10.11 Medical, Dental, and Developmental Needs | CWS

The Social Services Case Manager (SSCM) will:

For each child in care, the SSCM will:

The SSCM will:

The initial Health Check consists of a comprehensive unclothed physical examination, a dental examination and a developmental assessment (as applicable). All children should undergo an initial physical examination performed by a primary care physician and receive well-child checks based upon EPSDT standards. Children 12 months of age and older should also undergo an initial dental examination performed by a licensed dentist. Children under 12 months of age should undergo dental screening instead of a dental examination. Dental screening may be performed by a pediatrician or primary care physician. However, once these children reach 12 months of age, they should undergo an initial dental examination performed by a licensed dentist. Development assessments are performed on children from nine to 36 months of age by the primary care physician according to the EPSDT periodicity schedule. Babies Can’t Wait (BCW) also conducts Developmental Assessment Screening on children from birth to age three (see policy 19.28 Case Management: Children 1st and Babies Can’t Wait). Copies of BCW assessments should be maintained in the case record. Many medically fragile children are under the care of medical specialists. Special services, equipment needs, medical supplies, etc., may be recommended by the physician as medically necessary due to a child’s medical condition or diagnosis.

Children in foster care should be seen by Georgia Medicaid providers. The Medicaid program provides funds to the state for the costs of providing medical and some dental services to Medicaid eligible recipients. DFCS must utilize these funds for services to children entering DFCS custody to conserve state funds for those children not eligible for Medicaid (see policy 9.2 Eligibility: Applying for Medical Services at Initial Entry and Exit).

On March 03, 2014, the Georgia Department of Community Health (DCH) transitioned from a standard fee-for-service Medicaid program to a statewide Medicaid Care Management Organization (CMO) through Amerigroup Georgia Managed Care Company. The transition impacted children in DFCS custody and children receiving AA as they became members of a new program called Georgia Families 360˚. The new program is separate from Georgia Families, the general Medicaid program administered by DCH. Georgia Families 360˚ is designed to provide coordinated care across multiple services and focus on the physical, dental, and behavioral needs of member children. The program is designed to ensure each member has a medical and dental home, access to preventive care screenings, and timely assessments. It also seeks to ensure medical providers adhere to clinical practice guidelines and evidence-based medicine.

Each Georgia Families 360˚ member is assigned to a regional Care Coordination Team with a specified Care Manager. The Amerigroup CCT members are Masters level staff, the majority of whom hold a professional license to practice in their respective field. The Amerigroup CCT completes a Health Risk Screening (HRS) on youth in care to identify medical and/or behavioral needs. They ensure each child is assigned to a Primary Care Physician (PCP) and Primary Care Dentist, so every child has a medical and dental home. The Amerigroup CCT is responsible for coordinating the health components of the Comprehensive Child and Family Assessment (CCFA), including the initial physical, dental and trauma assessment. Care Managers are the primary partner of the SSCM for identifying and making referrals for needed services. Care Managers ensure each youth has an individualized care plan that addresses both physical and behavioral health needs. They work with community agencies to ensure appropriate services are provided.

Any services not authorized by the Amerigroup CCT will not be paid for out of Medicaid. Therefore, it is imperative that all medical/dental, behavioral health and developmental care be coordinated with the Amerigroup CCT to avoid any uncovered expenses. See Field Fiscal Services COSTAR Manual Section 3100 Family Foster Care for an explanation of the “Unusual Medical/Dental” funding source for children who are not Medicaid eligible or who receive a service not covered by Medicaid. For youth covered by other forms of Medicaid (i.e., Fee-for-Service) or health coverage, the SSCM should utilize known providers in the community and contact the WPAC Unit for further support or assistance.

DFCS communicates with Amerigroup utilizing an electronic notification form (E-Form). It is the primary means for communicating information about a member enrolled in Georgia Families 360˚. The E-Form must be completed and sent to Amerigroup within 24 hours of a youth entering foster care. It should be completed thoroughly to include demographic information, medical information, placement information, the identified CCFA provider and other referrals (e.g., Babies Can’t Wait). The E-Form is also used to report updates such as placement changes, a youth exiting care, etc. If there is information not available at the time of the initial referral to Amerigroup, submit an E-Form (update) as soon as the information is obtained. Accurate and timely communication with Amerigroup is vital to the Medicaid eligibility determination and the assignment of an Amerigroup CCT and service providers. Important decisions regarding the assignment of primary care providers and referrals are made based upon the information submitted on the E-Form.

Children 1^st was created by the state of Georgia to improve the health conditions of children from birth through five years of age. Children 1^st is the “Single Point of Entry” to a statewide collaborative system of public health, prevention-based programs and services, school, and community-based organizations to identify children at risk for poor health or developmental outcomes. Children 1^st identifies and screens children and links them to programs such as:

Referrals are submitted to the local Children 1^st District Coordinator. A list of Children 1^st District Coordinators is available at dph.georgia.gov/children1st.

A physical impairment is defined as a dysfunction of the musculoskeletal and/or neurological body systems that affects the ability of an individual to move or coordinate movement. This includes one or more of the following body systems: neurological; musculoskeletal; sensory organs; respiratory, including speech organs; cardiovascular; reproductive, digestive, genito-urinary; hemic and lymphatic, skin; and endocrine. A physical impairment on its own does not make a child eligible for BCW services. However, if there is a significant developmental delay due to the physical impairment, then the child may be eligible.

A developmental assessment is completed as part of the Health Check for children under four years of age who enter foster care. The assessment determines whether there are factors that may result in a developmental delay for a child or place a child at risk of delay. Any child in care [under the age of three] who has a suspected developmental delay, physical impairment or diagnosed disability must be referred to BCW via Children 1^st for assessment. DFCS cannot provide consent for BCW services. Consequently, a surrogate parent or other appropriate adult may be needed to act on behalf of the child and provide necessary consents. See policy 19.28 Case Management: Children 1st and Babies Can’t Wait.

A developmental delay is a chronological delay in the appearance of normal developmental milestones achieved during infancy and early childhood, adjusted for prematurity in one or more of the following areas: cognitive, physical (including vision and hearing), communication, social/emotional and adaptive. Such delays may be caused by organic, psychological, or environmental factors. Example: If most children crawl by eight months of age and walk by the middle of the second year, then a child five or six months behind schedule in reaching these milestones may be classified as developmentally delayed regarding mobility.

A delay is considered significant when it interferes with children’s ability to interact within their natural environment (relative to expected developmental sequences of cognitive, communication, adaptive, physical, and social-emotional development) to such a degree that ongoing development is compromised. In addition, secondary delays relative to the initial delay are likely to occur (e.g., significant delays in expressive communication may lead to compromised social skills with peers). Criteria for a significant delay include identification of deficits in skills which are instrumental in accomplishing later developing skills or functional tasks that would be expected of peers who are developing typically.

If the use of standardized diagnostic measures is deemed appropriate, a score of two (2) standard deviations below the mean (average) in one of the five developmental domains, or at least one and a half (1.5) standard deviations below the mean in two or more of the five developmental domains constitutes a significant delay. The determination of whether a child has a significant developmental delay must be made by a qualified clinician.

Sexual and reproductive needs of youth in foster care are addressed through the initial and follow-up health screening. Youth in foster care may receive health education and risk prevention services through Georgia’s Personal Responsibility Education Program (GA-PREP), which provides high risk youth (ages10-19) free access to evidence-based teen pregnancy prevention programs and supplemental adult preparation subjects. Youth in care access PREP services through the agency’s partnership with the Department of Public Health (DPH) Adolescent Health and Youth Development (AHYD) Program. GA-PREP is federally funded by the Administration for Children and Families’ (ACF) Family and Youth Service Bureau (FYSB).

If a child has signs or symptoms that may be consistent with HIV infection or whose health history places the child at-risk, the child must be evaluated by a physician to determine if testing is necessary and appropriate. Minors may receive HIV prevention counseling and testing services with or without parental consent. Whenever possible, parents should be involved in the counseling and testing. Local public health facilities with knowledgeable specialists in HIV may be contacted for consultation and information. The SSCM must recognize and understand the risk factors for HIV which may need to be brought to the attention of health care providers such as:

Almost all children who have become infected with HIV are infected prenatally by their mother. The maternal HIV antibody is present in children up to 18 months of age, resulting in a “false positive.” A “true negative” finding can only be made 18-24 months following birth, at which time seroconversion may have occurred. In other words, the child’s body would have begun to produce specific, detectable antibodies in response to the presence of the virus. Primary health care providers should be able to care for HIV-exposed children and for most asymptomatic HIV-infected children with normal immune systems. As children become symptomatic, they will need the care of a pediatric infectious disease specialist. Since a child with a depressed immune system is at greater risk of suffering severe complications from routine childhood illnesses such as chicken pox and measles, the physician needs to be consulted when determining the setting that is best for the child and the degree to which that setting should be restricted. Usually, the benefits of an unrestricted setting outweigh the risks of the child acquiring harmful infections. Often, the infected child can be served in a foster home and attend school and/or day care. The results of HIV testing are confidential and may be released only to the following individuals:

The WPAC Unit provides practice support, consultation and quality monitoring of physical and moderate behavioral health needs of children and youth in foster care. Specific functions of intensive support and monitoring include:

“High risk” youth are those with significant medical conditions or illnesses. Medical issues that contribute to children being considered as “high risk” include:

Down Syndrome
Cerebral Palsy
Multiple Sclerosis
Spina Bifida
Fragile X Syndrome
Von Willebrand Disease
Sickle Cell
Osteogenesis Imperfecta
Rickets
Cancer
Diabetes
Hypoxia
Neurological disorders
Epilepsy
TBI
Respiratory Illness
Respiratory Failure
Asthma
Gastrointestinal Illness
Short Gut Syndrome
Failure to thrive
Feeding disorders
Birth defect to organs
Organ failure
Organ transplants
Mechanically/Technology dependent…G-tube dependent
Trach and/or Vent dependent
Portacaths
Physically disabled children

In general, DFCS can give permission or consent for medical care deemed appropriate or necessary by competent medical authorities. Moreover, some court orders contain language that explicitly gives DFCS the authority to provide consent for ordinary medical care. This usually involves non-surgical procedures or routine surgical procedures that are considered low risk. However, when consent for extraordinary medical care (e.g., major surgery, potentially life-threatening procedures) is needed, it should be sought from a parent or the court. Even when DFCS has the legal authority to make medical decisions regarding children in DFCS custody, such authority must be exercised in a manner consistent with family-centered practice. Families should always be involved in the decisions affecting their lives. This applies to parents and the children. Decisions should always be based upon what is in the best interest of the child.