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Medical Visit Guidance

Interim guidance issued for medical visits during COVID-19.

Table of Contents

Medical Visit Guidance

Issued: 3/20/20

Updated: 8/4/20

This updated guidance is for DCF staff working with children in placement. In order to limit the spread of COVID-19, many medical offices suspended visits in March but many are now resuming in-person visits statewide. Pediatric and family medicine offices and health centers are now open and encouraging in-person visits, for well-child care, immunizations, sick visits, and initial screening and comprehensive exams after placement. In many cases, video tele-health remains an option.

Medical practices in Massachusetts require children over the age of 2 and adults to wear masks at all times during in-person visits. In addition, most practices have specific protocols in place to ensure safety of all; they will describe their protocols to you when you call to schedule the appointment.

We encourage you to check in with children, families, and foster/kin about any emergent or ongoing medical needs that children in placement may have. You may identify children that need medical attention, especially children who have recently entered placement. Children in care may have routine medical visits scheduled, complex medical needs that necessitate ongoing visits, or they may be sick. Please be aware that many children may have missed routine immunizations since March due to the previous restrictions to mitigate the spread of COVID-19. Now that it is safer to resume in- person medical visits, catching up with immunizations must be prioritized.

The DCF Medical Team and medical social workers are available to support you in coordinating care and answering any questions you may have.

Screening and Comprehensive Exams

Although comprehensive visits were mostly suspended in March, we now encourage all children entering a new placement to be seen for an initial screening exam within 7 days and a comprehensive medical exam within 30 days. Visits may be scheduled in-person or by telehealth. In person visits should occur whenever possible and appropriate. Offices may also screen sick children by telehealth to determine if they need to be seen in person. Priority should be placed on children with chronic medical conditions (like asthma, diabetes, cardiac conditions), children under 5, and children who are ill at the time of home removal.

If children are sick: Please call the health care provider as medical offices have specific screening protocols in place to mitigate the spread of COVID-19.

Missing or Absent Medical Visits

You may have a child that returns from an episode of being missing or absent from their placement. Medical visits are not required every time this occurs and should happen on an as needed basis. If sexual exploitation is suspected, the child has an injury, or is in an acute psychiatric state you should schedule a medical screening and/or a mental/behavioral health evaluation. Refer to the Children Who are Missing or Absent Policy for additional information on talking to children when they return from being missing or absent to determine if medical attention is needed.

Well-child check-ups and Immunizations

Well-child check-ups and immunizations may have been cancelled over the past few months. It is very important that children resume receiving their well- child exams and their immunizations, especially for children under 2 years of age. Pediatric and family practice offices and health centers are open, safe, and offering in-person as well as telehealth visits. They are also providing guidance for any behavioral or mental health issues that are coming up with children in our custody.

Getting Children to Visits Safely

Getting children to critical medical visits may become a challenge for foster and kin caregivers, especially if they are caring for multiple children. There may be situations where you will need to take children needing critical medical attention to a medical visit. If this occurs, we recommend talking to your supervisor, manager and the DCF Medical team to screen and plan for everyone’s safety. If you are transporting a child, there are precautions you should take to ensure safety, including utilizing PPE, maintaining as much distance as possible in the vehicle, opening windows when possible to support airflow and cleaning/disinfecting before and after transport. Please refer to DCF’s Guidance on Transporting Children for additional information.