DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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Handbook 3: Assessment Guides
3-13 Assessment of Medical, Educational and Mental Health Special Needs
Assessment Guides
3-13 Assessment of Medical, Educational and Mental Health Special Needs
Reference Points
Overview
Assessing Children with Special Medical Needs
Children with Extreme Behavior Disorders and/or Mental Illness
Assessing Children with Educational Learning Disabilities
Identifying Abuse or Neglect of Special Needs Children


Reference Points
Effective Date: 03/01/2006
Last Updated: 2/25/2011
 Non CWS/CMS Forms:
pdf SC 909
 CWS/CMS Forms:
bullet Health Notebook
bullet Screener's Narrative
bullet Referral Folder
bullet Contact Notebook


Overview   Each child is a special individual, having a unique personality like no other. However, there are populations of children who are born with or develop special needs as a result of physical conditions/medical disabilities, emotional/behavioral disorders and/or educational learning disabilities. These three categories are often interrelated in that children with physical disabilities frequently have emotional and/or behavioral problems that interfere with the appropriate rendering of prescribed medication. This, in turn, results in an exacerbation of the medical condition. Children with physical disabilities and/or mental or behavioral disorders are often identified in the school setting as in need of special education classes. In order to make a thorough assessment the SW must be familiar with all three categories of special needs children.

Although many children have long-term chronic or catastrophic physical disabilities or may develop serious mental illness or behavioral disorders, the majority of these children are well cared for and reside with their families or in appropriate facilities. However, there are also occasions when DFCS becomes involved with families who have special needs children, either when allegations of neglect/abuse directly involve an already-identified special needs child or when the special needs child is “discovered” in the process of investigating initially unrelated allegations.

Children with disabilities place a unique burden on their families. These disabilities can drain the family financially, take time and attention away from siblings and can contribute to a breakdown in communication between the parents. Special needs children are vulnerable due to their disabilities and are at greater risk for abuse, neglect and exploitation. In addition the special needs child is perceived as “different” from other children and is therefore easier to single out and scapegoat.
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Assessing Children with Special Medical Needs  

Some medical needs are temporary and others are chronic. Children with temporary disabilities such as victims of burns, broken bones, temporary colostomies or children with surgical wounds require medical assistance only for a specified period of time. However, those children who suffer from chronic disabilities such as asthma, HIV/AIDS, and diabetes, require ongoing assistance in coping with their disabilities. Those conditions which depend on technologies such as wheelchairs, braces, tracheostomies, internal feeding tubes, cardio-respiratory monitors, ventilators or dialysis, also require assistance from family members for an indeterminate period of time.

Another group of children within this population are those who are considered medically fragile. Typically, these are infants or children under two and one half years of age that are prone to re-hospitalizations. The risk of deterioration, resulting in permanent injury or death, persists, even though all procedures and ministrations are correctly performed. These may include children diagnosed with AIDS, congenital or hereditary defects (e.g., hydrocephalus, sickle cell anemia, cystic fibrosis), burns, epilepsy and prenatal exposure to drugs and/or alcohol.

Social Worker

Social workers may consult with CHDP public health nurses regarding medical conditions.

  1. Interview parents and obtain:
    • child’s health history
    • information related to child’s health condition, equipment, medications, supplies, all doctors treating the child and their phone numbers
    • consent to release of information
    • determine source of health insurance, if any

  2. Contact school personnel and obtain:
    • medication provided at school
    • known health problems
    • special education needs
    • current IEP (with parent’s consent)
    • attendance record
    • health/immunization record

  3. Interview siblings to determine how well they are able to cope with the effects of the medical needs of the identified patient.
     
  4. Obtain information from collateral contacts. Include teachers, counselors, community agencies, and current and previous healthcare providers.  

  5. Document your findings in the Contact Notebook.  Include both positive and negative findings.


Public Health Nurse

  1. Assist SW by explaining the condition and providing accepted standards of care, including medical regimens, equipment and supplies.
    • provide resources to the parent
    • locate a CHDP provider if appropriate
    • consult with school personnel as needed
    • consult with hospital personnel and discharge planner as needed
    • request medical records
    • call community agencies
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Children with Extreme Behavior Disorders and/or Mental Illness  

Extreme behavior patterns frequently place children in conflict with parents, siblings, teachers, peers and society at large. Diagnostic impressions may vary, but most revolve around psychosis, borderline conditions, severe character and personality disorders, lack of social skills, aggressive disorders, and attention deficit/hyperactivity disorder. These children are usually serviced through mental health clinics, psychiatric hospitals or therapists, are often prescribed psychotropic or other medications and are also placed in special education programs.

Frequently, parents/caregivers are unable to control or cope with their child’s symptoms and behaviors, which may have a negative effect on the whole family. When dealing with a mentally ill child, the SW must assess the safety of all siblings in the home. This is particularly relevant when the mentally ill child presents with symptoms of violence, rage, fire setting, or sexual acting out.

The origin of psychological problems in children may be organic and/or environmental. The SW should investigate and assess the environmental factors such as parental neglect and/or physical or sexual abuse as contributory factors in producing these types of symptoms in children. For example, a parent’s failure to follow through on prescribed treatment and medication can exacerbate a child’s mental illness. In contrast, a parent may have complied with all recommendations and exhausted all private and community resources, but still is unable to protect their child from harm.

The SW should be alert to the depressed and/or suicidal child, especially pre-teens, as the behaviors and symptoms of depression are initially less discernable.

Social Worker

  1. When assessing for potential mental/emotional disability consider:
    • acts or threats of violence, such as, threats to harm self or others, self-mutilation, harms animals, outburst of rage, excessive verbal or physical aggressiveness
    • a pattern of stealing, lying, fire-setting, or sexual acting out
    • sleep difficulties, depression
    • a history of enuresis or encopresis
    • impairment in reality testing, judgment, communication
    • visual and or auditory hallucination
  2.  
  3. If appropriate, request that the parents have the child be assessed by a professional.

  4. Assess the safety of all members of the household.

  5. Provide referrals and assist family in   accessing all available assistance as appropriate.

  6. Determine if all of the child's special needs are being met.
     
  7. Document your finding in the Contact  Notebook.  Include both positive and negative findings
     
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Assessing Children with Educational Learning Disabilities  

Many children with special medical needs or mental/emotional needs often require special education services as well. In this type of situation a whole constellation of services must be provided for the child to realize his or her full potential. These include children from infancy (screening for vision/hearing impairments), pre-school age (3-5), and school age (5-19) who are served by Regional Center (mental retardation, autism) or who have one or more of the following impairments:

  1. Hearing or vision
  2. Speech or language
  3. Mobility (requires braces/crutches/wheelchair)
  4. Brain injury
  5. Developmental delay or (retardation or autism)
  6. Special learning disability:  Learning Disability
  7. Mental Disorder (Seriously Emotionally disturbed or SED).  as found in the Diagnostic Statistical Manual (DSM) with substantial impairment in two of the following categories: self-care, school, community functioning, family relationships and one of the following categories:  psychotic features, risk of suicide and/ or violence. 
 

Social Worker

  1. Obtain information from the child’s school  regarding the nature of the child’s special educational needs.
     
  2. Determine the parent’s level of cooperation with the school on behalf of their child. 

  3. Advocate on behalf of the parent and child in terms of either requesting and/or  participating in an Individual Educational Plan (IEP).
    • Consult with the Educational Rights Coordinator on issues of educational advocacy or for information on educational rights of children.
     
  4. Provide referrals as appropriate. 

  5. Document your findings in the Contact Notebook. Include both positive and negative findings.
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Identifying Abuse or Neglect of Special Needs Children  

In order to determine if a special needs child is abused or neglected the SW must consider the family as a unit as well as the constellation of services required for this child to reach his or her full potential.
Continued child welfare services are not appropriate for special needs children when the SW’s assessment has concluded that there is no parental abuse or neglect involved. Every effort must be made to refer these children to other appropriate agencies such as the Department of Mental Health, or (if the child is school age) to the local school offices, for further assistance.

Social Worker

  1. Obtain a diagnosis and a treatment plan if  possible. 

  2. Identify the number and the nature of the special needs that must be met. 

  3. Identify what resources are being used or should be used to meet the child’s special needs. 

  4. Determine the parents/caregivers’ response to their special needs child.

  5. Is there neglect (e.g., medical) through intentional actions or omissions due problems such as parental/caregiver’s substance abuse, mental illness, developmental delay, etc.?

  6. Is there unintentional neglect due to parental or caregiver:
      • lack of knowledge?
      • inability to access resources (lack of transportation, childcare, medical insurance)?
      • limited ability (illiterate, unable to follow complex medical directions)?
       
  7. Are the available resources insufficient to meet the special needs, such as children with severe mental illness or conditions that cannot be controlled/resolved with the usual medical, psychological, educational interventions?

  8. Determine if the siblings are being appropriately cared for.

  9. Assess the stress level and coping skills of the parents.

  10. Determine if the parent/caregiver is both willing and able to provide for the needs of all of the children in the household.  

  11. Determine what support systems are available to the family.

  12. Provide referrals as needed.  

  13. Document your findings.  
  14.  
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