Chapter 3 : Section 7.6

HIV/AIDS Testing, Diagnosis, and Services

Procedures

Living Arrangements for a Child who is HIV/AIDS Positive

To determine the most appropriate living arrangement for a child who is HIV/AIDS positive, consider the:

• best interests of the child;

• provider's ability to provide specialized care;

• provider's ability to respect the child's right to confidentiality;

• impact of the child's placement on other children in the home; and

• least restrictive, most family-like setting that will meet the needs of the child.

When considering a living arrangement in a group care facility, consult the child’s physician and consider the:

• level of risk of transmission of HIV/AIDS to other residents through sexual contact or exchange of bodily fluids;

• ability of the HIV/AIDS positive child to manage their behaviors;

• maturity and ability of other residents to protect themselves and to manage their own behaviors;

• ability of the setting to protect the HIV/AIDS positive child from infections; and

• setting’s capacity to provide or to arrange for intensive medical services as medical needs increase.

Kinship or Foster Caregivers for a Child who is HIV/AIDS Positive:

• Allow a potential caregiver with other children in the home to determine whether they will consider being a caregiver for an HIV/AIDS positive child.

• Coordinate supportive services for the caregiver and child.

• Develop agreements with the foster family regarding payment rates and other issues arising from the special care needs of the HIV/AIDS positive child, if necessary.

• Confirm that caregivers receive training on working with a child in their care who has HIV/AIDS.

• Closely monitor the child's care and the caregiver's ability to be responsive to the child's medical and psychosocial needs. Discuss with the caregiver the child’s medical appointments, recommendations, and any follow-up needed.

Case Planning for a Child who is HIV/AIDS Positive

Provide all case planning and case management services for HIV/AIDS positive children as described in Family Centered Case Plan, with the following additions:

• Convene a case plan staffing to discuss the needs of the child:

  • before the child is enters into care, or within seven working days of an emergency removal, or

  • within the first 30 calendar days of opening an in-home services case.

• Visit the child and caregiver in the home at least twice during the first month after the initial placement of the child.

HIV/AIDS Testing of a Child in Out-of-Home Care

HIV testing is available to all children who are eligible for DCS CHP services. HIV testing must be deemed medically necessary and ordered by a qualified physician or practitioner to determine the diagnosis and identify the child's medical needs. An out-of-home care provider can consent for testing. When HIV/AIDS testing may be medically necessary, assist the caregiver by completing the following:

• Personally communicate to the child's health care provider any factors that would place the child at risk for HIV/AIDS exposure, including intravenous drug use, sexual abuse, and voluntary risk behavior of either the mother or the child.

• Provide information to the out-of-home care provider to assist them to obtain the physician's order for testing, such as information about medical providers in their area.

• To the extent possible, consult with each biological parent of the child whose parental rights have not been terminated, when making decisions about HIV testing for a child in the Department’s custody.

Complete the following additional steps for youth age 12 and over.

• Obtain counseling for the youth from the local health department or another professional.

• Allow the youth age 12 or older to consent to their own HIV/AIDS testing if the youth meets the criteria for testing. No additional consent is required, nor does the parent need to be informed, if the minor requests testing.

• Request court approval for a child age 12 or older, when the child meets the testing criteria and testing is determined to be medically necessary, but the child refuses to give consent for testing.

Obtaining Medical Treatment for a Child with HIV/AIDS

Support HIV/AIDS treatments ordered by a physician for dependent children.

Ensure the child receives HIV/AIDS treatment from someone considered an expert in this field. For a list of these healthcare providers, contact the CHP Nurse.

Participation in HIV/AIDS Clinical Trials

If a request is received for a child in out-of-home care to participate in a clinical trial, immediately notify the Program Supervisor, Program Administrator or designee, and the Assistant Attorney General (AAG). (Persons making the request may include the DCS Specialist, a child’s parent, out-of-home care provider, GAL, CASA, child, child’s attorney or physician).

• Obtain court approval for participation in clinical trials or protocols when it is the physician's opinion that the proposed protocol is beyond what is accepted as standard in the medical community.

• Obtain prior authorization from the Program Administrator or designee and written consent from the parent or guardian (as appropriate, see above), GAL, and child, if the child can give informed consent.

• Obtain the following information and forward to the AAG:

  • the child’s medical records;

  • information about the proposed treatment;

  • the name, address and phone number of the sponsoring health institution conducting the research; and

  • the names of the child’s treating physician and medical personnel responsible for or supervising the proposed clinical trial.

• Confirm the child has been appointed an independent advocate.

Child Care Services for a Child who is HIV/AIDS Positive

When considering child care services for a child who is HIV/AIDS positive:

• Assist the caregiver to make a referral to the Department of Economic Security (DES) Child Care Administration (CCA). (See Child Care Services)

• Advise the caregiver of available child care homes and center placement options.

• Advise the child care provider of the child's HIV/AIDS status only if this status impacts the child's daily care needs, the safety and well-being of the child or the safety of other children and/or adults in the facility. Any disclosure of medical information is limited to a clear need to know basis.

• Consider a setting which minimizes exposure of the child's bodily fluids to others if a child exhibits high-risk behaviors such as lack of control of body secretions or biting, or who has any type of draining lesion.

• Place a child who is HIV/AIDS positive and does not exhibit symptoms or high risk behaviors in any child care setting.

Adoption Planning for a Child who is HIV/AIDS Positive

For HIV/AIDS positive children whose permanency plan is adoption, follow procedures specified in Presenting the Child’s Information to the Prospective Adoptive Parents, with the following additions:

• For the purposes of recruitment, identify the child as "medically at risk."

• Consider the adoptive family's ability to meet the child's medical and mental health needs.

• When a child has been diagnosed with AIDS, consider the following when assessing the family's ability to meet the needs of the child:

  • the family's ability to deal with loss;

  • the family's expectations regarding terminally ill children;

  • the flexibility of the family's schedule to accommodate medical and/or counseling appointments;

  • the family's ability to accept the limitations on their lifestyle that a potentially terminally ill child would present.

• Fully inform prospective adoptive parents who have been determined to be appropriate for placement of an HIV/AIDS positive child of the child's medical condition and needs. Provide information contained in the physician's report detailing medical condition, prognosis and care.

• Arrange for specialized training to families expressing a willingness to consider HIV/AIDS positive children for adoption.

• Give the adoptive parents a written list of HIV/AIDS related resources and support services.

Documentation

Document that an out-of-home caregiver has been informed of a child's positive HIV/AIDS status in Notes.

Document consents or court approval for HIV/AIDS testing, treatment and/or participation in a clinical trial in the appropriate Notes.

Document any consultation with physicians regarding the child's condition and/or needs, as well as the physician's approval for testing using the Notes.

Coordinate with DCS CHP to ensure the child’s HIV/AIDS diagnosis is documented in Guardian.

Document supervisory approval of testing and notification of request for child’s participation in a clinical trial using the Notes tab.

Document AAG notification of requests for a child’s participation in a clinical trial using the Notes designated AG Contact type and titled AG Contact.

Document Program Manager approval and notification of requests for a child’s participation in a clinical trial using Notes.

Document staffings using Notes.

Effective Date: February 1, 2021

Revision History: November 30, 2012, August 9th, 2017