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11000 Healthcare

11100 Medical Consent

CPS October 2017

Legal Basis

Texas Family Code Subchapter G (153.371-153.377) and Chapter 266.004(c)provide the legal bases for DFPS's authority to make medical decisions for children and youth in DFPS conservatorship.

Exceptions

The medical consent policy outlined in this section applies to most medical situations, with a few exceptions. In the Medical Consent Resource Guide, see Exceptions.

Making Medical Decisions Until the Court Hearing

In most cases, DFPS petitions the court to authorize DFPS to consent to medical care. When the court authorizes DFPS to consent to medical care, DFPS must designate an individual as medical consenter. In the period between a child's removal and the ex parte or emergency hearing when temporary orders are requested, the caseworker may:

  •   consent to medical care until the court hearing; or

  •   designate one of the following to consent to medical care until the court hearing:

  •   a professional staff member of the emergency shelter; or

  •   the live-in caregivers with whom the child is placed.

See:

11111 Selecting Medical Consenter and Backup Medical Consenter

11115.2 Documenting in IMPACT

11110 Court Authorizes DFPS to Be the Child's Medical Consenter

CPS October 2017

When the court authorizes DFPS to consent to the child's medical care, the caseworker must designate a medical consenter and backup, and coordinate medical information.

Refer to the Medical Consent Resource Guide for a chart explaining the appropriate persons to designate as primary and backup consenters, based on the placement type.

Designating the Biological Parent as the Medical Consenter

The caseworker and supervisor may decide to designate the biological parent as the medical consenter for a child when:

  •   a plan is in place to return the child to the parent; or

  •   the child has been placed in the parent's home.

11111 Selecting the Medical Consenter and Backup Medical Consenter

CPS October 2017

DFPS must designate at least one primary medical consenter and one backup medical consenter for each child. A second primary and second backup medical consenter may be designated. The medical consenter or backup may be DFPS employees.

The goal of designating multiple consenters is to ensure a consenter can be present in person when the child receives treatment. This is particularly important when the child is receiving psychotropic medications. The medical consenter reviews and documents treatment when attendance at the appointment is required. See 11131 Participating in Each Medical Appointment.

Medical consenters and backups must be individuals, not a facility or a facility's shift staff.

The caseworker and supervisor must consult to determine the most appropriate medical consenter and backup. See the chart in the Medical Consent Resource Guide.

11112 Designating a Live-In Caregiver as the Medical Consenter

CPS October 2017

In most cases in which a child has a live-in caregiver, DFPS designates the live-in caregiver or caregivers as the primary medical consenter and secondary primary, and the caseworker as the backup consenter.

In the Medical Consent Resource Guide, see Designating a Live-In Caregiver as the Medical Consenter.

11113 Designating Medical Consenters for Children in Conservatorship Living in Residential Facilities

CPS October 2017

11113.1 General Residential Operation (GRO) Offering Emergency Services

CPS October 2017

DFPS may designate, as either the medical consenter or backup medical consenter, a professional staff member of a GRO offering emergency services (emergency shelter) who is knowledgeable about the child's medical condition and medical care needs.

11113.2 General Residential Operations With Shift Staff

CPS October 2017

DFPS must designate CPS staff as medical consenters for children in residential facilities with shift staff, unless another appropriate designee can be found, such as an involved relative or a CASA.

Residential Facility Employees Not Eligible To Be Medical Consenters

DFPS must not designate employees of the following residential facilities as a child's medical consenter or backup medical consenter:

  •   GROs operating as residential treatment centers (RTC);

  •   GROs offering therapeutic camp services;

  •   GROs offering child care services (group setting with shift staff);

  •   GROs offering intellectual disability or pervasive developmental disorder treatment services, or both;

  •   Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID), licensed by HHSC;

  •   nursing homes;

  •   state supported living centers (SSLCs, formerly known as state schools); and

  •   Home and Community-based Services (HCS) group homes (shift staff model).

11113.3 Designating CPS Staff as Medical Consenters for Children in Certain General Residential Operations (GROs) with Shift Staff
11113.31 Developmental Disability Specialist Medical Consenters

CPS October 2017

If a child is placed in a general residential operation (GRO) for children with intellectual and developmental disabilities, DFPS designates as the child's primary medical consenter the developmental disability (DD) specialist who is the child's secondary worker.

The DD specialist must attend all psychotropic medication appointments. If neither the DD specialist designated as the primary medical consenter nor the CVS caseworker designated as the backup medical consenter is able to attend a psychotropic medication appointment with a child, DFPS may designate another DD specialist as the secondary backup medical consenter to attend psychotropic medication appointments.

11113.32 CPS Local Permanency Staff Medical Consenters

CPS October 2017

Children Placed Out of Region

DFPS may designate Local Permanency specialists as primary medical consenters if regional management determines it is appropriate.

Children Placed In-Region

Regional management may designate a Local Permanency specialist as a backup medical consenter for psychotropic medication appointments only. The Local Permanency specialist must not consent to other medical care except psychotropic medications. The primary medical consenters and the second backup medical consenter must remain responsible for making all other medical care decisions.

See 6414 Local Permanency Supervision

11113.33 Temporary Backup Medical Consenters

CPS October 2017

The following CPS staff members, in the order listed, must be prepared to attend psychotropic medication appointments if none of the other designated consenters can be present at the appointment:

1.   another conservatorship caseworker in the child's conservatorship unit for children placed in the region;

2.   the conservatorship supervisor for the child placed in the region;

3.   another Local Permanency specialist in the unit;

4.   the Local Permanency supervisor; or

5.   a human services technician (HST) who has received specialized training. (See 11113.34 Local Permanency Human Services Technicians As Temporary Medical Consenters.)

The staff member must prepare for the appointment by reviewing the child's condition, current medications and response to treatment.

A person who is not one of the designated medical consenters may serve as temporary medical consenter for a 24-hour period. See:

11113.36 Extending a Temporary Medical Consenter's Service Beyond 24 Hours.

11118.1 Notifying the Court of a Temporary Medical Consenter

11113.34 Local Permanency Human Services Technicians As Temporary Medical Consenters

CPS October 2017

DFPS must not designate Local Permanency human services technicians (HSTs) as backup medical consenters unless no medical consenter or backup consenter is available to attend the appointment, which should be a rare occurrence. See 11113.33 Temporary Backup Medical Consenters.

Requirements

The Local Permanency HST must receive specialized training before being designated as a temporary medical consenter.

The Local Permanency HST may be designated as a temporary medical consenter only for a particular child or children and a particular psychotropic medication appointment.

Approval

One of the following must approve the designation:

  •   the HST's Local Permanency unit supervisor or designee;

  •   the conservatorship supervisor or designee; or

  •   a manager in the chain of command of the Local Permanency unit supervisor or CVS supervisor.

Documentation and Notification

If designating a Local Permanency HST as a temporary medical consenter:

  •   DFPS must document and track the designation using DFPS Form 2197 Designating Local Permanency Human Services Technician as Temporary Medical Consenter;

  •   the caseworker must notify the regional director and CPS State Office Medical Services division of each designation of a Local Permanency HST, by sending an email to the regional chain of command with a copy to the (Medical Consenter Mailbox.) The caseworker must attach the following forms:

  •   Form 2196 Notification Regarding Temporary Designation to Consent for Psychotropic Medication; and

  •   Form 2197 Designating Local Permanency Human Services Technician as Temporary Medical Consenter.

11113.35 Documenting Temporary Medical Consenters

CPS October 2017

If the caseworker designates any other CPS staff member as a temporary backup medical consenter the caseworker must:

  •   issue Form 2196 to the temporary backup medical consenter; and

  •   notify the court by filing a copy of Form 2196 Notification Regarding Temporary Designation to Consent for Psychotropic Medication.

See 11118.1 Notifying the Court of a Temporary Medical Consenter

11113.36 Extending a Temporary Medical Consenter's Service Beyond 24 Hours

CPS October 2017

If a temporary medical consenter needs to continue as medical consenter for longer than 24 hours, the primary caseworker must:

  •   designate that person as one of the child's four medical consenters (primary, backup, second primary, or second backup);

  •   issue a new Form 2085-B Designation of Medical Consenter;

  •   enter the information into IMPACT medical consenter pages; and

  •   notify the court using Form 2096 Notification Regarding Consent for Medical Care.

DFPS must not designate a Local Permanency human services technician (HST) as a medical consenter for longer than 24 hours.

See:

11115.1 Issuing Form 2085-B Designation of Medical Consenter

11115.2 Documenting in IMPACT

11118 Notifying the Court of the Designated Medical Consenter

11114 Ensuring Training on Informed Consent and Requirements for Medical Consenters

11114.1 DFPS-Approved Training for Medical Consenters

CPS October 2017

Before designating an individual as a primary or backup medical consenter, the caseworker must ensure that the person:

  •   is willing to follow the requirements for medical consenters. See 11130 Responsibilities of Medical Consenters and Backup Medical Consenters;

  •   has completed a DFPS-approved training on medical consent;

  •   has signed Form 2759 Acknowledgement and Certificate of Completion of Medical Consent Training, which includes the date training is completed and attests that the medical consenter:

  •   has completed the medical consent training;

  •   understands the principles of informed consent for psychotropic medications. See 11320 Psychotropic Medications; and

  •   understands that non-pharmacological interventions should be considered and discussed with the prescribing healthcare provider before consenting to the use of a psychotropic medication. See 11326 Non-Pharmacological Interventions.

Texas Family Code §§266.004(h) and 266.0042

Documentation

The caseworker must file a signed copy of Form 2759 for each medical consenter and backup medical consenter in the child's case record.

11114.2 DFPS-Approved Training for Parents

CPS October 2017

Parental Rights Not Terminated

If a parent's rights have not been terminated, the parent can be designated as the child's medical consenter without being required to complete the DFPS-approved training and sign Form 2759, unless the court orders the parent to complete the training.

Parental Rights Terminated

If the parent's rights have been terminated, the parent is required to complete the DFPS-approved training and sign Form 2759 in order to be designated as the child's medical consenter. If the child being placed with the parent is prescribed psychotropic medications, the caseworker may also require the parent to complete the DFPS Psychotropic Medications training. The caseworker may consult with the regional wellbeing specialist if needed.

11115 Documenting Medical Consent

11115.1 Issuing Form 2085-B Designation of Medical Consenter

CPS October 2017

Once the caseworker designates a medical consenter, and the medical consenter meets training requirements, the caseworker must:

  •   issue Form 2085-B Designation of Medical Consenter;

  •   have the appropriate parties sign the form;

  •   give signed copies to the medical consenter and backup medical consenter;

  •   give copies to the residential provider; and

  •   file a signed copy of Form 2085-B in the case record.

All parties must sign the appropriate forms by the next business day after placement of a child. Faxed forms are acceptable.

The caseworker must consent to medical care until a medical consenter (and backup medical consenter) has been designated and signed the appropriate forms.

An Individual Other Than a CPS Employee

If the medical consenter or backup medical consenter is a caregiver affiliated with a residential provider:

  •   the caseworker must discuss the designation with a representative of the residential provider; and

  •   the representative also signs the appropriate section of Form 2085-B Designation of Medical Consenter.

Residential providers include:

  •   emergency shelter professional employees;

  •   private Child Placing Agency (CPA) foster parents;

  •   pre-consummated adoptive parents;

  •   general residential operation (GRO) child care facility cottage parents; and

  •   persons providing support for family and caregivers.

CPS Employees

The primary caseworker and the supervisor must discuss any proposal to designate another caseworker as medical consenter or backup medical consenter. The supervisor must contact the potential designee's supervisor, who assigns the potential designee.

The primary caseworker must issue Form 2085-B Designation of Medical Consenter, entering the name of the medical consenter or the backup medical consenter in the appropriate sections. The caseworker serving as medical consenter, the primary caseworker, and the supervisor must sign Form 2085-B.

11115.2 Documenting in IMPACT

CPS October 2017

The caseworker must enter or add the names and contact information for each medical consenter (including backup medical consenters) on the following IMPACT pages, as soon as possible on the same day as the removal or change and no later than 7:00 PM the next day:

  •   Person Detail page; and

  •   Medical Consenter Detail page.

The caseworker must also enter or update information on the following IMPACT pages as soon as possible on the same day as the removal or change and no later than 7:00 PM the next day:

  •   Legal Actions Detail page; and

  •   Placement Detail page.

11116 Providing Medical Information to the Medical Consenter

CPS October 2017

The caseworker must provide the designated medical consenter with:

  •   the child's known medical history;

  •   copies of available medical records; and

  •   information about previous healthcare providers who have treated the child, if available.

11117 Changing Medical Consenter and Backup Consenter

CPS October 2017

Situations may arise that cause DFPS to change a medical consenter or backup medical consenter.

Justifying a Change in Consenters

DFPS may need to change a medical consenter if the child changes placements or the primary or backup medical consenter:

  •   is no longer associated with the child;

  •   fails to act in the best interests of the child;

  •   fails to appropriately involve DFPS in medical decisions as outlined in Form 2085-B Designation of Medical Consenter;

  •   fails to appropriately inform DFPS of the child's medical condition and medical care;

  •   is no longer affiliated with DFPS or a residential provider (including a foster parent);

  •   fails to provide consent in a timely manner without a reasonable explanation;

  •   fails to participate in the healthcare appointments of the child without a reasonable explanation; or

  •   fails to attend psychotropic medication appointments with the child without a reasonable explanation.

If a Non-CPS Employee Fails to Perform Duties

If a medical consenter or backup medical consenter who is not a DFPS employee fails to adequately perform the required duties, the caseworker must inform the supervisor. The supervisor must coordinate with the caseworker to resolve the problem. If these efforts are unsuccessful, the caseworker, with supervisory approval, may change the designee by repeating the steps in 11111 Selecting Medical Consenter and Backup Medical Consenter through 11118 Notifying the Court of the Designated Medical Consenter.

Completing Forms 2085-B and 2096

Every time DFPS names a new medical consenter or backup medical consenter, DFPS must:

  •   complete a new Form 2085-B Designation of Medical Consenter; and

  •   complete a new Form 2096 Notification Regarding Consent for Medical Care and send it to the court and the required parties. See 11118.2 Procedures for Notifying the Court and Other Parties.

Completing Form 2196

When providing a 24-hour designation of a temporary medical consenter for a child whose medical consenter is a Local Permanency specialist, DFPS must complete Form 2196 Notification Regarding Temporary Designation to Consent for Psychotropic Medication.

11118 Notifying the Court of the Designated Medical Consenter

CPS October 2017

Once DFPS designates a medical consenter, DFPS must notify the court and other parties, no later than the fifth business day after the date the court authorized DFPS to consent to medical care for a child in DFPS conservatorship.

Texas Family Code §266.004(c)

See 11118.2 Procedures for Notifying the Court and Other Parties.

11118.1 Notifying the Court of a Temporary Medical Consenter

CPS October 2017

The caseworker must inform the court and other parties no later than the fifth business day after designating a temporary medical consenter. See 11118.2 Procedures for Notifying the Court and Other Parties.

11118.2 Procedures for Notifying the Court and Other Parties

CPS October 2017

Whether notifying the court and other parties about who DFPS has designated as the medical consenter, or about a temporary medical consenter, the procedures are the same.

The caseworker must:

  •   complete the appropriate form;

  •   Form 2096 Notification Regarding Consent for Medical Care, if designating a medical or backup consenter;

  •   Form 2196 Notification Regarding Temporary Designation to Consent for Psychotropic Medication, if designating a temporary medical consenter;

  •   file the original form with the court;

  •   file a copy of the notification in the case record; and

  •   forward a copy of the form to the:

  •   person designated to consent to medical care;

  •   immediate preceding designee, if applicable;

  •   parents whose rights have not been terminated, or an attorney representing the parents;

  •   attorney representing DFPS;

  •   guardian ad litem and CASA, if one has been appointed;

  •   attorney ad litem, if one has been appointed;

  •   residential child care provider.

Confidentiality

The caseworker must inform the attorney representing DFPS if the caseworker, foster parents, or other caregivers who are designated as medical consenters do not wish to reveal the identity of the foster parents to the birth parents because of safety concerns or privacy issues (such as when the medical consenter is the child's pre-consummated adoptive parent). The attorney may ask the court to not make the information public. If the caseworker needs assistance in explaining these concerns to the attorney representing DFPS, the caseworker may request the regional attorney's assistance.

11120 Court Authorizes an Individual Other Than DFPS To Be the Child's Medical Consenter

CPS October 2017

A medical consenter must:

  •   provide the child with access to medical care that is covered by Medicaid and provided by Medicaid providers, unless an exception applies (see the Medical Consent Resource Guide);

  •   use STAR Health Providers for all children enrolled in STAR Health;

  •   inform DFPS of any medical care received by the child; and

  •   follow other requirements contained in Texas Family Code Chapter 266 that apply to medical consenters.

11121 Caseworker Responsibilities

CPS October 2017

The caseworker must inform the medical consenter about:

  •   requirements to use Medicaid providers and STAR Health Providers for all children enrolled in STAR Health;

  •   requirements to complete annual DFPS training regarding medical consent;

  •   requirements to successfully complete the annual Psychotropic Medication for Children in Foster Care training if the medical consenter may be asked to provide informed consent for a psychotropic medication for a child;

  •   the obligation to inform DFPS about the child's medical care; and

  •   requirements for the use of psychotropic medications for a child in DFPS conservatorship, including:

  •   that the medical consenter follow the requirements for informed consent if consenting to psychotropic medication;

  •   that the medical consenter attend any appointments when psychotropic medication may be prescribed, and all medication review appointments; and

  •   that each child prescribed a psychotropic medication must have an office visit with the prescribing healthcare provider no less than every 90 days for a review of the medication.

See:

11320 Psychotropic Medications

11322 Informed Consent for Psychotropic Medications

The caseworker must verbally provide the residential provider with the name and contact information of the individual authorized to consent to the child's medical care. The caseworker may also share the court order as needed.

The caseworker must complete the required documentation in IMPACT.

See:

11115.2 Documenting in IMPACT

11161 Including Medical and Behavioral Health Information in Court Reports

11162 Notifying Parents About Psychotropic Prescriptions and Significant Medical Conditions

11121.1 Notifying the Court When the Medical Consenter Fails to Perform Duties

CPS October 2017

If the individual authorized by the court to give consent fails to perform the required duties, the caseworker must inform the supervisor.

The supervisor must coordinate with the caseworker to resolve the problem.

If the efforts to resolve the problem are unsuccessful, the caseworker may, with supervisory approval, inform the attorney representing DFPS and request that the court do one or both of the following:

  •   issue a specific order related to medical care for the child; or

  •   change the authorization to consent to medical care to another individual or DFPS.

11130 Responsibilities of Medical Consenters and Backup Medical Consenters

CPS October 2017

All medical consenters and backup medical consenters, including CPS staff, must:

  •   be knowledgeable of the child's medical condition, history and needs before consenting to specific medical care or treatment;

  •   provide emergency contact information to the residential providers (such as a home phone or cell phone);

  •   provide the caseworker responsible for the child's legal case with evidence that the medical consenter has completed Medical Consent training. See 11114 Ensuring Training on Informed Consent and Requirements for Medical Consenters;

  •   provide the healthcare provider with signed copies of Form 2085-B Designation of Medical Consenter;

  •   follow the requirements of Form 2085-B Designation of Medical Consenter;

  •   keep the caseworker responsible for the child's legal case informed of significant medical conditions. See 11162 Notifying Parents About Psychotropic Prescriptions and Significant Medical Conditions;

  •   provide the caseworker responsible for the child's legal case with a summary of the child's medical care, verbally or in writing, as requested by the caseworker. See 11161 Including Medical and Behavioral Health Information in Court Reports;

  •   participate in each medical appointment. See 11131 Participating in Each Medical Appointment;

  •   follow all requirements for providing informed medical consent for psychotropic medications, complete Form 4526 Psychotropic Medication Treatment Consent if new psychotropic medications are prescribed, and ensure that the child attends an office visit with the prescribing healthcare provider at least every 90 days. See 11325 Psychotropic Medications Follow-Up Visits; and

  •   update all other medical consenters and backup medical consenters involved in the case on the results of new appointments and changes in the child's progress or treatment. See 11132 Informing Medical Consenters and Backup Medical Consenters.

Role of Backup Medical Consenters

Backup medical consenters may only consent to medical care if a primary medical consenter is not available.

For additional information on medical consenter responsibilities, see Responsibilities of Medical Consenters and Backup Medical Consenters in the Medical Consent Resource Guide.

11131 Participating in Each Medical Appointment

CPS October 2017

A person consenting to medical care for a child must participate in each appointment set for the child with the healthcare provider.

Texas Family Code §266.004(i)

Medical consenters must attend all appointments when a child may be prescribed psychotropic medications.

For other medical appointments, the level of participation depends on the nature of the medical care the child is receiving, and the healthcare provider's specific requirements. Medical consenters and residential providers must discuss with healthcare providers their expectations for participation.

The following sections describe the minimum guidelines for participation. However, healthcare providers may require greater participation. For example, some healthcare providers may be uncomfortable with phone participation for medical care and require the consenting individual to attend the appointment in person.

11131.1 Preventive Care

CPS October 2017

The medical consenter or backup medical consenter may provide written consent for the residential provider or another person to take the child for a preventive care appointment, unless the healthcare provider requires the consenter's participation in person or by phone.

To provide this consent, the medical consenter or backup medical consenter must complete Section 6 of Form 2085-B Designation of Medical Consenter.

11131.2 Ongoing Behavioral Health Therapy

CPS October 2017

The medical consenter or backup medical consenter must approve the behavioral care treatment plan and monitor the progress of the child's treatment.

The medical consenter is not required to attend every appointment or to be present during the entire therapy session, unless requested by the behavioral health provider. The medical consenter must collaborate with the behavioral health therapist to identify and provide non-pharmacological interventions for the child. See 11326 Non-Pharmacological Interventions.

11131.3 Allied Health Services

CPS October 2017

Allied health services include dietary services, occupational, physical, speech, or other therapy. The medical consenter must approve the allied healthcare plan and monitor the progress of the child's treatment. The medical consenter is not required to attend every appointment but must participate when requested by the allied healthcare provider.

11131.4 Psychotropic Medication Appointments

CPS October 2017

The medical consenter must attend all appointments with the child, when psychotropic medication may be prescribed, and all psychotropic medication follow-up appointments. See 11130 Responsibilities of Medical Consenters and Backup Medical Consenters.

The medical consenter may attend the psychotropic medication appointments with the child using healthcare providers who are enrolled in STAR Health as qualified Telemedicine providers.

The medical consenter and the healthcare provider must follow the requirements of valid informed consent as described in 11322 Informed Consent for Psychotropic Medication.

The medical consenter and healthcare provider must discuss non-pharmacological interventions, to determine if other interventions should be provided to the child, before using psychotropic medication, or along with psychotropic medication. See 11326 Non-Pharmacological Interventions.

The medical consenter may refer to the Making Decisions about Psychotropic Medications brochure for guidance on the principals of informed consent.

11131.5 Other Medical Care

CPS October 2017

For all other medical care, a medical consenter or backup medical consenter must either attend the appointment or participate by phone with the healthcare provider, as specified by the healthcare provider.

Medical care includes medical appointments for:

  •   providing physical health treatment, such as when the child is sick; and

  •   providing dental treatment, such as fillings and crowns.

11131.6 Emergency Medical Care

CPS October 2017

Consent or court authorization for medical care for a child is not required in an emergency where medical care must be provided immediately to prevent imminent death or substantial bodily injury to the child.

Texas Family Code §266.009

In an emergency situation, the child's caregiver or caseworker must transport the child to an emergency room or healthcare provider or call 911.

If the medical consenter is not available, the physician can decide if the child's condition is an emergency condition as defined by Texas Family Code §266.009(a).

If the physician provides medical care without consent, the physician must notify the medical consenter no later than the second business day after the medical care is provided.

Texas Family Code §266.009(b)

11132 Informing Medical Consenters and Backup Medical Consenters

CPS October 2017

Medical consenters and backup medical consenters must stay informed of the child's ongoing medical condition and treatment. When medical consenters and backup medical consenters allow caregivers to take children to preventive appointments, they must ensure that the caregivers report back to them about the appointment.

11133 Assent

CPS October 2017

Medical consenters must allow children and youth to participate in decisions about their medical care to the greatest extent feasible, depending on each individual's developmental capability. This process, called assent, empowers children and youth, helps prepare them to make their own medical decisions, and may improve long-term health outcomes.

In the Medical Consent Resource Guide, see Assent.

11140 Medical Consent by Minor Youth

CPS October 2017

A youth in foster care who is at least 16 years old may consent to receiving medical care if the court with continuing jurisdiction determines that the youth has the capacity to consent to medical care.

Texas Family Code §266.010

If a court determines that a youth is capable of consenting to his or her own medical care, the caseworker must:

  •   educate the youth about his or her medical care and the process for making informed decisions on an ongoing basis;

  •   ensure the youth completes the Caregiver Medical Consent Trainingin whichever of the following situations occurs first:

  •   within seven days of the court order authorizing the youth as his or her own medical consenter; or

  •   at least 48 hours before a non-emergency appointment with the youth's health or behavioral healthcare provider;

  •   file the youth's signed Form 2759 Acknowledgement of Completion of Medical Consent Training in the youth's case record;

  •   ensure a youth who has been prescribed psychotropic medication, or is considering taking psychotropic medication, completes the Psychotropic Medication for Children in Foster Care Training, in whichever of the following situations occurs first:

  •   within seven days of the court order authorizing the youth as his or her own medical consenter; or

  •   at least 48 hours before a non-emergency appointment with the youth's health or behavioral healthcare provider (see also 11141 Educating Children and Youth about Their Medical Care);

  •   file documentation in the youth's case record that the youth completed the training;

  •   document in IMPACT if the court authorizes a youth to consent to his or her medical care (see 11142 Documenting Court Authorization for Youth Consent);

  •   offer ongoing support and guidance to the youth (see 11143 Offering Ongoing Support to Youth);

  •   consent to payment for services on the youth's behalf;

  •   ensure the youth is making decisions in the youth's best interest;

  •   request, if needed, a court order authorizing medical care in certain situations when the youth refuses medical care (see 11144 Requesting a Court Order If a Youth Refuses Medical Care);

  •   access any of the youth's medical records;

  •   include medical information in court reports on an ongoing basis (see 11161 Including Medical and Behavioral Health Information in Court Reports);

  •   notify both parents of significant medical conditions (see 11162 Notifying Parents About Psychotropic Prescriptions and Significant Medical Conditions); and

  •   notify the youth's parents, at the next scheduled meeting, of the youth's decisions regarding the youth's medical care, including the youth's decision to consent or not consent to psychotropic medications.

11141 Educating Children and Youth About Their Medical Care

CPS October 2017

Consent at Age 16

Before a youth reaches age 16, DFPS must advise the youth of the right to request a hearing to determine whether he or she may be authorized to consent to his or her own medical care. DPFS provides the youth with training on informed consent and the provision of medical care as part of the Preparation for Adult Living (PAL) program.

Texas Family Code §266.010(l)

The youth's Attorney Ad Litem will also advise the youth of his or her right to request that the court authorize the youth to be his or her own medical consenter.

Texas Family Code §107.003

Reviewing Form 2092 With the Youth

Before a youth turns age 16, or for a youth who is at least 16 years old when he or she enters care, the caseworker must:

  •   review Form 2092 Notice of Your Right to Request the Court to Authorize Consent for Your Own Medical Care with the youth;

  •   sign the notice and have the youth sign the notice;

  •   provide the youth with a copy of the form;

  •   file the original form in the youth's case record; and

  •   review with the youth the PowerPoint presentation under "Medical Consent" on the General Health page of the Texas Youth Connection website.

In the Medical Consent Resource Guide, see Informing Youth About Certain Rights.

Consent at Age 18

Youth in DFPS conservatorship who are not authorized by the court to be their own medical consenters at age 16 or 17 will become their own medical consenters when they turn 18 years old. Conservatorship caseworkers must ensure that 17 year old youth complete Caregiver Medical Consent Training no later than 90 days before becoming 18 years of age.

Conservatorship caseworkers must ensure that youth 17 years of age who have been prescribed psychotropic medications also complete Psychotropic Medication for Children in Foster Care Training no later than 90 days before becoming 18 years of age.

If a youth is not able to complete the training online, the conservatorship caseworker must review the training with the youth using the documents available in PowerPoint on the DFPS public website.

The conservatorship caseworker must file the youth's signed Form 2759 Acknowledgement of Completion of Medical Consent training in the youth's case record. If the youth is required to complete Psychotropic Medication Training for Children in Foster Care, the caseworker must file documentation in the youth's case record that the youth completed the training.

The Transition Plan

The caseworker must include provisions in the youth's Transition Plan (Form 2500) to assist the youth to safely manage his or her medication after exiting foster care. The Transition Plan must include information that educates the youth about:

  •   the use of the youth's specific medications;

  •   resources available to help the youth safely manage the medication;

  •   informed consent (see 11320 Psychotropic Medications); and

  •   the youth's right to request to be his or her own medical consenter.

Texas Family Code §264.121(g)

See 6252 Permanency Planning Meetings for Youth Age 14 and Older

11142 Documenting Court Authorization for Youth Consent

CPS October 2017

The caseworker must document, on the IMPACT Medical Consent Detail page, whether the youth is authorized to consent to some or all of his or her medical care. The caseworker must document this as soon as possible the same day or no later than 7:00 PM the day following a new or updated action. If the youth is authorized to consent to some of his or her medical care, the caseworker must also document:

  •   the types of medical care the court has authorized the youth to consent to; and

  •   information about the individual authorized to consent to other medical care for the youth, such as the individual's name, role or relationship to the child, address, and phone number.

11143 Offering Ongoing Support to Youth

CPS October 2017

Caseworkers must help youth access information about their medical conditions, tests, treatment, and medications, and must support them in making informed decisions.

STAR Health provides healthcare for most children in DFPS conservatorship. If the court authorizes a youth to consent to some or all of his or her own medical care, the youth must still obtain treatment through STAR Health. These youths may contact STAR Health Member services (866-912-6283) for assistance in locating a healthcare provider.

11144 Requesting a Court Order If a Youth Refuses Medical Care

CPS October 2017

If the court determines that a youth who is at least 16 years old has the capacity to consent to medical care, and the youth refuses to consent to medical care DFPS or a provider believes is necessary, residential child care providers and CPS staff must make reasonable efforts to resolve the issue with the youth.

If unsuccessful, the caseworker working with the youth must inform the supervisor.

With supervisory approval, the caseworker may inform the attorney representing DFPS and request that the attorney file a motion with the court to order medical care for the youth.

The attorney representing DFPS may file a motion requesting the court to do one or both of the following:

  •   Issue a specific order related to medical care for the child.

  •   Change the authorization to consent to medical care to DFPS.

The motion must include:

  •   the youth's stated reasons for refusing medical care; and

  •   a statement that the medical care is appropriate, prepared and signed by the treating physician.

The caseworker must coordinate with the child's physician to obtain the required statement.

To issue an order, the court must find by clear and convincing evidence that the medical care is in the youth's best interests, and:

  •   the youth lacks the capacity to make a decision regarding the medical care;

  •   failure to provide the medical care will result in observable and material impairment of the youth's growth, development, or functioning; or

  •   the youth is at risk of causing substantial bodily harm to himself or herself or others.

Texas Family Code §266.010(d)-(g)

The court will appoint an attorney ad litem, if one is not already appointed.

11150 Special Circumstances

11151 Young Adults Who Are 18 Years or Older

CPS October 2017

Young adults are legally entitled to make their own medical decisions when they turn 18 years old, unless they have a legal guardian. Young adults who are not under guardianship may select the appropriate sections on the Voluntary Extended Foster Care Agreement to authorize CPS staff or caregivers, or both, to help facilitate their healthcare or access their Health Passport records, or both.

11152 Youth Under HHSC Guardianship in Extended Foster Care

CPS October 2017

The HHSC guardianship worker makes medical decisions for youth in extended foster care who are under HHSC guardianship.

The caseworker must enter the information for the HHSC guardianship worker in the IMPACT Person Detail and Medical Consenter Details, selecting Guardianship under the Court Authorized drop down list on the Medical Consenter Detail. The caseworker must enter this information as soon as possible and no later than 7:00 PM the day following a new or updated action.

The medical consenter information is automatically transmitted to STAR Health, allowing the HHSC guardianship worker to access the youth's Health Passport record and discuss protected health information with STAR Health staff. However, medical consent policy does not apply to the HHSC guardianship worker and the caseworker must not issue Form 2085-B Designation of Medical Consenter to the HHSC guardianship worker.

See 10343.6 HHSC Appointed as Guardian.

11153 Youth Who Are Parents in DFPS Conservatorship or Extended Foster Care

CPS October 2017

Youth parents make medical decisions for their children if their children are not in DFPS conservatorship.

The caseworker must enter the information in the IMPACT Person and Medical Consent Details by selecting NA-Youth Parent under the Court Authorized drop down list on the Medical Consent Detail pages, if DFPS takes conservatorship of a youth who is a parent or if a youth in conservatorship becomes a parent. The caseworker must enter this information as soon as possible and no later than 7:00 PM the day following a new or updated action.

The medical consenter information is automatically transmitted to STAR Health, allowing the youth parent to access his or her child's Health Passport record and discuss protected health information with STAR Health staff. However, medical consent policy does not apply to the youth parent and the caseworker must not issue Form 2085-B Designation of Medical Consenter to the youth parent.

See DFPS Form 2452 Step-by-Step Process to Select Youth Parent as Medical Consenter in SUB-C-PB Stages for Children Not in DFPS Conservatorship.

See:

6450 When a Youth in Substitute Care is Parenting

10510 Young Adults with Children

11160 Notification of Medical Care

11161 Including Medical and Behavioral Health Information in Court Reports

CPS October 2017

At each hearing under Chapter 263 of the Texas Family Code, or more often if ordered by the court, the court reviews a summary of the medical care provided to the child since the last hearing.

Texas Family Code §266.007

The caseworker must include a summary of medical care provided to the child in each court report, including court reports for status and permanency hearings.

In order to provide the court with a summary of the child's medical care, the caseworker must be kept informed of the medical care provided to the child. The caseworker must request that the medical consenter and backup medical consenter keep the caseworker informed either:

  •   verbally; or

  •   by completing Form 2094 Summary of Child's Medical Care, to include the child's opinion on the medical care, elicited in a developmentally appropriate manner.

The caseworker must request the information from the medical consenter in sufficient time to complete court reports in a timely manner.

The caseworker must complete the Summary of Medical Care section in the court report using information the medical consenter provided about the child's medical care.

11161.1 Including Abortion Information in Court Reports

CPS October 2017

If a minor in conservatorship has an abortion, the caseworker must include the abortion-related information in the court report for that reporting period unless:

  •   there is risk of harm or abuse to the minor that may result from that information; or

  •   a court has ordered DFPS not to inform the parents or caregiver.

11161.2 Addressing Psychotropic Medications in Court Reports or Testimony

CPS October 2017

Caseworkers must include detailed information about each psychotropic medication prescribed to a child in DFPS conservatorship in the Summary of Medical Care section of all court reports for status and permanency hearings.

Texas Family Code §266.007

11161.3 Including Information About Psychotropic Medications in Court Reports and Testimony

CPS October 2017

When addressing psychotropic medications in the Summary of Medical Care section of court reports and in court testimony, caseworkers must provide, in an objective manner, information about the child's behavioral health needs and response to psychotropic medications.

The caseworker must base this information on observations of the child and information from:

  •   the child;

  •   the child's medical consenter;

  •   healthcare providers;

  •   caregivers;

  •   parents;

  •   teachers;

  •   Court Appointed Special Advocates;

  •   Guardians ad Litem;

  •   Attorneys ad Litem; and

  •   the Local Permanency specialist, if applicable.

Caseworkers may consult with CPS regional nurse consultants for assistance as needed.

Information that caseworkers must address in court reports about each psychotropic medication includes but is not limited to:

  •   the diagnosis or target symptom for which the medication was prescribed;

  •   the child's progress with the medication;

  •   the degree to which the child or child's caregiver has complied or failed to comply with the medication regimen;

  •   any adverse reactions or side effects to the medication;

  •   the appropriate psychosocial therapies, behavior strategies and other non-pharmacological interventions provided to the child (see 11326 Non-Pharmacological Interventions); and

  •   the dates, since the previous hearing, of any office visits the child had with the prescribing physician, physician assistant, or advanced practice nurse. See 11320 Psychotropic Medications for requirements on visits to the prescribing healthcare provider.

11162 Notifying Parents About Psychotropic Prescriptions and Significant Medical Conditions

CPS October 2017

Within 24 hours of learning of an event, the caseworker must notify each parent of:

  •   an initial prescription of a psychotropic medication;

  •   the child's enrollment or participation in a drug research program; or

  •   a significant change in the child's medical condition, such as an injury or onset of illness, that is life-threatening or may have serious long-term health consequences, including injury or illness that requires hospitalization for surgery or a major emergency care procedure.

Texas Family Code §264.018

The caseworker must follow instructions for providing notice of the events listed above as provided in 6151.3 Notification Requirements and Schedule.

The caseworker must mail the DFPS form letter 2093 Parental Notification of Significant Condition to both of the child's parents. The caseworker must mail the letter to the parents even if the caseworker successfully notifies the parents by phone, text, or other means.

The caseworker must also discuss the child's medical situation with the child's parents as part of the case planning and review process.

See:

6241 The Child's Plan of Service

6242 The Family Plan of Service

The caseworker must document each notification regarding psychotropic medication in the entry documenting the parental contact in IMPACT.

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