11000 Health Care for Youth in Foster Care
11100 Medical Consent
CPS September 2026
Legal Basis
Texas Family Code §153.371-153.377 and Chapter 266.004©© provide the legal basis for DFPS’s authority to make medical decisions for children and youth in DFPS conservatorship.
Exceptions
The medical consent policy outlined in this section applies to most medical situations, with a few exceptions. The following exceptions can be found in the Medical Consent Resource Guide:
- Immunizations at 3-day—Texas Family Code §264.1076
- Inpatient Mental Health Treatment—Texas Family Code §32.001
- Substance Use Disorder Treatment—Texas Health and Safety Code Chapter 462.002
- Organ Donation—Texas Health and Safety Code Chapter 692A.004
- End of Life—Texas Health and Safety Code Chapter 166.035
Making Medical Decisions until the Court Hearing
In the period between a child’s removal and the ex parte or emergency hearing, when temporary orders are requested, the DFPS or SSCC caseworker may do one of the following:
- Consent to medical care until the court hearing.
- Designate the live-in caregivers with whom the child is placed.
DFPS or SSCC must not designate an employee or shift staff of a residential facility as a medical consenter. This includes the following:
- Residential treatment centers (RTC)
- Emergency shelters
- Psychiatric hospitals
- Juvenile detention centers
- Any other facility that does not have live-in caregivers
11110 Court Authorizes DFPS To Be the Child's Medical Consenter
CPS September 2026
When the court authorizes DFPS or a single source continuum contractor (SSCC) to consent to the child’s medical care, the DFPS or SSCC caseworker must designate a medical consenter and backup and coordinate medical information. A second primary and second backup medical consenter may be designated. The DFPS or SSCC caseworker must consent to the child’s medical care until a medical consenter (and backup medical consenter) has been designated and signed the appropriate forms.
The primary DFPS or SSCC caseworker and the supervisor must discuss any proposal to designate another caseworker as medical consenter or backup medical consenter. The supervisor must contact the potential designee’s supervisor who assigns the potential designee.
The DFPS or SSCC caseworker and supervisor can designate the biological parent (if the parent’s rights have not been terminated) as the medical consenter for a child for one of the following reasons:
- A plan is in place to return the child to the parent.
- The child has been placed in the parent’s home.
Medical consenters and backups must be specifically named individuals.
If the child is placed in a general residential operation (GRO) that has live-in caregivers (such as cottage parents), they can be listed as medical consenters.
DFPS and SSCCs must not designate employees of the following residential facilities as a child’s medical consenter or backup medical consenter:
- GROs operating as residential treatment centers (RTC)
- GROs operating an emergency shelter
- GROs offering therapeutic camp services
- GROs offering child care services (group setting with shift staff)
- GROs offering intellectual disability or pervasive developmental disorder treatment services or both
- Intermediate care facilities for individuals with an intellectual disability (ICF/IID) licensed by the Health and Human Services Commission (HHSC)
- Nursing homes
- State-supported living centers (SSLCs, formerly known as state schools)
- Home and Community-based Services (HCS) placements, regardless of type
If a child is placed in a general residential operation (GRO) for children with intellectual and developmental disabilities that has been designated as an institutional setting, DFPS or an SSCC designates as the child’s primary medical consenter the developmental disability (DD) specialist who is the child’s secondary worker.
The primary DFPS or SSCC caseworker designates DFPS local permanency specialists or an SSCC equivalent as medical consenters if regional management determines it is appropriate. When in person, consent is needed at medical appointments. A designated DFPS or SSCC equivalent and local permanency specialist participates in these appointments and provides consent.
The following DFPS or SSCC staff members, in the order listed, may be designated as temporary medical consenters if the child has a medical appointment or crisis medical need, and none of the other designated consenters can participate in the appointment:
- Another DFPS or SSCC caseworker in the child’s legal region, if the placement is in the child’s legal region.
- The DFPS or SSCC supervisor, if the placement is in the child’s legal region.
- Another DFPS local permanency specialist in the unit, if a local permanency specialist is assigned to the child.
- The DFPS local permanency supervisor, if a local permanency specialist is assigned to the child).
- On-call staff.
See guidance in the Medical Consent Resource Guide.
Approval
A DFPS or SSCC supervisor must approve the designation of a person as temporary medical consenter.
Documentation and Notification
DFPS and SSCC must document and track each designation of a temporary medical consenter using Form 2197 Designating Temporary Medical Consenter.
The DFPS and SSCC caseworker must notify the DFPS regional director or SSCC equivalent of each designation of a temporary medical consenter, by sending an email to the regional chain of command. The DFPS or SSCC caseworker must attach Form 2196 Notification Regarding Temporary Designation to Consent for Medical Treatment and Psychotropic Medication and Form 2197 Designating Temporary Medical Consenter.
11111 Documenting Temporary Medical Consenters
CPS September 2026
If a DFPS or a single source continuum contractor (SSCC) staff member, other than the primary DFPS or SSCC caseworker, is designated as a temporary medical consenter, the DFPS or SSCC caseworker must do both of the following:
- Complete and issue Form 2197 to the temporary medical consenter.
- Notify the court by filing a copy of Form 2196. See 11112 Extending a Temporary Medical Consenter’s Service Beyond 24 Hours.
11112 Extending a Temporary Medical Consenter's Service Beyond 24 Hours
CPS September 2026
If a temporary medical consenter needs to continue as medical consenter for longer than 24 hours, the primary DFPS or SSCC caseworker must do all of the following:
- Designate that person as one of the child’s four medical consenters (primary, backup, second primary, or second backup).
- Issue a new Form 2085B Designation of Medical Consenters
- Enter the information in IMPACT on the medical consenter pages.
- Notify the court using Form 2096 Notification Regarding Consent for Medical Care.
11113 Ensuring Training on Informed Consent and Requirements for Medical Consenters
CPS September 2026
Before designating an individual as a primary or backup medical consenter, the DFPS or SSCC caseworker must ensure that the person:
- Is willing to follow the requirements for medical consenters.
- Has completed a DFPS-approved training on medical consent.
- Understands the principles of informed consent for psychotropic medications.
- Understands that non-pharmacological interventions should be considered and discussed with the prescribing healthcare provider before consenting to the use of a psychotropic medication.
Documentation
The DFPS or SSCC caseworker must file a signed copy of the certificates of completion for trainings for each medical consenter and backup medical consenter in the child’s case record.
11114 DFPS Approved Training for Parents
CPS September 2026
Parental Rights not Terminated
If a parent’s rights were not terminated, the parent can be designated as the child’s medical consenter without being required to complete the DFPS-approved training, unless the court orders the parent to complete the training.
Parental Rights Terminated
If a parent’s rights were terminated, the parent is required to complete the DFPS-approved training for medical consent and psychotropic medication and provide a certificate of completion in order to be designated as the child’s medical consenter.
11115 Documenting Medical Consent
CPS September 2026
Once the DFPS or SSCC caseworker designates a medical consenter, and the medical consenter meets training requirements, the DFPS or SSCC caseworker must:
- Issue Form 2085b Designation of Meical Consenters.
- Have the appropriate parties sign the form by way of docusign.
- Give copies of Form 2085b Designation of Medical Consenter to the residential providers who are not designated as medical consenters.
Copies of Form 2085b will be automatically uploaded to OneCase/neuDocs through the DocuSign process. The DFPS or SSCC caseworker mails a copy of Form 2085b to the medical consenter.
If Form 2085b cannot be completed through DocuSign, the DFPS or SSCC caseworker does as follows:
- Completes the paper form with the medical consenter.
- Gives the caregivers and medical consenters a copy of the form.
- Uploads the form into the child’s Placement Records tab in OneCase/neuDocs.
11115.1 Documenting in IMPACT
CPS September 2026
The DFPS or SSCC caseworker must do the following, as soon as possible, on the same day as the removal or placement change and no later than 7 p.m. the next day:
- Enter or add the names and contact information for each medical consenter (including backup medical consenters) on the Person Detail page and Medical Consenter Detail page.
- Enter or update information on the Placement Detail page.
11116 Providing Medical Information to the Medical Consenter
CPS September 2026
The DFPS or SSCC caseworker must provide the designated medical consenter with:
- The child’s known medical history.
- Copies of available medical records.
- Information about previous healthcare providers who have treated the child, if available.
11117 Changing Medical Consenter and Backup Consenter
CPS September 2026
DFPS and single source continuum contractors (SSCCs) may need to change a medical consenter if the child changes placements or the primary or backup medical consenter:
- Is no longer associated with the child.
- Fails to act in the best interests of the child.
- Fails to appropriately involve DFPS or SSCCs in medical decisions as outlined in Form 2085b Designation of Medical Consenters.
- Fails to appropriately inform DFPS or SSCCs of the child’s medical condition and medical care.
- Is no longer affiliated with DFPS or a residential provider (including a foster parent).
- Fails to provide consent in a timely manner without a reasonable explanation.
- Fails to participate in the healthcare appointments of the child without a reasonable explanation.
- Fails to attend psychotropic medication appointments with the child without a reasonable explanation.
If a Non-CPS or SSCC Employee Fails to Perform Duties
If a medical consenter or backup medical consenter who is not a DFPS or SSCC employee fails to adequately perform the required duties, the DFPS or SSCC caseworker must inform the DFPS or SSCC supervisor. The DFPS or SSCC supervisor must coordinate with the DFPS or SSCC caseworker to resolve the problem. If these efforts are unsuccessful, the DFPS or SSCC caseworker, with supervisory approval, may change the designee by repeating the steps in Selecting a Medical Consenter.
Completing Forms 2085B and 2096
Every time DFPS or an SSCC names a new medical consenter or backup medical consenter, DFPS or an SSCC must:
- Complete a new Form 2085b
- Complete a new Form 2096 and send it to the court and the required parties.
- Update the medical consenter and placement tab in IMPACT.
11118 Notifying the Court of the Designated Medical Consenter or Temporary Medical Consenter
CPS September 2026
Once DFPS or a single source continuum contractor (SSCC) designates a medical consenter, DFPS or an SSCC must notify the court and other parties, no later than the fifth business day after the date the court authorized DFPS or an SSCC to consent to medical care for a child in DFPS conservatorship using Form 2096.
The DFPS or SSCC caseworker must also inform the court and other parties no later than the fifth business day after designating a temporary medical consenter by filing a copy of Form 2196 Notification Regarding Temporary Designation to Consent for Medical Treatment and Psychotropic Medication.
The DFPS or SSCC caseworker must:
- File the original form with the court.
- Save a copy of the notification in the case record.
- Forward a copy of the form to the:
- Person designated to consent to medical care
- Immediately preceding designee, if applicable
- Parents whose rights have not been terminated, or an attorney representing the parents
- Attorney representing DFPS
- Guardian ad litem and CASA, if one has been appointed
- Attorney ad litem, if one has been appointed
- Residential child care provider
Confidentiality
The DFPS or SSCC caseworker must inform the attorney representing DFPS if the caseworker, foster parents, or other caregivers who are designated as medical consenters do not wish to reveal the identity of the foster parents to the birth parents, because of safety concerns or privacy issues (such as when the medical consenter is the child’s pre-consummated adoptive parent).
11120 Caseworker Responsibilities in Managing the Medical Consenter
CPS September 2026
The DFPS or SSCC caseworker must inform the medical consenter about:
- Automatic enrollment in STAR Health Medicaid for youth in DFPS conservatorship.
- Requirements to complete annual training regarding medical consent.
- The obligation to inform the caseworker about the child’s medical care.
- Requirements for the use of psychotropic medications for a child in DFPS conservatorship, including:
- Completing the annual Psychotropic Medication for Children in Foster Care training.
- Following the requirements for informed consent for psychotropic medication.
- Attending any appointments when psychotropic medication may be prescribed and all medication review appointments.
- Ensuring that each child prescribed a psychotropic medication must be seen by the prescribing healthcare provider no less than every 90 days for a review of the medication.
The DFPS or SSCC caseworker must verbally provide the residential provider with the name and contact information of the individual authorized to consent to the child’s medical care.
11121 Notifying the Court When the Medical Consenter Fails to Perform Duties
CPS September 2026
If an individual authorized by the court to give consent fails to perform the required duties, the DFPS or SSCC caseworker must inform the DFPS or SSCC supervisor.
The DFPS or SSCC supervisor must coordinate with the DFPS or SSCC caseworker to resolve the problem.
If the efforts to resolve the problem are unsuccessful, the DFPS or SSCC caseworker, with supervisory approval, informs the attorney representing DFPS and requests that the court do one or both of the following:
- Issue a specific order related to medical care for the child.
- Change the authorization to consent to medical care to another individual, DFPS, or a single source continuum contractor (SSCC) representative.
11130 Responsibilities of Medical Consenters and Backup Medical Consenters
CPS September 2026
DFPS or single source continuum contractor (SSCC) staff acting as medical consenters, must:
- Be knowledgeable about the child’s medical condition, history, and needs before consenting to specific medical care or treatment.
- Provide emergency contact information to the residential providers (such as a home phone or cell phone).
- Ensure that any non-DFPS/SSCC medical consenter has completed Medical Consent training.
- Provide the healthcare provider with signed copies of Form 2085b.
- Follow the requirements of Form 2085b Designation of Medical Consenters.
- Participate in each medical appointment.
- Follow all requirements for providing informed medical consent for psychotropic medications:
- Complete Form 4526 Consent for Treatment with Psychotropic Medication, if new psychotropic medications are prescribed.
- Ensure that the child is seen by prescribing healthcare provider at least every 90 days.
- Update all other medical consenters and backup medical consenters involved in the case about the results of new appointments and changes in the child’s progress or treatment.
11131 Participating in Each Medical Appointment
CPS September 2026
A DFPS or SSCC caseworker consenting to medical care for a child must participate in each appointment set for the child with the healthcare provider.
DFPS and SSCC caseworkers who are medical consenters must do both of the following:
- Attend all appointments when a child may be prescribed psychotropic medications.
- Must discuss with healthcare providers their expectations for participation.
The following sections describe the minimum guidelines for participation. However, healthcare providers may require greater participation.
11131.1 Preventative Care
CPS September 2026
The DFPS or SSCC medical consenter or back up medical consenter provides written consent for the residential provider or another person to take the child for a preventive care appointment, unless the healthcare provider requires the consenter’s participation in person or by phone.
To provide this consent, the DFPS or SSCC medical consenter must complete Section 6 of Form 2085b.
11131.2 Ongoing Behavioral Health Therapy
CPS September 2026
The DFPS or SSCC medical consenter or backup medical consenter must approve the behavioral care treatment plan and monitor the progress of the child’s treatment.
The DFPS or SSCC medical consenter is not required to attend every appointment or to be present during the entire therapy session, unless requested by the behavioral health provider. The DFPS or SSCC medical consenter must collaborate with the behavioral health therapist to identify and provide non-pharmacological interventions for the child.
11131.3 Allied Health Services
CPS September 2026
Allied health services include dietary services, occupational, physical, speech, or other therapy. The DFPS or SSCC medical consenter must approve the allied healthcare plan and monitor the progress of the child’s treatment. The DFPS or SSCC medical consenter is not required to attend every appointment but must participate when requested by the allied healthcare provider.
11131.4 Psychotropic Medication Appointments
CPS September 2026
The DFPS or SSCC medical consenter must participate in all appointments with the child, when psychotropic medication may be prescribed, and all psychotropic medication follow-up appointments. Telemedicine is an approved method of participation in medical appointments including those for psychotropic medications. The participation via telemedicine is at the discretion of the medical provider. The DFPS or SSCC medical consenter and the healthcare provider must follow the requirements of valid informed consent. The DFPS or SSCC medical consenter and healthcare provider must discuss non-pharmacological interventions, to determine if other interventions should be provided to the child, before using psychotropic medication, or along with psychotropic medication.
Refer to the Making Decisions about Psychotropic Medications brochure for guidance on the principals of informed consent.
11131.5 Other Medical Care
CPS September 2026
For all other medical care, a DFPS or SSCC medical consenter or backup medical consenter must ensure that a child is seen by a healthcare provider, as specified by the healthcare provider.
Medical care includes medical appointments for:
- providing physical health treatment, such as when the child is sick; and
- providing dental treatment, such as fillings and crowns.
11131.6 Emergency Medical Care
CPS September 2026
Consent or court authorization for medical care for a child is not required in an emergency where medical care must be provided immediately to prevent imminent death or substantial bodily injury to the child.
In an emergency situation, the child’s caregiver or DFPS or SSCC caseworker must transport the child to an emergency room or healthcare provider or call 911.
11133 Assent
CPS September 2026
DFPS and SSCC must allow children and youth to participate in decisions about their medical care to the greatest extent feasible, depending on each individual’s developmental capability. This process, called assent:
- Empowers children and youth.
- Helps prepare children and youth to make their own medical decisions.
- May improve long-term health outcomes for children and youth.
11140 Medical Consent by Minor Youth
CPS September 2026
A youth in foster care who is at least 16 years old is able to consent to medical care, if the court with continuing jurisdiction determines that the youth has the capacity to consent to medical care.
If a court determines that a youth is capable of consenting to his or her own medical care, the DFPS or SSCC caseworker must:
- Educate the youth about his or her medical care and the process for making informed decisions on an ongoing basis.
- Ensure the youth completes the Medical Consent Training for Caregivers in whichever of the following situations occurs first:
- Within seven days of the court order authorizing the youth as his or her own medical consenter.
- At least 48 hours before a non-emergency appointment with the youth’s health or behavioral healthcare provider.
- File the youth’s signed copy of the certificate of completion in the youth’s case record.
- Ensure a youth who has been prescribed psychotropic medication, or is considering taking psychotropic medication, completes the Psychotropic Medication for Children in Foster Care Training, in whichever of the following situations occurs first:
- Within seven days of the court order authorizing the youth as his or her own medical consenter.
- At least 48 hours before a non-emergency appointment with the youth’s health or behavioral healthcare provider.
- File documentation in the youth’s case record the certificate of the completed training.
- Document in IMPACT if the court authorizes a youth to consent to his or her medical care.
- Offer ongoing support and guidance to the youth.
- Consent to payment for services on the youth’s behalf. (Note: There should be no out of pocket expenses for medical services for youth covered by STAR Health who receive treatment from an in network provider.)
- Ensure the youth is making decisions in the youth’s best interest.
- Request, if needed, a court order authorizing medical care in certain situations when the youth refuses medical care.
- Access any of the youth’s medical records.
- Include medical information in court reports on an ongoing basis.
- Notify both parents of significant medical conditions.
- Notify the youth’s parents and parent’s attorneys, at the next scheduled meeting, of the youth’s decisions regarding the youth’s medical care, including the youth’s decision to consent or not consent to psychotropic medications.
11141 Educating Children and Youth about Their Medical Care
CPS September 2026
Medical Consent at Age 16
When a youth turns 16 years old, a DFPS or Single Source Continuum Contractor (SSCC) caseworker must:
- Advise the youth of the right to request a hearing to determine whether he or she may be authorized to consent to his or her own medical care.
- Provide the youth with training on informed consent and the provision of medical care, as part of the Preparation for Adult Living (PAL) program.
- Complete Form 2092 Notice of Your Right to Request the Court to Authorize Consent for Your Own Medical Care with the youth.
- Instruct the caregiver to take the Medical Consent Training for Caregivers on the DFPS website.
STAR Health Service Coordination at Age 17
The DFPS or SSCC caseworker contacts the STAR Health service coordinator at 1-866-912-6283 to ensure the youth is receiving services from the transition specialist team no later than the 90th day after the youth’s 17th birthday.
Medical Consent at Age 18
For youth in DFPS conservatorship who are not authorized by the court to be their own medical consenters at age 16 or 17, they become their own medical consenters when they turn 18 years old. DFPS and SSCC caseworkers must ensure that 17-year-old youth complete Medical Consent Training for Caregivers no later than 90 days before turning 18 years old. The DFPS or SSCC caseworker files the certificate of completion in the case record.
If a youth is 17 years old and is prescribed psychotropic medication, the DFPS or SSCC caseworker must also ensure the youth completes Psychotropic Medication for Children in Foster Care Training no later than 90 days before turning 18 years old. The caseworker files the certificate of completion in the case record.
Plans for a Youth Transition to a Successful Adulthood
The DFPS or SSCC caseworker must include provisions in the youth’s Child’s Plan of Service (CPOS) to assist the youth in safely managing his or her medication after exiting foster care. The CPOS must include information that educates the youth about the following:
- The use of the youth’s specific medications.
- Resources available to help the youth safely manage the medication.
- Informed consent.
- The youth’s right to request to be his or her own medical consenter.
11142 Documenting Court Authorization for Youth Medical Consent
CPS September 2026
On the IMPACT Medical Consent Detail page, the DFPS or SSCC caseworker must document whether the youth is authorized to consent to some or all of his or her medical care. The DFPS or SSCC caseworker must document this as soon as possible on the same day or no later than 7 p.m. on the day following a new or updated action. If the youth is authorized to consent to some of his or her medical care, the DFPS or SSCC caseworker must also document both of the following:
- The types of medical care the court has authorized the youth to consent to.
- Information about the person who is authorized to consent to other medical care for the youth, such as the person’s name, role or relationship to the child, address, and phone number.
11143 Requesting a Court Order If a Youth Refuses Medical Care
CPS September 2026
DFPS or SSCC staff must make reasonable efforts to resolve an issue in which:
- The court has determined that a youth who is at least 16 years old has the capacity to consent to medical care.
- The youth refuses to consent to medical care that DFPS, SSCC, or a medical provider believes is necessary.
If unsuccessful, the DFPS or SSCC caseworker must inform the supervisor, and with supervisory approval, the DFPS or SSCC caseworker may inform the attorney representing DFPS and request that the attorney file a motion with the court to order medical care for the youth or change the authorization for consent to medical care to DFPS. As the attorney works to gather a statement prepared and signed by the treating physician, the DFPS or SSCC caseworker must coordinate with the child’s physician to obtain the required statement.
11150 Special Circumstances
11151 Youth under HHSC Guardianship in Extended Foster Care
CPS September 2026
The Health and Human Services Commission (HHSC) guardianship worker makes medical decisions for youth in extended foster care who are under HHSC guardianship.
The DFPS or SSCC caseworker must enter the information for the HHSC guardianship worker in the IMPACT Person Detail and Medical Consenter Details, selecting Guardianship under the Court Authorized drop-down list on the Medical Consenter Detail. The DFPS or SSCC caseworker must enter this information as soon as possible and no later than 7 p.m. the day following a new or updated action.
The medical consenter information is automatically transmitted to STAR Health, allowing the HHSC guardianship worker to access the youth’s Health Passport record and discuss protected health information with STAR Health staff. However, medical consent policy does not apply to the HHSC guardianship worker, and the DFPS or SSCC caseworker must not issue Form 2085B Designation of Meical Consenters to the HHSC guardianship worker.
11152 Youth Who Are Parents in DFPS Conservatorship or Extended Foster Care
CPS September 2026
Youth parents make medical decisions for their children if their children are not in DFPS conservatorship.
A youth in DFPS conservatorship who is a parent or becomes a parent becomes their own medical consenter. The DFPS or SSCC caseworker must enter the information in the IMPACT Person and Medical Consent Details by selecting NA-Youth Parent under the Court Authorized drop-down list on the Medical Consent Detail pages. The DFPS or SSCC caseworker must enter this information as soon as possible and no later than 7 p.m. the day following a new or updated action. The medical consenter information is automatically transmitted to STAR Health, allowing the youth parent to access his or her child’s Health Passport record and discuss protected health information with STAR Health staff. However, medical consent policy does not apply to the youth parent, and the DFPS or SSCC caseworker must not issue Form 2085B to the youth.
11160 Including Medical and Behavioral Health Information in Court Reports
11161 Including Medical and Behavioral Health Information in Court Reports
CPS September 2026
The DFPS or SSCC caseworker must include a summary of medical care provided to the child in each court report, including court reports for status and permanency hearings.
The DFPS or SSCC caseworker requests that the medical consenter and backup medical consenter keep the caseworker informed in one of the following ways:
- Verbally.
- By completing Form 2094 Summary of Child’s Medical Care, including the child’s opinion on the medical care, elicited in a developmentally appropriate manner.
The DFPS or SSCC caseworker must do both of the following:
- Request information from the medical consenter in sufficient time to complete court reports in a timely manner.
- Complete the Summary of Medical Care section in the court report using information the medical consenter provided about the child’s medical care.
11161.1 Including Information about Psychotropic Medications in Court Reports and Testimony
CPS September 2026
When addressing psychotropic medications in the Summary of Medical Care section of court reports and in court testimony, DFPS or SSCC caseworkers must provide, in an objective manner, information about the child’s behavioral health needs and response to psychotropic medications.
The DFPS or SSCC caseworker must base this information on observations of the child and information from all of the following:
- The child
- The child’s medical consenter
- Health care providers
- Caregivers
- Parents
- Teachers
- Court appointed special advocates
- Guardians ad litem
- Attorneys ad litem
- The local permanency specialist, if applicable.
Information that DFPS and SSCC caseworkers must address in court reports about each psychotropic medication includes but is not limited to:
- The diagnosis or target symptom for which the medication was prescribed.
- The child’s progress with the medication.
- The degree to which the child or child’s caregiver has complied or failed to comply with the medication regimen.
- Any adverse reactions or side effects to the medication.
- The appropriate psychosocial therapies, behavior strategies, and other non-pharmacological interventions provided to the child.
- The dates, since the previous hearing, of any office visits the child had with the prescribing physician, physician assistant, or advanced practice nurse.
11162 Notifying Parents about Psychotropic Prescriptions and Significant Medical Conditions
CPS September 2026
Within 24 hours of learning of a psychotropic event, the DFPS or SSCC caseworker must notify each parent and the parent’s attorney about:
- An initial prescription of a psychotropic medication.
- The child’s enrollment or participation in a drug research program.
- A significant change in the child’s medical condition, such as an injury or onset of illness, that is life-threatening or may have serious long-term health consequences, including injury or illness that requires hospitalization for surgery or a major emergency care procedure, and a suicide attempt.
The DFPS or SSCC caseworker must mail the DFPS form letter 2093 Parental Notification of Significant Condition to both of the child’s parents or the parent’s attorney, if the DFPS or SSCC caseworker successfully notifies the parents by phone, text, or other means.
The DFPS or SSCC caseworker must document each notification regarding psychotropic medication in the entry documenting the parental contact in IMPACT.
11200 Medical and Dental Services
CPS September 2026
DFPS and SSCC caseworkers must ensure that children in DFPS conservatorship receive medical care.
Each child’s care must include:
- Emergency treatment, whenever necessary.
- Timely examination and treatment of nonemergency injuries and illnesses.
- Regular preventive care appropriate to the child’s age and condition, including immunizations.
DFPS Rules, 40 TAC §700.1329(a)
DFPS and SSCC staff must do both of the following:
- Work with all substitute caregivers and medical consenters to make reasonable efforts to see that youth and children in DFPS conservatorship receive the medical care they need and are entitled to receive.
- Provide information about the services provided by STAR Health and traditional Medicaid, including the Texas Health Steps program. See the Medical Services Resource Guide.
Obtaining Services
All children and youth in DFPS conservatorship are enrolled in Texas Medicaid (through STAR Health or traditional Medicaid) and can receive medical and dental care through their network of doctors.
The DFPS or SSCC caseworker must contact the DFPS eligibility worker to resolve issues related to a health care provider’s inquiry about the Medicaid eligibility of a child or youth in DFPS conservatorship.
11210 Meeting the Requirements for medical and Dental Services
CPS September 2026
DFPS and SSCC caseworkers must follow the schedule for obtaining initial and routine medical and dental checkups and screenings for children in DFPS conservatorship. The schedule meets the medical care requirements in:
- The Minimum Standards and Guidelines for Child-Placing Agencies, Section 749.1151 and Section 749.1153.
- The Texas Health Steps periodicity schedule for medical and dental checkups.
- Also see the Medical Services Resource Guide and the 3 in 30 Resource Guide.
Exceptions to Required Scheduled Checkups
For children placed in the following facilities, the applicable facility rules for preventive care apply:
- A facility regulated by the Texas Juvenile Justice Department.
- A nursing home.
- A state supported living center.
- An intermediate care facility for individuals with an intellectual disability.
11211 3-Day Medical Exam
CPS September 2026
The 3-Day Medical Exam is a screening to provide a baseline of the child’s health, check for injuries and illnesses, and ensure treatments and medications are available for the child. The DFPS or SSCC caseworker or the medical consenter must provide known medical and trauma history, including circumstances of removal, to the exam provider.
If a child qualifies for a 3-Day Medical Exam, the child’s DFPS or SSCC caseworker must ensure that the child receives the exam within three business days of the removal.
For qualification details, see the 3 in 30 Resource Guide, 3-Day Medical Exam section.
The child qualifies for a 3-Day Medical Exam if the child meets any of the following criteria:
- Was removed as the result of sexual abuse. See 2113.1 Definitions of Abuse for the definition of sexual abuse.
- Was removed as the result of physical abuse. See 2113.1 Definitions of Abuse for the definition of physical abuse.
- Has an obvious physical injury. An obvious physical injury is defined as a physical injury that would be apparent to a prudent adult.
- Has a chronic medical condition. A chronic medical condition is defined as a long-term condition (approximately one year or longer) that requires ongoing medical attention or limits activities of daily living.
- Has a medically complex condition. A medically complex condition is defined as either:
- One or more diagnoses that affect multiple organ systems.
- One long-term health condition that results in functional limitations, high health care needs or usage, and often the need for medical technology.
- Has a diagnosed mental illness. A diagnosed mental illness is defined as a mental health diagnosis from a licensed medical or behavioral health professional (licensed professional for the healing arts).
If a child does not qualify for a 3-Day Medical Exam, the child may still receive treatment from a medical provider at any time when a caregiver believes it is necessary.
The DFPS or SSCC caseworker must attempt to contact the child’s primary care physician at the time of removal to ensure continuity of care and continuation of prescribed medication.
The DFPS or SSCC caseworker cannot:
- Consent for vaccination on behalf of the child. The only exception to consent for vaccination at the 3-Day Medical Exam is if there is an emergency that requires a tetanus vaccine.
- Obtain the parent’s consent for vaccination on behalf of the health care provider.
If a court holds a full adversary hearing and names DFPS as a managing conservator, the DFPS or SSCC caseworker can consent to vaccinations on behalf of the child. These vaccinations can occur during subsequent checkups.
In the 3 in 30 Resource Guide,see the 3-Day Medical Exam section.
11212 Texas Health Steps Medical Checkup
CPS September 2026
The child’s DFPS or SSCC caseworker must ensure that the child receives an initial Texas Health Steps medical checkup within 30 days after the child enters DFPS conservatorship. Texas Health Steps checkups must be completed by a Medicaid-credentialed provider. The DFPS or SSCC caseworker must ensure that all children in DFPS conservatorship continue to receive medical checkups in accordance with the Texas Health Steps Periodicity Schedule.
11213 Texas Health Steps Dental Checkup
CPS September 2026
All children who are at least six months old must receive an initial dental exam, known as a Texas Health Steps dental checkup, in accordance with the Texas Health Steps Periodicity Schedule.
11214 Immunizations
CPS September 2026
Unless there is a known objection by the parent or person with legal authority over the child, the DFPS or SSCC caseworker must ensure that children in DFPS conservatorship are immunized against disease. The immunization schedule is in accordance with the Centers for Disease Control recommended by the Texas Department of State Health Services (DSHS). Medical consenters may consent to vaccines not listed on the immunization schedule in consultation with the medical provider for the child.
Minimum Standards and Guidelines for Child-Placing Agencies, §749.1421
If the DFPS or SSCC caseworker has actual knowledge that the parent (or person who had legal authority to make medical decisions for the child before the child entered DFPS conservatorship) objects to the immunization, the DFPS or SSCC caseworker cannot consent to immunization without a court order. A foster parent does not have the legal authority to refuse vaccines for children in DFPS conservatorship and are required, under Texas law, to vaccinate any child placed in their home, unless the parent objects.
If the DFPS or SSCC caseworker has knowledge of the parent’s objection, the caseworker must note on Form 2085b Designation of Medical Consenters that the medical consenter may not consent to immunizations. If the DFPS or SSCC caseworker feels that a medical emergency requiring immunization exists, and there is a known objection by the parent, the DFPS or SSCC caseworker consults with the supervisor and the attorney representing DFPS in the case to determine whether to request a court hearing.
Consent for Immunizations by Pregnant or Parenting Foster Youth
A youth may consent to his or her own immunization for a disease if the youth is pregnant or parenting, and the Centers for Disease Control recommends the initial dose for the vaccine to be administered before seven years of age.
Centers for Disease Control and Prevention (CDC) Vaccines
The ability to consent for immunizations does not give the youth the right to refuse a vaccine that the healthcare provider recommends and the youth's medical consenter has agreed upon, unless the youth has been designated his or her own medical consenter.
11215 Hospitalization at a Medical Facility
CPS September 2026
A child may be admitted to a medical hospital if a healthcare professional evaluates the child and determines hospitalization is required for treatment of the child’s injury or condition.
Notifications
Treatment and admission to a medical hospital is a significant event. When this happens, DFPS and single source continuum contractor (SSCC) staff notifies people according to the following policies:
Caseworker Actions during Hospitalizations
While the child in DFPS conservatorship is in the medical hospital, DFPS and the SSCC caseworker, DFPS local permanency specialist (LPS), or other designated DFPS or SSCC staff must:
- Immediately, but no later than 24 hours after notification that a child or youth has been admitted for treatment:
- Make face-to-face contact with the child at the facility.
- Ensure that the hospital staff responsible for the child or youth have been provided contact information for the medical consenter and DFPS and the SSCC caseworker.
- Arrange for hospital sitters, as appropriate.
- Arrange daily visits to the youth while hospitalized. These can be conducted by the placement caregiver, DFPS or SSCC caseworker, DFPS LPS worker, or another designated DFPS or SSCC staff. Sitter services are not sufficient for DFPS or SSCC contact during hospitalization.
- Follow up daily with hospital staff on critical updates regarding the child or youth’s treatment, such as the discharge plan, basic care needs, and safety issues.
- Determine the discharge plan, including placement after discharge and transportation needs to placement. Communicate these plans with hospital staff.
- Request the child’s records and discharge summary and discuss with the treating physician what follow-up is necessary after discharge. Ensure this information is communicated with the placement.
11220 Reproductive Health
11221 Contraceptive Service
CPS September 2026
A youth may request contraceptive services through his or her physician or other family planning services provider. The decision to provide a minor with contraception and to obtain the appropriate consent, if applicable, is the health care provider’s responsibility. The DFPS or SSCC caseworker must not attempt to prohibit the youth from seeking contraceptive services.
11230 Using the Health Passport
CPS September 2026
The Health Passport is a web-based electronic system for storing and retrieving a child’s health information. Health care providers, caregivers, and authorized DFPS and Single Source Continuum Contractor (SSCC) staff use the Health Passport to manage a child’s health care needs.
All DFPS and SSCC staff planning to use the Health Passport must:
- Read and sign a user agreement.
- Take the online Health Passport training in the DFPS Learning Station.
Accessing the health information contained in a Health Passport without a business need is a violation that carries penalties up to and including termination.
11300 Medication
11310 If DFPS or SSCC Staff Administers Medication
CPS September 2026
DFPS or SSCC staff may be required to administer medications to children and youth as part of normal day-to-day responsibilities (such as transporting a child or youth to an appointment or supervised visit). In most circumstances, DFPS and SSCC staff members at all levels can administer medications. However, if the child is without placement and staying with DFPS or SSCC staff overnight, one of the following must administer the child’s medications:
- DFPS or SSCC staff member at the caseworker level or above.
- DFPS dedicated youth supervision staff member.
- Contracted registered nurse (as available).
If a DFPS or SSCC staff member or a contracted registered nurse (as available) administers medication, then the person who administers the medication must do the following:
- Refer to Form 2400 Prescription Medication for each prescribed medication or Form 2401 Non-Prescription Medication Log for over-the-counter medication.
- Be informed about the child’s diagnosis (if any) and other medications.
- Be informed about the effects of the medication and side effects.
- Administer medications only if they are stored in the original pharmacy container (for prescription medications), a blister pack created by a pharmacy, or a manufacturer’s container (for nonprescription medications).
- Administer medications according to the instructions on the container.
- Remove the prescribed dosage of the medication (or the dosage indicated in the instructions, if nonprescription) from the stored pharmacy (or manufacturer’s) container outside the presence of the child and return the stored container to the child’s lockbox or other suitable locking storage area.
- Prepare and administer medications for each child individually, and make sure the child takes the medication as prescribed or as directed on the container.
- Document that the medication was administered or, if applicable, that the child refused to take the medication at a certain date and time in both of the following places:
- IMPACT Contact Detail, if medication was administered while traveling, during a visit, or in another circumstance. Exception: For youth without placement, documentation must be entered into youth shift notes.
- Form 2406 Daily Prescription Medication Log Sheet or Form 2401 Non-Prescription Medication Log. Place the form in the child’s case record and provide it to the next caregiver upon placement change.
11311 Permissible and Non-Permissible Medication Administration Routes
CPS September 2026
Medication route refers to the way the drug is introduced into the body.
Permissible Administration Routes
DFPS or SSCC staff members may administer medications by the following routes:
- Capsules, pills, or liquids taken by mouth.
- Inhalers taken through the nose or mouth.
- Eye drops.
- Skin patches.
- Nebulizers.
Non-Permissible Administration Routes
DFPS or SSCC staff members must not administer medications by the following routes:
- Injection.
- Suppositories or creams taken through the rectum or vagina.
- Intravenous (IV).
- Nasogastric tube (NG-tube).
- Gastrostomy tube (G-tube or G-button) or any other ostomy site.
If a child is prescribed a medication to be administered in a way that is not approved for a DFPS or SSCC staff member, the staff member must:
- Contact the prescribing physician for alternatives.
- Seek assistance from a contracted nurse, if available.
- Seek emergency assistance at a local hospital or urgent care facility.
DFPS nurse consultants may be able to provide general guidance but cannot provide direct assistance with medication administration.
Insulin
If an older child has approval from their medical provider to administer their own insulin injections, then DFPS or SSCC staff may supervise this administration.
Suppositories
If an older child is prescribed and understands how to insert a suppository or cream that is administered through the rectum or vagina, DFPS or SSCC staff may hand the medication to the child for the child to insert. DFPS or SSCC staff members who are the same gender as the child may stand outside the door of the bathroom while the child inserts the medication. However, DFPS or SSCC employees must not directly assist the child in inserting the medication into the child’s rectum or vagina.
Exception: Rectal Antiseizure Drugs for Emergencies
Children with seizure disorders can experience life-threatening prolonged seizures (status epilepticus) and may be prescribed rectal antiseizure medication for such emergencies. Emergency medical services (9-1-1) must be called for a prolonged seizure (typically longer than five minutes).
For children who are in the care of DFPS or SSCC staff, who may experience life-threatening status epilepticus (prolonged seizure), and who are prescribed rectal antiseizure drugs for emergencies, DFPS or SSCC staff must follow the instructions on the package insert to administer the rectal antiseizure drug as indicated by the prescription.
Exception: Epinephrine Auto-Injectors for Emergencies
Epinephrine auto-injectors are used for life-threatening allergic reactions and for children who are at increased risk for these reactions. Immediate emergency medical help (9-1-1) must be sought whenever an epinephrine auto-injector is administered.
For children who are in the care of DFPS or SSCC staff, who may experience life-threatening allergic reactions (anaphylaxis), and who are prescribed epinephrine auto-injectors, DFPS or SSCC staff must follow the printed, easy-to-follow instructions and diagram to administer this drug in the event of a severe allergic reaction.
Exception: Glucagon Administration for Diabetic Low Blood Sugar (Hypoglycemia) Emergencies
DFPS or SSCC staff must immediately administer a Glucagon emergency kit, as outlined in the diabetic emergency plan, for a child who meets all of the following criteria:
- The child is in the care of DFPS or SSCC staff.
- The child is experiencing a life-threatening diabetic low blood sugar (hypoglycemia) emergency.
- The child has passed out or appears to be at immediate risk of passing out.
- The child cannot take some form of sugar by mouth.
- The child is prescribed a Glucagon emergency kit.
DFPS or SSCC staff must follow the prescription or kit instructions. Emergency medical services (9-1-1) must also be called immediately.
11312 Storing Medications
CPS September 2026
If children are in the temporary care of DFPS and single source continuum contractor (SSCC) staff, staff must ensure that children's medications are kept in a secure and locked location at all times, such as one or more of the following:
- A locked cabinet.
- The locked glove compartment or trunk of a car, if transporting a child.
- A lockbox at the location of supervision
11313 Destroying Medications
CPS September 2026
There may be cases in which medications that youth no longer need are left in the possession of DFPS or single source continuum contractor (SSCC) staff or in a DFPS or SSCC workplace. Staff must destroy medications that are expired, discontinued, or left at a location and no longer needed. In order to prevent medication errors, the medication destruction must occur as soon as possible, no longer than one week.
In these cases, a DFPS or SSCC staff member designated in each office does the following:
- Ensures the medication is stored in the original prescription bottle or over-the-counter packaging until it is ready for destruction.
- Ensures the medication is stored in a locked container and separate from current medication.
- Blacks out all identifying information on the medication package.
- Finds a certified location for medication destruction. Staff can find a location by contacting nearby pharmacies or searching the Drug Enforcement Administration website for nearby locations.
- Completes Form 2402 Medication Destruction Log. Include the names of the DFPS supervisor or SSCC equivalent approving destruction, person responsible for destruction, and witness to the destruction.
- Provides the DFPS or SSCC caseworker and supervisor with documentation verifying that the medication has been destroyed.
Documents destruction details in the case record (for example, May 2026).
11320 Psychotropic Medications
11321 Providing Required Information to Medical Consenters
CPS September 2026
If a medical consenter is not DFPS or single source continuum contractor (SSCC) staff, the DFPS and SSCC caseworkers must provide copies of the brochure Making Decisions about Psychotropic Medications to all medical consenters for a child in DFPS conservatorship:
- At the time of placement, along with Form 2085b Designation of Medical Consenters.
- Within seven days following the placement or within seven days following the court's authorization of one of the following:
- A non-CPS person as a child's medical consenter.
- A 16- or 17-year-old as his or her own medical consenter.
The DFPS or SSCC caseworker must encourage the medical consenter to read and use the brochure during office visits, at which time psychotropic medications will be discussed or prescribed.
11322 Informed Consent for Psychotropic Medication
CPS September 2026
Psychotropic medication is a medication prescribed for the treatment of psychosis or another mental, emotional, or behavioral disorder used to exercise an effect on the central nervous system to influence and modify behavior, cognition, or affective state.
DFPS and single source continuum contractor (SSCC) staff who are medical consenters must allow age and developmentally appropriate participation by youth in foster care in medical decisions, including prescribing of psychotropic medication.
Giving informed medical consent means making a decision about whether to agree to a medical test, treatment, procedure, or medication.
To make an informed decision about behavioral health treatment or medications voluntarily and without undue influencemeans that the medical consenter is deciding based on what is best for the child, not because of pressure to consent to the medication or treatment services. To ensure medical consent is informed and legally valid, the DFPS or SSCC caseworker must ensure that a medical consenter received the following information either verbally or in writing from the prescribing healthcare provider, and understand and consider its impact on the child:
- The specific condition to be treated, including the child's symptoms and medical diagnosis.
- The beneficial effects on that condition expected from the medication.
- The probable health and mental health consequences of not consenting to the medication.
- The probable clinically significant side effects and risks associated with the medication.
- The generally accepted alternative medications and non-pharmacological interventions to the medication, if any, and the reasons for the proposed course of treatment.
11323 Deciding Whether to Consent to Psychotropic Medication
CPS September 2026
Medical consenters decide whether to consent to, or choose not to consent to, psychotropic medication for children in DFPS conservatorship. DFPS and single source continuum contractor (SSCC) caseworkers must provide the medical consenters with the Making Decisions about Psychotropic Medications brochure and encourage them to review and use the information during office visits at which psychotropic medications will be discussed or prescribed.
11323.1 Providing Consent to an Initial Psychotropic Medication in an Inpatient Setting
CPS September 2026
If providing medical consent for a child in an inpatient setting, the DFPS or single source continuum contractor (SSCC) staff must:
- Consider all the elements of informed consent for psychotropic medications.
- Complete both:
- A hospital's required consent forms.
- DFPS Form 4526 Consent for Treatment with Psychotropic Medication.
The DFPS and SSCC staff must document either face-to-face or verbal informed consent for initial prescriptions or changes to psychotropic medication during a child’s inpatient stay and upload these forms into IMPACT.
Consent Forms Required by the Hospital
For children admitted to a psychiatric hospital, the DFPS and SSCC staff must provide informed consent for initial psychotropic medications and dosage changes, according to the hospital's requirements, in person or via telephone as appropriate. This includes completing the hospital's consent form.
If the medical consenter is not the child's DFPS or SSCC caseworker, the medical consenter must notify the DFPS or SSCC caseworker within 24 hours and send a copy of the signed hospital consent form to the caseworker within five business days.
11323.2 Deciding Not to Consent to a Psychotropic Medication
CPS September 2026
If a non-DFPS or the single source continuum contractor (SSCC) medical consenter decides not to consent to a psychotropic medication recommended by a child's healthcare provider, the DFPS or SSCC caseworker must discuss the elements of informed consent and the decision process with the medical consenter and must document the elements of informed consent in the child's case record.
11323.3 Withdrawing Consent
CPS September 2026
If a non-DFPS or the single source continuum contractor (SSCC) medical consenter decides to withdraw consent, the DFPS and SSCC caseworker must discuss with the medical consenter the reasons for the decision and the consultation with the prescribing healthcare provider.
The DFPS or SSCC caseworker must document this discussion, including any instructions about how to safely discontinue the medication, in the child's record.
11324 Documenting Consent to Initial Psychotropic Medications and Changes to Active Prescriptions
CPS September 2026
All medical consenters must complete and sign Form 4526 Consent for Treatment with Psychotropic Medication. The DFPS and the single source continuum contractor (SSCC) caseworker must obtain information from the medical consenter about the decision process used when consenting to psychotropic medications. The DFPS and SSCC caseworker must document the details of this form and upload a copy of the completed form to IMPACT.
11325 Psychotropic Medication Follow-Up Visits
CPS September 2026
The DFPS and the single source continuum contractor (SSCC) caseworker must ensure that each child, who is currently prescribed a psychotropic medication, attends an office follow-up visit with the prescribing health care provider and medical consenter at least once every 90 days for a review of the child’s progress with the medication
The medical consenter must attend the medical appointment with the child and the DFPS and the SSCC caseworker must upload a copy of the documentation of the medical appointment to OneCase/NeuDocs.
If the DFPS or the SSCC caseworker is the medical consenter, the DFPS or SSCC caseworker must attend each office visit in person and complete and upload the documentation.
11326 Non-Pharmacological Interventions
CPS September 2026
DFPS and single source continuum contractor (SSCC) caseworkers must discuss with medical consenters and other caregivers the fact that psychosocial therapies, behavior strategies, and other non-pharmacological (non-medicine) interventions should be considered before, or along with, psychotropic medications for children in DFPS conservatorship.
The DFPS and the SSCC caseworker must coordinate with the medical consenter, the healthcare provider, and the child placing agency case management staff, if applicable, to help the medical consenter make these arrangements for the child.
If psychotropic medication is necessary, medical consenters should ask the prescribing provider to recommend specific non-pharmacological interventions, tailored to the child's needs, which can be employed at the same time as the treatment with psychotropic medication.
11327 Psychotropic Medicataion Utilization Review (PMUR)
CPS September 2026
A Psychotropic Medication Utilization Review (PMUR) is the process used to screen and review a child’s psychotropic medications. A PMUR occurs when a child is prescribed medication that is outsidePsychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (7th Version), or if there is a concern regarding the medication.
The following people can request a PMUR any time they have concerns about a child’s psychotropic medication regime:
- DFPS and single source continuum contractor (SSCC) staff
- Court Appointed Special Advocates (CASA)
- Child’s caregiver
- Child’s medical consenter
- Attorney
- Residential child care provider
- Other interested parties
Following a PMUR, specific concerns should be addressed at a follow-up visit with the provider to discuss any potential alterations to the medication regimen. DFPS and SSCC caseworkers, medical consenters, and caregivers must not stop any child’s medication without consulting with the prescribing healthcare provider.
DFPS and SSCC staff must file the results of a medication review in the child’s record.
11400 Special Healthcare Needs
11410 Arranging for Disease Management Services for Specialized Healthcare Needs
CPS September 2026
When a child has been diagnosed with a qualifying condition as listed below, the child must receive specialized disease management services through STAR Health. The DFPS and the SSCC caseworker must call STAR Health to request it. The STAR Health service coordinator can assist with referring to these programs.
Disease management is designed to assist in managing, but is not limited to, the following conditions:
- Behavioral Health Program
- Attention Deficit Hyperactivity Disorder (ADHD)
- Bipolar
- Chronic Pain
- Depression
- Intellectual or Developmental Disability (IDD)
- Perinatal Depression
- Perinatal Substance Use Disorder
- Schizophrenia
- Substance Use Disorder (SUD)
- Cardiac Program
- Coronary Artery Disease
- Heart Failure
- Hyperlipidemia
- Hypertension
- Diabetes Program
- Type 1
- Type 2
- Lifestyle Program
- Exercise
- Nutrition
- Pediatric Obesity
- Puff Free Pregnancy
- Stress
- Tobacco Cessation
- Weight Management
- Respiratory Program
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Sickle Cell Disease
11411 Referring a Child to Medical Professionals and Helath-Related Community Services
CPS September 2026
If a child is diagnosed or suspected of having a disability, the DFPS and the SSCC caseworker must:
- Consult with the regional education specialist and developmental disabilities specialist, as appropriate.
- Refer the child to the appropriate professionals and community services.
- Ensure that the child is assessed and diagnosed.
If the child has already been assessed and diagnosed, the DFPS and the SSCC caseworker must ensure that the appropriate professional documentation is in the record.
11412 Working with Children in DFPS Conservatorship who Have Special Healthcare Needs
CPS September 2026
While a child with special healthcare needs is in DFPS conservatorship, the DFPS and the single source continuum contractor (SSCC) caseworker must:
- Develop an understanding of the child's medical needs and the services recommended by medical professionals.
- Ensure that the child is receiving the recommended services.
- Maintain contact with healthcare providers to ensure that the child's medical needs are being met.
Throughout the case, the DFPS and the SSCC caseworker must assess the caregiver's ability to meet the child's ongoing medical needs, working with the child's family, healthcare providers, and collateral to:
- Conduct ongoing home visits throughout the case to assess the home environment's appropriateness.
- Ensure that the caregiver is trained to meet or is proficient in meeting the child's special needs, including:
- Being trained to use or being proficient in using medical equipment.
- Administering prescribed medication.
- Providing needed supplies.
- Ensure that the caregiver has access to and uses the medical equipment recommended by medical professionals.
- Assess the child's care during each contact to ensure that the family continues to comply with the recommended medical care, including:
- Administering prescribed medication.
- Attending medical appointments. and
- Completing other tasks to meet the child's needs.
11500 HIV Testing and Care for Children in DFPS Conservatorship
CPS September 2026
The DFPS and the single source continuum (SSCC) caseworker must ensure that a child in DFPS conservatorship is tested for HIV infection, in accordance with the Texas Health Steps Medical Checkup Periodicity Schedule, Comprehensive Health Screening, or at any other time the child's healthcare provider determines the test is medically indicated.
The DFPS and SSCC caseworker must request that the healthcare provider test the child for HIV infection, if the child has a history of sexual abuse or other risk factors, or if the child requests to be tested.
11510 Counseling, Treatment, and Medical Management for a Child with HIV Infection
CPS September 2026
STAR Health provides counseling, treatment, and medical management for a child in DFPS conservatorship with HIV.
Counseling
DFPS must ensure that children with HIV and their caregivers are provided with age-appropriate post-test counseling and information in accordance with the Texas Health and Safety Code, §81.109.
11520 Maintaining Confidentiality of HIV Status
CPS September 2026
Information regarding a child's HIV status is confidential. DFPS and SSCC staff must not disclose a child's HIV status with any other individual or entity, except those listed in 11521 Required Notification About a Child's HIV Status and 11522 Allowable Releases of HIV Status Information, or under other applicable law or rule.
Medical Exception
DFPS may release information about an individual's HIV status to medical personnel in an emergency, if necessary, to provide for their protection and to provide for the patient's health and welfare. Other exceptions apply to healthcare providers who are required by law to report the information to certain governmental entities for purposes of communicable disease tracking.
Public Documents
The DFPS and the SSCC caseworker must keep information regarding a child's HIV status out of any documents that will be available to the public, such as removal affidavits or court reports. If the welfare of the child requires the child's status to be documented in a public document, DFPS and SSCC staff must use language such as confidential illness or confidential diagnosis.
Court Testimony
A child's HIV status may be discussed if DFPS is currently the child's managing conservator.
The judge has the discretion and authority to require testimony on any subject that he or she deems appropriate or necessary. In such cases, DFPS and SSCC staff must give testimony as requested.
Removal Affidavit
A person's HIV status must never appear in a removal affidavit. This is true for children coming into DFPS care and for any other adult or child referred to in the affidavit.
Adults
Section 81.103 of the Texas Health and Safety Code protects the confidentiality of an adult's HIV status and HIV test results. DFPS and SSCC staff must never disclose an adult's HIV status or HIV test results, without the adult's consent.
11521 Required Notification about a Child's HIV Status
CPS September 2026
If a child in DFPS conservatorship tests positive for HIV infection, the DFPS and the SSCC caseworker must notify the following parties of the child's condition:
- Child's legal parents (if parental rights have not been terminated and their whereabouts are known).
- Current and prospective foster parents, 24-hour childcare providers, prospective adoptive parents, or relatives with whom the child has been placed or with whom DFPS plans to place the child.
- Medical consenters.
11522 Allowable Releases of HIV Status Information
CPS September 2026
Release of Positive HIV result
If a child in DFPS conservatorship has tested positive for HIV infection, DFPS and the single source continuum contractor (SSCC) may notify the following parties of the child's condition:
- A physician, nurse, or other professional who has a legitimate need to know the information, in order to provide for the child's health and welfare.
- A court having jurisdiction of a proceeding involving the child, or a proceeding involving a person suspected of abusing the child, if requested.
- Any person with a legal right to obtain the information pursuant to law or court order.
- The child.
DFPS Rules 40 TAC §700.1404(a)
Release of Negative HIV result
If a child in DFPS conservatorship has tested negative for HIV infection, DFPS and the SSCC may notify the parties listed in this section and in 11521 Required Notification about a Child's HIV Status if:
- The party requests the information.
- DFPS or the SSCC determines that the information is needed to provide for the child's health or welfare.
DFPS Rules 40 TAC §700.1404(b)
11600 Behavioral Health Services
11610 Admission to a Mental Health Facility
11611 Request to Admit Child or Youth to an Inpatient Psychiatric Facility
CPS September 2026
A request for the admission of a child or youth in DFPS conservatorship to an inpatient psychiatric facility may be made if a physician states that, in his or her professional opinion, both of the following apply:
- The child or youth has a mental illness or shows symptoms of a serious emotional disorder.
- The child or youth poses a risk of serious harm to self or others if not immediately restrained or hospitalized.
A child or youth may also be admitted to an inpatient psychiatric facility if one of the following occurs:
- DFPS is granted court-ordered mental health services for the child or youth.
- DFPS or a single source continuum contractor (SSCC) consents to admission.
Notifications
Admission to an inpatient psychiatric facility is a significant event. When this happens, DFPS and the SSCC does the following:
- Notifies people according to the following policies:
- 6150 Notifications
- 6151 Whom to Notify
- Notifies the court with continuing jurisdiction within three business days after the admission.
Texas Health and Safety Code §572.001
11612 DFPS Representative to Approve Admission of Child or Youth
CPS September 2026
A medical consenter who is not a DFPS or a single source continuum contractor (SSCC) employee cannot consent to admission to an inpatient psychiatric facility.
If someone other than a DFPS or SSCC employee brings a child or youth to this type of facility for voluntary admission, that person is required to find a DFPS or SSCC representative to approve the admission.
The DFPS and the SSCC caseworker should review behavioral health history and reasons for admission, discuss recommendations with the admitting physicians, and make an informed decision about providing consent to admit the youth.
11612.1 Caseworker Actions during Psychiatric Hospitalizations
CPS September 2026
Role of Psychiatric Hospital Worker, Local Permanency Specialist, or Other Designated Caseworker During Psychiatric Hospitalizations
While the child or youth in DFPS conservatorship is in the psychiatric hospital, the psychiatric hospital worker, local permanency specialist, or other designated DFPS or single source continuum contractor (SSCC) caseworker must:
- Immediately, but no later than 24 hours after notification that a child or youth has been admitted for psychiatric treatment, confirm the mental health facility was provided with the name and contact information for the child's medical consenter.
- Make face-to-face contact with the child or youth at the facility within one to three business days of becoming aware of the admission, and weekly thereafter.
- Ensure that the care coordinator or similar hospital staff responsible for the child or youth were provided a copy of the child’s sexual history report, Attachment A, attempt to obtain the care coordinator or similar hospital staff’s signature on the document, and upload the signed document into OneCase.
- Document weekly face-to-face contact in IMPACT.
- Request and send the child or youth’s clinical record collected from the hospital to the DFPS and SSCC primary caseworker and assigned placement staff. The clinical record refers to any documentation of treatment services released by the hospital including the youth’s admission summary, psychiatric or psychological evaluation, therapy notes, psychiatric progress or nursing notes, and medication status.
- Communicate critical updates regarding the child or youth’s treatment (such as discharge plan, basic care needs, and safety issues) to the primary caseworker within 24 hours of being made aware of the new information.
- Coordinate and facilitate internal multidisciplinary staffings to assist with placement following discharge and securing services.
Role of the DFPS or SSCC Primary Conservatorship Caseworker during Psychiatric Hospitalizations
While the child or youth is in the psychiatric hospital, the DFPS and SSCC primary caseworker must do both of the following:
- Update the application for placement with the weekly progress, participation, therapy notes, and medication compliance. Continue required face-to-face contacts during hospitalization.
- Contact the regional education specialist to develop a plan to ensure the child or youth’s educational needs are met for the duration of the hospital stay.
11613 Youth Age 16 or Older Who Requests Admission
CPS September 2026
A youth who is at least 16 years old may seek voluntary admission to an inpatient psychiatric facility or outpatient mental health treatment services. He or she may be admitted without the consent of his or her parent, managing conservator, or guardian. The youth files a request with the administrator of the facility.
Texas Health and Safety Code §572.001
The facility is not required to accept the request for admission.
11614 Consent for Health Cae and Medications after Admission
CPS September 2026
Unless the youth has been authorized to consent to his or her own medical care under Texas Family Code §266.010, the designated medical consenter must provide or deny consent for the use of psychotropic medications once the youth is admitted.
The DFPS and the single source continuum contractor (SSCC) caseworker must provide the mental health facility with the name and contact information for the child's medical consenter.
11620 Emergency Detention Order and Order for Protective Custody
CPS September 2026
If a child or youth is experiencing a mental health crisis, a DFPS and a single source continuum contractor (SSCC) caseworker or the residential child care provider should seek crisis intervention services through the local mental health authority (LMHA). If a child or youth will not willingly or safely be evaluated by crisis intervention services, law enforcement assistance can be sought. Law enforcement can seek an Emergency Detention Order in order to transport the youth to a facility for a short-term evaluation to determine if hospitalization is necessary. Only DFPS and SSCC staff may consent to a child’s admission into a psychiatric facility.
11630 Involuntary Commitment Order for Mental Health Services
CPS September 2026
If DFPS, a single source continuum contractor (SSCC), or the staff of a residential childcare provider believes a youth requires admission to a facility and the youth will not comply, an order for involuntary commitment may be requested by the DFPS or the SSCC caseworker. DFPS and the SSCC must contact the local mental health authority (LMHA) for help and assessment.
11640 Discharge from Inpatient Psychiatric Facilities
CPS September 2026
DFPS and single source continuum contractor (SSCC) staff do not request discharge against the medical advice of the inpatient psychiatric facility staff, nor discharge a youth from a hospital without discharge orders being signed by the treating medical provider.
11700 Extraordinary Medical Conditions
11710 Enrollment and Participation in Certain Drug Research Program
CPS September 2026
Texas Family Code §266.0041 requires a court order before a child in DFPS conservatorship may enroll or participate in a drug research program, unless the person enrolling the child is the child's parent and was authorized by the court to make medical decisions for the child.
11720 Court-Ordered End-of-Life Medical Decisions
CPS September 2026
Before withholding or withdrawing life-sustaining treatment (including not attempting resuscitation) from a child in DFPS conservatorship with an “irreversible condition” or a “terminal condition,” a court order must be obtained authorizing the withholding or withdrawing of such treatment. A court order for non-routine medical care, such as consent for not attempting resuscitation or withholding or withdrawing life-sustaining treatment, must be obtained.
Irreversible condition means a condition, injury, or illness that meets all of the following criteria:
- May be treated but is never cured or eliminated.
- Leaves a person unable to care for or make decisions for him- or herself.
- Is fatal without life-sustaining treatment provided in accordance with the prevailing standard of medical care.
Texas Health & Safety Code §166.002(9)
Terminal condition means an incurable condition caused by injury, disease, or illness that, according to reasonable medical judgment, will produce death within six months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care. For the purposes of this policy, a patient is presumed to have a terminal condition if he or she was admitted to a program under which he or she receives hospice services provided by a home and community support services agency licensed under Chapter 142 of the Health and Safety Code.
Texas Health and Safety Code §166.002(13)
Withholding life-sustaining treatment means to refrain from administering or applying life support such as CPR, ventilators, defibrillation, and other similar treatments.
Withdrawing life-sustaining treatment means to discontinue life support previously administered or applied.
The DFPS caseworker and supervisor or single source continuum contractor (SSCC) equivalent staff person must follow the procedures outlined below when considering any end-of-life decisions for a child in DFPS conservatorship. Under those procedures, a party referenced in Section 266.004(e) of the Family Code (for example, parent, guardian, DFPS, or child’s attorney ad litem) may seek a court hearing any time the party is concerned about the child’s medical condition and believes such extraordinary medical care is in the child’s best interest.
11721 Court Order to Execute a Do-Not-Resuscitate Order
CPS September 2026
Steps When All Parental Rights Have Not Been Terminated
If the child's attending physician recommends a do-not-resuscitate (DNR) order, the parent or another person identified in Texas Family Code Section 266.004(e) may petition a court to hold a hearing to give the parent the right to sign a DNR.
DFPS may also petition a court to hold a hearing for such a determination. To do so, the DFPS caseworker and supervisor or the single source continuum contractor (SSCC) equivalent staff, in coordination with the DFPS physician, must do all of the following:
- Obtain a signed written statement from the attending physician certifying that the child has a terminal or irreversible condition, and that the physician recommends a DNR.
- Request a second opinion or a review by a hospital medical or ethics review board.
- Inform the parents about the child's medical condition and the recommendation by the attending physician and any hospital medical or ethics review board (if applicable).
- Arrange for the parents to discuss any recommendation with the attending physician directly (by phone or in person).
- Discuss the recommendation with the following people:
- DFPS program director or SSCC director
- DFPS regional director
- DFPS regional attorney
- Attorney representing DFPS
- Child's attorney ad litem, guardian ad litem
- Court appointed special advocate (CASA), if applicable
- Any other person with legal standing in the child protection case
After completing all the steps above, the regional director or the person identified in Texas Family Code Section 266.044 (e) must request a court hearing to allow the court to determine whether a DNR is in the best interest of the child and should be executed for the child.
The SSCC, by contrast, cannot request a court hearing to consider a DNR and cannot execute a DNR. Those actions must be performed by one of the following:
- Parent or other guardian retaining parental rights
- Attorney ad litem
- CASA
- DFPS acting through the DFPS regional director
| If a parent retaining parental rights … |
Then … |
|---|---|
Consents to the DNR |
The parent or DFPS will request a court hearing to obtain an order allowing the parents to sign the DNR. DFPS or SSCC staff must sign the DNR. |
Objects to the DNR |
DFPS or SSCC staff will take no further action. |
Cannot be located or is otherwise unavailable to make a decision regarding a DNR |
DFPS or SSCC staff notify relative, fictive kin, or other people with possessory or custodial rights or with another significant relationship with the child, including the foster parent or other caregiver, about the recommendation. If one is available, that person must be consulted. |
The DFPS regional director must ensure the attorney representing DFPS, the child's attorney ad litem, the child's guardian ad litem, anyone with possessory or custodial rights, and any other involved people receive notice of the court hearing. (If there is no attorney ad litem, DFPS or the SSCC must recommend that the court appoint one.)
The DFPS regional director must submit a notification memo along with the court petition for hearing, proposed court order, and medical documentation to the CPS director of field or CPS associate commissioner.
DFPS staff must facilitate action consistent with the court’s order, if an order is issued.
Steps When All Parental Rights Have Been Terminated
If the attending physician recommends a DNR order and parental rights have been terminated for both parents or both parents are deceased, the DFPS caseworker and supervisor or SSCC equivalent staff, in coordination with the DFPS physician, must do all of the following:
- Obtain a signed written statement from the attending physician certifying that the child has a terminal or irreversible condition, and that the physician recommends a DNR order.
- Request a second opinion or a review by a hospital medical or ethics review board.
- Notify and seek input from any parent, relative, fictive kin, or other person with a significant relationship with the child, including a foster parent or other caregiver, regarding the recommendation.
- Notify and discuss the recommendation with the following:
- DFPS program director or SSCC director
- Regional director
- Regional attorney
- Attorney representing DFPS
- Child's attorney ad litem
- Guardian ad litem and CASA (if applicable)
- Any other person with legal standing in the child protection case
After completing all steps listed above, the regional director or person identified in Texas Family Code Section 266.044 (e) must request a court hearing to allow the court to determine whether a DNR is in the best interest of the child and should be executed for the child.
The SSCC, by contrast, cannot request the court hearing to consider a DNR and cannot execute a DNR. Those actions must be performed by DFPS acting through the DFPS regional director.
The DFPS regional director must ensure the following receive notice of the court hearing:
- Attorney representing DFPS
- Child's attorney ad litem
- Child's guardian ad litem
- Anyone with possessory or custodial rights
- Any other involved person
Note: If there is no attorney ad litem, DFPS or the SSCC must recommend that the court appoint one.
The DFPS regional director must submit a notification memo, along with the court petition for the hearing, proposed court order, and medical documentation to the CPS director of field or CPS associate commissioner.
DFPS staff must facilitate action consistent with the court’s order, if an order is issued.
11722 Court Order to Withhold or Withdraw Life-Sustaining Treatment
CPS September 2026
Separate from the issue of withholding or withdrawing life-sustaining treatment, DFPS does not consent to medical orders to withdraw nutrition or hydration or withhold pain control measures for a child diagnosed with an irreversible or terminal condition. Therefore, DFPS never petitions the court for a hearing to consider such medical orders. If a court orders DFPS to authorize these measures, the DFPS regional director seeks legal guidance from the attorney representing DFPS.
Steps When All Parental Rights Have Not Been Terminated
If the child's attending physician recommends withholding or withdrawing life-sustaining treatment, the parent or another person identified in Texas Family Code Section 266.004(e) may request a court hearing so the court may determine whether these end-of-life treatments are in the child’s best interest.
DFPS may also request a court hearing for a determination regarding withholding or withdrawal of life-sustaining treatment, excluding the withdrawal of nutrition or hydration and the withholding of pain control measures. To do so, the DFPS caseworker and supervisor or SSCC equivalent, in coordination with the DFPS physician, must do all of the following:
- Obtain a signed, written statement from the attending physician certifying that the child has a terminal or irreversible condition, and that the physician recommends withholding or withdrawing life sustaining treatment.
- Request a second opinion or a review by a hospital medical or ethics review board.
- Inform the parents about the child's medical condition and the recommendation by the attending physician and any hospital medical or ethics review board (if applicable).
- Arrange for the parents to discuss any recommendation with the attending physician directly (by phone or in person).
- Discuss the recommendation with the following:
- DFPS program director or SSCC director
- DFPS regional director
- DFPS regional attorney
- Attorney representing DFPS
- Child's attorney ad litem
- Guardian ad litem
- Court appointed special advocate (CASA), if applicable
- Any other person with legal standing in the child protection case
After completing all steps listed above, the regional director or person identified in Texas Family Code Section 266.044 (e) must request a court hearing to allow the court to determine whether a DNR is in the best interest of the child and should be executed for the child.
The SSCC, by contrast, cannot request the court hearing to order to withhold or withdraw life sustaining treatment. Those actions must be performed by DFPS acting through the DFPS regional director.
| If a parent retaining parental rights … |
Then … |
|---|---|
Consents to withhold or withdraw life-sustaining treatment |
The parent, DFPS, or other legal party requests a court hearing to obtain an order authorizing the parents to consent to withhold or withdraw life-sustaining treatment. DFPS or SSCC staff must not sign the consent. |
Objects to withhold or withdraw life-sustaining treatment |
DFPS or SSCC staff take no further action. |
Cannot be located or is otherwise unavailable to make a decision to withhold or withdraw life-sustaining treatment |
DFPS or SSCC staff must notify a relative, fictive kin, or other person with possessory or custodial rights or with another significant relationship with the child, including the foster parent or other caregiver, about the recommendation. If one is available, that person must be consulted. |
The DFPS regional director must ensure the following receive notice of the court hearing:
- Attorney representing DFPS
- Child’s attorney ad litem
- Child’s guardian ad litem
- Anyone with possessory or custodial rights
- Any other involved people
Note: If there is no attorney ad litem, a DFPS or SSCC representative must recommend that the court appoint one.
The DFPS regional director must submit a notification memo, along with the court petition for the hearing, proposed court order, and medical documentation to the CPS director of field or CPS associate commissioner.
DFPS staff must facilitate action consistent with the court’s order, if an order is issued.
Steps When All Parental Rights Have Been Terminated
If the attending physician recommends withholding or withdrawing life-sustaining treatment and parental rights have been terminated for both parents, or both parents are deceased, the DFPS caseworker and supervisor or SSCC equivalent staff, in coordination with the DFPS physician, must do all of the following:
- Obtain a signed written statement from the attending physician certifying that the child has a terminal or irreversible condition, and that the physician recommends withholding or withdrawing life-sustaining treatment.
- Request a second opinion or a review by a hospital medical or ethics review board.
- Notify and seek input from parents, a relative, fictive kin, or another person with a significant relationship with the child, including the foster parent or current caregiver, regarding the medical recommendations.
- Notify and discuss the recommendation with the following:
- Program director
- Regional director
- Regional attorney
- Attorney representing DFPS
- Child's attorney ad litem
- Guardian ad litem
- CASA, if applicable
- Any other person with legal standing in the child protection case
After completing all steps listed above, the regional director or person identified in Texas Family Code Section 266.044 (e) must request a court hearing to allow the court to determine whether a DNR is in the best interest of the child and should be executed for the child.
The SSCC, by contrast, cannot request the court hearing to consider withholding or withdrawing life-sustaining treatment and cannot authorize the withholding or withdrawal of life-sustaining treatment. Those actions must be performed by DFPS acting through the DFPS regional director.
The DFPS regional director must ensure the following receive notice of the court hearing:
- Attorney representing DFPS
- Child’s attorney ad litem
- Child’s guardian ad litem
- Anyone with possessory or custodial rights
- Any other involved people
Note: If there is no attorney ad litem, the DFPS or SSCC representative must recommend that the court appoint one.
The DFPS regional director must submit a notification memo, along with the court petition for hearing, proposed court order, and medical documentation to the CPS director of field or CPS associate commissioner.
DFPS staff must facilitate action consistent with the court’s order, if an order is issued.
11730 Pregnancy
11731 If a Youth is Pregnant
CPS September 2026
If a youth in DFPS conservatorship is confirmed or suspected to be pregnant, the DFPS and the single source continuum contractor (SSCC) caseworker will do the following:
- Ensure the youth has an appointment with a STAR Health provider as soon as possible.
- Interviews the youth to assess whether she was a victim of incest, sexual abuse, or a criminal offense. If the youth is a suspected victim, DFPS and the SSCC caseworker notifies Statewide Intake, law enforcement, or both.
- Helps the youth plan for the pregnancy, in consultation with a health care provider. Referrals may be given to appropriate providers of pre- and postnatal care, including obstetric services provided through STAR Health.
- Encourages the youth to discuss options about the pregnancy, including adoption, with supportive people, such as the youth’s parents, caregivers, therapist, spiritual leaders, guardian ad litem, and attorney ad litem. DFPS and the SSCC caseworker will assist with post-delivery planning accordingly.
- Addresses the youth’s plans for the child in the youth’s Child Plan of Service (CPOS). If the youth chooses to care for the child herself, see 6440 When a Youth in Substitute Care Is Pregnant or Parenting and its subitems.
- Works with the youth to decide whether it is feasible and appropriate to work with the child’s father. If so, DFPS and the SSCC caseworker may do the following:
- Encourage the father to participate with the mother in considering alternatives for the child’s care.
- Help the father participate in planning for the alternative chosen.
- Help the father plan for the child’s financial support.
If the father is in substitute care, his DFPS and SSCC caseworker addresses the plans for the child in the father’s CPOS.
11732 Informing Parents and Legal Guardians about Pregnancy-Related Information
CPS September 2026
Federal laws and state licensing standards require DFPS or the single source continuum contractor (SSCC) to share a youth’s medical information with the youth’s parents and legal guardians, unless there are reasons not to do so.
DFPS or the SSCC caseworker must share pregnancy-related information with a youth’s parents and legal guardians, unless disclosure would put the youth at risk of harm or abuse.
When DFPS or the SSCC caseworker are not disclosing pregnancy-related information to parents or legal guardians, the caseworker must obtain approval from a second line manager and document the reasons for nondisclosure in the youth’s case record.
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