This revision of the Child Protective Services Handbook was published on June 20, 2014. Summaries of new or revised items are provided below.
Sections of CPS Medical Consent Policy (section 11000) have been revised to comply with HB 915, 83rd Legislative Regular Session (2013). These requirements are summarized below. CPS staff were informed of these policies with the issuance of PSA 14-005 on 9/10/2013.
Medical Consenter Attendance at Psychotropic Medication Appointments
Effective September 1, 2013, any child in DFPS conservator-ship who has been prescribed a psychotropic medication must have an office visit with the prescribing physician, physician’s assistant or advanced practice nurse and the Medical Consenter no less frequently than every 90 days.
DFPS staff who are designated as the medical consenter for a child must attend any appointments where psychotropic medication may be prescribed and all medication review appointments.
When the Medical Consenter is the child’s caregiver (foster parent, relative, etc.): The medical consenter must attend all appointments where psychotropic medications are reviewed and monitored. To promote medical consenter attendance at initial and follow-up psychotropic medication appointments, staff are encouraged to designate up to four medical consenters for each child in conservator-ship, especially if the child’s placement requires CPS staff are designated medical consenters. If there is more than one primary or backup medical consenter, they are no longer required to be a married couple.
Human Service Technician (HST) Support
Eleven new HST positions were allocated to regions by numbers of children placed in that region in a Residential Treatment Center. These staff positions were created by the legislature specifically for implementation of HB915.
These staff will help relieve I See You workers of some duties (not the psychotropic medication appointment duties) in order to create more time for I See You workers to attend psychotropic medication appointments.
Requirement for Informed Consent Before Prescribing Psychotropic Medications
This policy is in compliance with new Texas Family Code §266.0042.
Consent to the administration of a psychotropic medication is valid only if:
• the consent is given voluntarily and without undue influence;
• the person authorized by law to consent for the foster child receives details about the child’s condition, reasons for treatment, possible risks and expected benefits of the medication, probable consequences of not consenting to the medication, and alternative medications and non-pharmacological interventions verbally or in writing.
Notify Parents of Psychotropic Medication
This policy is in compliance with Texas Family Code §266.005.
DFPS is required to notify a child’s parents of the initial prescription of a psychotropic medication and any change in dosage of the psychotropic medication at the first scheduled meeting between the parents and the child’s caseworker after the date the psychotropic medication is prescribed or the dosage is changed.
DFPS is not required to provide the notice to a parent who cannot be located, who has executed an affidavit of relinquishment, who had rights terminated, or who has had access to medical information otherwise restricted by the court.
This policy is in compliance with Texas Family Code §264.121
The legislation adds a new requirement regarding the Transitional Living Services Program. DFPS must ensure that a youth’s transition plan includes provisions to assist the youth in managing medication usage after exiting foster care, including information that educates the youth.
The transition plan was updated and information about the plan is provided in PSA 13-067.
Medical Consenter Training
This policy is in compliance with Texas Family Code §266.004.
In addition to this law’s new requirements for informed consent, Medical Consent training now includes the requirement that Medical Consenters inform the child’s caseworker in writing (through email or fax) the next business day when a child is prescribed a psychotropic medication.
Judicial Review of Medical Care
This policy is in compliance with Texas Family Code §266.007(a).
The statute adds new responsibilities to the list of things the court is required to do at each permanency and placement hearing.
The following items are revised or added:
11000 Health Care
11100 Medical Consent
11110 Court Authorizes DFPS To Be the Child’s Medical Consenter
11111 Selecting Medical Consenter and Back Up Medical Consenter
11112 Live-In Caregiver Designated as the Medical Consenter
11113 Designating Medical Consenters for Children in Conservatorship Living in Residential Facilities
11113.1 General Residential Operation (GRO) Offering Emergency Services
11113.2 General Residential Operations With Shift Staff
11113.3 DFPS Staff Designated Medical Consenters for Children in Certain GROs With Shift Staff
11113.31 Developmental Disability Specialist Medical Consenters
11113.32 CPS I See You Staff Medical Consenters
11113.33 Temporary Backup Medical Consenters
11113.34 I See You Human Services Technicians As Temporary Medical Consenters
11113.35 Documentation of Temporary Medical Consenters
11113.36 Extending a Temporary Medical Consenter’s Service Beyond 24 Hours
11112 Ensuring Training on Informed Consent and Requirements for Medical Consenters
11115 Documenting Medical Consent
11113 Issuing Forms 2085-B Designation of Medical Consenter
11117 Documenting in IMPACT
11114 Providing Medical Information to the Medical Consenter
11115 Changing Medical Consenter and Back Up Consenter
11116 Notifying the Court of the Designated Medical Consenter
11118 Court Authorizes an Individual Other Than DFPS To Be the Child’s Medical Consenter
11120 Responsibilities of Medical Consenters and Back Up Medical Consenters
11121 Being Knowledgeable of Child’s Medical Condition
11122 Participating in Each Medical Appointment
11132.1 Preventive Care
11132.2 Ongoing Behavioral Health Therapy
11132.3 Psychotropic Medication Appointments
11132.4 Documenting Consent to an Initial Psychotropic Medication Prescription
11132.41 Documenting Consent for Changes in Psychotropic Medication
11132.42 Documenting Consent for Psychotropic Medication
11132.5 Consenting to an Initial Psychotropic Medication in an Inpatient Setting
11132.51 Documenting Consent to Psychotropic Medication in an Inpatient Setting
11132.6 Other Medical Care
11136 Emergency Medical Care
11123 Updating All Medical Consenters and Back Up Medical Consenters
11130 Medical Consent by Minor Youth
11131 Educating Children and Youth About Their Medical Care
11132 Informing Youth About Certain Rights
11133 Documenting Court Authorization for Youth Consent in IMPACT
11134 Offering Ongoing Support to Youth
11135 Requesting a Court Order When a Youth Refuses Medical Care
11140 Notification of Medical Care
11141 Including Medical and Behavioral Health Information in Court Reports
11151.1 Including Abortion Information in Court Reports
11151.2 Addressing Psychotropic Medications in Court Reports or Testimony
11151.3 Including Information About Psychotropic Medications in Court Reports and Testimony
11142 Notifying Parents About Significant Medical Conditions
11153 Notifying Parents About the Use of Psychotropic Medications
11150 Special Circumstances
11151 Youth Young Adults Who Are 18 Years or Older
11152 Youth Under DADS Guardianship in Extended Foster Care
11153 Youth Who Are Parents in DFPS Conservatorship or Extended Foster Care
11200 Medical and Dental Services
11211 Initial Texas Health Steps Medical Checkup
11212 Initial Texas Health Steps Dental Checkup
11213 Subsequent, Ongoing Texas Health Steps Checkups
11250 Service Planning
11261 Documenting Checkups (Medical and Dental) in IMPACT and the Case File
11270 Using the Health Passport to Store and Retrieve a Child’s Health-Related Information
11320 Administration of Medications by DFPS Staff
11322 Action When a Child Has Not Taken a Medication in Over 24 Hours
11330 Psychotropic Medications
11331 Informed Consent for Psychotropic Medication
11331.1 Legal Requirements for Valid Informed Consent
11331.2 Guidelines for Providing Informed Consent
11332 Deciding Whether to Consent to a Psychotropic Medication
11332.1 Deciding Not to Consent to a Psychotropic Medication
11333 Providing Required Information to Medical Consenters
11334 Psychotropic Medications Follow-Up Visits
11335 Non-Pharmacological Interventions
11335.1 Trauma Informed Care
11335.2 Behavioral Strategies and Psychosocial Therapies
11335.3 Serious or Complex Symptoms
11336 Psychotropic Medication Utilization Review (PMUR)
11336.1 Initiation of a PMUR
11336.2 Indicators That May Trigger a PMUR
11336.3 The PMUR Process
11337 Request for Information About a Child’s Psychotropic Medication
11400 Special Health Care Needs
11410 Arranging for Special Health Care Management Services
11411 Referring a Child to Medical Professionals and Health-Related Community Services
11412 Working With Children in DFPS Conservatorship Who Have Special Health Care Needs
References to items moved during this revision have been updated in:
3413 Required Content of the Family Service Plan
3593 Providing Notification of Removal After Reunification
3732 Documenting the Removal of a Child From His or Her Home
5332.5 Notifying the Court About a Designated Medical Consenter
5513.2 Status Report (Form 2070) – Filed 10 Days Before the Adversary Hearing
10465 Medical Consenter Issues and Documentation
11611 Voluntary Admission to Inpatient Mental Health Facility and Consent to Treatment
11614 Summary of Admission and Consent to Medical and Psychiatric Treatment Process
11711 Consent by Parent to Enroll Child in Drug Research Program or Administer Investigational New Drug
11712 DFPS Actions When a Physician Recommends Enrollment In a Drug Research Program
Appendix 5585: Legal Requirements Relevant to the Placement Review Report