Standards for public agencies

2020 Edition

Child and Family Services (PA-CFS) 17: Physical and Mental Healthcare for Children in Out-of-Home Care

Children in out-of-home care receive comprehensive healthcare services within appropriate timeframes to promote optimal physical, mental, and developmental health.



When possible, American Indian and Alaska Native children should receive services from qualified professionals who have experience working with the tribe and knowledge of tribal customs and practices. Agencies that have the responsibility for placing Indian children should be aware of services that the child may have access to through tribally contracted health facilities or through the federal Indian Health Services. The agency should work with the tribe or a local Indian organization to ensure they have access to needed medical information.

NA The agency does not work with children placed in out-of-home care.
2020 Edition




Child and Family Services promote child and family well-being, protect children’s safety, stablilize and strengthen families, and ensure permanency.
Examples: Providing children with a medical or health home, where care is provided by professionals with expertise on the issues of children in out-of-home care, can help to ensure that they receive comprehensive services that meet their needs.

Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions; exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement. 
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.  
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.  
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  
  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.   
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner. 
  • Service quality or agency functioning may be compromised.   
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Initial health screening procedures
  • Procedures for the coordination and provision of physical and mental health assessments and services
  • List of health and mental health care providers, with credentials
  • Informational health and wellness materials provided to children


  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Parents served
    4. Children served
    5. Resource parents
    6. Residential treatment providers
  • Review case records

Fundamental Practice

PA-CFS 17.01

Prior to or within 72 hours of initial entry into care children receive an initial health screening from a qualified medical practitioner to: 
  1. identify health conditions that require immediate or prompt medical attention;
  2. identify health conditions that should be considered in making placement decisions; and
  3. determine the need for further developmental assessment for children under age six.

Interpretation:  The initial health screening, as recommended by the American Academy of Pediatrics, should only be conducted by a qualified medical practitioner. When possible the screening should be performed by the child’s primary care physician who has knowledge of the child’s medical history or a physician that can serve as the child’s medical home while in out-of-home care. The screening may be completed by a nurse practitioner, registered nurse, or physician’s assistant if a physician is unavailable. The screening may be included in the assessment that occurs when a child is taken into custody following treatment at a hospital, clinic, or medical office.  


Agencies should develop their own procedures regarding whether it is appropriate for children in the temporary legal custody of kin to receive an initial health screening. 
Examples:  Conditions that require immediate or prompt medical attention include, but are not limited to: acute illnesses, chronic diseases requiring therapy, signs of abuse or neglect, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances. 

Fundamental Practice

PA-CFS 17.02

Qualified professionals provide children with age-appropriate health services including:  
  1. comprehensive medical examinations within 30 days of entry into care and according to well-child guidelines; 
  2. dental examinations for children over age three within 30 days of entry into care and every 6 months thereafter, or more frequently based on clinical need; 
  3. developmental screenings within 30 days of entry into care to identify the need for further assessment for children over age six;
  4. ongoing developmental screenings according to well-child guidelines to identify the need for further assessment;
  5. alcohol and drug abuse screenings within 30 days of entry into care and when indicated thereafter to identify the need for further diagnostic assessment; and 
  6. any services needed to address issues or conditions identified during health screenings, assessments, or examinations.



Agencies should follow the Recommendations for Preventative Health Care for children in foster care published by the American Academy of Pediatrics. Medical assessments should include, as appropriate to children’s ages and circumstances: lead exposure, tuberculosis testing, and HIV/STD risk assessment screening. 

Interpretation: Regarding dental exams, the agency can receive a rating of “2” if there is an annual preventive exam and evidence that recommendations from the dental care provider indicate children are not in need of more frequent care.

Fundamental Practice

PA-CFS 17.03

Children receive: 
  1. mental health screenings within 30 days of entry into care, and when indicated thereafter; and
  2. diagnostic mental health assessments, when indicated.



Initial screenings can be conducted by trained caseworkers, but follow-up mental health assessments must be provided by qualified mental health professionals in accordance with applicable state or local regulations. Screenings should include attention to trauma exposure and symptoms, and trauma-focused assessments should be provided when needed. When a child is in treatment foster care the diagnostic mental health assessment must occur within 30 days prior or subsequent to placement.

Fundamental Practice

PA-CFS 17.04

Qualified mental health professionals provide: 
  1. any needed mental health services, including evidence-based psychosocial services and pharmacological treatments, as appropriate; and
  2. appropriate oversight of psychotropic medication use, including close supervision and monitoring of children receiving medications for off-label uses.


PA-CFS 17.05

Relevant information about children’s health and mental health, including family history when available, is shared with providers and resource parents or residential treatment providers, as appropriate.

Fundamental Practice

PA-CFS 17.06

Children receive age-and developmentally-appropriate support and education regarding:  
  1. proper nutrition and exercise;
  2. substance use and smoking;
  3. personal hygiene;
  4. safe and healthy relationships;
  5. sexual development;
  6. family planning and pregnancy options;
  7. pregnancy, prenatal care, and effective parenting;
  8. prevention and treatment of sexually transmitted infections/diseases; and
  9. HIV/AIDS prevention.