1. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 1 Instructional tool CENTRALIZED NURSING REFERRAL PROCESS Illinois Department of Children and Family Services DCFS Child Welfare Nurse Specialists

2. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 2 GOALS Enhance the knowledge of the centralized nursing referral process whereby increasing the utilization of consultation services provided by DCFS Child Welfare Nurse Specialists (CWNS) utilizing consistent formalized training Enhance job performance and expectations of DCFS Child Welfare Nurses Improving the overall quality of health care acquisition and resources for children with special health care needs

3. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 3 Instructional objectives Upon completion of the training the learner will be able to: Recall an operational definition of children with special health care needs Know the job performance and expectations of the DCFS CWNS Recognize the need to request consultation services from a CWNS

4. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 4 Instructional objectives Know the types of nursing referrals Discuss the steps of the centralized nursing referral process Locate policy transmittal 302 Appendix O and the nursing referral form (CFS 531) on the DCFS D-Net and SACWIS template

5. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 5 Policy Guidelines for Nursing Referral Process DCFS Policy Transmittal – 2008.09 effective May 16, 2008 Policy Transmittal revisions: – 302 Appendix O – 300.70 Subsection (i) – 300.80 Subsection (g) – 302.388 Subsection (f) (2) – CFS – Nursing Referral Form

6. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 6 How to define a child with special health care needs The Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (MCHB) defines children with special health care needs (CSHCN) as: “... those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (McPherson, Arango, Fox, Mcmanus, Newacheck,Shonkoff, Strickland, 2012)

7. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 7 Diagnosis for children with special health care needs Any rare genetic disorder ( e.g.,Tay-Sachs) Asthma (moderate, persistent or severe) Apnea episodes Cerebral palsy Multiple psychiatric hospitalizations and/or medications Compromised immune system (HIV) Sickle Cell Disease/Trait Failure to thrive Diabetes type I or type II

8. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 8 Diagnosis (continued) Environmental modifications Metabolic disorders, (galactosemia, PKU (phenylketonuria) Second & third degree burns Respiratory problems Seizure disorder – Expanded list can be found on D-Net Policy Transmittal 302 Appendix O

9. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 9 Child Welfare Nurse Specialist is: An Illinois licensed Registered Nurse functioning primarily as a Health care services Consultant Liaison – consultant to residential and skilled nursing facilities providing: Advocate

10. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 10 Services NOT provided by CWNS  Second medical opinions  Direct care  Case management duties  Consent Approval

11. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 11 Reasons for Requesting consultation  Assessment and evaluation for placement  Protective custody for children with special health care needs (EMERGENCY)  Consultation – medications/regimen, compliance, regimen, polypharmaceutical evaluations * consult with medical director for further clarity if needed.  Understanding the cause and functional changes of documented diagnosis

12. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 12 Requesting consultation services  Participation in staffings’ and CIPP (clinical intervention for placement preservation)  Home modifications  home/school and hospital discharge assessments  Assistance in coordination of medical transportation for children with special health care needs

13. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 13 Requesting consultation services Consent procedure  CWNS does not sign consent  assist with problem identification  Dr. Billie Adams (773) 288-4824/ or Dr. Chaudhary 217-492- 2618 will provide approval for surgical procedure  * authorized agents located in regional offices will sign consents

14. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 14 Types of nursing referrals Formal Nursing Referral  Most commonly used for all request for nursing consultations  Suspected medical abuse/neglect  Participation in staffings/CIPPs  Medical record review  Physician contact  Home visit/hospital discharge assessment visits

15. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 15 Formal Nursing Referral CWNS will respond to the referral source (caseworker, DCP, Healthworks, etc.,) within 5 days of receiving the nursing referral from the central office Contact will be made via phone, e-mail and or in person Please ensure once referral is submitted – a contact number is provided – for nurse

16. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 16 Formal Nursing Referral o Documentation is submitted to the central office for review per policy transmittal 302 Appendix O. o Accepted documentation will be sent to worker/supervisor or entered into the SACWIS system o NANDA Documentation: Assessment Nursing diagnosis Plan Implementation Recommendations/evaluation *NANDA (approved documentation)

17. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 17 Types of Nursing Referrals Emergency Nursing Referral  Protective custody children with special health care needs needing immediate placement  Note: form 418J must be initiated during protective custody investigations by DCP for a child with special health care needs

18. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 18 Emergency Nursing Referral  CWNS will respond to the referral source (DCP) within 12 hours of receiving the nursing referral from the central office  Note: after hours – Chief Nurse is available 24 hours via cell phone for consultation as well as “gatekeeper” in specialized care for specialized placement. Children should be taken for observation via emergency room. DCFS nurse will receive Emergency referral during next business day to provide extended consultation

19. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 19 Types of Nursing Referrals Casual Inquiry  not “client specific”  Requesting information, e.g., understanding of a specific drug,  how to complete a nursing referral  what is the definition of a medical condition etc.  May occur in various settings, regional office(s), telephone or in person  Used by DCFS nurses “only”

20. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 20 Types of Nursing Referrals Notification only  Health Works lead agencies  status change  client being seen at one of our Health Works lead agencies  5 day response time after receipt by CWNS  When submitting nursing referral – attach CHE (Comprehensive Health Evaluation)

21. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 21 CFS 531 Nursing Referral Form Request for all nursing consultations (Formal, Emergency, and Notification Only) must be initiated by completing the Nursing Referral Form (CFS 531). DCFS, Health Works, or access to DNet – CFS 531 may be complete and submitted via SACWIS No access to DNet-CFS 531 may be faxed Form will not be processed if it is handwritten

22. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 22 Nursing Referral Form CFS 531 3 ways to submit CFS 531 requesting nursing consultation:  SACWIS  E-MAIL – complete form to “nurseref” via DCFS outlook (DCFS/DCP, Health Works – are to use e-mail submission  FAX – complete form to 1-866-531-1459 (outside agencies with no access to DCFS Outlook email system)

23. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 23 Nursing Referral Form CFS 531 CFS 531 – Hard copy 11 page document Pages 1- 4 completed by the individual making the request for nursing consultation Pages 5-11 completed by CWNS * nursing documentation will be noted on pages 5-11

24. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 24 CFS 531 Page 1 Date of Birth – refers to the child's date of birth Legal status of child – must be identified Primary language needed *(Burgos decree - bi- lingual nurses are available) Complete caregivers section Workers referral information Region/Site/ Field must also be completed

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26. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 26 CFS 531 Page 2

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28. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 28 CFS 531 Page 3

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30. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 30 CFS 531 Page 4

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32. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 32 CFS 531 Page 5

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34. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 34 SACWIS CFS 531–screen shots are identical to the hard copy CFS 531

35. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 35 Screenshot 1-click New Nursing Referral hyperlink after clicking Nursing Referral on left side of eHealth.

36. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 36 Screenshot 2-select a Referral Type. Enter a required comment. Click the Add hyperlink.

37. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 37 Screenshot 3-after adding the Nursing Referral, it can be deleted (if mistaken entry, etc) by clicking the Delete hyperlink. Click the Save button if retaining the referral.

38. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 38 Screenshot 4-Click the SUBMIT button to submit the referral to the nurses.

39. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 39 Screenshot 5-the Response Detail is accessed and filled out by the Nurses.

40. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 40 Screenshot 6-Shows the referral request date and the status. After the Nurses accept it, the Acceptance Date and Assessment date are displayed.

41. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 41 Summary of Centralized Nursing Referral Process CFS received via: – Fax 1-866-531-1459 – E-mail “nurseref” – SACWIS – Logged onto our Data base – Reviewed by Chief Nurse at central location – Referral is assigned to CWNS

42. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 42 Summary (continued)  CWNS makes contact per authorized time frame (5 days,12 hours)  Verbal recommendations initially  hard copy – worker/supervisor/health works or SACWIS input once reviewed and accepted (PT 302 App. O) *approval pending DCP

43. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 43 Case Study 12 hours (emergency referrals) Referral Evaluated logged onto database Make an assesment & provide verbal health safey recommendations Nurse assigned from Central office will contact referral source 531- complete all applicable areas-email to nurseref (via outlook) Complete 531 in SACWIS Referral source may be contacted for clairity and for ALL EMERGENCY REFERRALS Consultation Complete Chief Nurse contact ref. source 5 days (formal referral) 5 days (formal referral) Documentation of assessment & health safety recommendations submitted to Central office- reviewed document disseminated to referral source or placed on SACWIS

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45. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 45 References McPherson, M., Arango, P., & Fox, H. B. (1998). A new definition of children with special health care needs. Pediatrics, 102, 137-140. American Nurses Association. (2011). The nursing process: A common thread amongst all nurses. Retrieved http://nursingworld.org/EspeciallyForYou/StudentNurses/

46. Richard Calica, Director 03-12-12 Copyright © 2012 by the Illinois Department of Children and Family Services 46 QUESTION AND ANSWER PERIOD