ILLINOIS DEPARTMENT OF CHILDREN AND FAMILY SERVICES
AND FAMILY SERVICES PLAN
How can the Department best ensure that wards have access to and receive needed quality health care services while in the Departments care?
The Illinois Department of Children and Family Services (DCFS) is responsible for ensuring that all children in its care and custody receive documented quality health care services. Barriers that hindered wards from receiving documented health care services were:
Adequate physical and behavioral health care are important factors in ensuring the long-term well-being of a child. As a result, provision of such care is a vital part of DCFS mission to ensure the well-being of the children in its care and custody.
To address the barriers identified above, the Department implemented HealthWorks of Illinois in September of 1993. The HealthWorks system includes special health services and documentation designed to meet the unique needs of children in substitute care. These include Initial Health Screenings within 24 hours of DCFS custody, Comprehensive Health Evaluations by the primary care physician within 21 days of DCFS custody, behavioral health and other screenings, age-appropriate well-child care (including immunizations), and documentation of receipt of health care services in a Health Passport and on DCFS Medical Record Forms. These services are mandated as part of the B.H. Consent Decree.
Illinois has implemented a comprehensive statewide health care system that meets the Child Welfare League of Americas Standards for Health Care Services for Children in Out-of-Home Care. Primary care providers participating in the system meet standards of the former Healthy Moms/Health Kids program and have agreed to complete DCFS forms to document receipt of health care services. The primary care providers have also agreed to cooperate with medical case managers.
The Departments Office of Health Policy (OHP) is charged with the responsibility of developing, implementing, monitoring, and evaluating policies and systems to ensure that all wards have access to health care, obtain the services which are needed, and have accessible documentation regarding their health needs, services, and status.
Physical Health Care
At the end of FY99, the Department had approximately 39,000 children in substitute care; approximately 71% of these children are in Cook County. DCFS goal is to ensure that all wards statewide:
There are 21 Lead Agencies across Illinois. In Cook County, DCFS has contracts with two Lead Agencies. In downstate Illinois, DCFS contracts with the Department of Human Services (DHS) which then contracts with nineteen Lead Agencies (local health departments) across the state. Each of the 21 Lead Agencies is responsible for:
All DCFS wards are Medicaid eligible. The HealthWorks program is a Medicaid fee-for-service program, and adheres to the standard Medicaid payment processing procedures. In Cook County, Primary Care Physicians who have joined the HealthWorks network receive $5 per month per ward from the Illinois Department of Public Aid (DPA) as a patient management fee.
Wards ages 0 through 5 receive medical case management services funded by the Illinois Department of Human Services (DHS), which certifies and monitors the community-based organizations providing the case management. Medical case management for wards ages 6 and older are performed by the child welfare case worker. Medical case management services include:
For Cook County cases, OHP produces quarterly reports of unenrolled wards listing each childs name and case number, caseworker, and the substitute care givers name and address. These reports are sent to DCFS Regional Administrators and private agency Executive Directors for follow up and monitoring to ensure enrollment. Downstate enrollment data is collected on a quarterly basis by DHS and provided to DCFS through paper reports.
DCFS is also working with DHS staff to identify technical issues regarding the transfer to DCFS of DHS Cornerstone health information on wards when the health information component of SACWIS (Statewide Automated Child Welfare Information System) is operational.
Behavioral Health Care
A primary care provider (PCP) is required to do a mental health screen for children over 5 years of age as part of the Comprehensive Health Evaluation, or at any other time the PCP judges to be appropriate (a PCP also is required to do an alcohol and substance abuse screen if he or she feels a child or adolescent has a substance abuse problem). The PCP then makes a referral to the wards caseworker, who is responsible for arranging for additional behavioral health assessments and services. Several issues have been identified related to this process:
These issues are a concern for children of all levels of behavioral health needs. In order to address these issues, OHP is chairing an internal workgroup with broad representation (including the DCFS Medical Director) to discuss:
DCFS is undertaking a number of initiatives to further improve the system of health care for wards.
The current and future efforts in physical and behavioral health will enable DCFS to fulfill its responsibilities for ensuring the well-being of the children in its care and custody.
LONG RANGE GOALS AND OBJECTIVES
DCFS currently uses several process measures to gauge its progress in ensuring Wards physical well-being. These measures are: enrollment with a HealthWorks Primary Care Provider, immunization, and well-child examinations.
DCFS long term goals related to physical health care are:
DCFS long term goals related to behavioral health care are to have: