4.10.2 DCBS Medically Complex Placement



Practice Guidance

  • All medically complex consultations begin regionally between the SSW, medically complex liaison and the nurse consultant. T​he medically complex liaison contacts the Medical Support Section for any additional guidance. 
  • The foster/adoptive parent is required to receive child specific training from a health care professional or a resource parent who has been trained by a health care professional. Documentation that they are competent to meet the medical needs of the child should be placed in the Provide file. 
  • The following exception requests must be pre-approved by the SRA or designee: 
    • A one parent foster/adoptive home is caring for more than one medically complex child; 
    • A two parent foster/adoptive home caring is for more than two medically complex children (refer to SOP 12.11.1 Placement Exception Requests); and 
    • The home will have more than four children, including the foster/adoptive parent’s own children. 
  • The following exception requests must be pre-approved by the Director of the Division of Protection and Permanency: 
    • Non-medically complex placements; and 
    • Working outside of the home. 
  • The SSW may consult with the medically complex liaison, who in turn consults with the central office Medical Support Section or Out of Home Care Branch if a medically complex placement is not located after a medically complex determination has been made. 
  • When a medically complex child is hospitalized, DCBS staff should be available to receive regular updates and to meet with hospital staff regarding the child’s medical treatment plan. The hospital should have access to a DCBS representative at all times, even on weekends, holidays and after hours. 
  • When a foster parent, SSW or private agency staff are not available to stay with the child: 
    • A biological relative may be considered (on a case-by-case basis); or 
    • A contract with an agency may be initiated in order to have a responsible adult remain with the child (e.g. a sitter from a nursing pool or home health agency. The sitter does not have to provide direct medical care, but is to be in the room to facilitate access to medical personnel and provide support to the child, when needed). 
  • The medically complex liaison may consult with the Medical Support Section if there are questions regarding the child’s medical treatment. 
  • The SSW may contact the designated Commission for Children with Special Health Care Needs (CCSHCN) nurse for consultation at any point during the case. 
  • ​It is recommended that the SSW and CCSHCN Nurse attend medical appointments involving a medically complex child when decisions regarding treatment plans are discussed.


The SSW:

  1. Considers a child for a possible medically complex designation if the child has a medical condition diagnosed by a physician which includes: 
    1. Significant medically oriented care needs related to a serious illness or condition diagnosed by a health professional that may become unstable or change abruptly resulting in a life-threatening event; 
    2. A chronic condition that is expected to be life-long and progressive and will require additional oversight; or 
    3. A severe disability that requires the routine use of medical devices or assistive technology to compensate for the loss of a vital body function needed to participate in activities of daily living and significant and sustained care to avert death or further disability. 
  2. Obtains documentation of the child's medical condition from a physician and other healthcare providers; 1 
  3. Consults with the following people to determine if the child has a medical condition that meets medically complex criteria:
    1. Current medical providers; 
    2. The Family Services Office Supervisor (FSOS); 
    3. The regional Medically Complex Liaison; 
    4. The Medical Support Section; and 
    5. CCSHCN nurse consultant; 
  4. Completes the following documentation when requesting a medically complex designation: 
    1.  The DPP-106B Initial Physical and Behavioral Health History; 
    2. M-001 CCSHCN Verbal Release of Information; 
    3. Copy of the custody order; and 
    4. Any other supporting medical documentation. 
  5.  Once approval has been granted for a medically complex designation: 
    1.  The m​edically complex liaison, forwards the documents listed in procedure #4 to the Medical Support Section; 
    2. The SSW seeks placement for the child in an approved medically complex home; and 
    3. The SSW verifies that the foster/adoptive parents are willing to continue to care for the medically complex child, if placement occurred prior to designation; 
  6. The SSW or medically complex liaison contacts the CCSHCN nurse to provide case information prior to the first home visit and the individual health plan (IHP) meeting.

The Medically Complex Liaison:

  1. Assists the assigned Commission for Children with Special Health Care Needs nurse with arranging the initial individualized health plan meeting within thirty (30) days of the medically fragile complex determination.

Contingencies and Clarifications

If a medically complex child becomes hospitalized, the SSW completes the following tasks:

  1. Notifies the medically complex liaison, who in turn, notifies the Medical Support Section within seventy-two (72) hours; and 
  2. Ensures that the child has a responsible adult, excluding hospital staff, present at all times. 2 
  3.  When a child is placed in the home of a relative or out of state, the SSW: 
    • Ensures that the placement provider submits documentation from a medical provider that they are able to meet the medical needs of the child; 
    • Collects the DPP-104C Medically Complex Monthly Report and provides a copy to the Medically Complex Liaison and Medical Support Section.


  1. Phone verification with the physician, nurse or hospital social worker is acceptable documentation for confirmation of the child’s diagnosis. The Commission for Children with Special Health Care Needs may be contacted to assist with securing this information if the SSW encounters issues. 
  2. If the child is in an intensive care unit, a responsible adult is not required to be present at all times.​​​