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Health Issues for Children in Foster Care

Abraham Rice, M.D.

Foster Care Clinic

Medical Director

Contra Costa Regional Medical Center

Ab

Take Home Messages

Being in Foster Care has profound consequences on children Especially younger children

Children in Foster Care are children with special health care needs and need access to a medical home

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Foster children at risk for

Physical problems

Emotional and behavioral problems

Developmental delays

Academic problems

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Physical problems

Physical and sexual abuse Asthma Headaches Gastrointestinal problems

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Emotional / behavioral problems

Witnessing domestic violence Present based on developmental level

PTSD ADHD Aggressive / withdrawn Depression / anxiety Conduct disorders / truancy

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Developmental delays

Social / emotional delays

Language delays

Fine motor / gross motor

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Attachment system theory of development

Normal development is absolutely dependent on a bond with a loving caregiver

Affect regulation may be the most essential aspect of a child’s development

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(but wait, there's more)

So, foster children at much greater risk for serious adverse health outcomes.

Worse still………

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Access to poor health care

insufficient funding lack of access prolonged waits for medical and mental

health services lack of coordination of services

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Why foster children are at risk

infancy and early childhood are critical periods during which the foundations for trust, self-esteem, conscience, empathy, problem solving, focused learning, and impulse control are laid down.

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Long Term Effects Adverse Childhood Events

Children living in a home with domestic violence are more likely 50 years later to have stroke, myocardial infarction, suicide attempt, substance abuse problems and be incarcerated, COPD, heart disease. Adverse Childhood Events (ACE) Study, Kaiser

Permanente/CDC/USDHHS

Foster Care Children ARE

Children with special health care needs

And should have:

Access to a medical home designed to meet those needs

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Role of provider

AAP recommendations: Fostering Health: Health Care for Children in

Foster Care, second edition, 2005

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Role of provider

minimize the trauma of placement separation

improve the child’s health and development during the period of foster

care Advocate for child with child welfare

agencies, foster families, birth families, schools, and courts

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Role of provider

Will require extended time and frequent follow up visits

Provide care with minimal information Identify physical, emotional, behavioral,

psychosocial and developmental problems

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Role of provider

Assist social worker and parents additional forms of evaluations, care and community services the child requires

Advocate for child’s best interests with worker, foster parent, courts, school

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Goals

Provide access to a medical home, defined as care that is: Accessible, comprehensive, continuous,

coordinated, compassionate and family centered

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Health Care Components

Initial health screening Comprehensive health assessment Developmental and mental health

evaluations Primary care / health care maintenance

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Pitfalls

Fail to ID as foster child Kinship foster child is a foster child

Fail to collect adequate information Social worker / foster family / bio family Medical history

Fail to give adequate time

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Pitfalls (cont.)

Don’t ask why child removed Don’t assess how is doing in new home Fail to screen adequately for

Dev delays / abuse / chronic illness / behavioral and emotional problems

Communicate concerns To foster parent AND worker

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Pitfalls (cont.)

Fail to schedule adequate follow up Fail to make appropriate delays Don’t follow up on concerns

Weight, poor match between home and child

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Initial health screening

identify any immediate medical, urgent

mental health, or dental needs health conditions of which the foster

parents and caseworker should be aware Medications Direct communication with foster parents and

provider

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Initial health screening

Height / Weight / Head Circumference Head to toe exam, including genital exam

and workup as appropriate for concerns of abuse or other concerns

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Comprehensive Health Assessment

Caseworker and foster parents present

Health Education Passport (HEP)

Obtain information from birth parents and keep involved whenever possible

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Comprehensive Health Assessment

The historical review should include:

the circumstances that led to placement the child’s adjustment to separation from the birth family

adaptation to the foster home developmental or school progress

agency’s plans for permanency

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Comprehensive Health Assessment

Immunizations Dental evaluation Include scheduling follow up visit

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Development & mental health

Interview Foster parent, caseworker

Standardized tests

Review of educational evaluations

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Developmental and Educational

local consultants and community-based intervention programs

Supplemental Nutrition Program for Women, Infants, and Children [WIC] and Head Start, Regional center, special education (IEP), early intervention, CCS

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Subspecialty support

Mental health Therapy, psychiatry

Child Development Clinic Regional Center Neurology / Neurosurgery

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Treatment

All treatment recommendations and plans should be part of court approved social services plan

Ultimately is the agency / social worker’s responsibility to see the implementation of medical care plan

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Primary care

Should assess physical and emotional health and developmental status of child at every visit At risk for emotional problems / abuse Especially at times of transition

Access to medical home

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Ongoing care

Frequent routine evaluations Monthly until 6 months of age Every 2 months until 1 year of age Every 3 months until 2 years of age Every 6 months after 2 years of age

At times of transition Continuity of medical care

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Reminder

Advocate for child’s best interests with worker, foster parent, courts, school

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