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  DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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4-8 Public Health Nurse Home Visitation Program

 

Case Planning and Case Management Services
4-8  Public Health Nursing (PHN) Home Visitation Program
Reference Points
Overview
PHN Home Visitation Services
Eligibility for Public Health Nursing Home Visitation Services
Procedures for Referring to the Home Visitation Program for Informal Supervision, Voluntary Family Maintenance and Court-0rdered Family Maintenance Cases
Procedures for Referring to the Home Visitation Program for Court-ordered Family Reunification & Permanent Placement Cases
Public Health Home Visitation Nurse Services
Social Worker Responsibilities After the Initial Referral Is Made
Other Public Health Nursing Services
Child Health and Disability Prevention(CHDP Program Public Health Nurses
Contacts


Reference Points
Effective Date: 10/8/12
Last Updated: 4/24/13
 Non CWS/CMS Forms:
MS Word Consent for Services- Public Health Home Visitation Program (SCZ1651)
MS Word Referral to Public Health Nursing (SCZ1650c)
MS Word FIRST 5 PHD Home Visitation Consent Form
MS Word

PHD Authorization to Release Protected Health Information

MS Word PHD Notice of Privacy Practice
MS Word

PHD Notice of Privacy Practice Acknowledgement of Receipt

 CWS/CMS Forms:
 Service Management Section: Contacts


Overview  

Through FIRST 5 Santa Clara County funding, In partnership with the Department of Family and Children's Services (DFCS), the Public Health Department provides public health nursing assessment and home visitation services for children, from birth through age five (5) referred from the DFCS.  Children who are receiving services under Voluntary Family Maintenance(VFM), Informal Supervision (IS), Voluntary Family Reunification (VFR), Family Maintenance and Family Reunification services are eligible.

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Eligibility for PHN Home Visitation Services  

Home Visitation services through the Public Health Nurses are eligible for any child:

  • Birth through five years of age.
  • Who is receiving voluntary and Court-ordered services through and referred by DFCS.
  • The child resides or is placed in Santa Clara County.

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PHN Home Visitation Services  

Under the Public Health Nursing Home Visiting Program, PHNs provide the following services during home visits with the child(ren) and parent(s):

  • Assessment of the child which includes:
    • Ages and Stages Questionnaire (ASQ)
    • Ages and Stages Questionnaire / Social Emotional (ASQ-SE)
    • An evaluation of the child's health status, including an immunization record check
    • A home safety evaluation
    • A review of the child's medical records
  • Assessment of the birth mother, including a screening for postpartum depression.
  • A comprehensive infant/child nursing assessment. 

  • Child development education, using reflective practice  and anticipatory guidance with the parent.
  • Referrals to:
    • Early Start, High Risk Infant Follow-up/Infant Neurological Development (HRIF/IND) Clinic, CCS, immunizations and other medical/dental services.
    • The Mental Health Call Center for further assessments and treatment services, as appropriate.

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Procedures for Referring to the Home Visitation

Program for IS, VFM Cases and Court Ordered Family Maintenance Cases

 

The criteria for Public Health Nurse Home Visitation Program are that the family:

  • Has children birth through five years old
  • Agrees to voluntary services under the Voluntary Family Maintenance (VFM), or Informal Supervision (IS) program OR is receiving Court-ordered Family Maintenance Services.



Families may be referred to the Public Health Nursing Home Visitation Program by the Emergency Response (ER) or Dependent Intake (DI) social worker when voluntary services are offered to the family.  Once services begin, if the family did not initially agree to Home Visitation services but later decides to accept the services, the primary assigned DFCS social worker providing the voluntary services may make the referral.

Additionally, families who meet the above criteria and are referred to the Court while the children remain in the care of one or both parents (out-of-custody) should  to be referred to the Public Health Nursing Home Visitation Program by the Dependent Intake (DI) social worker.


Social Worker:

  • Reviews and completes the Consent for Services- Public Health Home Visitation Program (SCZ1651) with the parent
  • Asks the parent to indicate on the form whether they will accept or not accept services through the Home Visitation Program and sign the form.
  • Reviews the First 5 Santa Clara County Consent Form and the Public Health Department Authorization to Release Protected Health Information with the parents and requests they sign these forms.
  • Completes the Referral to Public Health Nursing (SCZ1650[c])
  • Submits to the DFCS CHDP clerk
    • A copy of the SCZ1650(c) and
      • copies, signed by the parent, of the
        • SCZ1651,
        • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form and
        • Public Health Department Authorization to Release Protected Health Information

    

 

 

 

 

Basket: Home Visitation Program basket on the 5th floor of the Julian Office near the Placement Tracking Team (PTT).

Fax: (408) 792-1413

Pony: DFCS CHDP Clerk, 373 Julian St., 5th floor.

E-mail: CHDPClerical@ssa.sccgov.org

 

Dependent Intake Control Clerk (DICC):

  • Forwards the Case Assignment log to the DFCS CHDP clerk on a weekly basis.


CHDP Clerk:

  • Receives the Consent for Services (SCZ1651), Referral to Public Health Nursing (1650[c]), First 5 (Santa Clara County) PHD Home Visitation Program Consent Form and the Public Health Department Authorization to Release Protected Health Information from the social worker.
    • The 1651 indicates whether the family consents or does not consent to receive services from the Public Health Home Visitation Program.
    • Confirms that the First 5 (Santa Clara County) PHD Home Visitation Program Consent Form and the Public Health Department Authorization to Release Protected Health Information are included in the referral and signed by the parent.

  • Matches the SCZ1651 referral with the corresponding name on the Case Assignment log from the DICC.
    • The DFCS CHDP clerk receives a list of new Intake cases from the Dependent Intake Control Clerk (DICC) on a weekly basis.
    • If a form is received that cannot be matched to a name on the log, hold the form until the name appears on one of the Case Assignment logs.


      If.. then the DFCS CHDP clerk....
      The parent accepts services
      • Prints out a copy of the Investigation Narrative.

      • Forwards to the Public Health Referral Center the:
        • Consent for Services (SCZ1651)
        • Referral to Public Health Nursing (SCZ1650c){Noting the name and contact information for the primary social worker, if different from the referring social worker}
        • Investigation Narrative
        • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form
        • Public Health Department Authorization to Release Protected Health Information

      • Receives confirmation of receipt of the above forms (referral packet) from the PHD Referral Center.
      • Enters information into Special Projects Code in CWS/CMS.
      The parent declines services
      • Does not forward the child's name to the Public Health Referral Center.

      • Maintains a file with all the forms indicating a client declines services.

     

  • Serves as a point-of-contact for Public Health Nurses if the family cannot be contacted from the information received in the referral packet.


Home Visitation Program services for families receiving voluntary services through DFCS may be initiated at any time during the voluntary service period.  If a parent does not opt to receive services initially, social workers may discuss the program benefits at a later time with the parent and refer for services, if the parent then opts to accept services, by having the parent sign the Consent for Services (SCZ1651) and sending the form to the DFCS CHDP clerk. 

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Procedures for Referring to the Home Visitation

Program for

Court-ordered Family Reunification & Permanent Placement Cases
 

The criteria for Public Health Nurse Home Visitation Program are that the family:

  • Has children birth through five years old
  • Child is placed in Santa Clara County

Families meeting the above criteria are  to be referred to the Public Health Nursing Home Visitation Program by the Dependent Intake (DI) social worker when the case is referred to Court.  

DI Social Worker:

Request, at the Initial Hearing, in the recommendations, (language included in the SC12 templates), that “The Court authorizes the Social Worker to refer the child(ren) to the First 5 Public Health Nurse Visitation Program, sign the necessary consents and releases of information for the child to receive those services, and provide the PHN with the Initial Hearing Report and Investigative Narrative. If it is determined that additional services are needed, the SW is authorized to sign the consents for those services and provide the service providers with necessary information, including the Initial Hearing Report, regarding the need for the requested services.” ***

                                  

*** NOTE: When approved by the Court, this language provides the social worker with the consent to refer the child(ren) to the PHN Nursing Visitation Program as well as sign necessary consents and releases of information pertaining to these services. Further, with Court authorization, if determined by the PHN Home Visitation Program that additional services are needed, the social worker is authorized to sign consents for those services.

 

If Court authorizes social worker make referral and sign the necessary consents, the social worker:

  • Completes the Referral to Public Health Nursing (SCZ1650[c])
  • Completes and signs the Consent for Services- Public Health Home Visitation Program (SCZ1651)
  • Completes the the top portion of the First 5 Santa Clara County Consent Form and signs the form.
  • Signs the Santa Clara County Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt
  • Fills in the child's name and date of birth and signs the Public Health Department Authorization to Release Protected Health Information
  • Submits a copy of the SCZ1650(c) and
    • Signed copies of the:
    • SCZ1651 (Consent for Services- Public Health Home Visitation Program),
    • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form,
    • Public Health Department Authorization to Release Protected Health Information and
    • Public Health Department Authorization to Release Protected Health Information
    • Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt

          to the DFCS CHDP clerk.

Basket: Home Visitation Program basket on the 5th floor of the Julian Office near the Placement Tracking Team (PTT).

Fax: (408) 792-1413

Pony: DFCS CHDP Clerk, 373 Julian St., 5th floor.

E-mail: CHDPClerical@ssa.sccgov.org

For children in open cases, who were not referred by Dependency Investigations Social Worker, the Continuing Services Social Worker can refer the child for services.

Continuing Social Workers:

Either in the recommendations  attached to the court report for an upcoming calendared hearing or through submitting an Ex-Parte Application and order to the Court, the social worker requests Court authorization for DFCS to sign the necessary consents and releases of information for referral to the First 5 Public Health Nursing Home Visitation Program.

Social workers need to add the following language in the recommendation template or include in recommendations/requests in Ex-Parte Application and Order:

“The Court authorizes the Social Worker to refer the child(ren) to the First 5 Public Health Nurse Visitation Program, sign the necessary consents and releases of information for the child to receive those services, and provide the PHN with the Initial Hearing Report and Investigative Narrative. If it is determined that additional services are needed, the SW is authorized to sign the consents for those services and provide the service providers with necessary information, including the Initial Hearing Report, regarding the need for the requested services.” ***

                                  

*** NOTE: When approved by the Court, this language provides the social worker with the consent to refer the child(ren) to the PHN Nursing Visitation Program as well as sign necessary consents and releases of information pertaining to these services. Further, with Court authorization, if determined by the PHN Home Visitation Program that additional services are needed, the social worker is authorized to sign consents for those services.

 

If Court authorizes social worker make referral and sign the necessary consents, the social worker:

  • Completes the Referral to Public Health Nursing (SCZ1650[c])
  • Completes and signs the Consent for Services- Public Health Home Visitation Program (SCZ1651)
  • Completes the the top portion of the First 5 Santa Clara County Consent Form and signs the form.
  • Signs the Santa Clara County Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt
  • Fills in the child's name and date of birth and signs the Public Health Department Authorization to Release Protected Health Information
  • Submits a copy of the SCZ1650(c) and
    • Signed copies of the:
    • SCZ1651 (Consent for Services- Public Health Home Visitation Program),
    • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form,
    • Public Health Department Authorization to Release Protected Health Information and
    • Public Health Department Authorization to Release Protected Health Information
    • Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt to the DFCS CHDP clerk.

Basket: Home Visitation Program basket on the 5th floor of the Julian Office near the Placement Tracking Team (PTT).

Fax: (408) 792-1413

Pony: DFCS CHDP Clerk, 373 Julian St., 5th floor.

E-mail: CHDPClerical@ssa.sccgov.org

Dependent Intake Control Clerk (DICC):

  • Forwards the Case Assignment log to the DFCS CHDP clerk on a weekly basis.

CHDP Clerk:

  • Receives the Referral packet including the:
    • Referral to Public Health Nursing -SCZ1650[c], copies of the
    • Consent for Services (SCZ1651) - signed by the social worker,
    • First 5 Santa Clara County Consent Form- signed by the social worker
    • Public Health Department Authorization to Release Protected Health Information signed by the social worker
    • Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt signed by the social worker
  • Matches the SCZ1650(c) referral with the corresponding name on the Case Assignment log from the DICC.
    • The DFCS CHDP clerk receives a list of new Intake cases from the Dependent Intake Control Clerk (DICC) on a weekly basis.
    • If a form is received that cannot be matched to a name on the log, hold the form until the name appears on one of the Case Assignment logs.

                                                    

 

If.. then the DFCS CHDP clerk....

Court authorizes Social Worker to Make Referral & sign Consents

 

  • Prints out a copy of the Investigation Narrative and Initial Hearing Report.
  • Forwards to the Public Health Referral Center the:
    • Referral to Public Health Nursing (SCZ1650c)
    • Consent for Services (SCZ1651)
    • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form
    • Public Health Department Authorization to Release Protected Health Information
    • Public Health Department Notice of Privacy Practices- Acknowledgement of Receipt
    • Investigation Narrative
  • Receives confirmation of receipt of the above forms (referral packet) from the PHD Referral Center.
  • Enters information into Special Projects Code in CWS/CMS.

                       

  • Serves as a point-of-contact for Public Health Nurses if the family cannot be contacted from the information received in the referral packet.

 

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Public Health Home Visitation Nurse Services  

In providing services through the Home Visitation Program, the Home Visitation PHN:

  • Receives by secure e-mail a referral packet from the DFCS CHDP clerk which includes:
    • Investigation Narrative and/or Initial Hearing Report, if applicable.
    • Consent for Services - Public Health Home Visitation Program (SCZ1651)
    • Referral to Public Health Nursing (SCZ1650c)
    • First 5 (Santa Clara County) PHD Home Visitation Program Consent Form
    • Public Health Department Authorization to Release Protected Health Information
    • Public Health Department Notice of Privacy Practices, if applicable (only needed when child is in foster placement. If child is in parent's care, the PHNs will review HIPPA law with parent & have them sign during first visit)
  • Schedules an appointment with the parent or caregiver.
  • Reviews the Release of Information with the parent, or the social worker if authorized by the Court,  and has him or her sign the release
  • Reviews the HIPAA consent with the parent or the social worker if authorized by the Court, and has him or her sign the consent.
  • Completes assessments, provides education, and makes referrals.
  • Sends to the social worker, the Educational Services Unit (EdSU@ssa.sccgov.org), and the CHDP PHN a copy of the:
    •  Client Status Report (CSR) with a summary of referrals and
    • ASQ Summary
  • Follows-up to assure that the family has been linked to appropriate services

 

If..   then the Home Visitation PHN..
The child is under age 1 year
  • Keeps the case open and provides assessments and developmental screenings every 2 months until the child reaches 1 year of age
    • If the child is medically fragile, the PHN follows the child as long as assessed to be needed until the child reaches 6 years of age.
  • Follows-up on linkages made.
The child is age 1 through 5 years
  • Closes the case after confirming that the family is linked to appropriate services.

 

   
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Social Worker Responsibilities after the Referral Is Made  

After the referral is made, the social worker:

  • Receives from the PHN for review and filing in the case file:
    • A Client Status Report and
    • ASQ Summary

  • Follows-up on referrals made by the Public Health Nurse, including working with the Education Services Unit on referrals to Early Start, Head Start, etc., as applicable.

  • Contacts the Public Health Department Referral Center to notify the Home Visitation Program of any placement changes.
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Other Public Health Nursing Services  

There are limited services available for children and youth ages 6 and older through the Public Health Department.  Referrals are accepted on a case-by-case basis.

See OPP Chapter 19-4.3: How to Refer to Public Health Nursing Services.

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CHDP PHN  

The Health Care Program for Children in Foster Care (HCPCFC) is administered by the Child  Health and Disability Prevention (CHDP) Program in collaboration with DFCS.  Its purpose is to provide public health nursing expertise in meeting the health needs of children and youth in foster care. The HCPCFC program is staffed by six (6) public health nurses located at DFCS, 373 W. Julian St. Office, 5th floor.  Their role is to:

  • Provide consultation and collaboration with social workers, probation officers, foster and relative caregivers, Foster Family Agencies, and Group Home staff regarding the health care needs of children in foster care placements.
  • Assist foster and relative caregivers to obtain timely comprehensive physical and dental exams.
  • Expedite referrals to specialty providers.
  • Maintain a list of CHDP doctors and Medi-Cal dentists and resources for medical and dental care both in and out of the county.
  • Perform quality assurance reviews to assess compliance levels with the required physical and dental exams.
  • Review health information forms, including Health Contact Forms, Receiving Center Clinic Discharge Summaries and Physician's Reports, Immunization Records, and CHDP physical exam reports, in order to identify and follow up on diagnosed conditions of foster children.
  • Provide CHDP HCPCFC trainings to new social workers and interns.

 

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Contacts  

Reminder: All referrals need to be submitted to and processed by CHDP Clerical

 

  • HCPCFC (Health Care Program for Children in Foster Care)  Main Number:  (408) 501-6669
  • Regional Public Health Nursing Referral Center
    • Anne Marie Santos, PHN Lead
      • E-mail: AnneMarie.Santos@phd.sccgov.org
      • Fax: (408) 494-1521
      • Phone: (408) 494-7548

       

  • Public Health Nursing Manager
    • Rhoda Blankenship

    Tel: (408) 494-1507

  • DFCS CHDP Clerk
    • Connie Robledo
    • Tel:  (408) 501-6847

     

  • DFCS Administration Support Bureau
    • Annette Stahlnecker

    Tel: (408) 501-6516

 

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Other References  
   
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