45171. Medically Fragile Children


Children in out-of-home care who meet the definition of medically fragile will be identified. Develop plans with caregivers of medically fragile children to identify necessary supports to meet the day-to-day needs of the child (including respite and emergency situations).


  1. Children who meet the following criteria are identified as medically fragile:
    1. Child has medical conditions that require the availability of 24-hour skilled care from a health care professional or specially trained family or foster family member.
    2. These conditions may be present all the time or frequently occurring.
    3. If the technology, support, and services provided to a medically fragile child are interrupted or denied, the child may, without immediate health care intervention, experience death.
  2. When there is an indication that a child is medically fragile, refer the child to the ADSA Fostering Well-Being Care Coordination Unit for consultation and determination of the child's need for services.
  3. All children identified as medically fragile and in out-of-home care must have an identified Primary Health Care Provider.
  4. Out-of-home caregivers must be provided a Caregiver Support Plan that addresses training and support needs related to caring for a medically fragile child.
  5. All children identified as medically fragile must be documented in the FamLink Special Needs page.


  1. Complete a referral by emailing the Fostering Well-Being Care Coordination Unit at: dhsfwbccu@dshs.wa.gov.
  2. When a medically fragile child is discharged from a hospital:
    1. Participate in a discharge planning meeting with the identified caregiver
    2. Coordinate with hospital or Primary Health Care Provider about the discharge plan to:
      1. Assess appropriate placement,
      2. Identify resources and training to support the care of the child,
      3. Obtain a copy of the child's treatment plan or identify the on-going plan for treatment and examinations, and
      4. Refer the medically fragile child to the Fostering Well-Being Care Coordination Unit.
  3. When the assigned social worker has received confirmation from the Fostering Well-Being Care Coordination Unit that the child meets the medically fragile criteria:
    1. Ensure any recommendations made by medical providers and in the Care Coordination Summary are followed-up on to address the ongoing medical needs of the child.
    2. Document the child as "medically fragile" in the Special Needs page in FamLink.
  4. Develop a Caregiver Support Plan for initial and any subsequent placements with a caregiver. At a minimum, the plan must address:
    1. Caregiver training specific to the child's needs,
    2. Additional supports to meet the child's needs, e.g. Medicaid Personal Care,
    3. Support for the caregiver to have alternate care for the child if needed, e.g. planned and emergency respite care, and
    4. Steps to take in an emergency situation when a caregiver is unable to care for the child.
  5. NOTE: Children placed in Behavioral Rehabilitation Services group or foster homes, skilled nursing facilities, on a trial return home, or who receive case management services from a Child Placing Agency do not require Caregiver Support Plans.
  6. Determine any additional support and training needs during the initial Social Worker Monthly Health and Safety Visit within the first 7 days of placement.
  7. Review the Caregiver Support Plan with the caregiver at each Social Worker Monthly Health and Safety Visit to determine if any changes to the plan are needed.
  8. Upload the Caregiver Support Plan signed by the caregiver into FamLink. Document the following in FamLink within 10 calendar days of receiving information:
    1. Child's medically fragile status on the FamLink Special Needs page per Medically Fragile Documentation, and
    2. Child's medical conditions/information in the Health/Mental Health page per Health Care Services for Children in Out-of-Home Care policy

See Also