Chapter 3: Section 7.8

Pregnancy Care Services

Procedures

Services to a Child Who Believes She is Pregnant

To determine whether involvement of the child’s parents in pregnancy care decisions is appropriate, consider these questions:

• the whereabouts of the parents are known;

• the parents are involved in the case;

• the child would like the involvement of the parents;

• the parents are supportive of the child;

• involvement of the parents does not endanger the child’s safety or welfare; and

• the parents have a legal relationship with the child.

 

Prior to arranging a medical examination to confirm the pregnancy, discuss with the child:

• the child informed the out of home caregiver that they believe they are pregnant:

  • if not, assist the child to inform the out-of-home caregiver of the possible pregnancy, or

  • if yes, continue to assess if the child feels comfortable involving the out of home caregiver in arranging services;

• involvement of the child’s parents in pregnancy care decisions;

• the child would like to have supportive people, such as a CASA, special friend, or a religious or spiritual advisor to speak with about the pregnancy;

• the child’s choice in who they would like to inform about the potential pregnancy;

• determine who the child would like to accompany with to the medical appointments;

• determine the appropriate medical provider that the child would feel comfortable with;

• determine who will make medical appointments, such as the child, out of home caregiver, parents, or DCS Specialist; and

• determine if the child has transportation to medical appointments or if the DCS Specialist will need to arrange for transportation.

Refer or arrange for a medical examination to confirm the pregnancy using a Mercy Care DCS CHP health care provider or a provider registered with the child’s AHCCCS health plan. Arrange the medical examination to occur no more than five work days from notification of the possible pregnancy.

If the child is not pregnant, refer or arrange for the child to receive family planning information and consultation using:

• information on abstinence from the Department of Health Services, school based education programs, or other community resources; and

• a Mercy Care DCS CHP health care provider; or

• a provider registered with the AHCCCS health plan.

Discuss with the child:

• if the child agrees with the out of home caregiver’s involvement in arranging medical appointments;

• if the child would like someone to accompanying them to family planning appointments; and

• transportation can be arranged for the child to get to appointments either by the caregiver or by the DCS Specialist.

If the sexual relationship with the alleged father is against the law or if the pregnancy is or may be due to rape or incest, confirm with the out-of-home caregiver that law enforcement has been notified. It is acceptable, and may be preferable, for the out-of-home caregiver to notify law enforcement if the out-of-home caregiver has first-hand knowledge of the child’s relationship with the alleged father. If a report has been filed, obtain the report number. If law enforcement declines to take a report, document the date and time law enforcement was notified, as well as the officer’s information including name and badge. If a report has not been filed, notify law enforcement or ensure the out-of-home caregiver does so within 24 hours of being notified of the possible pregnancy.

Services to a Child Whose Pregnancy Is Confirmed

To determine whether involvement of the alleged father in planning for the unborn infant is appropriate, consider:

• the nature of the relationship between the alleged father and the pregnant child appropriate;

• if the relationship violates state law due to differences in ages or other factors;

• if the pregnant child is willing and able to identify and contact the alleged father; and

• if involvement of the alleged father endangers the pregnant child’s safety or welfare.

If the examination confirms that the foster child is pregnant, and the caregiver is aware of the results of the examination, it is the responsibility of the caregiver to notify the DCS Specialist within one work day, unless the DCS Specialist is already aware of the results.

Caregivers must decide whether their foster child’s pregnancy and the decisions she will make regarding her pregnancy will impact their willingness and ability to continue caring for her. Regardless of her decision, the out-of-home caregiver must not verbally abuse, threaten or make humiliating comments, unreasonably deny privileges, contact and visitation, or isolate the child. These are Discipline Policy infractions.

Within one work day of the pregnancy confirmation, notify the DCS CHP Maternal/Child Nurse (CHPNurse@azdcs.gov).

Hold a case consultation with the supervisor within five work days to discuss who should participate in planning services needed by the child.

Following the case consultation between the DCS Specialist and the supervisor, discuss with the child who are the individuals she believes must be made aware of her pregnancy. Also discuss other potential service team members (such as a CASA, Special Friend, or religious or spiritual adviser) whom the child wants to be made aware of her pregnancy and who should be asked to participate in a case conference.

Hold a case conference within 10 days of the pregnancy confirmation to determine the roles and responsibilities of the participating service team members as to what, by whom and how medical, counseling and any other needed services will be provided to the child to assist her in making decisions. The case conference will include the DCS Specialist and supervisor, the child’s guardian ad-litem (GAL), attorney and the caregiver. Include other service team members and parties, such as the child’s parents, as appropriate and after considering the wishes of the child. In most instances, unless it is clearly not appropriate, include the child in the case conference.

At least two work days prior to the case conference, contact the assigned Assistant Attorney General to notify of the confirmed pregnancy and other significant information.

No more than five work days after the case conference, arrange non-directive, neutral assessment or counseling for the child through Mercy Care DCS CHP, if not already seeing a counselor. The purpose of the counseling is to provide information on the options, which include parenting the infant, planning for adoption or legal guardianship, temporary care of the infant by family or non-relatives, or termination of the pregnancy.

Assist the child in scheduling counseling and arranging transportation to this appointment.

Determine whether the out-of-home caregiver or another support person will participate in the counseling when agreed upon by the child.

Inform the child that medical assistance and other benefits and services may be available for her and her child through the Department of Economic Security and other organizations. These may include TANF, child support, child care, and WIC.

Obtain all known identifying information on any alleged father and assist the child to confirm the identity of the biological father. Inform the child of the father’s financial liability for the infant.

Keep out-of-home caregivers fully informed of the services being offered to the child.

Involve the child’s parents and the alleged father of the infant in the counseling sessions when agreed upon by the child and determined to be in the child’s best interest.

Services Provided When the Child Will Carry the Pregnancy to Term

The DCS Specialist, caregiver and medical providers should review the child’s medical and health condition, any other prenatal medical, nutritional and emotional needs, and any health or safety issues, such as substance abuse concerns. Each party shares the responsibility of assuring that the child receives early and consistent medical care.

The child should be visiting an OB provider at the following frequency:

• weeks 4 - 28: once per month;

• weeks 29 - 36: every two weeks; and

• weeks 37 - 40: every week.

Take the child or arrange transportation for her to medical and other appointments.

Encourage and assist the child to participate in parenting instruction if she plans to parent her infant.

Within five work days, update the DCS CHP Maternal/ Child nurse (CHPNurse@azdcs.gov) regarding the child’s decision.

Within ten work days of learning the child’s decision, hold a case conference to further assist the child in understanding the options available; to identify needs such as medical, social, emotional, and educational; and to identify current and future living arrangements. Develop a preliminary plan to address the child’s needs. At minimum, the case conference will include the DCS Specialist , the supervisor, the out-of-home caregiver, and the child’s GAL and attorney. Include other team members and parties, such as the child’s parents and significant support persons, such as a Special Friend, or a religious or spiritual adviser, as appropriate and after considering the wishes of the child. When appropriate, include the child in the case conference. The alleged father of the infant may be a participant in this conference when appropriate.

At least two work days prior to the case conference, contact the assigned Assistant Attorney General to notify of the child’s decision to carry the pregnancy to term and other significant information.

Ensure the provision of early and consistent medical care through communication with the child’s physician and/or out-of-home caregiver on medical appointment scheduling and results of all appointments.

Ensure that potential health risks to the unborn child or the pregnant child, such as substance abuse and known health concerns including high risk behaviors and HIV positive or diagnosed AIDS, are fully shared with the child’s physician.

Ensure that the out-of-home caregiver is fully informed and aware of the medical, health, nutrition, and other prenatal medical and emotional needs of the child and is willing and able to meet her needs.

Assure that transportation to medical and other appointments is arranged.

Encourage participation in parenting instruction for a child who plans to parent her infant, and make arrangements as indicated.

Encourage the pregnant child and the out-of-home caregiver to plan for the child’s continuing educational needs.

Assist the child to obtain information on medical and other benefits that may be available to her and her child through the Department of Economic Security, Family Assistance Administration. Assist the child to apply for any benefits for which she may be eligible.

Arrange for assessment or counseling related to the pregnancy, as needed.

Discuss with the child the identity of the father of the unborn infant, determine his role in planning for the unborn infant, and his financial responsibility for the child. In all cases where possible, obtain an affidavit of paternity from the father. If the alleged father denies paternity, discuss with the child and the alleged father that a paternity test is needed.

Discuss with the child the role of her parents in planning for the unborn infant.

Fully inform the child of services available from the Department and the community to support her ability to parent her child, including temporary care options such as care of the infant by family, in foster care, or through other arrangements.

With the current out-of-home caregiver and region designated staff, review living arrangement options available for the minor parent and her infant together.

Services Provided When the Child Decides on a Plan of Adoption For Her Infant

Fully support the child in the decision that she has made for herself and her unborn child. The caregiver should transport or DCS should arrange transportation for the foster child to adoption planning services, and if she is comfortable with their involvement, participate in the services with her.

Assist the child to arrange adoption planning services provided by Department adoption staff or a private adoption agency.

Consult with an adoption unit supervisor, or a supervisor with adoption experience, to obtain the names of private adoption agencies in the child’s local area and information on adoption services provided by Department staff.

Assist the child to obtain any additional information needed for the child to make an informed choice between the available resources.

Assist the child to obtain information on medical and other benefits that may be available to her and her child through the Department of Economic Security, Family Assistance Administration. Assist the child to apply for any benefits for which she may be eligible.

Involve the child’s parents and the alleged father of the infant in the planning when appropriate and in the pregnant child’s best interest.

Facilitate involvement of the child’s GAL and attorney throughout this process.

Services Provided When the Child Decides on a Plan of Legal Guardianship for Her Infant

Ensure that the child feels supported in the decision that she has made. These are very emotionally charged times for an adolescent girl and it is critical that the Department and caregiver supports her in achieve her goal. It is also important that the child know that the foster care is available to her and that she can continue to process her decision until the point that it is final.

Assist the child to consider the ability of the proposed guardian(s) to provide custodial care.

Inform the child and the proposed guardian(s) of the process for obtaining a legal guardianship for non-dependent children. If needed, consult with an Assistant Attorney General to learn this process.

Consult with a supervisor to determine what steps should be taken to protect the infant, if after the child’s birth the mother pursues legal guardianship with a proposed guardian who may be unable to meet the health and safety needs of the infant.

Involve the child’s parents and the alleged father of the infant in the planning when agreed upon by the child and determined to be in the child’s best interest.

Facilitate involvement of the child’s GAL and attorney throughout this process.

Documentation

Document the pregnancy of the child in the Note tab in Guardian. Include in the documentation alleged father, if the pregnancy resulted from consensual intercourse, rape, or incest, and any decision the child has made about who will be the caregiver for the newborn.

Document the pregnancy of the child in the Health tab in Guardian.

Document any medical appointments in the Health tab in Guardian.

Document the outcome of case conferences using Notes tabs.

If a child refuses medical or assessment services or counseling, document the types of services offered and the child’s response to the offers using Notes tab.

Effective Date: April 1, 2021

Revision History: November 30, 2012, February 1, 2021