Health Promotion Specialist It Takes a Village: Ensuring Vaccine Compliance Among Children in Foster Care and Kinship Care Everardo F. Aguilar, JD Health Promotion Specialist County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch

Co-Authors Tania Farley, MS-Community Outreach Manager, County of San Diego Immunization Branch Adrienne Yancey, MPH-County of San Diego Immunization Branch Chief Kathe Gustafson, MPH-Immunization Coordinator, County of San Diego Immunization Branch County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch

Issues Covered Defining foster care and kinship care. Immunization challenges to children in foster/kinship care. Access to vaccines for foster/kinship care children. Need for outreach to foster/kinship care families. The presentation will cover how the County of San Diego Immunization Branch collaborates with other county services and agencies to help provide access to vaccines for these children.

The Problem Increasing number of children being raised by non-parents. Children may be “falling through the cracks”. More and more children every year are being raised outside of their birth family either by foster care parents or kinship care givers. More than 500,00 children in the U.S. are in foster care. This represents about 10% of the more than 5 million children being raised by someone other than their parents. These children may not be vaccinated on time or at all because of frequent moving from home to home, lack of access to care and lack of up to date records.

Where Do The Children Go? Some children in the formal foster care system, raised by foster parents. Others are being raised by kinship caregivers, other adults (usually grandparents). Children of all ages are in foster or kinship care from being days or hours old to teenagers. Kinship care providers can be relatives, friends or neighbors of the parents. Usually placed informally.

Why Are Children Not At Home? Parents are unable or unwilling to care for children because of incarceration, chemical abuse or other reasons. Children are removed for their well being by a government agency, OR They are voluntarily placed with a relative. Substance abuse is the major reason children are removed from their home. According to Amnesty International, the United States has largest percentage of their population in prison. Handbook for Relative Caregivers in California, Tania Bowman, Esq.

What Is Foster Care? Foster care provides children a stable and secure home. Foster care is a formal placement through a government agency or other legal proceeding. Foster care is a formal placement and regulated by County and/or State government. Foster care parents are recruited, screened and trained to be foster care parents. They are prepared and expect to take care of other people’s children. www.sdcounty.ca.gov/fostercare

Handbook for Relative Caregivers in California, Tania Bowman, Esq. What is Kinship Care? Relatives raising children. Nothing new but happening more frequently. Placements usually informal. No formal legal status as caregiver. As more children are not being cared for by parents, increasingly, they are being raised by others. This is nothing new and common in many cultures, but this is happening more and more frequently. Kinship care providers are often relatives, usually grandparents, but can also be other adults, such as neighbors or friends of the parents. Handbook for Relative Caregivers in California, Tania Bowman, Esq.

Foster Care Foster care children have 4 or more placements a year. Foster care placements can be for days or may last for years. Sometimes end in adoption. Children are placed in foster care after being removed from their home by police or a government agency. Although sometimes foster parents end up adoption children. The intent of foster care is temporary, but can last from days to years. *A Handbook for Relative Caregivers in California," by Tania Bowman, Esq.

A Handbook for Relative Caregivers in California, Tania Bowman, Esq. Kinship Care 72% of children in kinship care are under 5 years old.* Average stay for a child under 5 in kinship care is 5 years.* Kinship care providers are usually unprepared and receive children in their care often at a moment’s notice. They are not screened or trained. They are usually grandparents who may be in their senior years and find themselves caring for very young children-again. A Handbook for Relative Caregivers in California, Tania Bowman, Esq.

Support For Foster Care Parents Training. Monitoring by a Public Health Nurse and a Social Worker. Medical and dental coverage. Tracking medical history through “Health Passport.” Immunization records in the Registry. Foster parents have resources available to them to assist with the care of their foster children. www.sdcounty.ca.gov/hhsa/fostercare

Immunization Registry Web based immunization records system. Foster care children are entered into Registry. Makes transferring records, tracking immunizations and entry into school easier. The Registry is a valuable tool to help make sure foster children are current by having their records available on line to avoid missing shots and unnecessary re-vaccination. See website: www.sdiz.org/registry

Support for Kinship Care No legal authority. No resources. No entitlement to health insurance for children. Kinship providers often do not have a legal relationship with the child. Legislation is being introduced in Congress to give kinship care givers some legal status.

Immunization Issues Children are removed by emergency. No or delayed access to records. Children may already be behind in immunizations. Because children in foster or kinship care are removed from their homes, often at a moment’s notice, there may not be access to records. Since the children are already not being properly cared for, they may already be behind on their shots or not vaccinated at all.

42 United States Code 11301 Sect. 101 School Entry California requires proof of vaccine for children to be enrolled in school or childcare. Federal law allows homeless/foster care children to be enrolled for 30 days without proof of immunizations. (See McKinney-Vento Homeless Education Act)* Lack of proof of vaccines can hamper foster and kinship care children from entering into school or childcare. The McKinney Vento Homeless Education Act does allow foster or homeless children entry into school for 30 days without a vaccine record. Without written authorization from parents, kinship care providers do not have authority for educational or medical decisions. California law allows for a Caregiver Affidavit that can be signed and notarized to give authority for school and medical conditions. Kinship care providers can also pursue legal custody or guardianship but that is costly. 42 United States Code 11301 Sect. 101

Outreach To Foster Parents County of San Diego Immunization Branch (SDIB) collaboration with County programs to outreach to foster families.* Collaboration to help foster children stay current on immunizations and access to care. County of San Diego Immunization Branch collaborates with CHDP (Child Health Disability Program), Foster Care Licensing and non-profits to outreach and train foster parents. *Foster Care Services and Child Health Disability Prevention (CHDP)

Example: La Cuna, Inc. Foster care for Latino children 0-5 years old. Trainings in English and Spanish to 50 to 60 potential foster parents. Trained on access to immunizations, reading immunization record and using Health Passport. Culturally sensitive to Latino families.

Outreach To Kinship Care Providers Unfamiliar with complicated immunization schedule or requirements. Language and immigration status barriers. Different schedules from other countries. Lack of access to health care. Essential to outreach to kinship providers because of the challenges they face to access vaccines and medical care in general.

Example: Grandparents Raising Grandchildren Conferences Schools provide resource fairs for kinship providers. Presentations by SDIB on immunizations and access to care. Information, materials and referrals. Conferences allow for opportunities to provide information and referrals to assist kinship providers to access care for their children and to get educated on school vaccine requirements and the recommended childhood vaccine schedule.

Unintended outcome: Adult Vaccines SDIB promotes vaccines for adults/seniors as well as children’s vaccines. Kinship caregivers are motivated to protect their OWN health with adult vaccines. An unintended outcome of outreach particularly to kinship care providers, is that these adults/seniors are now more motivated to receive adult vaccines, such as the flu shot and Tdap to protect the health of children in their care.

What’s Next? Continue to be a resource to foster and kinship care providers. Promote adult vaccines (particularly flu and Tdap vaccines) to care providers. Collaborate with other agencies to provide resources and services for foster and kinship care providers. County of San Diego’s efforts were published as best practices by IZTA in January. Strengthen current collaborations and collaborate with other groups supporting foster and kinship care providers County wide.

Acknowledgements County of San Diego Immunization Branch staff San Diego County Immunization Initiative (I-3) County of San Diego Health and Human Services Agency: Child Health Disability Prevention (CHDP) Share the Care Dental Program San Diego Kids Health Awareness Network (SDKHAN) Foster Care Services San Diego Acting Public Health Officer - Dr. Wilma Wooten San Diego Assistant Deputy Director – Carmel Angelo Tania L. Bowman, Esq. Grossmount College Thank you for your support and contribution to this presentation. County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch