12 Colo. Code Regs. § 2509-2-7.106

Current through Register Vol. 47, No. 11, June 10, 2024

Section 12 CCR 2509-2-7.106 - ADDITIONAL CATEGORIES OF ASSESSMENTS

7.106.1EGREGIOUS INCIDENTS OF ABUSE AND/OR NEGLECT, NEAR FATALITIES, OR CHILD FATALITIES [Eff. 1/1/15]

The requirements of this section address assessments of referrals of an incident of suspected abuse and/or neglect involving any of the following circumstances:

A. Significant violence, torture, use of cruel restraints, or other similar, aggravated circumstance;

B. A child has died; or,

C. A physician has determined that a child is in serious, critical, or life-threatening condition as a result of sickness or injury.

7.106.11Assessment Procedures - Timing and Requirements [Eff. 1/1/15]

A. County departments shall conduct a High Risk Assessment (HRA), or traditional response assessment of egregious incidents of abuse and/or neglect, a near fatality, or a child fatality in intrafamilial and institutional settings in those cases in which:

1. There is reason to know or suspect that abuse and/or neglect caused or contributed to the incident; or,

2. The cause of the incident is unknown or the information given is not consistent with the degree or type of injury and/or subsequent death.

B. County departments shall:

1. Coordinate with the following agencies to ensure prompt notification of an incident of egregious abuse and/or neglect, near fatality, or fatality of a child, which is suspicious for abuse and/or neglect:

a. Law enforcement;

b. District attorney's office;

c. Coroner's office; and,

d. Hospitals.

2. Coordinate the assessment with law enforcement. At a minimum in cases in which there are no surviving children, county departments shall provide law enforcement and the coroner with information related to any prior involvement with the child, the family, or the person alleged to be responsible for the abuse and/or neglect.

3. Assess the condition of any surviving child(ren) and take action necessary to ensure their protection by:

a. Visiting the child(ren)'s home or place of custody;

b. Interviewing and/or observing the child(ren);

c. Examining the child(ren) to include an assessment of the child(ren)'s overall current physical, mental, or emotional condition;

d. Assessing the safety of the home environment, to include an interview with the parents, guardians, and/or legal custodians; and,

e. Seeking an emergency protective order only when there are reasonable grounds to believe that a surviving or non-injured child(ren) is at risk of severe emotional or physical harm in his/her home environment.

7.106.121Additional Actions When County Department has had Prior/Current Involvement

A. When a county department has custody of the child/youth and/or protective supervision, it shall immediately take the following actions:

1. Notify the parents, guardians, and/or legal custodians of the incident. If the parents, guardians, and/or legal custodians reside in another county or state, the county department shall coordinate with the county department of residence for the parents, guardians, and/or legal custodians to provide personal notification, whenever possible.

2. Notify the sibling/s in an age-appropriate and developmentally appropriate manner of the event and any placement changes from the Department of Human Services directly or indirectly in consideration of the victim's preferences when possible.

3. Notify the director of the county department of the incident. The county director shall also be immediately notified if the department has had prior child welfare involvement within the last three (3) years that was directly related to the egregious incident of abuse and/or neglect, near fatality or fatality to include referrals that have been screened out. A complete copy of the child/youth's case record shall be made available to the director of the county department.

4. Notify the court, the attorney for the county department, and the Guardian Ad Litem (when one has been assigned) and/or counsel for youth (when one has been assigned) of the incident involving any child/youth who is under the court's jurisdiction.

B. Upon notification of an egregious incident of abuse and/or neglect, near fatality or fatality in which the county department has had prior child welfare involvement within the last three (3) years with the child, family, or person alleged to be responsible for abuse and/or neglect, the director of the county department shall take the following actions:

1. Designate an individual(s) who will be responsible for assessing the egregious incident of abuse and/or neglect, near fatality or fatality. In the event of a conflict of interest, the county department shall arrange for the assessment to be conducted by another county department with personnel having appropriate training and skill.

2. When a county department determines that an incident of egregious abuse and/or neglect, near fatality, or fatality of a child is founded for child abuse and/or neglect, the director shall ensure that the county department conducts a complete internal administrative review of any child welfare involvement in the case prior to the egregious incident of abuse and/or neglect, near fatality or fatality. This review shall be referred to as the county department's internal review and shall be completed whenever the county department has had current or prior involvement with the child, family or person alleged to be responsible for the abuse and/or neglect, within the last three (3) years. The review shall include, at a minimum:

a. Assessment of the interventions made by the county department.

b. Evaluation of the case plan.

c. Identified areas of strengths and/or weaknesses in the casework process.

d. Analysis of any systemic issues that may have led to delays or oversights.

e. Evaluation of the role played by other community agencies and the overall case coordination.

f. Recommendations for staff training or changes in the system that would avoid other similar occurrences.

3. Submit a written report of the county department's internal review within ninety (90) calendar days of the initial notification of the egregious incident of abuse and/or neglect, near fatality or fatality to the State Department.

C. If another county department also has current and/or prior involvement with the child, family or person alleged to be responsible for the abuse and/or neglect within the three (3) year period of the incident of egregious abuse and/or neglect, near fatality or fatality (including referrals that were screened out), the State Department shall decide whether a county department internal review report will be required.

7.106.13Reporting to the State [Eff. 9/1/2018]

A. Within twenty-four (24) hours (excluding weekends and holidays) of a county department becoming aware of an egregious incident of abuse and/or neglect, or near fatality or fatality of any child, which is suspicious for abuse and/or neglect, the county department shall call or email the following known information to the State Department which shall also be documented on the state prescribed form:

1. Name and age of victim;

2. The referral identification number generated by the state automated case management system;

3. Known circumstances around the egregious incident of abuse and/or neglect, near fatality or fatality;

4. A description of physical injuries or medical condition of the child(ren) at the time of receipt of the information;

5. The names and ages of surviving or non-injured child(ren) who may be at risk;

6. A brief description of family/caregiver's prior involvement with child welfare, if any;

7. The actions taken by the county department to date and future actions to be taken;

8. The involvement of other professionals in the case;

9. Whether the child was in out-of-home placement at the time of the incident; and,

10. For fatal incidents, the county shall enter the child's date of death in the state automated case management system.

B. Upon notification of an egregious incident of abuse and/or neglect, near fatality or fatality, the county department shall take the required steps to restrict access to the state automated case management system to the current assessment of the egregious incident of abuse and/or neglect, near fatality or fatality, and any prior involvement in the state automated case management system regarding this child, the child's family members, and the person(s) suspected of the abuse and/or neglect. Access shall remain restricted until the conclusion of the state child fatality review, at such time the county department shall determine whether the records shall be unrestricted.

C. The county department shall provide the following information to the State Department within sixty (60) calendar days of the initial notification of the egregious incident of abuse and/or neglect, near fatality or fatality, to the extent possible, and no longer than sixty (60) calendar days without a written request from the county department for an extension and subsequent State Department approval granting an extension:

1. The completed referral/assessment summary in the state automated case management system;

2. Copies of any pertinent social, medical, and mental health evaluations of all involved subjects (child(ren), family, caregivers, etc.);

3. Coroner's records, including autopsy report;

4. Police reports of present investigation as well as any prior criminal history of all subjects;

5. A copy of any of the case record not obtainable in the state automated case management system;

6. A statement of any human services and Medicaid assistance or services that were being provided to the child and are recorded in the state automated case management system, the Colorado Benefits Management System, or the Colorado child care automated tracking system, any member of the child's family, or the person alleged to be responsible for the abuse and/or neglect; and,

7. The age, income level, and education of the legal caregiver at the time of the fatality.

7.106.14State Review of an Incident of Egregious Abuse or Neglect, Near Fatality or Fatality of a Child [Eff. 1/1/15]

When a county department determines that an incident of egregious abuse and/or neglect, near fatality, or fatality of a child is founded for child abuse and/or neglect, and where a county department had previous involvement within 3 years prior to the date of the incident, the county department shall submit reports outlined in 7.106.13 C for review by the State Department in accordance with Section 7.106 of this rule, and cooperate with the State Department's review. The State Department shall conduct a multidisciplinary review of such cases, where a county department had previous involvement in the three years prior to the incident of egregious abuse and/or neglect, near fatality, or fatality. A county representative(s) from each county having previous involvement in the three years prior to the incident shall participate in the multidisciplinary review in person, by telephone, or through other emerging technology. The State Department Child Fatality Review shall occur within forty-five (45) business days of the State Department receiving all required and relevant reports and information critical to an effective fatality review. These reviews shall include:

A. The circumstances around the incident of egregious abuse or neglect against a child, near fatality, or child fatality;

B. The services provided to the child, the child's family, and the perpetrator by the county department for any county with which the family has had previous involvement, as defined in paragraph (c) of subsection (2) of this section, within three years prior to the incident of egregious abuse or neglect against a child, near fatality, or fatality of a child due to abuse or neglect;

C. The county department's compliance with statutes, regulations, and relevant policies and procedures that are directly related to the incident of egregious abuse or neglect against a child, near fatality, or fatality;

D. Identification of strengths and best practices of service delivery to the child and the child's family;

E. Consideration of factors that may have contributed to conditions leading to the incident of egregious abuse or neglect against a child, near fatality, or fatality, including, but not limited to, lack of or unsafe housing, family and social supports, educational life, physical health, emotional and psychological health, and other safety, crisis, and cultural or ethnic issues;

F. The supports and services provided to siblings, family members, and agency staff after the incident of egregious abuse or neglect against a child, near fatality, or fatality; and,

G. The quality and sufficiency of coordination between state and local agencies

7.106.15CASE SPECIFIC REVIEW REPORT [Eff. 1/1/15]

The Department will author confidential and non-confidential case specific review reports in accordance with Section 26-1-139, C.R.S. As part of this process, the Department shall request a response to the case specific review report from any county having previous involvement with the family as defined in Section 26-1-139(2)(c), C.R.S., and include the response(s) in the final confidential and non-confidential report.

7.106.16CHILD FATALITY REVIEW TEAM ANNUAL REPORT [Eff. 1/1/15]

By July 1 of each year, the Department will author an annual Child Fatality Review Team report. It shall contain the following information:

A. Policy recommendations based on the collection of reviews required by Section 26-1-139(5)(a), C.R.S.

B. Status of recommendations made in prior case specific, executive summary reports. This shall include all recommendations from publicly posted reports from the most recent, complete calendar year and all recommendations from prior years that were not completed at the time of the last annual report.

C. Aggregate demographic data. This may include, but not be limited to, data such as age of children at the time of the incident, race/ethnicity of the children, relationship of the perpetrator to the child, and other factors determined to be of importance.

D. A summary of review findings from reports completed on incidents from the most recent complete calendar year.

E. Joint recommendations made with the Colorado Department of Public Health and Environment's Child Fatality Prevention System as required by Section 25-20.5-407(1)(i), C.R.S.

7.106.2MEDICAL NEGLECT OF INFANTS AND TODDLERS WITH DISABILITIES - GROUNDS FOR ASSESSMENT [Eff. 1/1/15]

The requirements of this section address assessments of referrals of medical neglect involving:

A. Infants less than one (1) year of age who were born with a life-threatening condition and who may have additional non-lethal physical or mental disabilities; or,

B. Toddlers under three (3) years of age who have been continuously hospitalized since birth, who were born extremely premature, or who have a long-term disability.

7.106.21Agency Responsible for Conducting the Assessment [Eff. 1/1/15]

A. The county department responsible for conducting the assessment of a referral of medical neglect shall be the county in which the caregivers of the hospitalized infant reside.

B. If the caregivers' residence cannot be determined, the county department in which the hospital is located shall be responsible for conducting the assessment.

7.106.22Assessment Procedures - Timing and Requirements [Eff. 1/1/15]

County departments shall:

A. Work with medical organizations, hospitals, and health care facilities to implement procedures that ensure a timely response and resolution of referrals of medical neglect;

B. Obtain all relevant medical data concerning the child. County departments shall seek a court order to obtain records if the request for such material is refused;

C. Coordinate with any existing hospital review committees, which may have evaluated and recommended treatment in the case under assessment;

D. If, after assessing the medical neglect referral, there are indications that the referral of medical neglect may be founded, the county department shall interview the parent(s); and,

E. Refer the matter to the local law enforcement agency in cases in which the infant has died before the assessment is completed and the county department has reason to suspect withholding of medically indicated treatment. The matter shall be referred to the law enforcement agency in the location where the child died. However, if it is determined that treatment was not medically indicated, or that medically-indicated treatment had not been withheld, then the report shall be deemed unfounded.

7.106.23Medical Decisions Regarding Infants and Toddlers [Eff. 1/1/15]

A. County department staff shall make no medical decisions regarding infants and toddlers and shall seek an independent medical consultation when indicated.

B. If the parent(s) wish to seek a second medical opinion, the county department shall provide referral assistance.

C. If the county department finds that an independent medical evaluation is necessary to determine the infant or toddler's medical prognosis, the county department shall recommend to the parent(s) that an independent medical evaluation be done.

D. If the county department determines that medically-indicated treatment or palliative care is being or will be withheld; and:

1. The infant or toddler's condition requires an urgent response, or,

2. Efforts by the county department or hospital personnel to obtain parental consent to treatment would be futile or already have failed, then the matter shall be brought to court under a petition. The petition may include a request to place temporary custody of the child with the county department to ensure proper medical treatment is provided. The county department shall immediately secure a court order if indicated.

7.106.3ASSESSMENT OF MEDICAL NEGLECT IN WHICH RELIGIOUS CONSIDERATIONS ARE INVOLVED - GROUNDS FOR ASSESSMENT [Eff. 1/1/15]

County departments shall assess cases of medical neglect including those cases in which there is a failure to provide medical treatment based upon the parent's, guardian's, or custodian's religious beliefs and there is concern that such failure will result in a threat to child's health and welfare.

7.106.31Assessment Procedures - Timing and Requirements [Eff. 1/1/15]

The assessment shall be conducted as described below:

A. The county department shall obtain a medical evaluation if the child's condition presents substantial concern for the child's health and welfare. This evaluation shall be obtained with the consent of the parents, guardians, or legal custodians. If such consent is refused, the county department shall seek a court order to obtain medical evaluation;

B. The county department shall consult with medical practitioners and consider whether the child's condition is life-threatening or will result in serious disability without professional medical care; and,

C. If the child's condition is determined to be life-threatening or could result in serious physical impairment or serious disability without professional medical care, the county department shall seek a court order authorizing the provision of the necessary medical care in the event that such care is refused by the parent, guardian, or legal custodian. The county department may, but is not required to, seek temporary custody of the child in order to obtain judicial authorization for treatment.

7.106.32Spiritual Healing Considerations [Eff. 1/1/15]

If spiritual healing is involved, the county department shall follow the guidelines defined in Section 19-3-103(2)(a), (b), C.R.S., to decide whether the method is a "recognized" method of religious healing and whether such healing is considered to be medically effective for the child's condition.

7.106.33Impact of Parental Interference on Findings [Eff. 1/1/15]

A. If a parent, guardian, legal custodian, or caregiver inhibits or interferes with the provision of medical evaluation or treatment according to a court order, that act would constitute neglect and in such circumstances a referral shall be made to law enforcement and the county department may file a dependency and neglect petition.

B. For purposes of entering founded findings of abuse and/or neglect into the state automated case management system, reporting to police for criminal investigation, and filing of dependency and neglect petitions, no child who is under treatment by a recognized method of religious healing shall, for that reason alone, be considered to have been neglected and dependent unless the child's parent, legal guardian, custodian, or caregiver inhibits or interferes with the provision of medical services according to court-ordered medical evaluation or treatment.

7.106.4Safe Haven Voluntarily Surrendered Infant Grounds for Assessment

The requirements of this section address assessments of referrals when an infant is voluntarily surrendered to staff at a hospital, community clinic emergency center, or fire station within 72 hours of birth and the parent does not express an intent to return for the infant in accordance with section 19-3-304.5, C.R.S. Requirements set forth in section 7.104 through 7.104.15 do not apply to safe haven voluntarily surrendered infant assessments.

7.106.41Agency Responsible for Conducting the Assessment

The county department responsible for conducting the assessment of a referral of a safe haven voluntarily surrendered infant shall be the county in which the infant was voluntarily surrendered.

7.106.42Assessment Procedures - Timing and Requirements

County departments shall:

A. Assign priority in response time using the criteria set forth in section 7.103.60.

B. Conduct a face-to-face observation with the alleged victim child in accordance with the assigned response time.

C. Conduct a check with law enforcement for reported missing infants.

D. Place the infant in a potential adoptive home.

E. Open a case to pursue permanency.

F. Report the assessment to the state department within 5 business days of receiving a referral of a voluntarily surrendered infant.

G. If additional allegations of known or suspected abuse and/or neglect are identified during the course of the assessment, the requirements set forth in sections 7.104 through 7.104.15 shall apply.

7.106.43Findings

A. A parent shall not be the subject of a confirmed allegation of abuse and/or neglect solely based on surrendering an infant pursuant to section 19-3-304.5, C.R.S.

7.106.44Documentation Required at Conclusion of Assessment

A. Enter a closure summary containing a brief summary of initial concerns and any additional concerns discovered during the assessment and the actions that were taken.

B. The assessment shall be approved by a certified supervisor and closed within sixty (60) calendar days of the date the referral was received.

12 CCR 2509-2-7.106

38 CR 19, October 10, 2015, effective 11/1/2015

39 CR 17, September 10, 2016, effective 10/1/2016

39 CR 19, October 10, 2016, effective 11/1/2016

40 CR 11, June 10, 2017, effective 7/1/2017

40 CR 13, July 10, 2017, effective 8/1/2017

41 CR 01, January 10, 2018, effective 2/1/2018

41 CR 03, February 10, 2018, effective 3/2/2018

41 CR 15, August 10, 2018, effective 9/1/2018

42 CR 03, February 10, 2019, effective 3/15/2019

43 CR 09, May 10, 2020, effective 6/1/2020

44 CR 01, January 10, 2021, effective 1/30/2021

44 CR 13, July 10, 2021, effective 7/30/2021

44 CR 21, November 10, 2021, effective 11/30/2021

44 CR 23, December 10, 2021, effective 12/30/2021

45 CR 01, January 10, 2022, effective 1/30/2022

45 CR 05, March 10, 2022, effective 3/30/2022

45 CR 11, June 10, 2022, effective 6/30/2022

46 CR 03, February 10, 2022, effective 3/2/2023

46 CR 09, May 10, 2023, effective 6/1/2023

46 CR 11, June 10, 2023, effective 7/1/2023