Medical Hubs

0600-500.00 | Revision Date: 05/24/16

Overview

This policy guide provides information on Medical Hubs including their locations, the services they offer, and guidance on how to use them.

TABLE OF CONTENTS

Policy

Medical Hubs

Medical Hub Program

Out-Stationed CSWs

Out-of-County Placements

Hub-Affiliated Hospitals

Core Services

Initial Medical Examination

Forensic Evaluation

Mental Health Screening

Other Services

LAC+USC Hub Extended Care (E-Care) Clinic

Medical Examinations

Medical Examination Timelines

Parent/Guardian Rights in a Medical Examination

E-mHub System

Rightfax Transmission of Medical Hub Referral Form to Children’s Hospital Los Angeles (CHLA)

Procedure

Responding to a Detained Child

CSW/ERCP CSW Responsibilities

Responding to a Child who is Not Detained

CSW/ERCP CSW Responsibilities

Responding to an Inter-county Case Assignment

CSW/PHN Responsibilities

Examining Results Received from Medical Hub

Regional Staff Responsibilities

CSAT Staff Responsibilities

CSW Responsibilities

PHN Responsibilities

Approvals

Helpful Links

Attachments

Forms 

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 04/16 version to update medical examination requirements to reflect the Department's requirements in existence prior to April 20, 2016.

POLICY

Medical Hubs

The countywide Medical Hub System is a partnership between the Department of Health Services, the Department of Mental Health (DMH), and DCFS. Medical Hubs provide services for DCFS-served children who are newly detained.

 

The table below lists the Medical Hubs and highlights the DCFS offices that are geographically located to the nearest Medical Hub.

 

Medical Hub

Service Planning Area (SPA)

DCFS Office

High Desert Health System

1

  • Palmdale
  • Lancaster

Olive View – UCLA Medical Center

2

  • San Fernando Valley
  • Santa Clarita
  • West San Fernando Valley (Santa Clarita Satellite Office)

LAC+USC Medical Center

  • SCAN Clinic Community Assessment and Treatment Center

3,4,7

  • ERCP
  • Pasadena
  • Metro North
  • Belvedere
  • Santa Fe Springs

Children’s Hospital of Los Angeles

  • Foster Care Clinic
  • Forensic

 

Children’s Hospital of Los Angeles is a non-public entity but is operational to provide services to DCFS-supervised children.

5,2

  • West Los Angeles
  • San Fernando Valley
  • West San Fernando Valley (Santa Clarita Satellite Office)

LAC+USC East San Gabriel Valley Satellite

3

  • Pomona
  • Glendora
  • El Monte

Martin Luther King, Jr. Multi-Service Ambulatory Care Center

6,7

  • Compton Project
  • Compton West
  • Santa Fe Springs
  • Vermont Corridor
  • Wateridge
  • Wateridge Torrance Satellite

Harbor – UCLA Medical Center

  • Children’s Crisis Center
  • KIDS Clinic

8

  • Lakewood
  • Torrance

Medical Hub Program

The Medical Hub Program focuses on serving the following populations:

 

Additional populations are served based on capacity at each Medical Hub.

 

The caregiver who is most knowledgeable of the child’s health status should accompany the child to the Hub. The caregiver should be advised to take the child’s Health Education Passport(HEP) to each appointment at the Hub to be reviewed by a Hub physician.

 

If a child has severe or life threatening injuries, he/she should be brought to an emergency care facility or trauma center and then be referred to the Hub after his/her injuries have been stabilized.

Out-Stationed CSWs

There are DCFS CSWs out-stationed at the Medical Hubs, including after hours at the 24/7 LAC+USC Medical Center Hub. A list of CSWs out-stationed at the Medical Hubs is available on LA Kids.

Out-of-County Placements

The mandatory use of the Medical Hubs does not apply to children placed outside of Los Angeles County. However, if a caregiver who resides out-of-county is willing to travel to a Medical Hub, Hubs will service the DCFS child. If the child is subsequently placed in out-of-home care in Los Angeles County, the child should be taken for an Initial Medical Exam at a Medical Hub.

Hub-Affiliated Hospitals

For children who are being referred to a Medical Hub for an exam after being discharged from a Hub-affiliated hospital, the child should be referred to that Hub whenever possible. When referring child to a Medical Hub for an exam, if the child has been served prior at a Hub-affiliated Emergency Room where the question of child abuse was raised, the child should be referred to that Hub whenever possible.

Back to Policy

Core Services

Initial Medical Examination

The Initial Medical Examination is routine and preventative. It is also the first periodic medical exam that must occur when a child is initially placed under DCFS supervision. The child’s caregiver is responsible for transporting a child to this exam.

 

The Initial Medical Examination is not required when a child is being replaced from one placement to another in Los Angeles County. The CHDP Health Periodicity Schedule should be adhered to when implementing health examinations of the child.

 

The Initial Medical Examination consists of the following components:

Forensic Evaluation

A forensic evaluation may be authorized for a child when there are allegations of physical or sexual abuse and when the child has been placed in protective custody. A forensic evaluation is not required for all DCFS children.

 

Forensic evaluations require:

 

Absent either of these:

 

CSWs must request that a forensic evaluation be conducted at a Hub within seventy-two (72) hours of detention. Prior to the forensic evaluation, the CSW must consult with a medical provider who has specialized training in detecting, and treatment of, child abuse injuries and child neglect (Specialist).

 

It is the responsibility of the Specialist to determine if a physical examination is appropriate. If the Specialist determines that a physical examination is appropriate, the examination must be performed by a Specialist.

 

Referrals for forensic evaluations meeting any of the following criteria will be accepted and scheduled by the Medical Hubs, regardless of other case circumstances:

 

Hub personnel will review the request for a forensic evaluation following the submission of the Medical Hub Referral Form and a phone call from the CSW. Hub personnel/providers ultimately will direct the CSW on the appropriateness of a forensic evaluation and provide a timeframe for the child to be seen for the evaluation.

 

The forensic evaluation will vary based on the circumstances of the child but may include the following components:

 

DCFS referrals for forensic evaluations must be submitted electronically through the E-mhub System and be followed up by the referring CSW with a telephone call to the Medical Hub for consultation and intake.

 

If a child has received a forensic evaluation at another facility other than a Medical Hub, the CSW should consult with the Medical Hub to determine whether an additional Medical Hub examination is needed.

 

For siblings or other children who live in the same home and/or have contact with the alleged perpetrator (companion cases), Medical Hubs will request that the CSW provide complete information at intake from the CSW’s interview of each child.

 

Medical Hubs will request that DCFS provide all pertinent medical records and case information. If the requested information is not immediately available, the forensic examination will not be delayed if there is an immediate concern for the child’s safety or the observation of physical evidence. In these cases, however, the forensic examiner may wait to issue written findings to DCFS until the requested records and/or information are received. The Medical Hub will inform the CSW as to what items are missing and are required before the examiner can issue a report.

Mental Health Screening

Each Medical Hub will complete an age-appropriate mental health screening, using the Child Welfare Mental Health Screening Tools (CWMHST). This tool is used to determine if there is a need for a more comprehensive mental health assessment of the child.

Other Services

LAC USC Hub Extended Care (E-Care) Clinic

LAC+USC Hub Extended Care (E-Care) Clinic hours are:

 

The E-Care Clinic provides:

Back to Policy

Medical Examinations

State regulations require a medical examination for all children placed in out-of-home care.

Medical Examination Timelines

The Initial Medical Examination must be conducted according to the following timelines:

a

Type of Child

Timeline for Initial Medical Examination

High Risk Children and Children 0 - 3 years of Age

  • Within ten (10) days of initial placement following detention, or sooner if medically recommended or required

All Other Children

  • Within thirty (30) days of initial placement following detention

Allegations of Physical or Sexual Abuse

 

If a child has a severe or life threatening injury, he/she should be seen at an emergency care facility or trauma center. The child should then be referred to a Medical Hub after his/her injuries have been stabilized.

Parent/Guardian Rights in a Medical Examination

Officials (CSWs, law enforcement, etc.) cannot completely exclude parents from the location of their child’s physical examination absent parental consent, a legitimate basis for exclusion, or an emergency requiring immediate medical attention.

 

If there is a “valid reason” to exclude family members from the examination room during the medical procedure, a family’s right to be with each other during potentially traumatic medical examinations may be limited to being near the examination (e.g. in the waiting room or another nearby area). “Valid reason” may include authorities have reasonable evidence that a parent is abusive, cannot provide love and support to the child, or will in some significant way interfere with the examination.

 

If a CSW determines that he/she needs to exclude a parent/guardian from the medical examination, even if that medical examination was ordered by the court, the CSW should consult with his/her SCSW for guidance. The SCSW will consult with the Warrant Liaison or County Counsel as needed.

Back to Policy  

E-mHub System

E-mHub is a web-based system used by the DHS Medical Hubs to track the health status of children in the child welfare system and facilitate the provision of quality medical care. It is a joint effort between DHS and DCFS. It accepts the electronic transmission of the DCFS Medical Hub Referral Form and returns appointment status alerts and completed examination forms to DCFS via an email notification.

 

DCFS and DPH PHNs and PHN Supervisors have access to E-mHub screens pertaining to the health care of children served at the Hubs. Completed examination forms may be accessed through the link in the email notification by using the SITE User ID (employee number) and Password (current password used by employee). The link to the forms from the email notifications is only available to DCFS staff for ten (10) business days from the date of the email.

 

For a list of designated staff that receives these faxes and the designated office fax numbers, refer to the document, Designated Fax Lines

 

Once the Medical Hub Referral has been electronically submitted through the E-mHub System and the Medical Hub staff attempt to process the referral, an email notification will be sent to DCFS to alert the CSW and SCSW to any problems with the referral or appointment.

 

When DCFS receives an appointment status notification or link to an examination form from E-mHub, CSW/CMS is automatically searched to obtain the currently assigned CSW and SCSW and an email is routed to staff as follows:

 

Forms

Email Link Sent To:

DCFS 561(a), Medical Examination Forms

California Emergency Management Agency (CalEMA) Forms

  • Currently assigned CSW and SCSW

Child Welfare Mental Health Screening Tools (CHMHST) Forms

  • Currently assigned CSW, SCSW and respective CSAT staff

“Negative” appointment status notifications (no show, canceled, rescheduled, to be rescheduled, referred out, incomplete, returning referral)

  • Currently assigned CSW and SCSW

“Positive” appointment status notifications (scheduled, showed up)

  • Received by DCFS BIS for inclusion in tracking reports. These are not forwarded individually to staff

 

In some cases, the Medical Hub staff may return a Medical Hub Referral Form to the CSW to request additional information or report that they were unable to schedule the appointment. The Medical Hub staff will select one (1) of the reasons below and may also write a message to the CSW with details and specific instructions. CSWs must carry out the instructions presented by the Medical Hub in the email notification. The reasons for return are:

 

When a Medical Hub Referral is returned to DCFS, the referral is removed from the Medical Hub’s referral queue and the Medical Hub staff will no longer work on the referral. To reinitiate the referral, the CSW should either re-submit the referral form or call the Medical Hub. If any information has changed since the time of the original referral, a new form should be submitted.

 

E-mHub notifications of the following “negative” appointment statutes are also sent via email to the currently assigned CSW and SCSW:

 

CSWs are to follow up with parent/primary caregiver or out-of-home caregiver within three (3) calendar days on no show notifications to ensure that the forensic evaluation or Initial Medical Examination, or other medical appointment is rescheduled.

Back to Policy

Rightfax Transmission of Medical Hub Referral Form to Children’s Hospital of Los Angeles (CHLA)

DCFS can submit the Medical Hub Referral Form automatically to Children’s Hospital of Los Angeles (CHLA) through the Rightfax feature. Upon completion of a Medical Hub Referral Form, the CSW should press the same “SUBMITtoEmHub” button currently used to submit the Referral Form to the E-mHub System. The referral will automatically be faxed to the CHLA Hub.

 

The Rightfax feature does not provide electronic appointment status notifications to staff, and medical examination results will continue to be manually faxed to DCFS by the CHLA Hub.

Back to Policy

PROCEDURE

Responding to a Detained Child

If a child has severe or life threatening injuries, he/she should be brought to an emergency care facility or trauma center and then be referred to the Hub after his/her injuries have been stabilized.

CSW/ERCP CSW Responsibilities

The following procedures apply to the CSW who took the child into temporary custody.

 

  1. Complete the Medical Hub Referral Form.

 

  1. Submit the Medical Hub Referral Form to the Medical Hub that is in closest proximity to the caregiver’s home.

 

  1. Electronically submit the Medical Hub Referral Form through the E-mHub System to all Hubs except Children’s Hospital Los Angeles (CHLA).

 

Child(ren)'s Age or Risk Level

Timeframe for Submitting Initial Medical Examination Requests

  • Infants/children under three (3) or a High Risk child,
  • Complete and submit the Medical Hub Referral Form through E-mHub/Rightfax within three (3) calendar days of the child’s initial placement.
  • Children three (3) years or older
  • Complete and submit the Medical Hub Referral Form through E-mHub/Rightfax within five (5) business days of the child’s initial placement.

 

  1. At the time of initial placement, inform the caregiver of the requirement to utilize Medical Hubs.

 

  1. Review and complete the Medical Hub Notice to Caregivers with the caregiver.

 

  1. Instruct the caregiver to contact the Medical Hub closest to his/her home, within the designated timeframe for the submission of the Medical Hub Referral Form, or the estimated timeframe when the Referral will be submitted to the Medical Hub.

 

  1. Remind caregivers to take the DCFS 4158, Authorization for General Medical Care for a Child Placed by an Order of the Juvenile Court, or the DCFS 179, Parental Consent and Authorization for Medical Care, with them to the Hub appointment along with proper identification.

 

  1. Notify the caregiver that examinations at Medical Hubs are comprehensive and therefore can be lengthier than routine exams conducted by a community health care provider.

 

  1. If the child is placed in a Foster Family Agency (FFA) or group home, contact the social worker or group home representative.
  1. Provide him/her with the instructions/requirements for making an appointment and utilizing the Medical Hub closest to the child’s placement.
  2. Inform the social worker or group home representative of the time-frame in which the child is to be seen.

 

  1. Fax the Medical Hub Referral Form to the FFA social worker or group home representative within one (1) business day of the submission of the referral through E-mHub/Rightfax.

 

  1. Document all contacts with the FFA social worker or the group home representative, and all service providers in the Contact Notebook.

 

  1. Document the following recommendation in the Detention Report:

Back to Procedure  

Responding to a Child who is Not Detained

Medical Hubs are available to provide forensic evaluations for children who are not detained. In these cases, since the child is not under DCFS supervision, parental consent is required. If a child has severe or life threatening injuries, he/she should be brought to an emergency care facility or trauma center and then be referred to the Hub after his/her injuries have been stabilized.

CSW/ER CSW Responsibilities

The following procedures apply to the CSW conducting the ER investigation:

 

  1. When a child has been detained, complete the Medical Hub Referral Form for a forensic evaluation.

 

  1. Follow procedural the steps beginning with submitting the Medical Hub Referral form and ending with documenting all contacts with the FFA social worker under Child is Detained.

 

  1. Contact the Medical Hub to obtain direction from the Hub physician on the appropriateness of the forensic evaluation, including the time frame, and the most appropriate individual to accompany the child to the Hub.

 

  1. Proceed according to the direction received from the Medical Hubs.

 

  1. Document all contacts and actions taken in the Contact Notebook.

Back to Procedure

Responding to an Inter-county Case Assignment

CSW/PHN Responsibilities

  1. Within thirty (30) days of being assigned an inter-county transfer case (including FM, FR, PP cases), review the case record with the CSW/PHN to determine if there is a medical need to have the child seen by the nearest Medical Hub for an Initial Medical Examination.

 

  1. On the Medical Hub Referral Form, in the “Specify reason for DCFS current and prior involvement” field, note that this is an inter-county transfer case.

 

  1. Provide copies of any medical records contained in the case file to the Medical Hub personnel on or before the date of the examination. 

 

  1. Follow procedural the steps beginning with submitting the Medical Hub Referral form and ending with documenting all contacts with the FFA social worker under Child is Detained.

Back to Procedure

Examining Results Received from Medical Hub

The results of the Initial Medical Examination and any forensic evaluation, along with the Child Welfare Mental Health Screening Tools (CWMHST) and other ancillary documentation (the latter from some of the Medical Hubs) will be provided to the assigned CSW.

Regional Staff Responsibilities

The following procedures apply to Children’s Hospital of Los Angeles (CHLA) referrals only:

 

  1. Receive the documents faxed by the CHLA to the designated fax machine in the DCFS SPA office.
  1. Search and identify the current CSW and SCSW.
  1. Record them on the DCFS 561(a), Medical Examination Form and the CWMHST.

 

  1. Provide the SCSW and CSW with a California Emergency Management Agency (CalEMA) form.

 

  1. Make three (3) copies of the DCFS 561(a) for the SCSW/CSW, PHN, DMH and the Coordinated Services Action Team (CSAT) inbox.

CSAT Staff Responsibilities

  1. Upon receipt of the Initial Medical Examination or any urgent CWMHST from the Medical Hub, review the DCFS 561(a), and the CWMHST.

 

  1. Determine whether a referral to co-located DMH staff is needed.

CSW Responsibilities

  1. Review the information on the DCFS 561(a), Medical Examination Form, the California Emergency Management Agency (CalEMA), and CWMHST screen.

 

  1. Consult with the Service Linkage Specialist (SLS), the PHN, co-located DMH staff, and co-located Educational Liaison (if applicable) to coordinate follow-up care.

 

  1. Print out a copy of the DCFS 561(a), CalEMA, and CWMHST screen and file them in the Psychological/Medical/Dental/School Report Folder.

 

  1. Fax the completed DCFS 561(a) to the Foster Family Agency (FFA) or group home representative within five (5) business days of receipt.

 

  1. Document all contacts with the caregiver, Hub staff, the SLS, PHN, DMH co-located staff, and the Educational Liaison (if applicable) in the Contact Notebook.

PHN Responsibilities

  1. Review the DCFS 561(a), Medical Examination Form and the CalEMA (if applicable).

 

  1. Enter the results into CWS/CMS.

 

  1. Follow up on any health concerns indicated with appropriate parties.

Back to Procedure

APPROVALS

None

HELPFUL LINKS

Attachments

Medical Hubs for the Department of Children and Family Services, Initial Medical Examinations and Forensic Examinations

Know Your Rights for Sexual Health Services and Sexual Health Services Available at the Medical Hub Clinics

Forms

CWS/CMS

Detention Report

Medical Hub Referral Form

LA Kids

DCFS 174, Family Centered Referral and Services Form

DCFS 179, Parental Consent and Authorization for Medical Care and Release of Health and Education Records (also available in Spanish)

DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental Services (also available in Spanish)

DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (also available in Spanish)

DCFS 561(a), Medical Examination Form

DCFS 561(b), Dental Examination Form

DCFS 561(c), Psychological/Other Examination Form

DCFS 563, Medical Record Procedures for Foster Caregivers

DCFS 4158, Authorization for General Medical Care for a Child Placed by an Order of the Juvenile Court

Medical Hub Referral Form (with instructions)

Medical Hub Notice to Caregivers (also available in Spanish)

Hard Copy

Medical Hub DCFS Work Flow Process

Referenced Policy Guides

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0070-526.10, Assessment of Fetal Alcohol Spectrum Disorder (FASD)

0070-548.20, Taking Children into Temporary Custody

0070-570.10, Obtaining Warrants and/or Removal Orders

0080-505.20, Health and Education Passport (HEP)

1000-504.75, Inter-county Transfer (ICT)

Statutes

California Department of Social Services (CDSS), Manual of Policies and Procedures (MPP) Division 31-206.361 – States that each child in placement must receive a medical and dental examination within thirty (30) days of placement.

 

Welfare and Institutions Code (WIC) Section 324.5 – States that whenever allegations of physical or sexual abuse of a child come to the attention of DCFS, and the child is taken in to protective custody, DCFS must, as soon as practically possible, consult with a medical practitioner who is trained in detecting and treating child abuse injuries and child neglect, to determine whether a physical examination of the child is needed. If a physical exam is needed, DCFS must ensure the examination takes place within seventy-two (72) hours of the time the child was taken into protective custody. If the allegations are made while the child is in custody, the physical examination must be performed within seventy-two (72) hours of the time the allegations were made. In addition, DCFS must provide the results of the physical examination to the court, to any counsel for the minor, and any counsel for the parent/guardian of the minor. Failure to obtain the physical exam cannot be used as grounds for denying a petition.

 

The statutes also states that DCFS must, whenever possible, request that additional medical exams to determine child abuse injuries or neglect, be performed by the same medical practitioner who performed the initial exam. If this is not possible, DCFS must ensure that future medical practitioners to whom the child is referred for ongoing diagnosis and treatment have specialized training in detecting and treating child abuse injuries and neglect and have access to the child’s medical records covering the current and previous incidents of child abuse.

 

WIC Section 16010(c) – States that within thirty (30) days of initial placement of a child into foster care, DCFS must provide the caretaker with the child’s current health and education summary. For each subsequent placement, DCFS must provide the caretaker with a current summary within forty-eight (48) hours of the placement.

Back to Helpful Links