CHE ProviderThe completed CHE package is then sent to CHE provider for review and completion
29THE CHE & OUR EXPECTATIONS OF DCFS/POS WORKER WHAT DOES DCFS & HEALTHWORKS EXPECT FROM THE CASEWORKER?CAN’T STRESS ENOUGH THAT HealthWorks DEPENDS ON DCFS/POS WORKER for current information on child’s placement in order to schedule the CHE and assists the Foster Parent (SCG) In selecting PCPInform SCG to call/cooperate with HealthworksFill out Child and Family Health History CFS 656 and fax it to HealthWorks 5 days prior to CHECaseworker is to attend the CHEEncourage SCG to and to keep scheduled appointments and be on time (if appt missed?)Encourage Bio-parent to be present at the CHE (if there are no safety factors)Provide transportation for SCG if necessary(Slide 43 repeat)
30THE CHE & OUR EXPECTATIONS OF FOSTER PARENT WE EXPECT THE FOSTER PARENT:To cooperate with HealthWorksTo get in touch with Healthworks ASAPTo cooperate in scheduling the Comprehensive Health EvaluationTo select Primary Care Physician (SCG id free to pick the doctor of their choice as the child’s PCP)To be on time for the CHETo bring the temporary medical cardBy all means let HealthWorks know ASAP if they are going to miss the appointment.
31ACCESS TO THE COMPREHENSIVE HEALTH EVALUATION WHO CONTROLS ACCESS TO CHE EXAMS?Only HealthWorks can schedule the CHE.CHE must now be done only at one of 15 selected CHE sitesWho should be present at the CHE?1. Foster Parent2. Case worker (IS expected to participate in the CHE)3. Bio parent is also expected to participate in the CHE (If Safety is NOT a factor)
32THESE ARE THE CHE SITES IN THE CITY OF CHICAGO NORTH: Ravenswood Professional Medical GroupNORTHWEST: Prime Care Community Health – Northwest (Northwest Family Health Center)WEST: Lawndale Christian Health Center (3860 W. Ogden)Farragut Community Academy ( 2345 S. Christiana)Lawndale HC (Homan Square)SOUTH: La Rabida Children’s HospitalSOUTHEAST: Chicago Family Health Center (CFHC)SOUTHWEST: Holy CrossFAR SOUTH: Chicago Family Health Center (Roseland)NORTH: Ravenswood Professional GroupNORTHWEST: Prime Care Northwest
33AND THESE ARE THE CHE SITES IN SUBURBAN COOK COUNTY SUBURBAN CHICAGONORTHWEST: Lutheran General Children’s HospitalWEST: McNeil Family PracticeSOUTH: Family Christian Health Center (Harvey),Aunt Martha’s Community Health Center (Harvey),FAR SOUTH: Aunt Martha’s Health Center (ChIcago Heights)
34THE CHE & EXPECTATIONS OF HEALTHWORKS’ CARE COORDINATORS AFTER THE CHE: (Slide 44 )HealthWorks Care Coordinator’s Role:Continues Case Management of each new child case for the first 45 daysContinues collecting child’s Health DocumentationSENDS CHE DOCUMENTATION1. TO THE CHILD’S PRIMARY CARE PHYSICIAN: Copies of all CHE documentation2. TO FOSTER PARENT: Copies of all CHE documentation, PLUS the Child’s Health Passport3. TO CASEWORKER: Copies of all CHE documentation, PLUS Child’s Health PassportAnd In addition to all of the abovethe CW also gets the Child Health Summary (Part 3 of CFS 497) for the First ACR
35MODULE 4 (REPEAT OF SLIDE 12) HEALTHWORKS 1. Partner with HealthCare Network Providers: Doctors, Hospitals,Clinics who agree to complete DCFS forms1993 HW designed to addressLack of access to healthcare servicesLack of access to qualified providersLack of receipt of documentation of healthcare servicesLEAD AGENCY:?? At the head of, the one that coordinates, runs the networkPhysicians have to meet the standard of IDPA “Healthy Kids Program” aka Maternal and Child Health Primary Care Program. ( Illinois Department of Healthcare and Family Services HFS ) In addition they must beBoard certified either in Pediatrics, Family Practice, Internal Medicine, Obstetrics-GynecologyHW is also Partner with Caseworkers and with Foster Parent
36HEALTHWORKS: IS STATEWIDE DCFS Developed its own network of Healthcare ServicesLEAD AGENCIES: Coordinate this whole network1. HEALTHWORKS IN COOK COUNTY: Healthcare Consortium of Illinois (HCI ) Is the One Lead Agency Supported by:A NETWORK OF HOSPITALS, CLINICS, DOCTORS PRIMARY CARE PHYSICIANS (PCP)IHS SITESCOMPREHENSIVE HEALTH EVALUATION (CHE): 12 CHE Sites2. HEALTHWORKS OUTSIDE OF COOK COUNTY:PUBLIC HEALTH DEPARTMENTS IN 18 COUNTIES1 PRIVATE ORGANIZATION
37HEALTHWORKS AND THE HEALTHLINE: (Repeat of slide 18)24 HOUR TELEPHONE THAT CASEWORKERS TO MAKE AN APPOINTMENT FOR AN INITIAL HEALTHSCREENING EXAM( NOT TO BE CONFUSED WITH CHILD ABUSE HOTLINE ABUSE )1-800-KID-4345
38THE IMPORTANCE OF DOCUMENTATION DOCUMENTATION: A CRUCIAL RESPONSIBILITY OF HEALTHWORKS.(1) The documentation of health services is of critical importance in determining if children have in fact received the necessary services to insure their well being(2) HW is required to maintain a central file of every child’s health information. This will happen only with the cooperation of Healthcare providers, Caseworkers and Foster Parents.(3) Therefore, IHS, CHE, Well child visits, ETC. MUST ALL be documented and HW must collect this documentation(4) DCFS Health Forms & Child’s Health Passport MUST be used by PCPs(5) Finally HW not only has to collect documentation(2) But also has to provide Health Info for CHEs, has to share it with the child’s PCPs, CWs, SCGs
39EXPECTATIONS OF HEALTHWORKS’ CARE COORDINATORS Repeat Slide 28BEFORE THE CHE: SLIDE 28
40CHILD’S ENROLLMENT IN HEALTHWORKS PCP sf 45 DAYS: Enrollment IN HW: means identifying or selecting a HealthWorks Primary Care Physician (PCP) for each child.Enrollment should be within the first 45 days of DCFS custodyBenefits of PCP:1. CONTINUITY OF SERVICE: Using the same doctor who knows the child’s and family’s health history; who tracks the child’s health services (shots, problems,meds); checks the child’ s growth and development; makes referrals.2. PROFESSIONAl services3. DCFS HEALTH forms ARE UTILIZED4. COMPLETED documentation sent to Healthworks .HealthWorks can assist in selecting A PCP in the Network.NOTE: THE CHILD OR FOSTER PARENT HAS THE RIGHT TO CHOOSE WHO THE PCP WILL BEIf Out-of-Network Doctors is selected he/she should be encouraged to become part of the HealthWorks Network(10 days from identification – 90 days to complete)DCFS Expectation: at least 90% enrolled. Data shows about 94.6% actually enrolled in Cook County (June 2005)
41THE CHILD’S HEALTH PASSPORT (HP) VERY IMPORTANT TOPIC: MOST SCG GET THE HP BUT DON’T KNOW WHAT TO DO WITH IT!1. THE HP Is initiated by HealthWorks after the Comprehensive Health Evaluation-HP is meant to be a Compilation of : Family Health history, child’s birth history, age appropriate exams, hospitalizations, surgeries, medications, medical problems, immunization history, IHS,CHE, PCP name/phone,2. HP Is an up-to-date snapshot of child health information so any medical provider will have in hand a health summary of any child they have to examine3. CW should Remind Substitute Caregiver that H P Needs to be taken to and updated at every medical exam by HW Network PCP4. Medical Card & Health Passport GO WITH CHILD TO ANY NEW PLACEMENT 5. Caseworker CAN get an updated copy of Health Passport for ACR from HW or SCG
42HEALTHWORKS – A SUMMARY 1. HW To Maintain the HealthLine 24 hrs a day2. Provide Care Coordination Services for first 45 days3. To Schedule CHE at Selected Provider Sites4. To assist Foster Parent in selection of PCP within 45 days5. To Assign cases to MCM agencies for ages 0-5 & pregnant and parenting teens and their children 0-56. To Initiate and update Health Passport7. COLLECT & MAINTAIN HEALTH DOCUMENTATION IN CENTRAL HEALTH FILES & ENTER HEALTH DATA IN THE DCFS HEALTHCARE INFORMATION SYSTEM (HCIS) FOR EACH CHILD IN DCFS CARE8. PROVIDE HEALTH DOCUMENTATION: to PCP, SCG; & send all health related documents including the Child Health Summary (Pt 3 of 497) TO CASEWORKER.9. To Enlist, credential, re-credential, and monitor network of HealthWorks’ Primary Care Physicians10. To Provide training in DCFS mandated Healthcare Services to POS/DCFS/ personnel & HealthCare Providers
43WHAT HEALTHWORKS EXPECTS OF DCFS/POS WORKERS sf (Repeat of Slide 29 above- WORTH REPEATING)HW ASKS ALL CASEWORKERS TO:1. Inform HealthWorks where the Child is being place: Name, Address, Telephone of Foster Parent2. Inform Foster Parent to call and cooperate with HealthWorks for CHE scheduling and PCP Selection3. Share Health Info with Foster Parent4. Gather ALL child’s Health Information (CFS 656).5. Fax to HealthWorks 5 Days Prior to CHE6. Be present at the CHE7. Provide Transportation if needed8. Encourage Bio Parent to attend9. Arrive on Time
44WHAT CASEWORKERS CAN EXPECTS FROM HEALTHWORKS (Repeat of Slide 34 above)1. HealthWorks sends to CASE WORKER a copy of the CHE and ALL the Health-related documents within 7 Days of CHE.2. HealthWorks prepares a Health Summary after the CHE which helps CW in completing the Health Summary for Client Service Plan (497)3. Keeps Central File of Health Records for each child4. HealthWorks initiates and updates the Health Passport after CHE5. Caseworkers can also obtain current copy of Passport and child immunization records from HealthWorks for ACR(Slide 34 above)
46ONGOING HEALTHCARE SERVICES DCFS MANDATED ONGOING HEALTHCARE SERVICESSCHOOL HEALTH REQUIREMENTS
47SCHOOL HEALTH REQUIREMENTS Illinois schools have their own health requirements – and children can be excluded from school if they are not current with shots and health exams1. IMMUNIZATION, PHYSICAL, & DENTAL.IL law requires children entering K, 5th and 9th grades be current with immunizations and have a current physical examThe form used to document this school requirement is the CFS 600- The Certificate of Child Health ExaminationThe original copy of CFS 600 goes to school nurse2. (NEW IL LAW: Starting July 1, 2005 IL law requires all children in any K, 2nd, 6th grades to have dental exam by a licensed dentist prior to May 15th.DCFS Health Services reminds POS and DCFS workers each year of this SCHOOL requirement so our DCFS children are not excluded from school
48DCFS SCHEDULE FOR ALL ON-GOING WELL CHILD EXAMS: (Well child visits help to keep a child healthy, help detect and address problems before they become serious )< AGE 1: AT 1, 2, 4, 6, 9 MTHSAGE 1 TO 2 YRS AT 12,15, & 18 MTHSAGES 2 TO 21 Annual Physical and DentalAGES 3-21 Vision and Hearing AnnuallyHealthWorks needs all this< AGE 1: AT 2 WKSdocumentationRemind Foster Parent to comply with schedule of immunization & well child visitsAssist SCG with transportation if necessary
49ASTHMA MANAGEMENT sfAsthma can be a life-threatening condition THAT AFFECTS BETWEEN 12 AND 25% OF DCFS CHILDRENBUT WITH PROPER CARE ASTHMA CAN BE CONTROLLEDAt time of PC, DCP is to ask caretaker if child has any health issues, (allergies, asthma, respiratory problems)For child diagnosed with Asthma: CFS 690 & CFS 691 MUST BE COMPLETEDFAX CFS 691 TO HEALTH POLICY, SpringfieldASTHMA ACTION PLAN (AAP) (CFS 690)Share Copies of AAP: with SCG, HealthWorks, case fileWhen placing a child with SCG: DCFS/POS Worker MUST check for Asthma triggers before placing child in foster home ( animal dander, cockroaches, cigarette smoke)Reinforce with SCG the seriousness of AsthmaRefer serious cases of Asthma to DCFS nurse: ( serious case = 2 Emergency Room visits for Asthma in a year OR one hospitalization for Asthma in a year)For children taking Asthma medication in school, they are permitted to carry their asthma medication with them and use it while in school; school sponsored activitity; under supervision of school personnel; after school activities.To meet requirements of school code for self administrationWritten authoriation for self administrationWritten statement from child’s PCP withName of medicationDosageTimes or circumstances under which it must be taken/administered
50APORS: ADVERSE PREGNANCY OUTCOME REPORTING SYSTEM sf 1. Illinois law - Regarding children born with medically complex conditions: substance exposed infants (sei), low birth weight <3.5 lbs, blood disorders, serious congenital infections, fetal alcohol syndrome, discharge from icu2. Birth Hospitals are required to report these cases to IDPH, Local Public Health Depts. (CDPH, and CCDPH)3. IL law mandates Nursing Services for Medically Complex Children (0-2 Years of Age)4. APORS children 0-2 years are cared for by Nurses from Chicago Department of Public Health or Cook County Department of Public Health (2 MCMA)5. Nurses visit, make assessments, assist families with access to appropriate services6. These 2 MCMA also assist Caseworkers with the Health Summary for Client Service Plan7. DCFS/POS WORKERS MUST CALL DCFS nurses for consultation on ALL medically complex cases8. SEI INFANTS: IL law & DCFS Policy On HIV testing for SEI infants. AIDS PROJECT REFERRAL; CONFIDENTIALITY; DOCUMENTATIONIn our presentation we usually just mention APORS. This is just to make case managers aware of the Illinois Law and the other players involved with a special group of children ages 0 to 3.APORS stands for Adverse Pregnancy Outcome Reporting System which is mandated by Illinois Law. Illinois Department of Public Health requires all hospitals to report to Chicago Department of Public Health, Cook County Department of Public Health or other local Health Departments (depending on where the child lives) all newborns with complex medical conditions. Babies with serious congenital issues, children born substance exposed or showing signs of withdrawal, with very low birth weight, with blood disorders just to name a few.Nurses from Chicago Department of Health or Cook County Health Department follow these children until age two. They visit the homes, make assessments, help with parental instruction and assist in obtaining resources . These nurses know the needs of these children and understand what services are needed. So for children in DCFS care who belong to this group, the nurses can assist your case workers or case managers with part 3 - Health Summary section of the Client Service Plan
51WHY DCFS REQUIRES ONGOING HEALTHCARE SERVICES? Dental/Oral Health: Children need regular dental care starting at age 2 or earlier: to prevent problems with gums, teeth, mouth. This should be part of annual physical exam and is a DCFS requirement. .Hearing/Vision screen: to identify children who may have a visual or hearing problem. These often go unnoticed until a child develops significant educational and/or medical problems.Immunizations: One of the best ways to protect a child’s health is with immunizations. Not adequately immunized a child may suffer from illnesses, a lifetime of disability, or even death.Annual Physical: Important to track child’s growth and development. Detect and address health problems before they become serious. Keep child healthy
52TRANSPORTATION : ACCESS TO HEALTHCARE SERVICES: sf POS/DCFS CW Can Call Regional Medical Liaisons for Transportation to Doctor’s Appointments.RML will call First Transit to get an approval numberApproval number is given to Transportation Service (registered with First Transit)As of April 04, you can call RML only for transportation to Medical visits, (not for therapy sessions or counseling)RMLs need to be called about a week ahead of time.Telephone # for Regional Medical Liaisons
53HW IN PARTNERSHIP WITH MEDICAL CASE MANAGEMENT AGENCIES 1. Medical Case Management Agencies provide services for DCFS children age 0-5; for all APORS children (0-2) and for Pregnant or parenting Wards and their children (0-5)2. There are seven (7) MCM Agencies including CDPH, and CCDPH3. CDPH & CCDPH use Public Health Nurses who provide In-Home Assessments, Parental Instruction for APORS Infants until age 0-24. CCDPH And Five (5) MCM Agencies serve children ages 0-5:Facilitate access to follow-up with Primary Health Care, and Specialty Services (For Wards 0-5; and children of parenting wards 0-5)Assure that each Ward (0-5) in their care has a Health Care Plan for Inclusion in Client Service Plan.HealthWorks sends CW the very first child Health Summary after CHE (part 3 of 497)MCM sends caseworker subsequent Health Summary for part 3 of Client Service Plan. MCMA Update Cornerstone database (Immunization, EPSDT Exams)
54WE HAVE SAID THIS BEFORE : FOSTER PARENT ARE HEALTHWORKS’ CRITICAL PARTNER HealthWorks needs child’s current placement information: Foster Parent’s current phone number and addressHealthWorks needs the COOPERATION of the Foster ParentHW & DCFS/POS workers depends on SCG to schedule the CHE, to follow Immunization & DCFS Well Child Visit Schedules.HealthWorks asks SCG to take Passport to every medical visit and get the Passport Updated by the DoctorHealthWorks needs to obtain all current health documentation.
56IDPA HEALTH BENEFITS HOTLINE 800-226-0768 (different from printed copy)Ready to assist with finding specialty medical services if neededIDPA HEALTH BENEFITS HOTLINE (call for any healthcare provider)Call Doral Dental for closest dentistCall Vision Care for eye examsMedical Card Hotline
57HIPAA: HEALTH RECORDS & FEDERAL LAW sf The Health Insurance Portability and Accountability Act of 1996.A Federal Statute designed to protect confidentiality of health information; to restrict disclosure of health information to the minimum necessary.Penalties for non-compliance There are new Consent Forms signed by the DCFS Guardian which are HIPAA Compliant .Over and above Consent For the Release of Information, you might be asked to provide proof that a child is a ward of the State: Send the provider a Dispositional Order : either for Temporary Custody or for Guardianship.
58HEALTH RECORDS NEEDED FOR ADMINISTRATIVE CASE REVIEWS sf 1. Health Passport:Foster Parent will have the most current updated copy of HPHealthworks can now electronically update the Health Passport. (HealthWorks depend on SCG and CW for most current health information)2. CFS 497 Client Service Plan: Child Health Summary3. Age Appropriate Forms CFS 652 F-T4. CFS 600 Certificate of Child Health Examination5. Up-to-date immunization record (Cornerstone report accepted)6. Current annual health exam (AGE 2-21)7. Current annual vision /hearing (AGE 3-21)8. Current annual dental/oral exam (AGE 2-21)
59SUMMARY (a) sfDCFS/POS Workers MUST comply with ALL DCFS Health Policies and Mandated Healthcare Services in a timely mannerIHS Within 24 Hrs for ALL New Custody CasesALWAYS call HealthWorks with current placement information when you place a child.ALWAYS call the Healthline to arrange for and IHS (1-800-KID-4345 for New Custody CasesGather health info on CFS 655 (DCP) and CFS 656 (CW) & fax to HealthWorks
60SUMMARY (b)5. Assist HW & SCG in scheduling Comprehensive Health Evaluation within 21 Days of Temporary Custody (TC)6. CW, SCG need to participate in CHE. Bio Parent also to participate when safety is not an issue.Documentation – HealthWorks keeps a CENTRAL HEALTH FILE for each Child, needs to get copies of ALL Health Records.
61SUMMARY (c)Healthworks provides Caseworker with ALL Health related documentation after the CHE. CW also gets Child Health Summary Part 3 for inclusion into your Client Service Plan.Partnership & Cooperation: HealthWorks, Caseworker, Foster Parent, PCP form a partnership for accessing Healthcare services for DCFS Children10. Ultimately, the Caseworker is responsible for compliance with ALL DCFS Health Services in a timely manner.
62IMPORTANT TELEPHONE NUMBERS E R C (Shelter 810 W Montrose)HEALTHLINE (COOK) KID-4345HEALTHWORKS (phone)HEALTHWORKS (fax)MEDICAL CARD HOTLINEOUT-OF-STATE MEDICAL CARD ^DCFS CONSENT HOTLINEDORAL DENTALIDPA HEALTH BENEFITS HOTLINE *HEALTH SERVICES (SPRNGFLD) TELHEALTH SERVICES (SPRNGFLD) FAXHEALTH SERVICES (CHICAGO) / 6976DCFS NURSESDCFS AIDS PROJECTMEDICAL TRANSPORTATION LIAISONSNORTH REGIONCENTRAL REGION:SOUTH REGION :^ When children placed out-of-state need medical card of that state* Call this number to find a medical doctor/specialist who take medical card