Rule 290-2-6-.12. Assessment and Planning for Transition Care Services.

Georgia Administrative Code




Current through Rules and Regulations filed through August 31, 2020

Rule 290-2-6-.12. Assessment and Planning for Transition Care Services

(1) Health Service Plan. A written assessment and health service plan shall be developed by a RN on the day of admission and must include preliminary discharge plans for the child, including the anticipated date of discharge.
(a) The health service plan throughout the child's stay at the center shall also include but not be limited to:
1. Identification of each child's current, priority health care issues relating to medical, physical, intellectual, emotional/behavioral, psychosocial/developmental, and spiritual needs;
2. The short term and long term outcomes, interventions, and resources engaged to promote outcome achievement;
3. Daily progress notes reflecting the child's progression towards the achievement of each specific outcome;
4. The input and participation of involved health care team members (child's pediatrician, specialty physicians, therapists, HSP, counselors, care givers, and family members); and
5. Documentation of updates and monthly reviews.
(b) Arrangements shall be made with at least one physician and one dentist or a health care agency that provides physician or dental services in order to meet the health and medical support needs of children in care.
1. A general physical examination of the child shall be provided by a by a medical doctor, physician's assistant, or public health department within 72 hours (excluding weekends and holidays) of admission unless such an examination has been completed within one year prior to admission.
2. The general physical examination shall include basic diagnostic laboratory work, including but not limited to a Complete Blood Count (CBC) and basic urinanalysis; required immunizations; and vision and hearing tests.
(c) Within ten days of admission, an assessment of the children's medical and dental health shall be completed by the designated intake HSP.
(d) Policies shall be in place for the emergency medical care of children with a local hospital or other health care facility that provides emergency services or with a local physician;
(e) Children shall receive annual medical check-ups and semiannual dental check-ups;
(2) Comprehensive Service Plan. The center shall complete a full written assessment of each child admitted for care and of each child's family and develop an individual written comprehensive service plan for each child based on the assessments within ten (10) days of admission. If an assessment is not completed within ten (10) days, the reasons for the delay shall be documented in the child's case record and such documentation shall include statements indicating when the assessment is expected to be completed.
(a) The assessment shall be coordinated by a registered nurse, and shall assess the needs of the child in the areas of health care, education, family relationships, personal social needs, and any behavioral issues that require monitoring.
(b) A comprehensive service plan to address the transition needs of the child, the child's family or prospective family other than the medical and nursing needs addressed by the health services plan shall be developed by a RN or other assigned HSP in concert with the RN who has responsibility for supervision of the child in the area where the child resides. The plan shall contain the following data:
1. The results of the assessment and identified needs other than those medical and nursing needs;
2. Statements of time-limited goals and objectives for the child and family and methods of achieving them and evaluating them;
3. Statements of daily activities to be followed by the child, the child's family or prospective family and staff members in pursuit of the stated goals and objectives;
4. Statements of any special care and educational services that will be arranged for or provided directly;
5. Statements of goals and preliminary plans for discharge, including referrals for appropriate community support services;
6. Statements about the plan for behavior management that should be employed when necessary; and
7. Statements about any restrictions of communications or visitations with any persons; such statements shall clearly show that the health, safety, and welfare of the child would be adversely affected by such communications or visits.
(c) The child, and the parent(s) or guardian(s), or child placing agency representative shall be involved in the development of the comprehensive service plan, and its periodic updates as described below.
(d) The comprehensive service plan shall be updated by the HSP at a minimum of every thirty days, or whenever the child experiences a significant change in condition, and pertinent progress notes and data shall be incorporated in the plan to measure attainment of stated goals and objectives.
1. The review shall consider input from the care team providing services directly to the child.
2. The center shall be responsible for implementing the comprehensive service plan.

Cite as Ga. Comp. R. & Regs. R. 290-2-6-.12

Authority: O.C.G.A. Secs. 49-5-8, 49-5-12.

History. Original Rule entitled "Assessment and Planning for Transition Care Services" adopted. F. Jan. 27, 2009; eff. Feb. 16, 2009.