Medical Services Initiative

Improving Healthcare for Children in Foster Care

What is the DFPS Medical Services Initiative?

As part of Child Protective Services (CPS) Renewal, the Department of Family and Protective Services (DFPS), the Health and Human Services Commission (HHSC), the Department of State Health Services (DSHS) and other state agencies are coordinating to improve health outcomes for children served by CPS. 

Senate Bill 6 passed by the 79th Legislature directs DFPS and HHSC to implement medical services initiatives to improve access by CPS caseworkers to healthcare professionals and to develop a healthcare delivery model and medical passport for children infoster care.  This web site provides information on the various components of the DFPS Medical Services Initiative.  It also provides a list of medical resources available to the children and families of Texas.

Statewide Healthcare Delivery Model

At the direction of the Legislature, the Department of Family and Protective Services and the Health and Human Services Commission (HHSC) are launching an important effort to improve the quality of healthcare services for children in foster care.

The goal of this project is to create a medical home for each child in foster care through the development of a seamless system of accessible, coordinated, comprehensive, and continuous healthcare services. In the new system, a health organization will provide and coordinate services for children in foster care.

Background

In 2004, Gov. Rick Perry directed HHSC to review the state's Child Protective Services program. This review found that children in the foster care system may not receive optimal healthcare because of a variety of factors, such as the frequent movement of children from one foster care setting to another. Foster children, who are eligible for comprehensive medical benefits through Medicaid, can easily become disconnected from their medical and educational histories when they experience multiple placements.

To address these issues, Section 1.65 of Senate Bill 6 (79th Regular Session) directs HHSC to develop a comprehensive, cost-effective medical services delivery model to meet the medical and behavioral needs of foster children.   HHSC has been working to develop this healthcare delivery model.  To implement this model, HHSC is seeking to contract with   one managed care organization (MCO) to provide and coordinate services statewide.  By contracting with only one MCO, HHSC can ensure better accountability for outcomes and better track children’s care.   

Goals for the model

• Expedited enrollment for immediate access to Medicaid benefits.
• Health care coordinated through single point of contact.
• Enhanced access to services.

Implementation of this project will allow foster care children to receive the medical and behavioral health care services they need in an expedited and coordinated manner.  These services will be available to these children no matter where they are in the state or how often they move.

Service Delivery Components Using a Medicaid Managed Care Model

• Provides a Medical Home through a Primary Care Provider (PCP) or PCP Team.
• Promotes coordination of physical and behavioral health
• Promotes preventive care.
• Improves access through a defined network of providers.
• Improved access to health history and medical records via electronic "Health Passport."
• Provides 7-day, 24-hour Nurse Hotline and Behavioral Health Hotline for caregivers and caseworkers.
• Establishes medical advisory committees to monitor provider performance.
• Recruitment of providers that currently provide Medicaid services to children in foster care.

In addition, this model will include:

• Physical and behavioral healthcare
• Dental services Optical services  Attendant care (long-term service)
• Service Coordination
• Clinical Service Management and Disease Management
• Health Passport
• Hotlines for  member and provider assistance

Timeline and Meetings

Timeline: see HHSC website

Meetings
The Texas Health and Human Services Commission (HHSC) conducted forums to receive public comment on the proposed Comprehensive Healthcare Program for Children in Foster Care.  Please note that this forum was conducted as a web cast in 11 statewide locations. A recording of the meeting is available for listening and viewing on the HHSC website.

Consent to Medical Care

Effective September 1, 2005, Senate Bill 6 added Chapter 266 to the Texas Family Code addressing medical services for children in DFPS conservatorship.  Among the new provisions are important changes in the law related to medical consent for children in DFPS conservatorship.  The intent of these changes is to help children achieve positive physical and behavioral health outcomes through the provision of continuous and coordinated medical care. 

Overview of Legislative Changes

Among the new provisions of Texas Family Code Chapter 266 are requirements for:

• Court authorization of an individual or DFPS to consent to medical care for each child in DFPS conservatorship.  If the court authorizes DFPS to consent, DFPS will designate an individual and notify the court and other parties, including birth parents;
• Completion of training on Informed Consent and participation in each medical appointment by the medical consenter;
• DFPS to inform 16 and 17 year old youth of rights to a court determination of their capacity and ability to consent to some or all their own medical care ;
• Obtaining medical care in an emergency;
• Judicial review of medical care; and
• Notifying parents of significant medical conditions.

New Policy

DFPS developed a new policy on medical consent by collaborating with legislative offices, advocacy groups, physicians, and residential child care providers.  The policy is complex and will require a change in the way CPS workers are trained and oversee the medical care of children in DFPS conservatorship.

For additional information, please see Medical Consent page on this website.

Forensic Assessment

Through the enactment of SB 6 DFPS is required to designate health care facilities with expertise in forensic assessment, diagnosis and treatment of child abuse and neglect as pediatric centers of excellence (aka “forensic assessment centers”) and establish a statewide telemedicine system to link DFPS investigators and caseworkers with the pediatric centers of excellence or other medical experts for consultation. 

DFPS entered into an interagency contract with the University of Texas Health Science Center to create a statewide network of resources to improve CPS’ access to medical professionals with expertise in the diagnosis of child abuse or neglect.  Access to such expertise is intended to support CPS staff in making decisions relating to the presence/absence of child abuse/neglect during CPS investigations.

Psychotropic Medications

The Texas Department of State Health Services coordinated the creation of the best practice guidelines, Psychotropic Medication Utilization Parameters for Foster Children, to ensure  the appropriate use of Psychotropic Medications for children in foster care.  They were developed by a panel of child and adolescent psychiatrists, psychologists, guideline development specialists, and other mental health experts.

Below are links to the guidelines and a letter distributed to health care providers through a variety of associations and state programs. The guidelines were developed for use in the treatment of foster children who receive services through Medicaid. However, the guidelines may be a valuable resource in the treatment of any child diagnosed with a mental health disorder, regardless of the type of health insurance coverage the child may have.

• Cover Letter
• Guidelines

For more information about this topic, please see:

• HHSC: Improving Health Care for Children in Foster Care
• October 2007: Update on the Use of Psychoactive Medications in Texas Foster Children Fiscal Years 2005 – 2007
• October 2006: Examining the Foster Care Reimbursement System and the Impact on the Prescribing of Psychotropic Medication (pdf)
• June 2006: Use of Psychoactive Medication in Texas Foster Children (pdf)

 

Children with Disabilities and Special Needs

Child Protective Services (CPS) provides services to children with an array of disabilities and special healthcare needs (SHCN) during all stages of CPS service.  Meeting the needs of these children is especially challenging for caregivers and CPS caseworkers.

The DFPS renewal seeks to link CPS caseworkers with subject matter experts (SMEs).  Developmental disability (DD) specialists and nurse consultants serve as SMEs for children with disabilities and SHCN.

Specifically, DD Specialists serve as regional subject matter expert for children with developmental disabilities and participate in child service planning activities and identifying needed wrap-around services.  They facilitate the transition of children out of institutions and advocate for Medicaid waiver slots for children with developmental disabilities and placement on appropriate Medicaid waiver lists.  The DD assist staff in making a determination of Mental Retardation (DMR) for children with suspected mental retardation.  They are the liaison with the local Mental Retardation Authorities (MRAs) and facilitate MR services. 

The DD Specialist further facilitate placement of children into Home and Community Based Services (HCS), Intermediate Care Facility (ICF)-MR programs, state schools, nursing homes, Casa Esperanza and Mission Road.  They provide training to staff and foster parents and assist with making referrals of appropriate children aging out of DFPS conservatorship to the Department of Aging and Disability Services (DADS) guardianship program.

The DFPS Nurse Consultants serve as regional subject matter experts for children with SHCN and other health-related issues.  They help identify medical and physical indicators of abuse and neglect during the investigation of cases and help make decisions concerning child safety.  They are available to staff to provide nursing consultation on health-related issues and medications and to review and summarize medical records in easy to read format. 

Nurse consultants provide nursing assessment, including physical, psychosocial and environmental assessment and developmental screening.  They also participate in child service planning activities and other regional meetings as needed.  They further provide or coordinate training on health-related subjects, help CPS staff make informed decisions on the healthcare of children and serve as point of contact for medical consent policy and assist with medical issues related to pre- and post-organ transplant.