Statement of Cooperation
between The Department of Family and Children's Services
and The Public Health Nursing Division

The purpose of this statement is to clarify the roles and responsibilities of the Department of Family and Children's Services and the Division of Public Health Nursing in relation to:

A. Assessment of need for services to abused or potentially abused children and their families/caretakers.

B. Provision of services to abused children and their families.

C. Cooperation between the two agencies including referrals to and coordination between personnel of each agency regarding abused children and their families.

The Department of Family and Children's Services and Public Health Nursing are committed to:

• The alleviation of child abuse and neglect.
  
  
• The provision of services in a timely manner to realize this commitment. The Department of Family and Children's Services provides services within the legal framework set by law, primarily in W&I Code Sections 16500 et seq. These laws and the regulations stemming from them provide the legal and operational framework in which Child Welfare Services exist. Public Health provides services under the mandate of Title 17, California Code of Regulations.

II. Statement of Need

Given the numbers of reported cases of abuse and neglect in Santa Clara County, the need for a broad and comprehensive variety of services to child victims of abuse/neglect and their families is critical. Public health nurses offer a large repertoire of health-related services which provide an important resource to the Department of Family and Children's Services staff who are responsible for case management and delivery of services. This is even more important within the legal mandate addressing "reasonable efforts" and its underlying philosophy of family preservation. The mandate requires that all reasonable efforts be made to keep families together or to reunite families where children have been separated from parents or guardians. These efforts may include the collaborative effort between Social Services and Public Health to promote a healthy family life situation.

III. The Role of Social Services Agency

The Santa Clara County Social Services Agency and its Department of Family and Children's Services is a Child Protection Agency as defined by Penal Code Section 11165, W&I Code 16504, and SDSS Regulation 30-194.12 directs the Child Welfare Agency to provide these services, and, as such, accepts reports for assessment of risk to children and the need for services to child victims and their families when there is evidence of or reasonable suspicion that a child is or is at substantial risk of becoming a victim of:

1. Physical Abuse
2. Sexual Abuse
3. Severe Neglect
4. Neglect
5. Emotional Abuse
6. Exploitation
7. Caretakers Absence or Incapacity

Social Services' interventions include a continuum of services, ranging from reasonable efforts to prevent removal of children from his/her family, to family reunification services when removal is necessary, to permanency planning services, including termination of parental rights.

Entrance into the Child Welfare System is through the Emergency Response Program, which has the responsibility for the timely assessment of risk to the child and the need for services. Assessment is conducted often in conjunction with Public Health and other agencies involved with the family. Responses to reports from public health nurses are made within the following timeframe:

A. Immediate Response (right away) shall be made in situations likely to cause immediate physical pain, injury, disability, severe emotional harm or death to the child, or at the request of a local law enforcement authority. .

B. Urgent Response (a face-to-face contact with the alleged child victim within three calendar days of receipt of the report information by the Emergency Response Social Worker) shall be made in situations of other alleged abuse when the child is not in immediate danger.

C. 10-Day Response (a face-to-face contact with the alleged child victim within 10 calendar days of receipt of the report) shall be made in situations of general neglect (failure of parent/guardian to provide adequate food, clothing, shelter, or supervision) where no physical injury has or is likely to occur.

It is the goal of the Department of Family and Children's Services to keep any public health staff who reports child abuse confidential as per Penal Code, Article 2.5, Child Abuse and Neglect Reporting Act - Section 11167.d. A written letter regarding the Emergency Response disposition of the report and relevant information will be forwarded to the reporting public health nurse within 30 days of the assessment and/or termination of intake services by the Emergency Response Social Worker (P.C. 11170, Subdivision b). The written letter regarding disposition should be sent to Susan Kerr, PHN, Child Abuse Prevention Coordinator, 976 Lenzen Ave., San Jose, CA 95126.

The findings of the Emergency Response Social Worker determine the further involvement of the Child Welfare System. The following are possible dispositions for the cases:

A. Services Terminated (case closed) by Emergency Response.

B. Voluntary Family Maintenance means that the family has signed a voluntary family maintenance agreement for services with SSA. These cases need administrative approval and usually last for six months unless another child abuse report is received. Families receiving these services are referred by the Emergency Response Social Worker to one of the Family Resource Centers.

C. Pending Dependency Investigation. These cases have been referred by the Emergency Response Social Worker for a dependency investigation based on findings that physical abuse, sexual abuse, or severe neglect did occur. There are three types of Dependency Investigations:

1) Those taken into custody by the Emergency Response Social Worker in conjunction with the police and placed in the Children's Shelter, or left in a safe environment (i.e., relatives) with a paper admit to the Children's Shelter; 2) those brought into the Children's Shelter by a Police Agency; and 3) those left with a parent/guardian in an out-of-custody placement but supervised by SSA .

D. Informal Supervision (IFS) are those cases where there is sufficient grounds to proceed with a dependency petition, but where the family voluntarily agrees to sign a contract stipulating activities required by the parent necessary to avoid court action. Failure of the parents to abide by the contact may result in a dependency petition being filed. The case is managed by a continuing unit of SSA.

E. Court Dependent or Dependency Petition Sustained means that Santa Clara County has jurisdiction or custody of the child. Physical custody may reside with the parents, foster parents, or a relative. The case is managed by a continuing unit of SSA.

V. The Role of Public Health Nursing

Public health nurses are mandated reporters of child abuse/neglect by virtue of Penal Code 1165. They are required to have at least seven hours of specific training related to child abuse prevention, identification, intervention, and reporting. Public health nurses are mandated to report abuse and neglect immediately to a Child Protective Agency, and to follow up the verbal report in writing within 36 hours. Written reports will be sent to the agency to which the telephone report was made.

The Department of Public Health provides two types of Public Health Nursing services:

A. Child Health & Disability Prevention (CHDP) Foster Care Program: Public health nurses provide services to foster parents, social workers, and clients in the following ways:

• Answer questions and concerns about the health needs of a specific child.
• Refer for CHDP exams.
• Provide names of doctors and dentists who accept Medi-Cal. Page five
• Follow up for conditions found on CHDP exams. * Make referrals to resources for other health care needs.
• Provide training, as applicable, to social work staff, caretakers/foster parents.

Specifics of these services are covered by an interagency agreement between CHDP and the Social Services Agency.

B. Regional Public Health Nursing Services: These services are provided largely in the home or community. The remainder of this Statement of agreement refers to Regional Public Health Nursing Services.

The Public Health Child Abuse Program Coordinator serves as a liaison to other county agencies involved with the prevention and treatment of child abuse and coordinates the Multidisciplinary Child Abuse Team and Death Review Team. The Coordinator acts as a consultant regarding child abuse/neglect laws and intervention for all the Public Health Department staff and their managers.

Regional Public Health Nursing services may be appropriate at any point throughout the continuum of the Child Welfare process. Public Health accepts referrals for assessment and follow-up services as indicated in the following categories

A. Infants who were substance exposed in utero, especially newborns having signs and symptoms of withdrawal or fetal alcohol syndrome/ effects.

B. Infants or children where there are unmet health needs and/or significant coordination of medical care is needed.

C. Infants of parents who are mentally ill or developmentally delayed.

D. Infants where there is concern regarding weight gain and/or growth and development.

Cases which do not directly fit the above criteria may be accepted for Public Health nursing services, follow case-specific discussion with the Public Health Child Abuse Prevention Coordinator--(408) 792-5055.

The public health nurse responds to child abuse referrals as follows:

The functions of the public health nurse include assessment, nursing intervention, education, linkage to health services and on-going monitoring of health. Other interventions include coordination of medical care, referral to private and public agencies as indicated by need, and coordination with other professionals working with the child and family. Ongoing PHN services are provided as long as the family and child need and utilize the service. Written reports will be provided upon request. Testimony and/or records will be provided as per subpoena.

If, at any point, the client cannot be contacted or located, the public health nurse shall inform the involved social worker, if known by the PHN.

Regional Public Health nursing cases are closed based on any of the following criteria:

A. Parents, consistently and over a period of time, have failed to improve their care techniques or failed to show movement to solve identified problems.

B. Parents refuse or do not utilize public health nursing assistance and intervention despite active efforts by the public health nurse to establish an effective relationship.

C. Family is maintaining a program of preventive health care and uses community resources appropriately.

D. The public health nurse determines that services are not currently needed, and family knows how and will seek PHN assistance when needed.

V. Interdepartmental Agreement for Collaborative Services Between Public Health and Department of Family and Children's Services

To promote and support cooperative and collaborative efforts in behalf of shared child abuse/neglect cases, the Department of Family and Children's Services and Public Health establish the following guidelines for joint intervention strategies.

A. Understanding of the services provided by each agency is promoted during new staff orientation and informational sessions for continuing staff members.

B. If at all possible, it is desirable for staff from both Public Health and the Department of Family and Children's Services to verify if a case is open to either of these agencies and to communicate the findings.

Contact numbers for case identification: Social workers may call 792-5162; public health nurses may call the medical clerk at 441-5309.

C. Social workers will solicit input from an already involved public health nurse at the Emergency Response level when indicated. Ideally, this will also be done when the public health nurse is not the reporting party.

D. Referral to and utilization of Public Health nursing services is encouraged as soon as an appropriate public health need is identified for continuing Child Welfare cases. Referrals for Public Health nursing services may be made either by phone (885-2110) or by faxing (885-2115) the "Referral to Public Health" form (SC837). Joint case planning may include a joint home visit, or, minimally, a telephone discussion for assessment and coordination of case plans.

E. Interagency communication shall be fostered by regular contact between the Child Welfare Social Worker and the Public Health Nurse:

1. Arranging case conferences or multidisciplinary team consultations as needed, with both professionals attending.

2. Reporting on important aspects of the shared cases in a timely manner.

3. Responding to telephone messages in a timely manner.

4. Making periodic joint home visits, if indicated.

F. Each agency will identify a designated liaison to the other agency to facilitate communication, coordination of services, and problem solving. The liaison will act as the key link on systems issues or particular problems that go beyond individual cases.

G. Each agency will keep the other informed of any major changes in legal, regulatory, or operational areas that would bear or interdepartmental relationships.

VI. Agreement Conditions

This agreement is to be reviewed annually and will be considered in effect until or unless either agency revokes it with a 30-day notice or there is mutual agreement to a revision.

Dated: December, 2000