Legal Authority/Introduction 

LEGAL AUTHORITY:

• N/A

In the course of exercising custodial responsibility for children in out of home care (OOHC), DCBS staff is responsible for ensuring that the medical and mental health treatment needs of children are met.   In some circumstances, children may be admitted to a medical or psychiatric hospital, or residential treatment facility.  In those settings, physicians and mental health professionals will  be making recommendations for treatments such as medications, medical procedures, surgeries and length/duration of placement in that setting.   Procedures for providing consent for medications and medical procedures are outlined in SOP 4.26.2 Authorization for Medical Services.

In the event that the SSW, who is operating as the custodial agent for a child, is of the opinion that a child’s continued placement in a specific hospital or residential program is not in that child’s best interest the procedures outlined below are followed.

Procedure

The SSW:

1. Consults with the FSOS or designee when considering a placement change for a child in a hospital/facility that is against medical advice (AMA) provided by the hospital’s/facility’s medical staff to include any facility or group home that provides treatment to children in the custody of, or committed to the Cabinet; 1 
2. Follows procedures outlined in the following standards of practice (SOP) if it is determined, upon consultation with the FSOS or designee, that the child is in imminent danger of harm:
1. SOP Chapter 2-Child Protective Services (CPS) Intake and Investigation; and
2. SOP 2.17 Specialized Investigations;
3. Informs the treatment staff of the hospital/facility that a child will be moved, if after consultation with the FSOS or designee and the child’s family (when appropriate) it is determined that an alternative placement is in the best interest of the child, in situations other than imminent danger of harm;
4. In collaboration with the treatment provider, identifies a more appropriate treatment setting and the child is transferred as soon as safely possible, when the treating hospital’s/facility’s medical or mental health staff agrees that the child should be moved; 2
5. Informs the SRA or designee of the situation, when the treating hospital’s/facility’s responsible medical or mental health staff does not agree that a change in placement is in the best interest of the child and upon SRA approval, a change in placement is pursued against the advice of the current medical provider;
6. Provides the Medical Support Section staff with:
1. Case specifics on why a placement change is in the best interest of the child; and
2. A written report obtained from the facility on why the medical staff feels it is not medically advisable to discharge the child at this time along with the medical staff’s current recommendations;
7. And FSOS consult with the Medical Support staff to develop a discharge plan to address the following issues if the child’s AMA discharge is approved by the SRA:
1. Proposed date of discharge from the treatment facility;
2. Proposed new placement; and
3. Health issues (mental/physical) of the child that will need to be addressed by the caretaker at the new placement;
8. Consults with the family and keeps the family informed throughout the process, as appropriate, regarding the change and placement options;
9. Follows guidelines described on the Placement Change Tip Sheet.

Central office staff in the Medical Support Section:

1. Is consulted regarding discharge planning, prior to proceeding with any placement change that is against medical advice;
2. Reviews the information provided by the SSW regarding the proposed placement change;
3. Attempts to contact the current treatment providers to gather information and to determine if consensus can be reached;
4. Advises the SSW, FSOS and SRA or designee in writing of their opinion regarding the situation;
5. Provides written advisement as to medical risks of an AMA discharge versus the need for an alternative placement after review of the information and consultation with the treatment members. 3

The SRA: 

1. Approves or denies the removal of a child from a hospital/facility when the hospital/facility does not agree that a change in placement is in the child’s best interests;
2. In consultation with the SSW, FSOS and other regional staff will make the final decision as to whether a child will be removed AMA, after reviewing the written advisement of the Medical Support section.

Practice Guidance

• The SSW may contact the central office (CO) Out of Home Care (OOHC) branch if assistance is required in locating an alternate placement, if during the investigation it is determined that the child should be immediately removed from the setting.
• The CO Medical Support staff may consult with the Division of Protection and Permanency Director, CO Out of Home Care specialists, or other CO resource staff to determine the best interests of a child when considering whether to remove a child from a hospital/facility against medical advice. 

Related Information

• Medical Support Section
  (502) 564-6852
• Out of Home Care Branch
  (502) 564-2147

Footnotes

1. This would include residential treatment facilities, private child caring (PCC) facilities, clinical treatment facilities and hospitals.  Medical staff includes any Qualified Mental Health Professional (QMHP) pursuant to KRS 600.020 (47).
2. This might be to a less restrictive setting such as a foster home, an alternative medical or mental health facility.  The CO Medical Support staff at (502) 564-6852 may assist in determining an appropriate placement.
3. A specific recommendation will be made as to the appropriateness of removing the child AMA.  A hard copy of this written advisement will be placed in the case record.