April 20, 2018
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Meeting the special health care needs of foster children

Photo: U.S. Centers for Disease Control and Prevention | BDN
Photo: U.S. Centers for Disease Control and Prevention | BDN
By Dr. Adrienne Carmack, Penobscot Pediatrics

Foster children often come from an environment in which their health care needs are neglected. It has only been in the last quarter-century that the unique health care needs of foster children have started to receive the attention they deserve.   In 1983, the American Academy of Pediatrics Committee on Adoption reported that children in foster care were not likely to receive routine health care, immunizations, dental care, or hearing or vision screening.  In 1988, the Child Welfare League of America published guidelines for the care of foster children which included an initial screen for immediate health needs, a comprehensive assessment within one month of entering into foster care, and a developmental and mental health assessment for all children whether or not neglect is perceived as an issue in their previous home.   Moreover, in 1994 the AAP Committee on Early Childhood, Adoption, and Dependent Care recommended a comprehensive and coordinated treatment approach.

National organizations that recognize and support the medical needs of foster children include Healthy Foster Care America and Fostering Connections.  Healthy Foster Care America’s website states that its’ “resources are intended to assist all health care professionals in improving their primary care office setting so that each child or teen in foster care receives health care in a medical home.”  Fostering Connections has sponsored legislation that,  according to its website, “include requiring the State Department of Social Services…in consultation with pediatricians, health care experts, and experts in and recipients of child welfare services to develop a plan for the ongoing oversight and coordination of health care services for a child in a foster care placement.”

Unfortunately, health care professionals rarely have had significant training regarding issues that relate to children in foster care and proper evaluation and proper referrals are often not accomplished.  Recognizing this need while working in an organization with limited funds, in 2008 Dr. Adrienne Carmack, a pediatrician who works for Penobscot Pediatrics at Penobscot Community Health Care, applied for and received an American Academy of Pediatrics Community Access to Child Health (CATCH) grant.  The goal of this grant was to assess the needs and resources of the community, survey foster parents, caseworkers, and providers, and start a pilot program to provide medical care to this unique and underserved population.  Part of the grant also required that she work to educate foster parents and case workers.  After receiving the CATCH grant, Penobscot Pediatrics opened their new “Key Clinic” in February 2008 which began to offer care for foster children within 72 hours of entering custody to address immediate concerns, update medications, and begin the process of collecting medical records. The availability of this care was made known to case workers, the Department of Health and Human Services, and the foster care community.   The Key Clinic protocol is as follows: After the initial visit, which is performed ideally within 72 hours, a comprehensive outpatient visit in the office is scheduled, which includes a summary of medical and psychosocial records, a thorough physical examination, an evaluation with a social worker, developmental and mental health screening, medication reconciliation, laboratory work, vision and hearing testing, and making any necessary referrals including a dental referral.  Follow up visits after this comprehensive evaluation are scheduled as indicated for acute illnesses and preventive care.   By November of 2010 the clinic had grown to 151 patients.

Barriers encountered to this new model of health care for foster children were the fluidity of the population moving in and out of homes, difficulty in communicating and collaborating with caseworkers, difficulty in obtaining prior records from multiple health facilities, and problems obtaining signed releases of information.  In addition, foster families often felt the comprehensive evaluation was unnecessary because it was a new concept for many long term foster parents.

Despite these barriers, the Key Clinic has grown and has now become accepted in the area.  Morever, the high quality of care it has provided for over two years has been noticed and recognized by the Department of Health and Human Services.   As a result, the agency has mandated that foster children in Penobscot and Piscataquis Counties have a visit with a PCP within 72 hours of joining a new family and be referred specifically to the Key Clinic for a comprehensive evaluation.  In order to provide this unique and excellent care, support staff for the Key clinic has also grown to include a nurse care manager, social worker, and pediatrician as well as office support staff.

The Key Clinic for foster children represents a  major step forward in meeting the unique health care needs of this population of children who need all of our help and support.  To have a foster child seen by Dr. Carmack and the staff of the Key Clinic, please call Penobscot Pediatrics at (207)947-0147.

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