1. CHIPRA Foster Care Initiative FYI – Comparison of Standards Esther Smith MD Pediatrician Triad Adult & Pediatric Medicine Guilford Child Health Guilford County, Greensboro NC

2. North Carolina State Standards for Foster Care AAP Standards (Foster Care America Recommendations) Fostering Connections

3. North Carolina State Standards for Foster Care AAP Standards (Foster Care America Recommendations) Fostering Connections

4. NCDSS Child Placement Services Policy Medical requirements Information about child’s medical needs, medications, any special conditions and instructions for care should be given to the resource parent at the time of placement and documented. Child Health Status Component shall be completed within 7 days of initial placement and a copy given to the resource parent for medical visits. It must be updated at least every 6 months. The Child Physical Evaluation form is recommended for use by physicians each time the child is seen to record findings and assure continuity among providers. A child must have a physical exam scheduled within 7 days of placement. Social workers will also schedule dental, developmental, psychological, and educational assessments when needed within one week from the identification of the need.

5. NCDSS Placement Services Policy Children receiving foster care services have individualized, written Out of Home Family Services Agreements outlining the plan goals and objectives. Children in foster care placement receive services designed to assure their emotional and developmental needs are met including services that help mitigate the feelings of grief and loss that result from removal from the home. The agency ensures that the child receives all needed evaluations, medical care and psychological treatment services through referral to other agencies and providers.

6. NCDSS Placement Services Policy To aid the case decision and initial service planning, a Structured Documentation Instrument requires the documentation of the social activities, economic situation, environmental issues, mental health needs, activities of daily living, physical health needs, and summary of strengths (SEEMAPS) of the child and family during the completion of a CPS Assessment. Further assessment and documentation is recorded on the Family Assessment of Strengths and Needs Tool completed with all cases where the case decision was made to provide CPS In- Home or Out-of-Home Services prior to completing the Family Services Agreement.

7. The Family Strengths and Needs Assessment Documents Child and Family Well-being items: Child/Family Educational Needs Child/Family Physical Health Needs Child/Family Mental Health Needs

8. Child and Family Educational Needs Special education classes, when applicable; Normal grade placement, if child is school age; Services to meet the identified educational needs, Early intervention services, if needed; Advocacy efforts with the school, unless the child is not school age or no identified needs are unmet How the educational needs of the child/family have been included in the case planning, unless the child is not school age or has no identified education needs.

9. Child and Family Physical Health Whether the child/family has: received preventive health care and if not, the efforts the agency will take to ensure that this care is obtained; received preventive dental care and if not, the efforts the agency will take to ensure that this care is obtained; up-to-date immunizations and if not, what efforts the agency will take to obtain them; Whether the child/family is: receiving treatment for identified health needs and if not, what efforts the agency will take to obtain the treatment; receiving treatment for identified dental needs and if not, what efforts the agency will take to obtain the treatment.

10. Child/Family Mental Health Needs Whether the child/family is receiving appropriate treatment for any identified mental health needs and if not, what efforts the agency will take to obtain such treatment.

12. North Carolina State Standards for Foster Care AAP Standards (Foster Care America Recommendations) Fostering Connections

13. AAP Standards http://www2.aap.org/fostercare/health_care_ standard.html http://www2.aap.org/fostercare/health_care_ standard.html

14. Healthy Foster Care America The American Academy of Pediatrics (AAP) and Child Welfare League of America (CWLA) have published standards for health care for children and teens in foster care. These standards are designed to help professionals from all disciplines understand the complexity of health problems and the quality of care issues in foster care. The standards specify the parameters for high-quality health care, and enable us to improve services and outcomes, as well as create an opportunity to measure the outcomes, provide a framework for child welfare to assess services for children and teens, determine the appropriateness of funding, and provide a foundation for health advocacy.

15. Fundamental Principles Children and teens in foster care should be seen early Children and teens in foster care should be seen often upon entry to foster care Children and teens should have an enhanced health care schedule Children and teens in foster care should be seen often while they are in foster care Children and teens in foster care should have comprehensive evaluations

16. … Should be seen early To assess for signs and symptoms of child abuse and neglect To assess for presence of acute and chronic illness To assess for signs of acute or severe mental health problems To monitor adjustment to foster care To ensure a child or teen has all necessary medical equipment and medications To support and educate parents (foster and birth) and kin

17. … Should be seen often upon entry to foster care Health screening visit within 72 hours of placement Comprehensive health admission visit within 30 days of placement Follow-up health visit within 60 to 90 days of placement

18. … Should have an enhanced health care schedule Because of a high prevalence of health care problems and often multiple transitions that can adversely impact their health and well-being, children and teens in foster care should have an enhanced health care schedule to include: To monitor for signs and symptoms of abuse or neglect To monitor a child's or teen's adjustment to foster care and visitation To ensure a child or teen has all necessary referrals, medical equipment, and medications To support and educate parents (foster and birth) and kin

19. … Should be seen often while they are in foster care Monthly for infants from birth to age 6 months Every 3 months for children age 6 to 24 months Twice a year for children and teens between 24 months and 21 years of age

20. … Should have comprehensive evaluations Within 30 days of placement, children and teens in foster care should have the following detailed, comprehensive evaluations: – A mental health evaluation – A developmental health evaluation if under age 6 years – An educational evaluation if over age 5 years – A dental evaluation

21. … Should have comprehensive evaluations (continued) Such evaluations can be conducted as part of the comprehensive health assessment by a multi- disciplinary team or through referral to specialists. It is important that they be conducted in a timely manner and information is shared among all the professionals and parents caring for the child or teen. Information from these assessments should be shared with child welfare and the courts to ensure that it is incorporated into permanency planning for the child or teen.

22. AAP Policy Statements are organizational principles to guide and define the child health care system and/or improve the health of all children. AAP Policy Statements AAP Clinical Reports provide guidance for the clinician in rendering pediatric care. AAP Clinical Reports

23. AAP Policy Statements Health Care of Young Children in Foster Care (under revision) Health Care of Young Children in Foster Care Health Care for Youth in the Juvenile Justice System Identification and Care of HIV-Exposed and HIV-Infected Infants, Children, and Adolescents in Foster Care Identification and Care of HIV-Exposed and HIV-Infected Infants, Children, and Adolescents in Foster Care Developmental Issues for Young Children in Foster Care (under revision) Developmental Issues for Young Children in Foster Care Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health Families and Adoption: The Pediatrician’s Role in Supporting Communication (under revision) Families and Adoption: The Pediatrician’s Role in Supporting Communication

24. AAP Policy Statements (continued) Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children with Special Health Care Needs Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children with Special Health Care Needs Using Personal Health Records to Improve the Quality of Health Care for Children Using Personal Health Records to Improve the Quality of Health Care for Children The Pediatrician's Role in Community Pediatrics The Medical Home Medicaid Policy Statement The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care

25. AAP Clinical Reports Comprehensive Health Evaluation of the Newly Adopted Child Comprehensive Health Evaluation of the Newly Adopted Child Understanding the Behavioral and Emotional Consequences of Child Abuse Understanding the Behavioral and Emotional Consequences of Child Abuse Special Requirements of Electronic Health Record Systems in Pediatrics Special Requirements of Electronic Health Record Systems in Pediatrics Recognizing and Responding to Medical Neglect Technical Report: The Lifelong Effects of Early Childhood Adversity and Toxic StressThe Lifelong Effects of Early Childhood Adversity and Toxic Stress

27. North Carolina State Standards for Foster Care AAP Standards (Foster Care America Recommendations) Fostering Connections

28. The Fostering Connections to Success and Increasing Adoptions Act of 2008 became Public Law 110-351 on October 7, 2008. aims to promote permanency and improved outcomes for children in foster care through policy changes in six key areas: – 1) support for kinship care and family connections, – 2) support for older youth, – 3) coordinated health services, – 4) improved educational stability and opportunities, – 5) incentives and assistance for adoption, and – 6) direct access to federal resources for Indian Tribes.

29. 3) Coordinated Health Services Under prior law, states were required to maintain case plans for children in foster care that contained, "to the extent available and accessible," the health and educational records of the child, including the names of providers, the child's grade level performance, the child's school records, assurances that a child's placement in foster care took into account proximity to the child's school of origin, a record of the child's immunizations, known medical problems, medications taken, and other relevant health and educational information. Health: The Fostering Connections Act builds on prior law by adding a new requirement for states to develop a plan for the ongoing oversight and coordination of health services for children in foster care.

30. The Mandate The 2008 federal Fostering Connections law specifically requires state child welfare and Medicaid agencies, in consultation with pediatricians, other experts in health care, and experts in and recipients of child welfare services, develop a plan for the ongoing oversight and coordination of health care services for any child in a foster care placement.

31. The Plan is called the Health Oversight and Coordination Plan The plan must ensure a coordinated strategy to identify and respond to the health care needs of children in foster care placements, including mental health and dental health needs, and must include an outline of: – a schedule for initial and follow-up health screenings that meet reasonable standards of medical practice – how health needs identified through screenings will be monitored and treated – how medical information for children in care will be updated and appropriately shared, which may include the development and implementation of an electronic health record – steps to ensure continuity of health care services, which may include the establishment of a medical home for every child in care – the oversight of prescription medicines – how the state actively consults with and involves physicians or other appropriate medical or nonmedical professionals in assessing the health and well-being of children in foster care and in determining appropriate medical treatment for the children

32. North Carolina Plan State Division of Social Services contract with NC Pediatric Society Planning grant is November 1, 2012 – September 30, 2013 Project Co-Directors: Dana Hagele, M.D., and Leslie Starsoneck, M.S.W. Consulting Child Psychiatrist: Dr. Allan Chrisman Leadership Team and Advisory Group

34. Resources http://www.acf.hhs.gov/programs/cb/researc h-data-technology/reporting-systems http://www.acf.hhs.gov/programs/cb/researc h-data-technology/reporting-systems http://www2.aap.org/fostercare/health_care_ standard.html http://www2.aap.org/fostercare/health_care_ standard.html http://www.fosteringconnections.org/