11200 Medical and Dental Services
CPS October 2017
DFPS must ensure that children in DFPS conservatorship receive medical care.
Each child's care must include:
• emergency treatment, whenever necessary;
• timely examination and treatment of nonemergency injuries and illnesses; and
• regular preventive care appropriate to the child's age and condition, including immunizations and tuberculin (TB) tests.
DFPS Rules, 40 TAC §700.1329(a)
CPS staff must work with all substitute caregivers and medical consenters to make reasonable efforts to see that youth and children in DFPS conservatorship receive the medical care they need and are entitled to receive.
Obtaining Services
All children and youth in DFPS conservatorship receive medical and dental care through Texas Medicaid.
STAR Health
STAR Health, a comprehensive healthcare system offered statewide, provides Medicaid services for most children and youth in DFPS conservatorship.
For children enrolled in STAR Health, including those in kinship placements, medical consenters must use STAR Health and its network of providers for the medical care described above.
In the Medical Services Resource Guide, see STAR Health.
Traditional Medicaid
If a child or youth in DFPS conservatorship is not eligible for enrollment in STAR Health, then traditional Medicaid or, if applicable, an HHSC Medicaid Managed care health plan, provides medical care.
In the Medical Services Resource Guide, see Traditional Medicaid.
Confirming Eligibility
The caseworker must contact the CPS eligibility worker to resolve issues related to a healthcare provider's inquiry about the Medicaid eligibility of a child or youth in DFPS conservatorship.
Medical and Dental Checkups
The Texas Health Steps program provides medical and dental checkups to children and youth in DFPS conservatorship.
Texas Health Steps is Texas Medicaid's comprehensive and preventive child health service. Texas Health Steps medical and dental checkups are available through both STAR Health and traditional Medicaid.
In the Medical Services Resource Guide, see Texas Health Steps.
11210 Meeting the Requirements for Medical and Dental Services
CPS November 2018
CPS staff must follow the schedule for obtaining initial and routine medical and dental checkups and screenings for children in DFPS conservatorship. Review the following for more information:
11212 Initial Texas Health Steps Medical Checkup
11213 Initial Texas Health Steps Dental Checkup
11214 Subsequent, Ongoing Texas Health Steps Checkups
11320 Psychotropic Medications
The schedule meets the medical care requirements in:
• The Minimum Standards and Guidelines for Child-Placing Agencies, §§749.1151 and 749.1153.
• The Texas Health Steps periodicity schedule for medical and dental checkups.
Also see the Medical Services Resource Guide and the 3 in 30 Resource Guide
Children in Special Facilities
For children placed in the following facilities, the applicable facility rules for preventive care apply:
• A facility regulated by the Texas Juvenile Justice Department.
• A nursing home.
• A state supported living center.
• An intermediate care facility for individuals with an intellectual disability.
For more information, see 4230 Facilities Under the Authority of Other State Agencies.
11211 3-Day Medical Exam
CPS August 2023
If a child qualifies for a 3-Day Medical Exam, the child’s caseworker must ensure that the child receives the exam within three business days of the removal. The child qualifies for a 3-Day Medical Exam if the child meets any of the following criteria:
- Was removed as the result of sexual abuse. See 2113.1 Definitions of Abuse for the definition of sexual abuse.
- Was removed as the result of physical abuse. See 2113.1 Definitions of Abuse for the definition of physical abuse.
- Has an obvious physical injury. An obvious physical injury is defined as a physical injury that would be apparent to a prudent adult.
- Has a chronic medical condition. A chronic medical condition is defined as long-term condition (approximately one year or longer) that requires ongoing medical attention or limits activities of daily living.
- Has a medically complex condition. A medically complex condition is defined as either:
- One or more diagnoses that affect multiple organ systems.
- One long-term health condition that results in functional limitations, high health care needs or utilization, and often the need for medical technology.
- Has a diagnosed mental illness. A diagnosed mental illness is defined as a mental health diagnosis from a licensed medical or behavioral health professional (Licensed Professional for the Healing Arts, LPHA).
The 3-Day Medical Exam is a screening to provide a baseline of the child’s health, check for injuries and illnesses, and ensure treatments and medications are available for the child. DFPS must provide known medical and trauma history, including circumstances of removal, to the exam provider.
If a child does not qualify for a 3-Day Medical Exam, the child may still receive treatment from a medical provider at any time when a caregiver believes it is necessary.
The caseworker attempts to contact the child’s primary care physician at the time of removal to ensure continuity of care and continuation of prescribed medication.
A health care provider must not administer a vaccination as part of the 3-Day Medical Exam without parental consent. The only exception is that the provider can administer a tetanus vaccination if the provider determines an emergency situation requires it.
The caseworker can help the health care provider contact the parent for consent for vaccination. However, the caseworker cannot do the following for the 3-Day Medical Exam:
- Consent for vaccination on behalf of the child.
- Obtain the parent’s consent for vaccination on behalf of the health care provider.
If a full adversary hearing is held and DFPS is named a managing conservator, the caseworker can consent to vaccinations on behalf of the child. These vaccinations can occur during subsequent checkups.
In the 3 in 30 Resource Guide, see 3-Day Medical Exam.
11212 Initial Texas Health Steps Medical Checkup
CPS October 2017
The child's caseworker must ensure that the child receives an initial Texas Health Steps medical checkup within 30 days after the child enters DFPS conservatorship. The checkups are available to all children through both STAR Health and traditional Medicaid.
An initial medical checkup:
• must be performed by a licensed health practitioner who is enrolled in Texas Medicaid as a Texas Health Steps provider;
• must be completed within 30 days after a child enters DFPS conservatorship; and
• is considered overdue 31 days after entering conservatorship.
A child who is being transferred from one licensed agency to another licensed agency (for example, from one child-placing agency, residential treatment center, or general residential operation to another) is exempt from receiving another Initial Texas Health Steps checkup after changing placements, as long as he or she has had a Texas Health Steps medical checkup within the past year, while in DFPS conservatorship.
11213 Initial Texas Health Steps Dental Checkup
CPS October 2017
All children six months of age or older must receive an initial dental exam, known as a Texas Health Steps dental checkup.
The checkup must be performed by:
• a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider; or
• a dental hygienist who is working under the supervision of a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider.
The initial checkup:
• must be scheduled within 30 days after placement in DFPS conservatorship; and
• is considered overdue after 60 days.
If a child turns six months of age while in care, the initial Texas Health Steps dental checkup:
• must be scheduled within 30 days of the date the child reaches six months of age; and
• is considered overdue after 60 days.
Care Provided by STAR Health
The child's caseworker must ensure that the child receives an initial Texas Health Steps dental checkup within 60 days after the child enters DFPS conservatorship. STAR Health helps to ensure that children in DFPS conservatorship receive an initial Texas Health Steps dental checkup in a timely manner by requiring the checkup within 60 days of enrollment in STAR Health.
For details, see:
Minimum Standards and Guidelines for Child-Placing Agencies, Child Care Licensing Division, §§749.1153 and §749.1409
Follow-up appointments and services are scheduled as needed, or as requested by the Texas Health Steps medical or dental provider.
11214 Subsequent, Ongoing Texas Health Steps Checkups
CPS October 2017
Annual Medical Checkups
Following the initial medical checkup through Texas Health Steps, the caseworker must ensure that all children in DFPS conservatorship continue to receive medical checkups in accordance with the Texas Health Steps Periodicity Schedule.
The caseworker must ensure the medical checkups are conducted by a licensed health practitioner who is enrolled in Texas Medicaid as a Texas Health Steps provider.
The caseworker must ensure that subsequent medical checkups are in accordance with the Texas Health Steps Periodicity Schedule. In the Medical Services Resource Guide, see Texas Health Steps.
A child being transferred from one licensed agency to another licensed agency (for example, from one child-placing agency, residential treatment center, or general residential operation to another) is exempt from receiving an additional annual Texas Health Steps checkup after changing placements, as long as he or she has had a Texas Health Steps medical checkup within the past year, while in DFPS conservatorship.
Minimum Standards and Guidelines for Child-Placing Agencies, §§749.1151 and 749.1401
Routine Dental Checkups
The caseworker must ensure that, beginning at the age of 6 months, children in DFPS conservatorship must receive dental checkups through Texas Health Steps, in accordance with the Texas Health Steps Periodicity Schedule.
The caseworker must ensure that the dental checkups are provided by:
• a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider; or
• a dental hygienist who is working under the supervision of a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider.
Subsequent dental checkups:
• must be scheduled six months after the month in which the child received the previous checkup; and
• are overdue at nine months.
For licensed foster care placements, Licensing requires compliance with the dentist's recommendations for examinations and treatment.
Minimum Standards and Guidelines for Child-Placing Agencies, §749.1411
Follow-up appointments and services are scheduled as needed, or as requested by the Texas Health Steps medical and dental provider.
11215 Immunizations
CPS January 2020
Unless there is known objection by the parent or person with legal authority over the child, the caseworker must ensure that children in DFPS conservatorship are immunized against disease. The immunization schedule is in accordance with the American Academy of Pediatrics Periodicity Schedule, as recommended by the Texas Department of State Health Services (DSHS).
Minimum Standards and Guidelines for Child-Placing Agencies, §749.1421
In the Medical Services Resource Guide, see Immunizations.
If the caseworker has actual knowledge that the parent (or person who had legal authority to make medical decisions for the child before the child entered DFPS conservatorship) objects to the immunization, the caseworker cannot consent to immunization without a court order.
If the caseworker has knowledge of the parent’s objection, the caseworker must note on Form 2085B Designation of Medical Consenters that the Medical Consenter may not consent to immunizations.
If the caseworker feels that a medical emergency requiring immunization exists, the caseworker consults with the supervisor and the attorney representing DFPS in the case to determine whether to request a court hearing.
Consent for Immunizations by Pregnant or Parenting Foster Youth
A youth may consent to his or her own immunization for a disease if the youth is pregnant or parenting and the Centers for Disease Control recommends the initial dose for the vaccine to be administered before 7 years of age. See:
Centers for Disease Control and Prevention (CDC) Vaccines and Immunizations
The ability to consent for immunizations does not give the youth the right to refuse a vaccine that the healthcare provider recommends and the youth's medical consenter has agreed upon, unless the youth has been designated his or her own medical consenter.
11216 Tuberculosis Screening
CPS January 2020
The caseworker must ensure that children entering DFPS conservatorship are screened for tuberculosis (TB). A TB screening may include a skin or blood test.
In addition to the initial screening the caseworker must ensure that children who may be high risk are tested for TB if there are circumstances that warrant it, such as known exposure to someone with tuberculosis. Such recommendations would be made by the child’s:
• Healthcare provider, or,
• Regional DSHS offices, or
• Local public health authorities in the county in which the child has been living.
Minimum Standards and Guidelines for Child-Placing Agencies, §749.1417
11220 Reproductive Health
11221 Contraceptive Services
CPS October 2017
A youth may request contraceptive services through his or her physician or other family planning services provider. The decision to provide a minor with contraception and to obtain the appropriate consent, if applicable, is the healthcare provider's responsibility. The caseworker must not attempt to prohibit the youth from seeking contraceptive services.
Restrictions on Sterilization
If a youth in DFPS's conservatorship asks to be sterilized, the youth's primary caseworker must consult with the regional attorney to determine whether to ask the court to make a ruling on the request. Neither DFPS nor the medical consenter have the authority to consent to the request.
Federal Regulation
Medicaid funds must not be used to pay for the sterilization of any individual who:
• is less than 21 years old; or
• has been declared mentally incompetent by a federal, state, or local court of competent jurisdiction, unless the individual has been declared competent for purposes that include the ability to consent to sterilization.
In the Medical Services Resource Guide, see Contraceptive Services.
11230 Informing Caregivers and Medical Consenters About Health Services
CPS October 2017
CPS staff must provide caregivers and medical consenters with:
• pamphlets and other information about the services provided by STAR Health and traditional Medicaid through the Texas Health Steps program; and
• the addresses of the websites for these programs.
In the Medical Services Resource Guide, see Texas Health Steps.
Staff must direct individuals with questions about how to obtain particular medical or dental services to the STAR Health and the Texas Health Steps program, as appropriate.
11240 Using the Health Passport
CPS October 2017
The Health Passport is a Web-based electronic system for storing and retrieving a child's health information. Healthcare providers, caregivers, and authorized CPS staff use the Health Passport to manage a child's healthcare needs.
All CPS staff planning to use the Health Passport must first carefully read and sign a user agreement.
All caseworkers must take the online Health Passport training in the DFPS Learning Station.
Accessing the health information contained in a Health Passport without a business need is a violation that carries penalties up to and including termination.
In the Medical Services Resource Guide, see Using the Health Passport.
11300 Medication
11310 If DFPS or SSCC Staff Administers Medications
CPS May 2024
DFPS or single source continuum contractor (SSCC) staff may be required to administer medications to children and youth as part of normal day-to-day responsibilities (such as transporting a child or youth to an appointment or supervised visit). In most circumstances, DFPS or SSCC staff members at all levels can administer medications. However, if the child is without placement and staying with DFPS or SSCC staff overnight, one of the following must administer the child’s medications:
- DFPS or SSCC staff member at the caseworker level or above.
- DFPS dedicated youth supervision staff member.
- Contracted registered nurse (as available).
Contracted registered nurses are sometimes available when DFPS staff are supervising children. DFPS does not provide contracted registered nurses when SSCC staff are supervising children.
If a DFPS or SSCC staff member or a contracted registered nurse (as available) administers medication, the following requirements apply:
- The person who administers the medication (DFPS or SSCC staff member or contracted registered nurse) must do the following:
- Refer to Form 2400 Prescription Medication Information for each prescribed medication or Form 2401 Non-Prescription Medication Log for over-the-counter medication.
- Be informed about the child’s diagnosis (if any) and other medications.
- Be informed about the actions of the medication and side effects.
- Administer medications only if they are stored in the original pharmacy container (for prescription medications), a blister pack created by a pharmacy, or a manufacturer’s container (for nonprescription medications).
- Administer medications according to the instructions on the container or from the prescribing licensed health care provider.
- Remove the prescribed dosage of the medication (or the dosage indicated in the instructions, if nonprescription) from the stored pharmacy (or manufacturer’s) container outside the presence of the child and return the stored container to the child’s lockbox. (If no lockbox is available, the staff member or nurse uses another suitable locking storage area.) This removes any chance of the child grabbing the container and possibly taking an overdose.
- If caring for more than one child, prepare and administer medications for each child individually. This minimizes the possibility of giving the wrong medication to a child and the possibility of a child grabbing another child’s medication and taking it.
- Make sure the child takes the medication as prescribed (if it is a prescription medication) or as directed on the container (if nonprescription).
- Documentation that the medication was administered (or, if applicable, that the child refused to take the medication at a certain date and time) is required in both of the following places:
- IMPACT Contact Detail entered by a DFPS or SSCC staff member if medication was administered while traveling, during a visit, or in another circumstance. Exception: For youth without placement, documentation must be entered into youth shift notes.
- Form 2406 Daily Prescription Medication Log Sheet or Form 2401 Non-Prescription Medication Log (entered by the staff member or nurse who administered the medication).
A DFPS or SSCC staff member must do the following when a medication is administered or attempted to be administered (regardless of whether a staff member or a contracted registered nurse administered the medication):
- Place the original Form 2406 or Form 2401 (or both, if applicable) in the child’s case record.
- Give a copy of Form 2406 or Form 2401 (or both, if applicable) to the child’s next caregiver.
DFPS or SSCC staff must contact the regional CPS nurse consultant or a contracted registered nurse (as available) with any questions or concerns about a medication for a child.
11311 DFPS or SSCC Staff Administration of Medication to Children
CPS March 2024
Medication route refers to the way the drug is introduced into the body.
Permissible Routes
DFPS or SSCC staff members who are not licensed health care providers may administer medications and assist older children in taking medications by the following routes:
- Capsules, pills, or liquids taken by mouth.
- Inhalers taken through the nose or mouth.
- Eye drops.
- Skin patches.
- Nebulizers.
Non-Permissible Routes
DFPS or SSCC staff members who are not licensed health care providers may not administer medications by the following routes:
- Injection.
- Suppositories or creams taken through the rectum or vagina.
- Indwelling IV.
- Nasogastric tube (NG-tube).
- Gastrostomy tube (G-tube or G-button).
If a child is prescribed a medication to be administered in a way that is not approved for a DFPS or SSCC staff member (such as an NG-tube or injection) or a DFPS or SSCC staff member has questions, the DFPS or SSCC staff member contacts the child’s health care provider or calls STAR Health at 1-866-912-6283 for help. CPS nurse consultants may be able to provide general guidance but cannot provide direct assistance with medication administration.
Insulin
If an older child has approval by their medical provider to administer their own insulin injections, then DFPS or SSCC staff may supervise this administration. DFPS or SSCC staff members who are not licensed health care providers may not supervise insulin administration by children who are still learning to administer their own insulin and need guidance on technique.
Suppositories
If an older child is prescribed and understands how to insert a suppository or cream that is administered through the rectum or vagina, DFPS or SSCC staff may hand the medication to the child for the child to insert. DFPS or SSCC staff members who are the same gender as the child may stand outside the door of the bathroom while the child inserts the medication. However, DFPS or SSCC employees must not directly assist the child in inserting the medication into the child’s rectum or vagina.
Exception: Rectal Antiseizure Drugs for Emergencies
Children with seizure disorders can experience life-threatening prolonged seizures (status epilepticus) and may be prescribed rectal antiseizure medication for such emergencies. Emergency medical services (911) must be called for a prolonged seizure (typically longer than five minutes).
For children who are in the care of DFPS or SSCC staff, who may experience life-threatening status epilepticus (prolonged seizure), and who are prescribed rectal antiseizure drugs for emergencies, DFPS or SSCC staff must follow the instructions on the package insert to administer the rectal antiseizure drug as indicated by the prescription.
Exception: Epinephrine Auto-Injectors for Emergencies
Epinephrine auto-injectors are used for life-threatening allergic reactions and for children who are at increased risk for these reactions. Immediate emergency medical help (911) must be sought whenever an epinephrine auto-injector is administered.
For children who are in the care of DFPS or SSCC staff, who may experience life-threatening allergic reactions (anaphylaxis), and who are prescribed epinephrine auto-injectors, DFPS or SSCC staff must follow the printed, easy-to-follow instructions and diagram to administer this drug in the event of a severe allergic reaction. A severe allergic reaction can be characterized by the following:
- Skin reactions such as hives or itching.
- Difficulty breathing.
- Low blood pressure.
- Weak pulse.
- Vomiting.
- Diarrhea.
- Dizziness.
- Fainting.
Exception: Glucagon Administration for Diabetic Low Blood Sugar (Hypoglycemia) Emergencies
DFPS or SSCC staff must immediately administer a Glucagon emergency kit for a child who meets all of the following criteria:
- The child is in the care of DFPS or SSCC staff.
- The child is experiencing a life-threatening diabetic low blood sugar (hypoglycemia) emergency.
- The child has passed out or appears to be at immediate risk of passing out.
- The child cannot take some form of sugar by mouth.
- The child is prescribed a Glucagon emergency kit.
DFPS or SSCC staff must follow the prescription or kit instructions. Emergency medical services (911) must also be called immediately.
11312 Action If a Child Has Not Taken a Medication in Over 24 Hours
CPS October 2017
Cases may arise in which a child has missed taking a prescribed medication for a period of time because the child ran away, the medication was left at the child's birth home or previous placement, the child refused to take the medication, or other reason.
Some medications should NOT be resumed at all or at the same dose if the child has not taken the medication for a period of time.
If Less Than 24 Hours Have Elapsed
If less than 24 hours have elapsed since the child took the last dose of the medication, the caseworker may administer the medication according to the instructions on the label.
If 24 Hours or More Have Elapsed
If 24 hours or more have lapsed since the child took the last dose of the medication, or if the caseworker is not informed about the child's medications as required in 11310 If CPI, CPS, or SSCC Staff Administers Medications, the caseworker must determine whether to give the medication by contacting:
• the child's healthcare provider; or
• STAR Health Nurse Wise at 1-866-912-6283.
11313 Storing Medications
CPS October 2017
If children are in the temporary care of CPS staff, staff must:
• ensure that children's medications are kept in a secure and locked location at all times, such as:
• a locked file cabinet in a CPS office, or
• the locked glove compartment or trunk of a car, if transporting a child.
• immediately turn in medications that the child can no longer use to a staff member designated in the office to receive the medication. Staff may contact their supervisor to determine the designated recipient of the medication. Regions must designate appropriate staff in each office. The person may be a supervisor, program director, CPS nurse consultant, or other suitable staff person.
Safeguarding Controlled Substances
Some children may be prescribed medications considered as controlled substances that have substance abuse potential, such as psycho-stimulants used to treat Attention Deficit/Hyperactivity Disorder (ADHD), tranquilizers, and pain medications. These medications must be kept in a locked area and secure at all times.
11314 Destroying Medications
CPS November 2024
There may be cases in which medications that youth no longer need are left in the possession of DFPS or SSCC staff or in a DFPS or SSCC workplace. Staff must destroy medications that are expired, discontinued, or left at a location and no longer needed. Destruction must occur every quarter, at minimum.
In these cases, a staff member designated in each office does the following:
- Ensures the medication is stored in the original prescription bottle or over-the-counter packaging until it is ready for destruction.
- Ensures the medication is stored in a locked container and separate from current medication.
- Blacks out all identifying information on the medication package.
- Finds a certified location for medication destruction. Staff can find a location by contacting nearby pharmacies or searching the Drug Enforcement Administration website for nearby locations.
- Completes Form 2402 Medication Destruction Log. Include the names of the DFPS supervisor or SSCC equivalent approving destruction, person responsible for destruction, and witness to the destruction.
- Provides the caseworker and supervisor with documentation verifying that the medication has been destroyed.
- Uploads documentation of the medication's destruction into OneCase and documents in IMPACT that the medication was destroyed.
For more information, see the Medical Services Resource Guide (see Destroying Medications).
11320 Psychotropic Medications
CPS October 2017
Psychotropic medication is a medication prescribed to treat symptoms of psychosis or another mental, emotional, or behavioral disorder. It affects the central nervous system to influence and modify behavior, cognition, or affective state. The term includes the following categories:
• psychomotor stimulants;
• antidepressants;
• antipsychotics or neuroleptics;
• agents for control of mania or depression;
• antianxiety agents; and
• sedatives, hypnotics, or other sleep-promoting medications.
Texas Family Code §266.001
11321 Providing Required Information to Medical Consenters
CPS October 2017
Caseworkers must provide copies of the brochure Making Decisions about Psychotropic Medications to all medical consenters for a child in DFPS conservatorship:
• at the time of placement, along with Form 2085B Designation of Medical Consenters;
• within seven days following the placement; or
• within seven days following the court's authorization of:
• a non-CPS person as a child's medical consenter; or
• a 16 or 17 year old as his or her own medical consenter.
The caseworker must encourage the medical consenter to read and use the brochure during office visits at which psychotropic medications will be discussed or prescribed.
11322 Informed Consent for Psychotropic Medication
CPS October 2017
Giving informed medical consent means making a decision about whether to agree to a medical test, treatment, procedure, or medication.
To make an informed decision about behavioral health treatment or medications without undue influence means that the medical consenter is deciding based on what is best for the child, not because of pressure to consent to the medication or treatment services. For example, a decision must not be made based on a school's or other entity's insistence that a child take medication in order to participate or receive services.
Consent must be given voluntarily and without undue influence.
To ensure medical consent is informed and legally valid, the medical consenter must receive the following information either verbally or in writing from the prescribing healthcare provider, and understand and consider its impact on the child:
• the specific condition to be treated, including the child's symptoms and medical diagnosis;
• the beneficial effects on that condition expected from the medication;
• the probable health and mental health consequences of not consenting to the medication;
• the probable clinically significant side effects and risks associated with the medication;
• the generally accepted alternative medications and non-pharmacological interventions to the medication, if any (see 11326 Non-Pharmacological Interventions); and
• the healthcare provider's reasons for the proposed course of treatment.
Texas Family Code §266.0042
The medical consenter may refer to the Making Decisions about Psychotropic Medications brochure for guidance on the principals of informed consent.
11323 Deciding Whether to Consent to a Psychotropic Medication
CPS October 2017
Medical consenters decide whether to consent to, or choose not to consent to, psychotropic medication for children in DFPS conservatorship. The medical consenter, including CPS staff medical consenters, must discuss with the prescribing healthcare provider any non-pharmacological interventions that may be helpful to use before trying the medication, or to use along with the medication. See 11326 Non-Pharmacological Interventions.
The medical consenter considers all the elements of informed consent for the individual child described in 11322 Informed Consent for Psychotropic Medication. The medical consenter asks the healthcare provider questions about the medication and appropriate non-pharmacological interventions.
Conservatorship caseworkers must encourage medical consenters to read and use the Making Decisions about Psychotropic Medications brochure during office visits at which psychotropic medications will be discussed or prescribed. DFPS must provide this brochure to the medical consenter within the time frames described in 11321 Providing Required Information to Medical Consenters.
11323.1 Providing Consent to an Initial Psychotropic Medication in an Inpatient Setting
CPS October 2017
If providing medical consent for a child in an inpatient setting, the medical consenter must:
• consider all the elements of informed consent for psychotropic medications in policy (11320 Psychotropic Medications);
• complete both:
• a hospital's required consent forms; and
• the DFPS Form 4526 Psychotropic Medication Treatment Consent.
Consent Forms Required by the Hospital
For children admitted to a psychiatric hospital, the medical consenter must provide informed consent for initial psychotropic medications and dosage changes according to the hospital's requirements. This includes completing the hospital's consent form.
If the medical consenter is not the child's primary caseworker, the medical consenter must send a copy of the signed hospital consent form to the caseworker within five business days.
If Face-to-Face Medical Consent is Possible
In addition to following any consent process the hospital requires, the medical consenter must attempt to meet in person with the hospital's prescribing provider and the child to:
• provide informed consent for an initial psychotropic medication;
• sign DFPS Form 4526 Psychotropic Medication Treatment Consent; and
• obtain the signature of the prescribing provider or designee.
If Face-to-Face Medical Consent is Not Possible
If the medical consenter is unable to meet with the provider face to face, the medical consenter must provide by phone verbal informed consent to an initial psychotropic prescription or dosage change. The medical consenter must complete and sign Form 4526 and note on the form:
• consent was provided verbally; and
• the prescribing provider's name and credentials.
11323.2 Deciding Not to Consent to a Psychotropic Medication
CPS October 2017
If a medical consenter decides not to consent to a psychotropic medication recommended by a child's healthcare provider, the medical consenter must notify the child's caseworker in writing within 24 hours. Notification must include the healthcare provider's recommendation and the reason the medical consenter decided not to consent.
Following a decision not to consent, the caseworker must discuss the elements of informed consent and the decision process with the medical consenter and must document the elements of informed consent in the child's case record. See 11322 Informed Consent for Psychotropic Medications.
11323.3 Withdrawing Consent
CPS October 2017
The medical consenter may withdraw consent to treatment with a psychotropic medication at any time after consulting with the prescribing provider and the child's caseworker. The caseworker must discuss with the medical consenter the reasons for the decision and the consultation with the prescribing healthcare provider.
The caseworker must document this discussion, including any instructions about how to safely discontinue the medication, in the child's record.
11324 Documenting Consent for Psychotropic Medications
11324.1 Documenting Consent to Initial Psychotropic Medications and Changes to Active Prescriptions
CPS April 2024
The medical consenter and medical provider must complete and sign Form 4526 Consent for Treatment with Psychotropic Medication during the appointment.
The medical consenter must notify the conservatorship caseworker by the next business day, in writing, of any initial psychotropic medication prescription or changes to active psychotropic medication prescriptions. The medical consenter can provide this notification by fax, email, or other written communication, or by providing a copy of the completed Form 4526.
If the next-day written notification does not include a copy of the completed Form 4526, the medical consenter must provide a copy of the form to the child’s caseworker within five business days (see 11323 Deciding Whether to Consent to a Psychotropic Medication).
The caseworker must obtain information from the medical consenter about the decision process described in 11323 Deciding Whether to Consent to a Psychotropic Medication.
The conservatorship caseworker must document the details of this form and upload a copy of the completed form to OneCase in the Child’s Medical/Dental/Mental Health Records tab.
See:
11324.2 Documenting Consent to Psychotropic Medication in an Inpatient Setting
11320 Psychotropic Medications
11324.2 Documenting Consent to Psychotropic Medication in an Inpatient Setting
CPS April 2024
To document either face-to-face or verbal informed consent for initial prescriptions or changes to psychotropic medication during a child’s inpatient stay, the caseworker must upload both of the following to OneCase:
- Form 4526 Consent for Treatment with Psychotropic Medication.
- A signed copy of any informed consent form required by the hospital.
See 11323.1 Providing Consent to an Initial Psychotropic Medication in an Inpatient Setting.
11325 Psychotropic Medications Follow-Up Visits
CPS April 2024
The caseworker must ensure that each child who is currently prescribed a psychotropic medication attends an office follow-up visit with the prescribing health care provider and medical consenter at least once every 90 days for a review of the child’s progress with the medication. The visit allows the health care provider to do the following:
- Monitor the medication’s side effects appropriately.
- Determine whether the medication is helping the child achieve the treatment goals.
- Determine whether it is appropriate to continue using the medication.
The medical consenter must attend the medical appointment with the child and provide the caseworker with documentation of the medical appointment. The caseworker must upload a copy of the documentation to OneCase.
If the caseworker is the medical consenter, the caseworker must attend each office visit in person. The caseworker must complete and upload the documentation.
11326 Non-Pharmacological Interventions
CPS October 2017
Caseworkers must discuss with medical consenters and other caregivers the fact that psychosocial therapies, behavior strategies and other non-pharmacological (non-medicine) interventions should be considered before or along with psychotropic medications for children in DFPS conservatorship.
The medical consenter or caregiver should seek assistance from the child's healthcare provider, child placing agency, caseworker, and therapist to develop strategies to help the child to manage behaviors.
If the parties agree on non-pharmacological interventions, the medical consenter arranges for the child to receive them. The caseworker must coordinate with the medical consenter, the healthcare provider, and the child placing agency case management staff, if applicable, to help the medical consenter make these arrangements for the child.
If psychotropic medication is necessary, medical consenters should ask the prescribing provider to recommend specific non-pharmacological interventions, tailored to the child's needs, which can be employed at the same time as the treatment with psychotropic medication. See 11320 Psychotropic Medications.
Discussions with medical consenters and caregivers about non-pharmacological interventions may address various issues. In the Medical Consent Resource Guide, see Non-Pharmacological Interventions.
11327 Psychotropic Medication Utilization Review (PMUR)
CPS August 2022
A Psychotropic Medication Utilization Review (PMUR) is the process used to screen and review a child’s psychotropic medications. A PMUR occurs when a child is prescribed medication that is outside Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version), or if there is a concern regarding the medication.
CPS and Single Source Continuum Contractor (SSCC) staff, Court Appointed Special Advocates (CASA), the child’s caregiver, the child’s medical consenter, an attorney, a residential child care provider, and other interested parties can request a PMUR any time they have concerns about a child’s psychotropic medication regime.
When CPS staff request a PMUR, they must request a written response from STAR Health Behavioral Health.
CPS staff, medical consenters, and caregivers must not stop any child’s medication without consulting with the prescribing healthcare provider.
In the Medical Services Resource Guide, see Psychotropic Medication Utilization Review (PMUR).
CPS staff must file the results of a medication review in the child’s record.
11400 Special Healthcare Needs
CPS March 2018
See the Primary Medical Needs Resource Guide.
11410 Arranging for Special Healthcare Management Services
CPS October 2017
If a child needs or would benefit from special healthcare management, the caseworker must call STAR Health to request it. Caregivers and medical consenters may also call to request this service.
Special healthcare management may involve care related to:
• a condition (such as diabetes or hearing loss);
• a transplant (such as a kidney transplant) and follow-up; or
• an injury (such as physical therapy following traumatic brain injury or a sports injury).
11411 Referring a Child to Medical Professionals and Health-Related Community Services
CPS October 2017
If a child has or appears to have a disability, the caseworker must:
• consult with the regional education specialist and developmental disabilities specialist, as appropriate;
• refer the child to the appropriate professionals and community services; and
• ensure that the child is assessed and diagnosed.
If the child has already been assessed and diagnosed, the caseworker must ensure that DFPS has the appropriate professional documentation on record. If needed, the caseworker contacts the CPS program specialist for children with disabilities at the CPS regional or state office for further information or resources.
11412 Working With Children in DFPS Conservatorship Who Have Special Healthcare Needs
CPS October 2017
While a child with special healthcare needs is in DFPS conservatorship, the caseworker must:
• develop an understanding of the child's medical needs and the services recommended by medical professionals;
• ensure that the child is receiving the recommended services; and
• maintain contact with healthcare providers to ensure that the child's medical needs are being met.
Throughout the case, the caseworker must assess the caregiver's ability to meet the child's ongoing medical needs, working with the child's family, healthcare providers, and collateral to:
• conduct ongoing home visits throughout the case to assess the home environment's appropriateness;
• ensure that the caregiver is trained to meet or is proficient in meeting the child's special needs, including being trained to use or being proficient in using medical equipment, administering prescribed medication, and providing needed supplies;
• ensure that the caregiver has access to and uses the medical equipment recommended by medical professionals; and
• assess the child's care during each contact to ensure that the family continues to comply with the recommended medical care (including administering prescribed medication, attending medical appointments, and completing other tasks to meet the child's needs).
See:
6241 The Child's Service Plan
6242 The Family's Service Plan
11500 HIV Testing and Care for Children in DFPS Conservatorship
CPS October 2017
The caseworker must ensure that a child in DFPS conservatorship is tested for HIV infection in accordance with the Texas Health Steps Medical Checkup Periodicity Schedule, Comprehensive Health Screening, or at any other time the child's healthcare provider determines the test is medically indicated.
The caseworker must request that the healthcare provider test the child for HIV infection if the child has a history of sexual abuse or other risk factors, or if the child requests to be tested.
DFPS Rules, 40 TAC §700.1401
11510 Counseling, Treatment, and Medical Management for a Child With HIV Infection
CPS October 2017
STAR Health provides counseling, treatment, and medical management for a child in DFPS conservatorship with HIV.
Counseling
DFPS must ensure that children with HIV and their caregivers are provided with age-appropriate post-test counseling and information in accordance with the Texas Health and Safety Code, §81.109.
DFPS Rules, 40 TAC §700.1402
The caseworker must secure age-appropriate post-test counseling and information for the child with HIV and their caregivers through STAR Health.
11520 Maintaining Confidentiality of HIV Status
CPS October 2017
Information regarding a child's HIV status is confidential. Staff must not disclose a child's HIV status with any other individual or entity, except those listed in 11521 Required Notification About a Child's HIV Status and 11522 Allowable Releases of HIV Status Information, or under other applicable law or rule.
DFPS Rules, 40 TAC §700.1405
Medical Exception
DFPS may release information about an individual's HIV status to medical personnel in an emergency, if necessary to provide for their protection and to provide for the patient's health and welfare. Other exceptions apply to healthcare providers, who are required by law to report the information to certain governmental entities for purposes of communicable disease tracking.
Public Documents
The caseworker must keep information regarding a child's HIV status out of any documents that will be available to the public, such as removal affidavits or court reports. If the welfare of the child requires the child's status to be documented in a public document, staff must use language such as confidential illness or confidential diagnosis.
Court Testimony
A child's HIV status may be discussed if DFPS is currently the child's managing conservator.
The judge has the discretion and authority to require testimony on any subject that he or she deems appropriate or necessary. In such cases, staff must give testimony as requested.
Removal Affidavit
A person's HIV status must NEVER appear in a removal affidavit. This is true for children coming into DFPS care and for any other adult or child referred to in the affidavit.
Adults
Section 81.103 of the Texas Health and Safety Code protects the confidentiality of an adult's HIV status and HIV test results. Staff must never disclose an adult's HIV status, or HIV test results, without the adult's consent.
11521 Required Notification About a Child's HIV Status
CPS October 2017
If a child in DFPS conservatorship tests positive for HIV infection, the caseworker must notify the following parties of the child's condition:
• the child's legal parents (if parental rights have not been terminated and their whereabouts are known);
• current and prospective foster parents, 24-hour child-care providers, prospective adoptive parents, or relatives with whom the child has been placed or with whom DFPS plans to place the child; and
• the medical consenters.
DFPS Rules, 40 TAC §700.1403
11522 Allowable Releases of HIV Status Information
CPS October 2017
Release of Positive HIV result
If a child in DFPS conservatorship has tested positive for HIV infection, DFPS may notify the following parties of the child's condition:
• a physician, nurse, or other professional who has a legitimate need to know the information in order to provide for the child's health and welfare;
• a court having jurisdiction of a proceeding involving the child or a proceeding involving a person suspected of abusing the child, if requested;
• any person with a legal right to obtain the information pursuant to law or court order; and
• the child.
DFPS Rules 40 TAC §700.1404(a)
Release of Negative HIV result
If a child in DFPS conservatorship has tested negative for HIV infection, DFPS may notify the parties listed in this section and in 11521 Required Notification About a Child's HIV Status if:
• the party requests the information; or
• DFPS determines the information is needed to provide for the child's health or welfare.
DFPS Rules 40 TAC §700.1404(b)
11600 Behavioral (Mental Health) Services
11610 Mental Health Treatment
11611 Admission to a Mental Health Facility
CPS October 2017
11611.1 Request to Admit a Child or Youth to an Inpatient Psychiatric Facility
CPS February 2019
A request for the admission of a child or youth in DFPS conservatorship to an inpatient psychiatric facility may be made if a physician states that, in his or her professional opinion, both of the following apply:
• The child or youth has a mental illness or shows symptoms of a serious emotional disorder.
• The child or youth poses a risk of serious harm to self or others if not immediately restrained or hospitalized.
A child or youth may also be admitted to an inpatient psychiatric facility if one of the following occurs:
• DFPS applies for court-ordered mental health services for the child or youth.
• DFPS requests an emergency detention.
• A court grants an order for protective custody.
Notifications
Admission to an inpatient psychiatric facility is a significant event. When this happens, DFPS does the following:
• Notifies people according to the following policies:
• Notifies the court with continuing jurisdiction within three business days after the admission.
Texas Health and Safety Code §572.001
More Information
See Inpatient Mental Health Treatment in the Mental Health Resource Guide.
11611.11 Caseworker Actions During Psychiatric Hospitalizations
CPS February 2021
Role of Psychiatric Hospital Worker, Local Permanency Specialist, or Other Designated Caseworker During Psychiatric Hospitalizations
While the child or youth in DFPS conservatorship is in the psychiatric hospital, the psychiatric hospital worker, local permanency specialist, or other designated caseworker must:
- Immediately, but no later than 24 hours after notification that a child or youth has been admitted for psychiatric treatment, confirm the mental health facility has been provided with the name and contact information for the child's medical consenter.
- Make face to face contact with the child or youth at the facility within 1–3 business days of becoming aware of the admission, and weekly thereafter.
- Ensure that the care coordinator or similar hospital staff responsible for the child or youth have been provided a copy of the child’s sexual history report, Attachment A, attempt to obtain the care coordinator or similar hospital staff’s signature on the document, and upload the signed document into OneCase.
- Document weekly face to face contact in IMPACT according to CPS policy.
- Request and send the child or youth’s clinical record collected from the hospital to the primary caseworker and assigned placement staff or single source continuum contractor (SSCC) staff. The clinical record refers to any documentation of treatment services released by the hospital including the youth’s admission summary, psychiatric or psychological evaluation, therapy notes, psychiatric progress or nursing notes, and medication status
- Communicate critical updates regarding the child or youth’s treatment (such as discharge plan, basic care needs, and safety issues) to the primary caseworker within 24 hours of being made aware of the new information.
- Coordinate and facilitate internal multidisciplinary staffings to assist with placement following discharge and securing services.
Role of the Primary Conservatorship Caseworker During Psychiatric Hospitalizations
While the child or youth is in the psychiatric hospital, the primary conservatorship (CVS) caseworker must do all of the following:
- Immediately, but no later than one business day after notification that a child or youth on the CVS caseworker’s caseload has been admitted to a psychiatric hospital, send an email to those who have a role in ensuring the youth’s needs are met, as outlined below (the INV caseworker must do this if a CVS caseworker is not assigned). See the Mental Health Resource Guide for more information.
- Notify the child or youth’s parent within 24 hours of notification of the admission (unless an exception listed under 6151.1 Exceptions to the Notification Requirements exists).
- As soon as possible, but no later than 10 days after admission, notify the guardian ad litem, attorney ad litem, parent’s attorney, and court appointed special advocate.
- Update the application for placement with the weekly progress, participation, therapy notes, medication compliance, and so on. If the child or youth is being served by the SSCC as part of Community Based Care, the assigned SSCC staff person updates the application for placement as described.
- Conduct required monthly face-to-facecontact if the child or youth is hospitalized in the legal region. If out of region, the caseworker must make the required contact by phone.
- Contact the regional education specialist to develop a plan to ensure the child or youth’s educational needs are met for the duration of the hospital stay.
More Information
See Inpatient Mental Health Treatment in the Mental Health Resource Guide.
11611.2 Youth Age 16 or Older Who Requests Admission
CPS February 2019
A youth who is at least 16 years old may seek voluntary admission to an inpatient psychiatric facility or outpatient mental health treatment services. He or she may be admitted without the consent of his or her parent, managing conservator, or guardian. The youth files a request with the administrator of the facility.
Texas Health and Safety Code §572.001
The facility is not required to accept the request for admission.
11611.3 DFPS Representative to Approve Admission of Child or Youth
CPS February 2019
A medical consenter who is not a DFPS employee cannot consent to admission to an inpatient psychiatric facility.
If someone other than a DFPS employee brings a child or youth to this type of facility for voluntary admission, that person is required to find a DFPS representative to approve the admission. The person requesting the admission does as follows:
• He or she contacts the child’s or youth’s caseworker or the caseworker’s supervisor.
• If he or she cannot reach the caseworker or supervisor, he or she calls Statewide Intake at 1-800-252-5400, and Statewide Intake finds the caseworker.
11611.4 Consent for Health Care and Medications After Admission
CPS October 2017
Unless the youth has been authorized to consent to his or her own medical care under Texas Family Code §266.010, the designated medical consenter must provide or deny consent for health care or the use of psychotropic medications once the youth is admitted.
The caseworker must provide the mental health facility with the name and contact information for the child's medical consenter.
11611.5 Change of Medical Consenters While a Child or Youth Is Hospitalized
CPS February 2019
The caseworker reconsiders the designation of medical consenter if a child or youth is admitted to an inpatient psychiatric facility.
The caseworker follows the guidelines in the table below.
| If: |
Then: |
|---|---|
the child or youth may return to the placement he or she was in before admission, |
the caseworker determines whether there needs to be a change in medical consenter while the child or youth is hospitalized. |
the child or youth will not return to the previous placement, and someone who is not a DFPS employee is the primary or backup medical consenter, |
DFPS makes the caseworker the primary and backup medical consenter while the child or youth is hospitalized. |
DFPS finds a new placement for the child or youth to go to after discharge from the inpatient facility, |
the caseworker determines the most appropriate medical consenter, backup medical consenter, or both, based on the new placement. |
See:
11117 Changing Medical Consenter and Backup Consenter
11111 Selecting the Medical Consenter and Backup Medical Consenter
11323.1 Providing Consent to an Initial Psychotropic Medication in an Inpatient Setting
Texas Health and Safety Code §572.001(d)
11612 Emergency Detention Order and Order for Protective Custody
CPS October 2017
A caseworker or the residential child care provider may seek law enforcement assistance if he or she believes that a child needs a temporary involuntary mental health commitment and the child will not willingly be evaluated by mental health professionals.
In the Medical Services Resource Guide, see Emergency Detention and Order for Protective Custody.
Medical Consenter's Role
The medical consenter must provide or deny consent for any health care and the administration of psychotropic medication, except in an emergency, during the time that the Emergency Detention Order and the Order for Protective Custody are in effect.
11613 Involuntary Commitment Order for Mental Health Services
CPS February 2019
If the staff of DFPS or of a residential childcare provider believes an order for involuntary inpatient mental health services (court commitment) is necessary for a child or youth, a staff member contacts the local mental health authority (LMHA) for help and assessment. LMHAs were formerly known as mental health and mental retardation (MHMR) centers.
See Involuntary Commitment Order for Mental Health Services in the Mental Health Resource Guide.
11614 Discharge from Inpatient Psychiatric Facilities
CPS February 2019
A DFPS staff member makes weekly visits to the inpatient psychiatric facility. This person can be DFPS psychiatric hospital staff, local permanency specialist staff, or the primary caseworker. During these visits, the staff member does as follows:
• Visits the child or youth.
• Talks to the staff of the inpatient psychiatric facility about progress, needs, and discharge.
If the medical provider determines that the child or youth is ready for discharge, and DFPS agrees, the child or youth does one of the following:
• Returns to his or her previous placement.
• Goes to a new placement that DFPS has arranged.
See the Placement Process Resource Guide.
If the medical provider determines that the child or youth is ready for discharge, but DFPS disagrees, DFPS staff consults with the supervisor to determine the next steps.
DFPS staff does not request discharge against the medical advice of the inpatient psychiatric facility staff.
11700 Extraordinary Medical Conditions
11710 Enrollment and Participation in Certain Drug Research Programs
CPS October 2017
Texas Family Code §266.0041 requires a court order before a child in DFPS conservatorship may enroll or participate in a drug research program, unless the person enrolling the child is the child's parent and has been authorized by the court to make medical decisions for the child.
In the Medical Services Resource Guide, see Enrollment and Participation in Certain Drug Research Programs.
11720 End of Life Medical Decisions
CPS October 2017
If a child in DFPS conservatorship has been diagnosed with an "irreversible condition" or a "terminal condition" and medical professionals suggest withholding or withdrawing life-sustaining treatment, the regular process for medical consent does not apply.
Withholding life-sustaining treatment means to refrain from administering or applying life support such as CPR, ventilators, defibrillation, and other related treatments.
Withdrawing life-sustaining treatment means to discontinue life support previously administered or applied.
In some cases, decisions to withhold or withdraw treatment may be done in advance of the need, such as with an Advance Directive or Do Not Resuscitate Order. This policy applies to advance directives and orders as well as other end-of-life medical care decisions.
See Texas Health and Safety Code Chapter 166 for Texas law regarding advance medical directives for more information.
The caseworker and supervisor must follow the procedures outlined below. However, any party may seek court intervention at any time if all parties do not agree on a course of action or if any party is concerned about the child's rights.
11721 DFPS has TMC or PMC but Parental Rights Have Not Been Terminated
CPS October 2017
If parental rights have not been terminated and the child's attending physician recommends end-of-life care, the parents have the authority to make the end-of-life decisions even if DFPS has temporary managing conservatorship (TMC) or permanent managing conservatorship (PMC). CPS staff or other medical consenters do not have the legal authority to consent in these circumstances.
The caseworker and supervisor must:
• obtain a written statement from the attending physician certifying that the child has a terminal or irreversible condition and that the physician recommends withholding or withdrawing life-sustaining treatment;
• request a second opinion or a review by a hospital medical or ethics review board if there are any concerns about the attending physician's recommendation. The hospital decides whether to convene a review committee;
• inform the parents of the child's medical condition and the recommendation of the attending physician and any hospital medical or ethics review board (if applicable);
• arrange for the parents to discuss any recommendation with the attending physician directly (by phone or in person); and
• discuss the recommendation with the program director, regional director, regional attorney, attorney representing DFPS, the child's attorney ad litem, guardian ad litem, CASA (if applicable), and any other legal party to the case.
| If the parents… |
Then… |
|---|---|
consent to the DNR, advance directive, or recommended end-of-life care… |
the parents are the party that must execute any order and sign any required documents. CPS staff must not do so. |
refuse to consent to the DNR, advance directive, or recommended end-of-life care… |
the caseworker and supervisor must not take further action. |
cannot be located, or are otherwise unavailable to make a decision… |
the caseworker and supervisor must request that the attorney representing DFPS initiate proceedings to seek termination of parental rights (TPR) and PMC of the child and obtain TPR and PMC; and follow procedures in 11722 DFPS has TMC or PMC and Parental Rights Have Been Terminated or Parents are Deceased. |
Staff must ensure all parties are informed of the decision once a decision has been made.
11722 DFPS has TMC or PMC and Parental Rights Have Been Terminated or Parents Are Deceased
CPS October 2017
If parental rights have been terminated for both parents, or the parents are deceased, and the attending physician recommends end-of-life care, the caseworker and supervisor must:
• obtain a written statement from the attending physician certifying that the child has a terminal or irreversible condition and that the physician recommends withholding or withdrawing life-sustaining treatment;
• request a second opinion or a review by a hospital medical or ethics review board if there are any concerns about the attending physician's recommendation. The hospital decides whether to convene a review committee;
• confirm that there is no relative, fictive kin, or other individual with possessory or custodial rights. If one is available, that person must be consulted for end-of-life decisions if possible;
• notify and discuss the recommendation with the program director, regional director, regional attorney, attorney representing DFPS, the child's attorney ad litem, guardian ad litem, CASA (if applicable), and any other legal party to the case; and
• notify and consult with the local court, according to the procedures explained below.
| If the court … |
The caseworker must… |
|---|---|
will rule on the decision… |
• involve the attorney representing DFPS, the child's attorney ad litem, the child's guardian ad litem, any individual with possessory or custodial rights, and any other involved individuals in developing a recommendation for the court. (If there is no attorney ad litem, the caseworker must recommend that the court appoint one); and • comply with the court's directive or order. The commissioner must take any action necessary to carry out the court's decision. |
declines to rule on the decision… |
• involve the attorney representing DFPS, the child's attorney ad litem, the child's guardian ad litem, any individual with possessory or custodial rights, and any other involved individuals in developing a recommendation about the child's care; • present the recommendation to the regional director; • the regional director must present the recommendation to the commissioner for the commissioner's decision; • notify the hospital or healthcare provider and the court of the commissioner's decision. The commissioner must take any action necessary to carry out the decision. |
11730 Organ Donation/Anatomical Gifts
CPS October 2017
If the Parents Decide to Donate the Child's Organs
The child's parents are legally authorized to donate the child's organs in the event of death, if the parental rights have not been terminated (Chapter 692A.004, Health and Safety Code).
CPS staff must never sign consent forms for organ donation on behalf of a child's family member who has made a decision to donate the child's organs. If the family members retain their legal rights to the child but are unavailable to consent, DFPS must not give consent for organ donation in the family member's absence.
When DFPS May Decide to Donate the Child's Organs
CPS staff may make the decision to donate an organ of a child if DFPS is managing conservator and:
• parental rights have been terminated; or
• the parents are deceased.
In some instances, DFPS may decide not to approve organ donation. In the Medical Consent Resource Guide, see Organ Donation/Anatomical Gifts.
11740 Pregnancy
11741 If a Youth Is Pregnant
CPS June 2023
If a youth in DFPS conservatorship informs a caseworker that she is, or believes she may be, pregnant, or the caseworker otherwise becomes aware of the youth’s pregnancy or possible pregnancy, the caseworker makes sure that the youth has an appointment with a STAR Health provider as soon as possible.
In addition, the caseworker does the following five tasks.
Task One
The caseworker interviews the youth to assess whether she was a victim of incest, sexual abuse, or a criminal offense. If the youth is a victim, the caseworker notifies Statewide Intake and/or law enforcement.
Task Two
The caseworker encourages the youth to discuss options about the pregnancy, including adoption, with supportive people, such as the youth’s parents, caregivers, therapist, spiritual leaders, guardian ad litem, and attorney ad litem. The caseworker refers the youth to a STAR Health provider. See the Women and Children webpage on the Texas Health and Human Services website.
Task Three
The caseworker helps the youth plan for the alternative she chooses, in consultation with a health care provider. Referrals may be given to appropriate providers of pre- and postnatal care, including obstetric services provided through STAR Health.
Task Four
The caseworker addresses the youth’s plans for the child in the youth’s Child’s Plan of Service (CPOS). If the youth chooses to care for the child herself, see 6440 When a Youth in Substitute Care Is Pregnant or Parenting and its subitems.
Task Five
The caseworker works with the youth to decide whether it is feasible and appropriate to work with the child’s father. If so, the caseworker may do the following:
- Encourage the father to participate with the mother in considering alternatives for the child’s care.
- Help the father participate in planning for the alternative chosen.
- Help the father plan for the child’s financial support.
If the father is in substitute care, his caseworker addresses the plans for the child in the father’s CPOS.
11742 Informing Parents and Legal Guardians about Pregnancy-Related Information
CPS June 2023
Federal laws and state licensing standards require DFPS to share a youth’s medical information with the youth’s parents and legal guardians, unless there are reasons not to do so.
DFPS must share pregnancy-related information with a youth’s parents and legal guardians, unless disclosure would put the youth at risk of harm or abuse.
Unless the condition above is met, DFPS informs the youth that the youth’s parents and legal guardians will be informed about the pregnancy.
When DFPS is not disclosing pregnancy-related information to parents or legal guardians, the caseworker does the following:
- Obtains approval from the program director.
- Documents the reasons in the youth’s case record.
See the Medical Consent Resource Guide.
11743 Documenting Pregnancy-Related Information for Youth in Conservatorship
CPS June 2023
DFPS staff document pregnancy-related information in the case record.