module 9: education, medical and mental health · web viewsay: remember once the case is yours, you...

Module 9: Education, Medical and Mental Health

Time: 6 hours

Module Purpose: Participants will understand their role in assessment, implementation and documentation of a child’s well-being needs being met.

Demonstrated Skills:1. Review and process the K-12 Report Card.2. Using case scenarios, complete a K-12 Report Card.3. Assure children’s medical and dental needs are met.4. Implement policy, law and rule for children on psychotropic

medications.5. Through the use of case scenario demonstrate full

understanding of Informed Consent.6. FSFN- Demonstrate effective documentation of medication-

related activities regarding a child’s medical and mental health needs, including Psychotropic Medication management.

There are 3 units in this module.

Materials: Child Welfare Operating Manual Chapter 8 Participants Guides Flipchart paper Markers Audiovisual equipment

Trainer Notes: The Child Welfare Practice Manual Chapter 8 will be used for tis Module. A classroom copy should be printed for each table.

The Psychotropic Medication Job Aids are also a separate attachment and can be printed as a classroom copy or provided to each participant.

CM9_TG_Education, Medical and Mental Health1

Agenda:Unit 9.1 Education Unit 9.2 Medical and Dental Health Unit 9.3 Mental Health and Psychotropic Medication

Trainer Instructions and Script:

Display slide 9.0.1: Module 9 Education, Medical and Mental Health (PG:1)

Display slide 9.0.2: Learning Objectives (PG:1)

Display slide 9.0.3: Agenda (PG:1)

Say: This module is another essential step to prepare you to gather information for the FFA-Ongoing as well as for the life of the case. A section of the FFA-Ongoing, which we will create in the next module requires us to assess the child’s functioning and the child’s needs. The priority needs that we


identify will guide our case plan to assure that the parents either already possess or need to build upon their protective capacities in certain areas to assure child safety. We will focus here on assessing a child’s educational, medical and mental health needs. We begin with education.


Unit 9.1: EducationTime: 2 hours

Unit Overview: In this unit, participants will fully understand the role of education in child and adolescent well-being.

Learning Objectives:1. Describe the steps in assessing a child’s educational needs.2. Explain the law and Best Interest Assessment.3. Explain the importance of the child’s educational stability.4. Discuss the benefits of ensuring that children 0-5 receive

developmental and diagnostic educational screening.5. Review and process the requirements of the Rilya Wilson Act.6. Describe the steps in assessing a child’s educational needs. 7. Review and process the K-12 Report Card.8. Review your local interagency agreement on the coordination of

educational services for children in care. 9. Describe the role and obligations of a Surrogate Parent.

Display slide 9.1.4: Unit 9.1 Education (PG:2)



Display slide 9.1.6: Everybody’s a Teacher (PG:3)

Show brief 1 minute 39 second video as opening to Unit purposeClick on link and view video

Display slide 9.1.7: Mythbusting (PG:3)

Say: The child’s educational progress is often directly linked to the child’s sense of safety and security. Children understand school and want to be like every other child, in school and doing well. If the child is doing well at school, placements will be more stable, reunification or permanency will be easier to achieve, and the child’s prospects for the future will improve.

Trainer Notes: This following activity is designed as a True or False game. It can be done by teams or with a whole group.

Activity #1: Participants will take T/F Quiz either on paper or via PPT Slide. This can be done individually, in teams, or group overhead.

Activity Tools: Mythbusting Quiz

Purpose: Participants will assess their knowledge about education statistics in out of home care.

PG:3


Trainer Instructions: Deliver Everybody’s A Teacher Mythbusting Quiz on either PPT or as

a paper tool on PG:# If PPT is used, click one time for answer and a second time for

further information. Answer Key below (optional: print key for participants after taking

quiz)

. Everybody’s a Teacher ~ Mythbusting- Answer Key T or F

1. Children in foster care overcome the trauma of abuse as soon as they are removed from the abusing parent and are in a safe place. Answer: False. The trauma of both abuse and removal from all the child knows lingers beyond immediate safety.

F

2. Children taken into foster care are enrolled in school right away. Answer: False. Too often the Protective Investigators or case-workers do not have the paperwork to enroll the child and believe this to be a roadblock. Many of them don’t realize that they do not even need the paperwork for enrollment. Florida Statutes allow immediate enrollment without the birth certificate and immunization record but require those documents to be provided within 30 days. Paperwork is unnecessary if the child returns to the same school where he or she is already known.

F

3. The research data shows that every time a student is moved to a new school the student falls behind 4 to 6 months in their educational progress.

T

4. Schools are the entity responsible for the education of a child in foster care. While the primary caregiver is primarily responsible, everyone is responsible: School, Case-worker, parent or foster parent or other caregiver, GAL, courts (TEAM). The case manager is responsible to be sure it gets done.

T

5. Changing schools is a small set back that children in foster care can easily overcome. Actually, research says when a student in foster care changes schools, an average of four to six months of educational progress is lost. (Calvin, Making a Difference in a Child’s Life, 2001)

F

6. Children in foster care earn diplomas at same rate as their peers. DCF’s test analysis of youth who aged out of care in 2007 showed that 40% had dropped out of school in contrast to 16% of all youth. DCF’s 2007 Independent Living survey showed that 55% of 17 year olds are below grade level and 58% of 17 year olds failed the FCAT. The 2009 Survey showed some improvement with “only” 50% below grade level and “only 46% failing the FCAT.

F

7. Because students in foster care have free tuition in state colleges and universities, they enroll at a higher rate than students not in care. Only 26% of youth aging out of care that year received a standard high school diploma compared to 47% of all youth that year. One cannot go

F


to college if one does not graduate high school. (DCF analysis 2007)8. Children in Foster care experience disabilities at same rates as their

same age peers. National data shows that youth in state care have disabilities at a greater rate than the general population – perhaps as high as 28% or more.

F

9. Studies show that kids in care have twice the post-traumatic stress as the rate of US war vets.

T

10. Infants and toddlers in foster care just need food, shelter and nurturing and they will be fine. A 2005 national study of youth in state care found that 40% of toddlers and 50% of pre-schoolers had significant behavioral and developmental needs. Yet only 21% of the youth were receiving services. National Working Group on Foster Care and Education, Educational Outcomes for Youth in Foster and Out-of-Home Care (September 2007).

F

Activity STOP

Display slide 9.1.8: The Law Best Interest Assessment (PG:5)

Say: As we have just learned, education outcomes for children in the dependency system are generally very poor.

Both the Federal Fostering Connections to Success Act and F.S. s. 39.0016 require that when we change a child’s home, we should not necessarily change the child’s school.

We are required to do a best interest assessment of whether the child should stay in the school he or she was attending immediately prior to our removal to the new home (the “school of origin”).

The child’s best interest is based on a number of factors, including distance (which implicates travel time), the quality of the current school vs. that of the proposed new school, whether the child’s needs are being met in the current school v. whether they can be met in the proposed new school, etc.


If it is in the child’s best interest to remain in the current school, then it is up to the CBC to ensure transportation, although the CBC may rely on the school system for transportation if the school will transport.

If it is not in the child’s best interest to remain in the current school, then we are also required to ensure the child is enrolled in the new school immediately (using the dictionary definition, i.e., without delay).

Remember every time a student is moved to a new school the student falls behind 4 to 6 months in their educational progress.

Refer to Job Aid PG :6 Discussion Questions Concerning School Stability.

Trainer Notes: The McKinney-Vento Act is a federal law designed to increase the school enrollment, attendance, and success of children and youth who lack a fixed, regular and adequate nighttime residence. It provides modest grants to states to provide supplemental services to eligible youth. The McKinney-Vento Act applies to children and youth living in a wide variety of unstable or inadequate situations. Many children in out- of-home care change living placements frequently. The McKinney-Vento Act specifically applies to such children who are considered to be “awaiting foster care placement.” The McKinney-Vento Act’s protections are invaluable in helping children in out-of-home care to succeed in school, as well as contributing to success and stability in the home placement.The McKinney-Vento Act provides eligible children with many rights and services, including:

The right to remain in one school even if their temporary living situation is located in another school district or attendance area, as long as remaining in that school is in their best interest.

The right to receive transportation to and from the school of origin. The right to enroll in school and begin participating fully in all

school activities immediately, even if they cannot produce normally required documents, such as birth certificates, proof of guardianship, school records, immunization records, or proof of residency.

Supplemental services such as tutoring and mentorship.If it is suspected that a child could be eligible under McKinney-Vento, a child welfare professional (caseworker, CASA, attorney, foster parent or other advocate) contact the McKinney-Vento homeless education liaison


from the school district immediately. Every school district is required to designate a liaison.

http://centervideo.forest.usf.edu/dep10/schoolstab/handout02.pdf

Say: In order to try and achieve more educational stability and better educational outcomes for our kids, case managers and CPIs should both consider and discuss the “Questions Concerning School Stability” with your supervisor and CLS attorneys when a child is sheltered and when a child's placement is being changed.

Activity #2: School Stability and Well Being

Purpose: Participants will begin to understand the effect of school stability on child’s well being

PG:5

Materials: Discussion Questions Concerning School Stability.

Trainer Instructions: Divide the 18 discussion questions among the table group. Provide the groups 3-5 minutes to discuss the effects that question

will have on a child’s well-being. Ask groups to report out to class

Activity STOP

Display slide 9.1.9: Age 0-5 (PG:8)

Say: When we look at children’s education we automatically think of the “school years “ but it is just as important that we make sure that children from 0-5 are assessed for their educational and developmental needs.


The first five years of life are an amazing time.

Ask: Did you know that 90% of brain development occurs before the age of five?

The growth during this period is greater than any subsequent developmental stage. These developmental years provide the foundation for later abilities and accomplishments.

Significant differences in children's abilities are associated with social and economic circumstances that may be impacting learning and development.

The cumulative impact of multiple risk factors on development is well documented.

Examples of risk factors are: o having a parent who abuses substances, o exposure to violence and trauma, o inappropriate child care and nurturing, and o living in a dangerous environment or community

Children served by child welfare systems are at very high risk for developmental delays; and children with some delays often represent over 50% of the children under age five served through child welfare.

Some things to consider are: o substance and/or alcohol exposure in uteri, o failure to thrive, and serious physical abuse/neglect

resulting in brain injury (shaken baby, drowning, and heat exposure)

Because this developmental period is critical to the child's future social, emotional, and cognitive development, every attempt should be made to provide these children with early intervention services both within the home and in child care settings.

Ask: What tools or services have we learned about so far that can help us to assure that the needs of children 0-5 are assured?

Refer participants to Operating Manual 8.7.8 and ask volunteer to read out loud to class.

We will learn about more tools in Module 10


Display slide 9.1.10: Rilya Wilson Act (PG:8)

Say: 39.604 Rilya Wilson Act; requires that a child from birth to the age of school entry, under court-ordered protective supervision or in the custody of the Department of Children and Families or a community-based lead agency, and enrolled in a licensed early education or child care program must attend the program 5 days a week.

Ask: Has anyone heard of Rilya Wilson?

Ask: Does anyone know the story of Rilya Wilson and why her name became a law?

Provide brief synopsis of story below

Trainer Notes: Rilya Wilson was born Sept. 29, 1996, to a homeless cocaine addict. The girl's name was an acronym for "remember I love you always." She was taken into state custody when she was less than 2 months old.The girl was last seen in 2001 living in a home shared by Geralyn Graham and Pamela Graham, who are not related. When it was discovered in 2002 that she was no longer living there, the Grahams claimed a Department of Children and Families worker had taken her for medical tests and never returned.Rilya's body has never been found. Police have no witnesses to any killing and scant physical evidence. The crux of the case are alleged confessions Graham made to fellow jail inmates that she killed Rilya and buried her body near a lake. Graham was sentenced to 55 years in prison. That means the 67-year-old Graham will likely die behind bars. The judge lamented that Florida’s child welfare system failed the 4-year-old girl, whose disappearance from Graham’s home went unnoticed for more than a year.An investigation showed that a DCF caseworker, did not make required monthly visits to the Grahams' home for more than a year, even though she was filing reports and telling judges the girl was fine. She was


eventually placed on five years' probation after pleading guilty to official misconduct for falsifying time The case led to the launching of several reforms, including a new missing child tracking system linked to the Florida Department of Law Enforcement. State lawmakers also made it illegal to falsify records of visits between child welfare workers and children in the agency's care.In addition, legislators required DCF to contract out casework to private organizations, which experts said has contributed to a 28 percent drop in the overall number of kids in care since Rilya disappeared. That was the event that drove privatization, for all practical purposes, and truly changed case management.

Ask: What would have happened if there was someone else who had their eyes on Rilya on a daily basis?

Ask: Maybe someone from the community?

Say: Let’s take a look at the Rilya Wilson Act

Refer participants to PG:9 where there is a copy of the 2014 legislation regarding the requirement under the Rilya Wilson Act 39.604 F.S.

Activity #3: Rilya Wilson Requirement

Purpose: Participants will recognize the case management requirements under the Rilya Wilson Act.

PG:8

Materials: Flip Chart Markers

Trainer Instructions: Divide the class into 6 groups and assign each group one citation

from 39.604 as follows: (3) Requirement 4 (a) 4(b) 1. 4(b) 2 4(b) 3 4(b) 4


Ask groups to put their creativity to work and create a drawing on flip chart paper that will be a visual representation of the assigned requirement.

The drawing should be such that it could be interpreted without explanation if possible.

Provide 5 minutes Ask each group to explain their drawing

Activity STOP

Say: Now let’s talk about the outcomes and needs for school age children from Kindergarten to 12th grade.

Trainer Notes: Currently, more than 500,000 children and youth are in foster care on any given day in the United States; half of them are over the age of 10 and more than one quarter remain in foster care for three years or more. Each year some 20,000 youth age 16 and older, transition from foster care to legal emancipation and find themselves on their own. Without adequate independent living skills, resources, or safety nets, many experience homelessness and unemployment. The majority of these children experience seven or more unplanned school changes while in long-term foster care, barely half of them graduate from high school, and estimates suggest only 7 to 13 percent of them enroll in higher education

Display slide 9.1.11: 9 Outcomes (PG:11)

Refer participants to PG:12, K-12 Report Card

Say: Case Managers will score K-12 Report Cards every 30 days for children:

• Ages 5 through 17 years inclusive • Under FL Jurisdiction (residing within or outside of FL); and • Placed in Licensed or Non-licensed Out-of-Home Care


settings.

The K-12 Report Card lists the 9 outcomes or domains that have been shown to be the most important areas to guide children’s success in school.

We will use a case scenario to decide what score should go in each box of the K-12 Report Card

Refer participants to PG:13 K-12 Scenario - below

Activity #4: K- 12 Report Card

PG:18

Activity Tool: K-12 Report Card- Scoring Tool

Purpose: Participants will become familiar with the K-12 as scoring process. When scores are completed participant will discuss what this score might be telling them.

Materials: Scenario K-12Report Card K-12 Scoring Tool

Trainer Instructions: Ask participants to read Part One of the scenario- provide one

minute.

Say: We will score the first ”baseline” score together .

Refer participants to PG: # K-12 Scoring Tool. Ask a volunteer to read the first tool description. Clarify that the goal is not to have all 5’s on the Report Cards, it is

important to be accurate with ratings so youth educational status, goals, improvements and plans are appropriate and accurate.

Use completed report card sample below and discuss score. Ask a different volunteer to read or each scoring for 2-9 domains,

discussing one score at a time. Note the bottom of report card for explanation of 3 or below.


Discuss explanations.

Discuss: ? What questions do you have?? What has grading this report card shown us?? What can you as a case manager do?? How can this help Michaela?

Say: The initial Report Card should not include any “U”s as it will be used as a baseline for improvement measurements going forward.

Direct participants to read Part Two of the scenario and score it. When complete ask them to discuss the following 2 questions with

their table groups.

? Are there any differences?? What do these differences tell us?? What more do you as a case manager need to do?

Debrief

K-12 Report Card Answer Key


K-12Desired Outcomes

Report Card Rating and

Survey Date

Impr

ovem

ent

From

Initi

al R

ating

Initial Most Recent

1 School Stability: a. Student been enrolled in same school during school yr.

3 3

b. If the student changed schools during the school year, the student was enrolled within two (2) school days.

5 NA

2. Attendance: The student is free of absences and tardiness. 1 5 43. Performance: The student is:

a. passing all courses.2 3 1

b. at the age-appropriate level for Reading and Math. 4 44. Student Involvement: The student is involved in at least one

extracurricular (school or other) program.3 3

5. Parent Involvement: Parent or caregiver actively communicates w/ tchrs & participates in school events.

4 4

6. ESE: The student has no Exceptional Student Education (ESE) needs OR has a current Individual Education Plan (IEP) to address their special needs.

4 4

7. Graduation Progress: The student is on schedule to graduate from High School or obtain a GED.

3 4 1

8. Behavior: The student exhibits age appropriate school behavior and participation.

3 4 1

9. Mentor: Student has connection to community through a tutor, surrogate parent for education, big brother/sister, mentor from formal mentoring program, adult volunteer in service learning project or similar connection.

4 5 1

+8Comments* Or Suggestions (from above Report Cards)1. Changed schools in beginning of school year at the beginning of placement. School is closest to her present home environment and easier for participation in activities.2. All 5 absences were excused.3a. Failing English and Spanish4. Michaela willing but school policy prevents it5. Michaela’s parents have not been involved in her new school7. Michaela may be having adjustment problems but will get back on track8. Minor comments about not participating in English and Spanish.

Ratings of 3 or under and rating of U or N/A must have explanations in the comment section


Trainer Notes: Be sure to enforce the importance of “changes” both up and down and to recognize the child for improvements and to assure any declines are addressed. Emphasize that the conversations about education between themselves, caregivers and youth is the most important part of the process, not completing the K-12 Report Card with all 5’s.Trainers are encouraged to supplement this topic with local data and programmatic information that supports education outcomes and the K-12 Report Card.

Activity STOP

Display slide 9.1.12: Interagency Agreements (PG:19)

Refer participants to quote on PG:19

Ask Volunteer to read out loud

“It’s hard to be making new friends, meeting new people, and getting used to each school’s vibe. And it can be hard to concentrate when you jump from home to home and school to school…Sometimes teachers assume you’re just passing through their school and class, and won’t take an interest in you. And if an adult in school does take a special interest in you, you usually lose that connection when you switch schools.” Russell Morse, School Daze, Foster Care Youth United, p.9 (Nov/Dec 1999).

Say: School personnel often do not know a child is in foster care or the implications of foster care on a child’s education.

Child welfare professionals often lack the training to provide the advocacy these children require in the other systems.

The Statewide “Interagency Agreement”” seeks to coordinate


services for children Partnerships empower students in foster care to improve performance and prepare for post-secondary education, the world of work and independence.

For Child Welfare System: Children doing well in school are more stable in their home placements and develop better social skills and self-esteem.

For Schools: Children learn better, behave better, test better and school assessments improve.

Trainer Notes: Get a copy or a version of your local Interagency agreement so that Case managers will know what they can expect from the local school districts and vice versa.

Ask: Does anyone know what a surrogate parent is?...in the field of education?

Display slide 9.1.13: Surrogate Parent and Review Slide (PG:19)

Say: It is so that one person is there for the child and making sure his or her educational needs are met. They will attend IEP’s and teacher meetings to be sure the child’s hopes and dreams are attained.

Refer participants to PG:19 What is a Surrogate Parent?

What is a surrogate parent? The surrogate parent is a substitute for the child’s parent as to educational matters, and is a trained, interested, and consistent educational decisionmaker for the child. The surrogate parent makes educational decisions for (and with) the child, and functions as an advocate for the child. A very important function of the surrogate parent is to work with the schools to determine the content of the child’s Individualized Education Plan (IEP) and to sign that. (This is an active function that goes far beyond attending IEP


meetings and signing whatever the schools have prepared).

When does a student require the appointment of a surrogate parent?39.0016(3)(a)2.c.

a) when the child’s parent is determined to be legally unavailable or

b) when the foster parent is unwilling, has no significant relationship with the child, or is not trained in the exceptional student education process.

This language indicates that the child’s parent is not automatically removed from serving as the child’s educational advocate when the child’s custody is removed from the parent and placed into DCF’s temporary custody. When the child still has a parent who is willing and able to be involved, that parent will continue to function as the child’s educational decisionmaker, and the child does not need a surrogate parent. However, if the parent is unable or unwilling, or it is not in the child’s best interest for the parent to remain involved in the child’s education, the court must make a finding that the parent is legally “unavailable” to the child.

Since this language then goes on to speak about the child’s foster parent, who has the general authority to act as the child’s educational decisionmaker under IDEA, acting as the substitute parent. If a foster parent is willing and able to serve, the foster parent technically does not need any judicial action to serve instead of the child’s parent. However, many of our children live in group homes, or live with foster parents who do not desire to become the decisionmaker. In these situations, we should seek the appointment of a surrogate parent.

Is there anyone who may not be appointed as a surrogate?

Yes, the following individuals are prohibited from appointment as a surrogate: Employees of

the Department of Education the local school district a community-based care provider the Department of Children and Family Services or any other public or private agency involved in the education

or care of the child. This prohibition includes group home staff and therapeutic foster parents.

However, any person who acts in a parental role to a child, such as a foster parent or relative caregiver, is not prohibited from serving


as a surrogate parent if he or she is employed by such agency, willing to serve, and knowledgeable about the child and the exceptional student education process.

Pursuant to Florida statute, the Guardian ad Litem, if one has been appointed by the court for the child, must be considered for appointment as the surrogate parent.

How is a surrogate parent appointed?

For a child known to the department, the responsibility to appoint a surrogate parent resides with both the district school superintendent and the court with jurisdiction over the child. If the court elects to appoint a surrogate parent, notice shall be provided as soon as practicable to the child's school. At any time the court determines that it is in the best interests of a child to remove a surrogate parent, the court may appoint a new surrogate parent for educational decisionmaking purposes for that child.

What does a case manager do if the child needs a surrogate and none has been appointed?

Speak with the CLS attorney on the case.

Useful websites concerning special education laws and programs:http://idea.ed.gov/explore/home Federal Government website concerning IDEA – federal law for education of children with disabilities.http://www.nichcy.org/Pages/Home.aspx Resource for all aspects of resources for children with disabilities. This includes IDEA, and more.

Display slide 9.1.14: Everybody is a Teacher (PG:21)

Say: We will now take a look at how we will document much of the education information in FSFN.

Refer participants to PG:21 FSFN - How Do I, where information is provided


on how to:1. Create an Education Record2. Access an Existing Education Record3. Complete an Education Record4. Maintain Education History

Demonstrate actions in Training Region if possibleRemind participants to put these pages in their FSFN folder

15 min

Click on the hyperlink on the top of Slide #14 after the words FSFN

This is an eLearning enhancement of the Education Tabs

http://centervideo.forest.usf.edu/fsfnenduser/ehanceeducation/start.html

Click link on PPT and show brief 1 min 39 second video to reinforce the learning in this unit.

Say: Everybody is a teacher!

Children learn from us: parents, caregivers and case managers. They learn from our actions as well as our words. When we take the time to explain, the child begins to understand. When we believe in the child, the child begins to believe in him or herself. And when we place a priority on education, guess what? The children will also place a priority on education. In this way, we are all teachers. We are teaching the children around us, by our own actions and words.


Unit 9.2: Medical, Dental and Mental healthTime: 1 hour

Unit Overview: In this unit, participants learn to ensure that they as Case Managers understand their role in assessing and assuring the child’s medical and dental health needs are met.

Learning Objectives:1. Assure children’s medical, dental and mental health needs are met. 2. Recognize the importance of ongoing assessment of medical and

dental needs.3. Identify the Case Manager responsibilities for establishing and

documenting continuity of care.4. FSFN- Recognize effective documentation of medication-related

activities regarding a child’s medical and mental health needs.

Display slide 9.2.15: Unit 9.2 Medical, Dental and Mental Health (PG:27)


Refer to Operating Manual 8.7.6-7 and 8.7.9 Activity: Participants will demonstrate the medical screenings

required for children in care.

Display slide 9.2.17: Child Health Checkup (PG:28)


Activity #1: Most Memorable Contest

PG:28

Activity Tool: Child Welfare Practice Manual 8.7.6-7,9

Purpose: Participants will gather information about children’s medical screenings requirements.

Trainer Instructions: Divide the 2 topics to groups- the more groups the better:

1. 8.7.6-7 Child Health Checkup and 8.7.7-Comprehensive Health Evaluation AND

2. 8.7.9 Dental Services Ask groups to prepare a 1 -2 minute presentation of the topic

assigned in the most memorable way. (song, dance, drawing, acronym…be creative)

Activity STOP

Ask: Where do you think all of the medical information about the child is kept?

Say: It remains with the child throughout the life of the case. Child Welfare Practice Manual 8.7.5(b) (13) refers to the Child’s Resource Record.We will learn more about this in Module 12.

Trainer Notes: Florida Administrative Code 65C-30.001 (24) a “Child’s Resource Record” means a standardized record developed and maintained for every child entering out-of-home care that contains copies of the basic legal, demographic, available and accessible educational, and available and accessible medical and psychological information pertaining to a specific


child, as well as any documents necessary for a child to receive medical treatment and educational services.

Display slide 9.2.18: CBHA (PG:29)

Trainer Notes: Attempt to obtain a copy of a CBHA with identifying information redacted, so that participants can review the information that is assessed and provided.

Collect these copies after review

Say: The CBHA is a tool used to gain insight into the emotional well-being and stability of a child. It is an in-depth and detailed assessment of the child’s emotional, social, behavioral, and developmental functioning within the family home, school, and community as well as the clinical setting

The CBHA is integral to the FFA Ongoing and the Case Plan and assuring that the child’s needs are attended to.

Refer participants to CW Practice Manual 8.7.10 and ask them to silently read


Display slide 9.2.19: FSFN (PG:29)

Say: Case Managers (and to some extent protective investigators, depending on the status of the case), are responsible for entering a timely, accurate and complete documentation of a child’s health history and current status in FSFN.

Let’s look at the Medical Tabs

Refer participants to PG:30, How Do I – Medical Tabs

Ask participants to read along as you display the next 4 screen shots

Display slide 9.2.20: Medical Profile Tab (PG:36)

Trainer Notes: Slides 20-23 are screen shots of the FSFN Medical Tabs. These screen shots can be removed and used as a job aid.The Disability Tab is explained in the FSFN Enhancement eLearning that follows.

Say: You will enter the documentation under five tabs in FSFN. Medical Profile TabMedications TabMental Health Profile TabMedical History TabDisability Information

The first tab is the Medical Profile tab. This is where details about


the child’s Primary Health Care Provider(s,) such as name, address, phone number, etc., are entered. Other health care status information is also entered here, including any known health problems, allergies, immunization status, the child’s Medicaid number, etc.

Display slide 9.2.21: Medications Tab (PG:36)

Say: The next tab is the Medications tab. This is where all prescribed medications are summarized, even if they have since been discontinued.

Information to be entered on this tab includes name of medication, whether is prescribed for psychotropic purposes, the quantities and dosages, any precautions and warnings, as well as, any additional instructions. For each psychotropic medication the date that informed parental consent or a court order was obtained must also be entered.

We will talk about informed consent in the next unit.

Display slide 9.2.22: Mental Health Profile Tab (PG:37)

Say: The Mental Health Profile tab is used to record the date of the most recent Comprehensive Behavioral Health Assessment, or CBHA, evaluation.


Details about the referral; and information about any Axis I or Axis II diagnoses for the child must be documented here.

This tab may also include diagnoses made by a health care provider regarding the child’s mental/behavioral health condition, as well as caregiver provided information at time of intake (for example, whether the child has an Emotionally or Behavioral Disturbance, Learning Disability, has a physical disability, or history of Drug or Alcohol Abuse, to name a few examples).

Display slide 9.2.23: Medical History Tab (PG:37)

Say: The Medical History tab is used to document all health-related services provided to the child, particularly those identified through initial Child Health Checkup and all subsequent visits with health care providers. Information to be entered includes appointment dates, provider information, procedures, diagnoses, and treatment information. Descriptions of treatments should be provided, including both physical treatment or other types of treatments such as counseling or other mental health therapies), as well as other information such as whether or not the visit was for monitoring of medication effect, symptom relief progress, if X-rays were taken, etc

11 min

Click hyperlink on PPT Slide #23 to display FSFN enhancement eLearning that describes further enhancement to these pages as well as the Disability Tab

http://centervideo.forest.usf.edu/fsfnenduser/enhancemed/start.html

Say: Now let’s talk about Psychotropic Medications


Unit 9.3: Psychotropic MedicationTime: 3 hours

Unit Overview: In this unit, participants learn to the requirement for children and families regarding psychotropic medication and how to fully document and implement policy and procedure.

The job aids for this unit are a separate attachment and were created and re-printed courtesy of Community Based Care of Central Florida

Learning Objectives:1. Identify requirements for children on psychotropic medications

from F.A.C 65C- 35 and F.S. 39.407(3) (a).2. Implement policy, law and rule for children on psychotropic

medications.3. Understand the appropriate authorization required for

medications.4. Through the use of case scenario demonstrate full understanding

of Informed Consent.5. Explain the necessity for parental and caregiver involvement.6. Explain the importance of a coordinated service delivery approach. 7. FSFN- Recognize effective documentation and Psychotropic

Medication management.

Display slide 9.3.24: Unit 9.3 Psychotropic Medication (PG:38)



Display slide 9.3.26: 20/20 Video (PG:39)

10:49 Setup Video from 20/20, in order to get the emotional “buy in” for the training and the need for case managers to be invested in what happens to children who take psychotropic medications.

When video is complete, survey the room for comments and tie to “their need to know” & “what they will learn” in this training when possible.

Provide a few minutes for participants to speak their emotions.

Ask: What are some things that you do you know about psychotropic meds?

Accept all responses- repeat answers- both as a way of recognizing participants knowledge, expertise and establishing connections

Ask: What are some of the problems associated with managing psychotropic meds?

Say: In this unit we are going to learn how to help the children we serve and their parent’s and caregiver’s best manage these medications.Let’s look at the definition


Display slide 9.3.27: Definition. (PG:39)

Display slide 9.3.28: Policy & Practice Tools (PG:39)

Say: Throughout today’s training we will be referring to and using the flow chart job aids and the information in these manuals, especially Chapter 8.

If not provided already, distribute Psychotropic Medication Job Aid 1-6 Suggest participants remove this chart from their binders as we will be referring to them for the remainder of the unit.

Provide 2-3 minutes for participants to look through the Psychotropic Medication Charts and Practice Manual Chapter 8.8

Refer to Job Aid #1 At Removal

Begin with brief overview of the CPI’s responsibilities at shelter.


Display slide 9.3.29: Whose job is it? (PG:40)

Say: Remember once the case is yours, you are now not only responsible to be sure it was done, but if not done, you need to do it.

“The team” Protective Investigators, Case Managers, Medical Professionals, Attorneys and the Family or legal guardians must work together to obtain the appropriate authorization for every child in DCF custody who:

was taking a psychotropic medication at the time the child was sheltered OR is being prescribed a new psychotropic medication while in care OR is being prescribed a change to an existing psychotropic medication while in care.

Display slide 9.3.30: Informed Consent (PG:40)

Say: One of the first important concepts that must be understood is that of “Informed Consent”Per Florida Statute 39.407(3)(a) and (c), Appropriate Authorization comes in ONLY two forms:

Informed Parental Consent which is provided by the parent’s signature on the required Informed Consent documents (this pertains only to those parents who still have their parental rights in tact). A Court Order when parental consent cannot be obtained because


of parent unwillingness, unavailability, or when parental rights have been terminated. Also per Florida Statute 394.459(3)(a)), informed consent must come from the child’s parent or legal guardian. Consent from a Case Manager, Foster Parent, or other substitute caregiver is NOT appropriate authorization for the administration of psychotropic medications. Consent can be obtained ONLY after direct contact between a parent and the prescribing doctor. Because of the importance of direct contact, Statute requires case managers to make efforts to ensure the parent’s participation in the child’s evaluation appointment. Efforts made by the case manager to arrange or support parent participation in the child’s doctor’s appointment might include: explaining to parents why participation is so important, assisting in having the parent attend and coordinating related medical or psychotherapeutic appointments. Only when a prescribing physician certifies that a delay of the administration of the medication would, more than likely cause significant harm to the child, that the medication can be administered without a court order or an informed consent by the parent.

As we go one with more of the policies regarding psychotropic mediation, you will see how much easier your case will be when you work with the parents to provide informed consent!

Say: if the parent does not participate in the child’s evaluation appointment at the doctor, either in person or by phone, the case manager cannot relay the doctor’s information to the parent Instead, the case manager must arrange a subsequent meeting or phone call between the parent and the doctor.

If a subsequent meeting or phone call cannot be arranged, then the parent cannot grant Express & Informed Parental Consent and the department must obtain a court order as authorization for the use of psychotropic medications. Let’s look at an example.


Display slide 9.3.31: Louis (PG:40)

Refer to PG: # Louis- Part One-

Activity #1: Louis Scenario

PG:41

Purpose: Participants will become familiar with the steps needed at removal

Activity Tools: CM Psychotropic Job Aid Case scenario Child Welfare Operating Manual 8.8

Trainer Instructions: Direct the participants to the Psychotropic Medication Job Aid #1 to

answer the questions in the scenario. Depending on time- you can have them do all of the questions or

divide the questions out to groups.

Debrief: When complete- review in table groups, provide responses in the answer key below and discuss any misperceptions.


Louis Scenario ~ Part 1– Use the Psychotropic Medication Job Aid #1 for assistance

9 year old Louis was removed from his home and placed in Out of Home Care. At the time of removal Louis’s mother Ms. Ryme, told the CPI that Louis was diagnosed with ADHD and was taking Adderal. The CPI asked for the prescription bottle.

1. What should the CPI do next? Ask the parent to sign “Emergency Intake” (5314) providing

written consent for continued use medication Contact the physician/pharmacy to verify medication- obtain

verification in writing (prior to shelter hearing) (If medication cannot be confirmed child must be evaluated by

physician within 72 hours to determine need for continued use. If parent does not provide consent CPI must ask CLS to file

motion. Provide & explain medication to the caretaker (This authorization

is valid for 28 days of removal or arraignment)

The case is staffed for ESI and the case manager is advised that Louis had been taking Adderal at home and that and Emergency Intake form was signed by the mother at removal.

2. Do we have informed consent? NO- Informed consent can only be direct contact between doctor

and parent.

3. What steps should the case manager take next? In any case, child must be seen by a physician to determine

appropriateness of medication..DCM or caregiver can make appointment.

Inform and invite parent to medical appointment (provide transportation of necessary. ( So that parent can provide informed consent)

Inform and invite caregiver to appointment

4. What assessment and critical questions and should the case manager be asking?


Speak with the mother Ms. Ryme regarding Louis’s behaviors and need for medication

Speak with caregiver and school personnel or after school care providers abut Louis’s behaviors

Assess whether Louis has every received any other type of therapy or medications.

The case manager has engaged the mother Ms. Ryme and has made an appointment with Louis’s new doctor to assess Louis’s continued need for the Adderal. The case manager advises Ms. Ryme of the appointment and picks her up to assure that she attends. Ms. Ryme discusses the medication with the doctor and provides her informed consent.

5. What does the case manager need to do next? Assure that medical report is filled out by physician. Provide medical report to CLS along with informed consent or

efforts to obtain informed consent, within 2 business days File medical report in CRR and with court at next JR

Activity STOP

Display slide 9.3.32: Medical Report – Key Requirement (PG:42)

Say: When Louis goes to the doctor there is a very important form that must be filled out by the doctor. The Medical Report Form is a required form for Psychotropic Medication Prescription and Administration (You can pre-fill)

This form is not in FSFN but will be in the child’s case file and in the Child Resource Record (CRR).

65C-35.013 FAC


New Medical Report by MD whenever the information in the original changes as regards medication. Doctors may use their own form which includes all necessary Information F.S. 39.407 (3)(c)(1)-(5).

Change in child’s MD: Must produce updated report within 3 days of taking over child’s treatment.

If no consent, DCM must give report to CLS to file for a court order.If express and informed consent, file at next JR.

Say: There is an emergency rule for administration of psychotropic medications: On this form there is a box that a doctor can check Certification of Significant Harm upon any delay.

Display slide 9.3.33:Coordinated Service Delivery (PG:42)

Say: Another case management practice for foster children on psychotropic medications is Coordinated Service Delivery.

Children who require psychotropic medications often have complex emotional, behavioral or mental health needs that must be addressed through a multi-disciplinary, or team-based approach with the necessary expertise actively involved in that child and family’s individual team. It is through effective teaming that we accomplish integrated, or well-coordinated, practice, with that child and family.

For children taking psychotropic medications, effective teaming and coordination in decision-making and in service delivery is a critically important aspect of care because the child’s mental health concern action is usually only one part of the child and family’s larger picture, in which other child and family needs may be present.


Many times, there are other complicating issues for the child and family, such as parental mental illness, parental substance abuse, or domestic violence, each of which can result in situations that are unstable and volatile, with frequent changes in status for the family.

It is this complexity and volatility that makes individual teaming, and the related coordinated delivery of services across all team members, which includes the child and family, so important.

In order to protect children from taking too many medications or the wrong medications there is a pre-consent review process

Display slide 9.3.34:Pre-Consent Review and read slide (PG:43)

Display slide 9.3.35:Med Consults (PG:43)

Click link to Med Consult on PPT slide

Review links and information available

Med Consult offers submission support as well as information commonly submitted medications.

Trainer Notes: Review MedConsult site prior to training and prepare and plan what areas you may want to show the class.


Display slide 9.3.36: Louis Part 2 (PG:43)

Activity #2: Louis Part 2

PG:44

Purpose: Participants will process ongoing psychotropic medication procedures.

Activity Tools: CM Psychotropic Job Aid 2,3,4 Case scenario Child Welfare Operating Manual 8.8

Trainer Instructions: Read scenario and answer questions

Debrief: When complete-Provide answers from answer key, review in table groups and discuss any misperceptions.


Louis Scenario ~ Part 2– Use the Psychotropic Medication Job Aid Two months later, the caregiver (foster mom) reports that Louis’s behavior has become “out of hand and the school is calling her every day, he is up all night and no one is getting any sleep”. The caregiver has made an appointment for Louis with a psychiatrist. The case manager informs Ms. Ryme (Louis’s mother) of the appointment and Ms. Ryme was supposed to meet Louis and the caregiver at the doctor’s office. The caregiver could not make the appointment, so the case manager attended. Ms. Ryme did not show up. The psychiatrist said the medication was very necessary and increased the dosage as prescribed and added a sleeping aid. The case manager tried to call Louis’s mom so she could participate in the appointment by phone. When the case manager could not reach Louis’s mom by phone, the case manager told the doctor that she would arrange a phone call between Louis’s mom and the doctor so he could provide Louis’s mom with all of the required information and answer any questions she might have.

The case manager was unable to get Louis’s mom on the phone with the doctor in order to provide informed consent for Louis’s medications.

1. Is the mother’s original informed consent still good? No because there has been a change in medication

2. When Louis’s mom refused to meet or talk on the phone with the doctor, why couldn’t the case manager just give the mom the information from the doctor and get the mom’s informed consent that way?

Because informed consent can only be obtained through direct contact between the parent and doctor.

3. What would have helped the physician make the determination whether the medication dose need to be increased?

Information from caretaker, school personnel, mother and case manager.

4. What should the case manager do next? Assure that Medical Report is filled out in its entirety, as well as

Medication Treatment Plan (5279) Assure physician certifies that “delay in providing medication will

likely cause harm to the child”, so that child can continue


medication. Assess accurate monitoring plan Contact UF for “Pre- Consent Review” due the fact that Louis is

under and taking 2 psychotropic medications Update FSFN within 72 hours File Medical Report, Treatment Plan & Pre-Consent Review with CLS

within 3 business days with request for court order Ensure Medication Log is updated and medical plan is followed.

Activity STOP

Display slide 9.3.37: Medication Administration & Monitoring (PG:46)

Say: The case manager must: review the Child’s psychotropic medications with their

supervisor or other agency designee assure that the diagnosed condition and the effects of

medication are routinely reviewed and monitored by the MD; report to the MD when the condition of a child is not improving

or is deteriorating

Display slide 9.3.38: Request for Second Opinion (PG:46)

Say: As per 65C-35.012 FAC A case manager may seek at any time after consulting with

supervisor;


When a party files a motion seeking another opinion, the Court may require DCF or contracted providers to obtain one within a reasonable time and the DCM will make an appointment within one business day of the order;

The appointment must occur within 21 calendar days of the Court order or the reason for the delay must be reported to the Court.

After reviewing refer back to video in beginning how the Foster Mom went on her own and got a second opinion- that she had to pay for-

This would not happen today.

Ask: Has anyone here ever wanted a second opinion?Ask: Do you think a child can ask for a second opinion?

Display slide 9.3.39: Parental Involvement (PG:47)

Ask: Name some other ways that parent can be involved?

Examples: sending copies of forms referring child for evaluation to parents; calling or mailing letters to parents to notify or remind them of the

appointment date, time, and location; offering to assist parents with transportation; or offering to let parents to participate in the appointment by phone

Ask: What are some of the Benefits of parental involvement?

The parent might have important behavioral and medical history that would be important for the evaluator to have and to hear directly from the parent

Display slide 9.3.40: Child Involvement and review (PG:47)


Display slide 9.3.41: Caregiver Involvement (PG:47)

Say: Caregivers are to make every effort to attend medical appointments and to become educated about the medications the child is taking, but they cannot provide express and informed consent.

They are also the ones who see the child every day and have important information for the doctorCaregiver’s must monitor the Child for side effects or other issues, and provide information during the decision-making process.


Display slide 9.3.42: Placement Change (PG:X)

Say: When a child changes placement, medical care must not be disrupted. Case manager or CPI must arrange for transportation to existing MD. If impossible, case manager or CPI shall secure medical records and history for new MD within 3 days of the change in medical provider

Refer to Job Aid 5 & 6

If time allows: Ask table groups to brainstorm all of the tasks required by the case manager in this scenario.

If short on time- ask general overhead questions of the class.

Responses: Change in Doctor New Medical Report Involve Mom- get informed consent? Or court order? Talk to and involve Grandmother

Note the importance of Transition Planning- when making changes in placement.

Activity #3: Placement Change

PG:48

Purpose: Review the process for psychotropic medications when there is a placement change

Activity Tools: Psychotropic Medication Job Aids 4,5,6

Trainer Instructions: Ask table groups to brainstorm all of the tasks required by the case


manager and answer the question: What must the case manager do?

Activity STOP

Ask: Where and how would you assure this information is provided and documented in the case file?

Display slide 9.3.43: FSFN (PG:49)

Trainer Notes: Explain to class how your agency files medical case information? Are they scanned, are they in a paper file? or Are they attached to FSFN?

Say: All details about prescribed psychotropic medication MUST be entered into FSFN within 3 business days of the action.

Files MUST contain: Complete medical reports. A record of the administration of the medication given. Information that the case manager obtained updated health

information about the child and the effects of medication therapy during the required 30-day contact with the caregiver.

Medication administration records MUST be reviewed by the case manager each month.

While the FSFN system does not force users to complete every data field, it is important to note that every field pertaining to psychotropic medications must be completed. No field pertaining to psychotropic medication should ever be left empty, even if the system does not force the user to complete it! Therefore, if the child welfare professional who is entering the data into FSFN does not have the information needed to complete a field, then s/he must get the information


So, as you can see, FSFN provides a very thorough and comprehensive portfolio of information to be used by child welfare professionals in caring for children on psychotropic medications.

Tell the story of Megan:

Say: Megan, is a 16-year-old girl in foster care. She has a history of bi-polar disorder with psychotic features and is receiving psychotropic medications schizophrenias part of her treatment. Sadly, she attempted suicide 5 days ago. Megan was taken to the Emergency Room by her foster parent. The case manager called Megan’s mother who accused the case manager of quote, “doping Megan up” and said that Megan never should have been on all those “pills and drugs” in the first place.

Megan’s mother subsequently filed a lawsuit against the department and community-based care agency. In preparation for the trial, the case manager provided legal counsel with the “Parental Consent” form completed and signed by Megan’s mother. The case manager also gave the attorney documentation that Megan’s mother was at Megan’s psychiatric evaluation appointment and had had all her questions answered by the doctor and that she had willingly given her Express & Informed Parental Consent.

Display slide 9.3.44: CRR (PG:49)

Say: Do Not Forget to put all pertinent information in the child’s Resource Record.

Ask: Where should the CRR be?

Answer: With the child, wherever the child is located


Say: Now, let’s turn our attention to reviewing documentation that is required. These are considered to be the Golden Rules of Psychotropic medication Documentation.

Activity #4: Golden Rules

Purpose: Review the documentation requirements for psychotropic medications

PG:49

Trainer Instructions: Refer participants to PG:50, Golden Rules Quiz Provide 5 minutes Depending upon time remaining:

o Provide Answer Key and have table groups reviewo or Review answers with the group

Psychotropic Medication Golden Rules Quiz- Answer Key

1. All details about prescribed psychotropic medication MUST be entered into FSFN within 3 business days of the action.

2. NO areas in FSFN pertaining to psychotropic medication should be left blank.

3. Files MUST contain documentation that the case manager obtained the child's resource record and psychotropic medications from the former caregiver and provided the new caregiver sufficient information about the medication to ensure that the medication is continued as directed by the physician.

4. Files MUST contain documentation that the caregiver receiving the child signed and dated the medication inventory to indicate receipt of the child's medication from the case manager.

5. File MUST contain documentation of attempts to invite the parent to the child’s doctor appointment, or documentation of communication with the parent regarding how to contact the physician, or attempts to facilitate transportation to the appointment.

6. File MUST contain documentation of information that the case


manager provided the parent with a copy of the medical report when the parent did not attend the medical appointment

7. The medication log MUST document the administration of psychotropic medications and any side effects or adverse reactions.

8. Case managers will review the medication logs during home visits and obtain updated health information about the child and the effects of medication therapy during the required 30 - day contact with the caregiver and document in FSFN

9. All court orders for psychotropic medication expire after one year

10. The Child’s Resource Record is required for all children in out of home care. It must be maintained in the home that the child is living in and transported with the child to every medical and therapy visit.

Activity STOP

Display slide 9.3.45: Knowledge Assessment (PG:51)

Display slide 9.3.46: Q1 (PG:51)

Answer: B



Answer: C


Answer: D


Answer: A



Answer: C


Answer: A


module 9: education, medical and mental health · web viewsay: remember once the case is yours, you...

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