Medically Fragile Children in DCPP/DYFS Custody


Children who are considered “special needs” that end up in resource care are required to be placed with special placement providers who are trained to provide a higher degree of care. These homes are referred to as “ships” placements. “Ships” is abbreviated as SHSP (Special Home Service Provider).

Children who are placed in SHSP’s homes are typically those with medical injuries that require more frequent medical attention than children in the same age category without such injuries. However, not every child who has some form of medical ailment or injury requires such a placement. For instance, a baby who was not yet ambulatory at the time of an injury that is now in a cast requires no higher degree of attention and care than any other baby, except that she must have her cast carefully cleaned, examined, et cetera.

The determination of whether a child requires a SHSPs home is an important one. If the child is placed in such a home, the parent will likely receive substantially less parenting time with the child, as relative placements are unlikely. With standard placements, relatives can be provisionally approved, subject to completing the foster parent training (i.e., referred to as the Pride training course). If a child is medically fragile, the placement must be a SHSPs foster placement, and the division and the court are less likely to approve a relative for placement, subject to subsequent training.

Of course, one must question why this is the case. After all, if a parent leaves the hospital with a child in a cast, with a medical problem, one requiring higher attention in the detailed medical instruction, that child is still released to his parents with instruction from his doctors. Yet, with foster placements, the state takes the position that some “high degree” of medical training is required in order to have placement of the child, no matter the degree of injury or ailment from which the child suffers. This is likely because parents are entitled to commit simple negligence when caring for their children, whereas the state is not. As such, the state is less likely to accept well-intentioned foster placements that do not meet their highest criteria for care if the child has already been physically injured, resulting in removal from the parents and placement in foster care.

It is important to look to the child’s specific injuries when evaluating whether or not a SHSP home is required. Many times, when such a placement is not required, exploring the basis for the placement can give helpful insights to the court when evaluating the case as a whole. Specifically, if the Division has reached the knee-jerk conclusion that it must have been the parent’s abuse that caused the child’s injuries, the division often takes draconian measures to ensure the parent is afforded as little contact with the child as possible while in placement. This often occurs by the Division’s insisting upon a SHSP’s placement when one is not required.

One way of uncovering such a tactic is by demanding a copy of the nurse’s notes that must be maintained for every SHSP’s placement. The division’s nurse is required to see the child weekly and make a detailed log of the child’s medical status, feeding schedule and care instructions administered by the resource parents in order to ensure that the child’s medical needs are being met in that placement. The parent is entitled to receive a copy of this nurse’s log upon request.

Rarely are these logs kept consistent with the training protocols and the requirements set forth in the administrative code. When these deficits are highlighted, the court will often grow weary of the division’s position as to the necessity of the placement, thereby calling into question the division’s position as to other issues in the case, including the parents’ culpability for the child’s injuries. One never knows what will be found until the information is sought and explored.

If you or someone you know has a child in placement that has been declared medically fragile when that designation appears unwarranted, please contact Paragano and Williams, LLC for assistance.

One thought on “Medically Fragile Children in DCPP/DYFS Custody

  1. Pingback: Grandparent Custody in South Carolina DSS Cases | South Carolina DSS Attorney--Social Services Defense Help & Resources

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