8/5/ 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 8/5/2015 2

Foster children at risk for Physical problems Emotional and behavioral problems Developmental delays Academic problems 8/5/2015 3

Physical problems Physical and sexual abuse Asthma Headaches Gastrointestinal problems 8/5/2015 4

Emotional / behavioral problems Witnessing domestic violence Present based on developmental level PTSD ADHD Aggressive / withdrawn Depression / anxiety Conduct disorders / truancy 8/5/2015 5

Developmental delays Social / emotional delays Language delays Fine motor / gross motor 8/5/2015 6

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 8/5/2015 7

(but wait, there's more) So, foster children at much greater risk for serious adverse health outcomes. Worse still……… 8/5/2015 8

Access to poor health care insufficient funding lack of access prolonged waits for medical and mental health services lack of coordination of services 8/5/2015 9

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. 8/5/

8/5/ 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 8/5/

Role of provider AAP recommendations: Fostering Health: Health Care for Children in Foster Care, second edition, /5/

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 8/5/

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 8/5/

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 8/5/

Goals Provide access to a medical home, defined as care that is: Accessible, comprehensive, continuous, coordinated, compassionate and family centered 8/5/

Health Care Components Initial health screening Comprehensive health assessment Developmental and mental health evaluations Primary care / health care maintenance 8/5/

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 8/5/

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 8/5/

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 8/5/

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 8/5/

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 8/5/

Comprehensive Health Assessment Caseworker and foster parents present Health Education Passport (HEP) Obtain information from birth parents and keep involved whenever possible 8/5/

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 8/5/

Comprehensive Health Assessment Immunizations Dental evaluation Include scheduling follow up visit 8/5/

Development & mental health Interview Foster parent, caseworker Standardized tests Review of educational evaluations 8/5/

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 8/5/

Subspecialty support Mental health Therapy, psychiatry Child Development Clinic Regional Center Neurology / Neurosurgery 8/5/

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 8/5/

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 8/5/

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 8/5/

Reminder Advocate for child’s best interests with worker, foster parent, courts, school 8/5/

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