Library: Policy

340:75-1-113. Acquired Immunodeficiency Syndrome (AIDS) or Human Innumodeficiency Virus (HIV) requirements related to the child in Oklahoma Department of Human Services (OKDHS) custody

Revised 7-1-13

(a) Care and treatment for the child in OKDHS custody diagnosed with AIDS or HIV. • 2

(1) The child in OKDHS custody has special needs when the child is:

(A) at risk for HIV;

(B) seropositive for HIV; or

(1) The child in OKDHS custody has special needs when the child is:

(A) providing education regarding the transmission of HIV and precautions exercised to prevent transmission;

(B) providing therapeutic intervention for the child found at risk of exposure to HIV;

(D) protecting the child's right to privacy.

(2) The principles of care and treatment include:

(A) providing education regarding the transmission of HIV and precautions exercised to prevent transmission;

(B) providing therapeutic intervention for the child found at risk of exposure to HIV;

(D) protecting the child's right to privacy.

(b) Legal authority to provide care for the child in OKDHS custody with HIV or AIDS.

(1) Sections 1-7-102 and 1-7-103 of Title 10A of the Oklahoma Statutes (10A O.S. §1-7-102 and 1-7-103) require OKDHS to provide care and treatment of the child in OKDHS custody.

(A) contagious or infectious screening examinations or tests of the child; and

(B) the results of the child's examinations or tests to the placement provider.

(2) Per 10A O.S. § 1-7-104, OKDHS provides the child's placement provider with sufficient medical information to enable the placement providers to care for the child safely and appropriately. The placement provider for the child in OKDHS custody may request OKDHS to provide:

(c) Definitions. The following words and terms, when used in Part 9 of this Subchapter, shall have the following meaning, unless the context clearly indicates otherwise:

(1) "Acquired Immunodeficiency Syndrome (AIDS)" means a condition caused by a virus, Human Immunodeficiency Virus (HIV), that attacks the body's natural immune system, reducing the ability to fight off infections and diseases.

(A) is trained and certified by Oklahoma State Department of Health or American Red Cross in the health implications of HIV/AIDS; and

(B) offers supportive services for a person dealing with suspected or actual HIV infection or HIV/AIDS.

(2) "AIDS counseling" means counseling provided by a designated person who:

(A) obtained pursuant to a release of confidential HIV-related information;

(B) regarding a person who:

(i) is the subject of an HIV-related test; or

(ii) has HIV infection, HIV-related illness, or AIDS; or

(C) that identifies or may identify a person with one or more such conditions, including information pertaining to the person's contacts.

(3) "Confidential Human Immunodeficiency Virus (HIV)-related information" means information:

(4) "Exposure to HIV" means the blood, semen, vaginal fluids, breast milk, or other bodily fluid of an HIV infected person comes in contact with the blood stream or a mucous membrane of an uninfected person.

(A) unprotected sexual contact between such persons;

(B) sharing syringe needles among such persons;

(D) breast feeding when the mother is HIV infected.

(5) "High risk behaviors" means activities or conditions that place a person at risk of exposure to HIV due to contact with certain bodily fluids of a person who is infected with HIV, such as:

(6) "HIV" means the virus that causes AIDS.

(7) "HIV test" means a blood test used to detect the presence of antibodies to HIV.

(A) understands and is competent to make an intelligent decision about the request for consent and any resulting consequences;

(B) understands any risk involved and the procedures to be undertaken; and

(8) "Informed consent" means consent obtained from a person who:

(9) "Need-to-know" means a person who needs to be informed about the HIV status of a child due to the person's direct responsibility or accountability for the child's care.

(10) "Reduction of risk to HIV exposure" means reduced exposure to HIV through universal application of infection control procedures. Exposure occurs when fluids such as, semen, blood, vaginal fluids, breast milk, or other bodily fluids from an infected person comes in contact with the bloodstream or a mucous membrane of an uninfected person.

(11) "Release of confidential HIV-related information" means disclosure through written authorization, including informed written consent for testing and release of HIV test results, that is signed by the person who has the authority to consent.

(12) "Serologic testing and screening" means blood tests used to detect antibodies to HIV, including Enzyme-Linked Immunosorbent Assay (ELISA) and Western Blot.

(13) "Seronegative" means a blood test indicates a negative result for the presence of a disease such as AIDS.

(14) "Seropositive" means the result of a blood test indicates the presence of a disease such as AIDS.

(A) is trained by Oklahoma State Department of Health or American Red Cross in the health implications of HIV and AIDS; and

(B) provides AIDS-related training.

(15) "Specialized AIDS trainer" means a person who:

(A) sexual contact, including oral, vaginal, or anal contact, with an infected person's blood, semen, vaginal secretions, or other bodily fluids;

(B) exposure to infected blood or blood products through needles, occupational exposure, or transfusions; or

(16) "Transmission of HIV" means passing or spreading HIV infection through:

(17) "Universal precautions" means an approach to infection control in which all human blood and certain human body fluids are treated as infected with bloodborne pathogens, such as bacteria, HIV, or other viruses or disease.

(d) Required AIDS and HIV educational training for CW staff and placement providers. Educational training regarding AIDS and HIV infection is required for Child Welfare (CW) staff and placement providers.

(e) Certified HIV/AIDS counselor role. OKDHS provides trained certified HIV/AIDS counselors who participate in HIV pre-test and post-test activities.

(f) HIV confidentiality.

(1) Per 63 O.S. § 1-502.2, except as otherwise provided by law, all information and records concerning any person who may have a communicable or noncommunicable disease required to be reported by Oklahoma statute are confidential. 10A O.S. §1-6-101 defines agency records as records prepared, obtained, or maintained by the agency and would include the medical records of a child in OKDHS custody, including information regarding any communicable or sexually transmitted disease, pertaining to a child. 10A O.S. § 1-6-103 provides OKDHS records may be inspected and contents disclosed without a court order to certain persons showing proper credentials and pursuant to their lawful duties. HIV-related information about the child, or any person who is a member of the child's case record, may be disclosed to:

(A) the court having the child currently before it in any proceeding pursuant to Title 10A of the Oklahoma Statutes;

(B) a district attorney (DA) or employee of the DA's office in the course of his or her official duties pursuant to Title 10A of the Oklahoma Statutes;

(D) others entitled to access CW records without a court order, per 10A O.S. § 1-6-103; and

(E) per 10A O.S. §1-7-104, the placement provider, if this information is known to OKDHS.

(2) Disclosure of the child's HIV serological status is limited to the child's placement provider, court, DA, and child's attorney. OKDHS consults with the judge and DA to determine the appropriate method of disclosure of HIV-related information to the court and DA to prevent inadvertent disclosure by inclusion of the information in the court file regarding the child. Others entitled to access to CW records without a court order, per OAC 340:75-1-44, are provided communicable disease information on a need-to-know basis.

(3) A person advised of another person's HIV status, with the exception of the court, DA, or child's attorney, signs and dates a statement similar to the statement of confidentiality in (A) of this paragraph.

(A) This information is disclosed to you from confidential records that are protected by state law. State law prohibits you from making any further disclosure of this information without obtaining specific written authorization, per Part 9 of OAC 340:75-1, or as otherwise permitted by law. Any unauthorized further disclosure is in violation of state law and may result in civil or criminal sanctions as provided by Oklahoma Statutes.

(B) A general authorization for release of medical or other information is not sufficient authorization for further disclosure of a person's HIV status.

(g) Early identification of communicable disease. Per 10A O.S. § 1-7-103, OKDHS provides medical care as is necessary to preserve the child's health and protect the health of others in contact with the child.

(h) Placement provider's request for HIV test. • 3 When requested by the placement provider, OKDHS provides for the HIV examinations or tests on the child based on the Centers for Disease Control guidelines for time and frequency of testing. Per 10A O.S. §1-7-104 OKDHS provides the child's placement provider with sufficient medical information to enable the placement provider to care for the child safely and appropriately. The medical information includes, but is not limited to:

(1) any medical or psychological conditions;

(2) diseases, illnesses, accidents, allergies, and congenital defects;

(3) the child's Medicaid card or information on any other third-party insurer, if any; and

(4) Immunization history.

(i) Authorization for HIV testing. When requested by the child's placement provider, per 10A O.S. §1-7-104, OKDHS obtains authorization for an HIV test for the child and release of the test results to the placement provider. Authorization for HIV testing or release of HIV test results may be obtained by informed written consent of the child's parent or legal guardian or court order. • 5

Instructions to Staff 340:75-1-113

Issued 7-1-13

1. Human Immunodeficiency Virus (HIV)-related services for the child not in Oklahoma Department of Human Services (OKDHS) custody.When the child has engaged or is engaging in high risk behaviors associated with HIV, or the child's parent believes there is a risk of HIV exposure, the parent is referred to medical and counseling providers.

2. HIV-related services for the child in OKDHS custody.Services provided to the child in OKDHS custody by the Child Welfare (CW) specialist includes, but are not limited to education, screening and early identification, individualized needs-based service and treatment planning, counseling, placement, and case management, per OAC 340:75-1-115.

(1) HIV education.The CW specialist educates the:

(A) child about the methods of HIV transmission, high risk behaviors, methods to reduce HIV risk, consequences of the child's behaviors, and confidentiality related to HIV; and

(B) child's placement provider about methods of HIV transmission, high risk behaviors, methods to reduce HIV risk, consequences, HIV confidentiality, infection control in the placement, and universal precautions related to HIV.

(2) HIV assessment.The CW specialist assesses the risk behaviors associated with the transmission of HIV when developing each child's individualized service plan.

(3) HIV counseling.The CW specialist obtains HIV and Acquired Immune Syndrome (AIDS) counseling for the child who exhibits a need.Specialized HIV and AIDS counseling is provided by persons trained through Oklahoma State Department of Health or American Red Cross.

(4) HIV case management and planning.Case management and planning activities for the child in emergency or temporary OKDHS custody include the child's parent.The parent is encouraged to provide input into the planning and management of the child's treatment and placement.The CW specialist shares HIV-related information concerning the child with the child's parent.

(5) Placement for the child diagnosed with HIV.The child with medically diagnosed HIV infection is placed in an out-of-home placement consistent with the child's assessed treatment needs.

3. Disclosure of confidential HIV information to the placement provider.Prior to disclosure of confidential HIV related information to the placement provider or other person with a need to know, Form 04MP063E, Confidential Human Immunodeficiency Virus (HIV)-Related Information Disclosure Statement, is signed and dated by the placement provider or other person.A copy of the form is filed in the child's separate and confidential case record.

4. Early HIV identification.When the child's medical history or behaviors, as assessed by the CW specialist, indicate a risk of exposure to HIV, an HIV test may be performed at the time of the initial health screening.The CW specialist schedules the test as soon as feasible after the deprived petition is filed.

(1) The first HIV test is obtained when indicated or requested by the placement provider when no previous testing has occurred.The first test serves as a baseline.

(2) Regardless of results from the first test, a second test is done six months after the first to confirm whether HIV transmission has occurred.

5. Authorization for HIV Serological Testing.When the child in OKDHS emergency or temporary custody requires HIV serological testing, the CW specialist obtains informed consent from the child's parent, when possible utilizing Form 04MP062E, Authorization for Human Immunodeficiency Virus (HIV) Serological Testing and Test Results.Separate consents are required for the HIV testing and release of the HIV test results.

(1) When informed written consent from the child's parent or legal guardian is not obtained due to the parent's refusal to consent or inability to locate the parent, the district director or designee may consent to HIV testing and disclosure of the HIV test results.

(2) The district director or designee may consent for testing and release of test results for a child in permanent OKDHS custody.

(3) Parental consent received by OKDHS, per Form 04MP100E, Consent for HIV Serological Testing and Disclosure of Results, applies to any future examination or tests and disclosure of results as OKDHS determines necessary or upon request to the placement provider.

(4) The CW specialist explains to the child and the parent or legal guardian:

(A) the HIV testing need;

(B) medical procedures to be conducted;

(C) confidentiality associated with HIV testing and test results disclosure;

(D) time requirements for HIV test results;

(E) reasons HIV test results are provided to the CW specialist and placement provider;

(F) other persons who have a need to know about the child's HIV-related information; and

(G) how HIV is transmitted and necessary universal precautions.

(5) Form 04MP062E, Authorization for Human Immunodeficiency Virus (HIV) Serological Testing and Test Results is maintained in the child's HIV-related case record and includes:

(A) consent for testing or for disclosure of confidential HIV-related information;

(B) to whom consent or disclosure is authorized; and

(C) the purpose for consent or disclosure.

6. (a) Human Immunodeficiency Virus (HIV) pre-test activities. The HIV/Acquired Immune Deficiency Syndrome (AIDS) counselor:

(1) requests a copy of completed Form 04MP062E, Authorization for Human Immunodeficiency Virus (HIV) Serological Testing and Test Results and informs the Child Welfare (CW) specialist when the test is complete, if results were not previously provided by the CW specialist;

(2) provides pre-test counseling for the parent and child, as applicable;

(3) arranges for the child to be tested when informed written consent is obtained;

(4) schedules an appointment with the parent and child, as applicable, for post-test counseling and disclosure of test results;

(5) explains to the parent and child, as applicable, the importance of disclosing test results to the:

(A) assigned CW specialist to ensure proper case management and planning; and

(B) placement provider to ensure proper care and treatment for the child;

(6) explains other persons such as the court, district attorney, and child's attorney, per Section 1-6-103 Title 10A of the Oklahoma Statutes may have access to HIV-related information in the case record; and

(7) notifies the assigned CW specialist within two business days when the test is complete and provides the CW specialist with the date for post-test counseling for the parent and child, as applicable.

(b) HIV post-test activities. The HIV/AIDS counselor:

(1) provides post-test counseling to the parent and child, as applicable; and

(2) notifies the CW specialist of the test results the same day post-test counseling with the parent and child, as applicable, occurs.

7. HIV case record maintenance and contents.

(1) HIV-related information is maintained in a separate and confidential case record.

(2) The primary CW supervisor oversees case planning and maintains written documentation of all medical and case planning information regarding the health status of the child who is:

(A) tested for HIV;

(B) HIV seropositive; or

(C) medically diagnosed with AIDS.

(3) The HIV-related case record includes, but is not limited to:

(A) a list of persons receiving disclosure information;

(B) the specific purpose for disclosure;

(C) testing and health status information;

(D) narrative and other case documentation;

(E) the plan for child's care and treatment;

(F) a copy of authorizations for HIV testing and release of the HIV test results; and

(G)confidentiality statements.

8. Public information.Medical information concerning specific clients is not disclosed to the public.