Chapter 3 : Section 7.9

Pregnancy Care Services and Abortion

Procedures

Factors to Consider

When considering filing a motion for a child to have an abortion, consider the following:

• The child wants to have an abortion.

• The child able to understand information and the options regarding pregnancy, birth, parenting, and abortion.

• A medical doctor advised that the child is not physically able to carry the baby to term.

• A medical doctor advised that the child is physically able to have an abortion without major medical risk.

• The child has a medical condition that could affect the success of a pregnancy or birth.

• The developmental functioning of the child.

• Emotionally stability of the child.

To determine whether involvement of the child’s parents is required, consider:

• The parent’s whereabouts are known.

• The parents are involved in the case.

• The parent’s involvement endangers the child’s safety or welfare.

• The child’s pregnancy is the result of rape or incest.

• The parents have a legal relationship with the child.

• The child wants the parents to be notified and involved.

Implementation

Follow all applicable policy and procedures required in Pregnancy Care Services.

The Caregiver Should:

If the child’s physician determines that an abortion is necessary to save the child’s life or is medically necessary due to rape or incest, the out-of-home caregiver should:

• Notify the DCS Specialist immediately or by the next work day, and follow the instructions of the physician.

• Take or arrange transportation for the child to post-termination counseling, if arranged by the DCS Specialist; participate in the counseling sessions if the child agrees.

If the child wants an abortion that is not medically necessary to save the child’s life or necessary due to rape or incest, out-of-home caregivers must:

• Immediately or by the next work day notify the DCS Specialist of the child’s decision unless the DCS Specialist is already aware of the decision.

• Be informed by the DCS Specialist that it is against the law to use public funds to pay for the abortion and for licensed out-of-home caregiver to consent to an abortion for a child.

When a pregnant child’s physician determines that an abortion is medically necessary to save the child’s life:

• As needed, assist the child’s physician to arrange the medical procedure and obtain prior authorization from Mercy Care DCS CHP.

• Upon learning of the medical necessity, immediately inform the child’s parents of this medical condition and the arrangements for the medical appointment, unless, in consultation with the Program Supervisor at minimum, it is determined that informing the parent is detrimental to the safety and welfare or best interest of the child, or the child requests the parents not be informed. If a parent is willing and able to consent to the procedure, facilitate the consenting parent’s signature of the medical facility’s forms.

• If the child has requested the parents not be informed or involved or no available parent is willing and able to consent to the medical procedure, obtain a court order before the procedure is performed, unless an emergency exists. Complete the motion for medical/ surgical treatment no more than one work day from learning of the need for the medical procedure.

• Arrange for post-termination counseling for the child, family members and other significant persons.

When a child states a desire to terminate the pregnancy and an abortion is not necessary to save the child’s life, call the DCS eligibility unit within two work days to verify the child’s Title XIX eligibility status, confirming that the eligibility specialist or supervisor has the most recent and accurate eligibility related information.

Follow procedures for high profile cases as described in Developing and Reassessing the Family-Centered Case Plan.

If the pregnancy is due to rape or incest or necessary to prevent harm to bodily function of the pregnant child, and the child is Title XIX eligible:

• Arrange a case conference to be held no later than five days from the date of notification of the child’s decision. Obtain recommendations from the involved service team members regarding supportive services for the child, and determine the roles and responsibilities of the participating service team members as to the medical procedure, assessment or counseling and any other needed services.

• At minimum, the case conference will include the DCS Specialist, the Program 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 advisor, as appropriate and after considering the wishes of the child. When appropriate, include the pregnant child and the alleged father of the infant.

• Prior to the case conference, obtain recommendations from an independent child welfare professional, such as a psychologist on contract with the Department, to provide consultation regarding the child’s choice to terminate the pregnancy, the child’s best interest relative to the pregnancy, and supportive services. Present the recommendations of the independent child welfare professional if not present in the case conference.

• No less than two days prior to the case conference, notify the assigned Assistant Attorney General that the child is requesting an abortion and share other significant information.

• If the child has consented to the involvement of the parents and it has been determined that their involvement is not detrimental to the child’s safety and welfare, inform the parent, at the case conference or no more than two work days following the case conference, of the child’s decision and the arrangements for the medical appointment, unless they have previously been informed. If a parent is willing and able to consent to the procedure, facilitate the consenting parents’ signature of the medical facility’s forms.

• If the child has requested the parents not be informed or involved or no parent is available or willing to consent to the medical procedure, obtain a court order before the procedure is performed, unless an emergency exists. File the motion for medical/ surgical treatment no more than one work day from learning of the planned medical procedure.

• To assist with prior authorization, provide documentation to Mercy Care DCS CHP that the incident of rape or incest was reported to a law enforcement agency. Documentation should include the name of the law enforcement agency, report number, if available, and date the report was filed.

• Arrange for post-termination counseling for the child, family members and other significant persons.

When no state or federal funds are available for abortion services because:

• the abortion is not necessary to save the life of, or prevent bodily harm to, the pregnant child, nor due to rape or incest; or

• the pregnancy is due to rape or incest or necessary to prevent harm to bodily function of the child, but the child is not Title XIX eligible; complete these tasks in addition to those listed above:

• Inform and explain to the child, the out-of-home caregiver, other participating service team members, and the child's parents if they have been involved in the decision making process, that there are no federal or state funds available to pay for an abortion.

• Hold a case conference no later than 10 work days from the date of notification of the child's decision, inviting parties as described in the previous section. The Assistant Attorney General should attend the conference to address funding and potential legal issues.

• At the case conference or no more than two work days following, inform the involved service team members of the Department's position relative to the medical procedure, based on the child's best interest, relevant law, and the recommendations received. Determine the roles and responsibilities of the participating service team members in timely arrangement of the medical procedure, obtaining parental consent or a court order for medical or surgical treatment, and supporting the child.

• If a court order is required for the medical procedure because the child has requested the parents not be informed or involved or no available parent is willing and able to consent, provide to the court any service team member's and the independent child welfare professional's recommendations.

• If the child's GAL or another party files a motion for an order allowing the child to have an abortion, support or oppose the motion according to the child's best interest, unless the fetus is viable in the judgment of the attending physician.

• Oppose all motions for an order allowing a child to have an abortion of a fetus that is viable in the judgment of the attending physician.

• Consult an Assistant Attorney General if the Department is ordered to pay for the abortion.

• Arrange for post-termination counseling for the child, family members and other significant persons.

If notified after the procedure that a child has obtained an abortion, ensure that appropriate medical services are provided to the child, and arrange post-termination counseling for the child, family members and other significant persons. If the child refuses medical services or counseling, continue to offer appropriate services.

Documentation

Document the pregnancy of the child and other medical information in the Health tab.

Document all medical examinations of the child in the Health tab.

Document the contact with the health care provider in Notes.

Document the provision of assessment or counseling in Notes.

Document the outcome of case conferences using Notes.

Document the child’s decision to terminate the pregnancy, outcome of the pregnancy and the date of the outcome in Notes.

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.

Effective Date: February 1, 2021

Revision History: November 30, 2012