Child Protective Services

Handbook Revision, June 20, 2014

This revision of the Child Protective Services Handbook was published on June 20, 2014. Summaries of new or revised items are provided below.

Medical Consent

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 conservatorship 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 conservatorship, 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.

Transition Plan

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.

Items Affected

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

11114 11112 Ensuring Training on Informed Consent and Requirements for Medical Consenters

11115 Documenting Medical Consent

11115.1 11113 Issuing Forms 2085-B Designation of Medical Consenter

11115.2 11117 Documenting in IMPACT

11116 11114 Providing Medical Information to the Medical Consenter

11117 11115 Changing Medical Consenter and Back Up Consenter

11118 11116 Notifying the Court of the Designated Medical Consenter

11120 11118 Court Authorizes an Individual Other Than DFPS To Be the Child’s Medical Consenter

11130 11120 Responsibilities of Medical Consenters and Back Up Medical Consenters

11131 11121 Being Knowledgeable of Child's Medical Condition

11132 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

11132.7 11136 Emergency Medical Care

11133 11123 Updating All Medical Consenters and Back Up Medical Consenters

11140 11130 Medical Consent by Minor Youth

11141 11131 Educating Children and Youth About Their Medical Care

11142 11132 Informing Youth About Certain Rights

11143 11133 Documenting Court Authorization for Youth Consent in IMPACT

11144 11134 Offering Ongoing Support to Youth

11145 11135 Requesting a Court Order When a Youth Refuses Medical Care

11150 11140 Notification of Medical Care

11151 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

11152 11142 Notifying Parents About Significant Medical Conditions

11153 Notifying Parents About the Use of Psychotropic Medications

11160 11150 Special Circumstances

11161 11151 Youth Young Adults Who Are 18 Years or Older

11162 11152 Youth Under DADS Guardianship in Extended Foster Care

11163 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

11214 Immunizations

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