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Assessing the Special Health Care Needs of Children in Foster Care

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A review of all medical, school, and mental health records ... Medical Exam. Review all medical history and request records for review. Full comprehensive PE ... – PowerPoint PPT presentation

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Title: Assessing the Special Health Care Needs of Children in Foster Care


1
Assessing the Special Health Care Needs of
Children in Foster Care
  • Wake County Human Services
  • Raleigh, North Carolina
  • Jean C. Smith, MD
  • Susan Schiewe, MSW, LCSW

2
  • When I was little I would think of ways to kill
    my daddy. …But I did not kill my daddy. He
    drank his own self to death the year after the
    County moved me out.
  • Ellen Foster

3
Health Needs of Children in Foster Care
  • Children and adolescents in foster care have
    higher prevalence of -
  • Physical
  • Developmental
  • Dental
  • Behavioral
  • health conditions

4
  • …my teacher noticed a bruise he put on my arm
    and they all had a field day over it in the
    school nurses office. Calling in everybody but
    the janitor to look at it. I had rather nobody
    saw my business.

5
Health Status of Children Adolescents Entering
Foster Care
  • More than 90 have abnormality in at least 1 body
    system
  • Vision hearing problems common
  • Suboptimal growth 5 times expected
  • (Large cohort study of children entering foster
    care - Baltimore, MD)

6
Health Status of Children Adolescents Entering
Foster Care
  • lt 20 had NO medical conditions
  • gt20 had growth abnormalities
  • 30 had neurological disorders
  • 16 had asthma (3 times national ave.)
  • (Large cohort study of children in foster care
    in Oakland, CA)

7
Health Status of Children Adolescents Entering
Foster Care
  • High incidence of anemia
  • High incidence of infectious diseases
  • Increased risk for vertically transmitted
    infections (HIV, hepatitis B C, syphilis,
    herpes simplex)

8
  • I try not to leave her by herself with him.

9
Other problems
  • gt80 exposed to domestic and/or community
    violence
  • High risk behaviors in adolescents in foster care
    with risk for STDs, etc.
  • No cohesive system of care for this vulnerable
    population
  • Little tracking or monitoring of care that does
    exist.

10
  • When they came back in they said they had
    decided what to do with me. Its about time I
    thought. Yes Lord its about time.

11
Fostering Health Health Care for Children
Adolescents in Foster Care
  • Task Force on Health Care for Children in Foster
    Care
  • American Academy of Pediatrics, 2005

12
Child Welfare League of America
  • Standards for Health Care Services for Children
    in Out-of-Home Care
  • Washington, DC Child Welfare League of America
    1988

13
Evaluating Quality of Care for Children in Foster
Care -CWLA
  • Seven criteria
  • Access to care
  • Appropriateness of services
  • Comprehensiveness of care
  • Coordination

14
Quality of Care Criteria Continued
  • Continuity
  • Relation to the community
  • Family-centered service

15
Health Care Delivery Models for Children in
Foster Care
  • Agency-based care
  • Specialized foster care clinics
  • Community-based care

16
  • Since my first day here all I felt is luck
    coming my way. I never thought I could have it
    this good.

17
Components of Health Care Services
  • Initial health screening
  • Comprehensive health assessment
  • Developmental mental health evaluation

18
Components of Health Care Services
  • Primary health care and monitoring health
    developmental status
  • Transfer of medical information

19
  • All I did was wish him dead real hard every now
    and then. And I can say for a fact that I am
    better off now than when he was alive.

20
Children's Health and Development Program A
collaboration of John Rex Endowment and Wake
County Human Services

21
  • Wake County Human Services (WCHS) is a
    consolidated agency including health, mental
    health and social services.

22
  • ..there have been more than a plenty days when
    she has put both my hands in hers and said if we
    relax and breathe slow together I can slow down
    shaking. And it always works.

23
Services
  • A comprehensive health assessment within a month
    which will include gathering and reviewing all
    past medical records, school/child care
    information, immunization status, etc.
  • A developmental and mental health evaluation
    (which may occur in the home)
  • A review of all medical, school, and mental
    health records are done for children not
    receiving direct assessment by the CHDP.
  • A plan of care to include identification of a
    medical home, special health needs, specific
    behavioral/developmental concerns, and assistance
    for families in securing needed referrals.

24
Medical Exam
  • Review all medical history and request records
    for review
  • Full comprehensive PE
  • Required state DSS PE form sent
  • Assess if HIV testing or other lab work needed
  • Skeletal survey done per protocol for children lt
    2 years of age

25
Child Health Clinic routine screens
  • Labs
  • Hgb 1 year
  • Lead 1 and 2 years
  • Cholesterol Kindg visit
  • Vision
  • Lang Stereotest 3 years and up
  • HOTV/Snellen/Letter Chart 4 years and up
  • Hearing
  • Beltone Audiometric - 4 years and up
  • OAE if fails or does not understand Beltone
  • This is possibly being changed

26
Developmental Assessment
  • Review developmental history, school history, and
    any interventions including IFSP/IEP
  • Developmental screening for all children less
    than 5 years of age
  • Neurodevelopmental screening for school age
    children who have not had psychoeducational
    testing at school.
  • Review school records for those children with
    IEPs to determine the need for changes and/or
    updating.

27
Developmental Screening Protocol for Child Health
Clinic
  • 2 and 4 mo Edinburgh Depression Screen
  • 6 months PEDS Response
  • 12 months PEDS Response
  • 18 months PEDS Response and M-CHAT
  • 24 months ASQ and M-CHAT
  • 3, 4, 5 years PEDS Response
  • gt6 years Pediatric Symptom Checklist (PSC)
  • Adolescent CES-DC Depression Scale

28
Developmental Assessment
  • For children in foster care, a developmental
    screening for all children less than 5 years of
    age is done that is not dependent on caregiver
    report.

29
Brigance Screens
  • Birth through First grade
  • Direct elicitation
  • 15-20 minutes to complete
  • Standardized and validated

30
Domains
31
Brigance Domains
  • Screens across 6 Developmental Domains
  • - Fine Motor
  • - Gross Motor
  • - Receptive Language
  • - Expressive Language
  • - Self Help
  • - Social Emotional

32
Developmental Screening Tools -ordering
information
  • www.dbpeds.org tools, screening information,
    tips
  • www.curriculumassociates.com -
  • The Brigance System
  • www.epsbooks.com (PEEX 2, PEER, PEERAMID 2)
  • www.brightfutures.aap.org

33
Developmental Assessment
  • Neurodevelopmental screening for school age
    children who have not had psychoeducational
    testing at school.

34
Neurodevelopmental Screening PEEX 2 PEERAMID 2
  • School age children
  • 45-60 minutes to administer
  • Positive experience for children
  • When are we going to play more games?

35
Domains
  • Fine Motor
  • Graphomotor
  • Gross Motor
  • Language
  • Memory
  • Visual Processing

36
Referrals
  • Birth to age 3 years CDSA
  • (Childrens Developmental Service Agency)
  • ( Eligibility for Early Intervention)
  • Age 3-5 years School System
  • (Eligibility for Special Education process)
  • School age - Base school and request testing
  • (IEP process)

37
School referrals/IEP reviews
  • Review school records for those children with
    IEPs to determine the need for changes and/or
    updating.
  • How to refer to SST

38
McKinney Vento Part C
  • Part of Homeless Assistance Act 1980s
  • Allows students to remain in their base school
  • Schools responsible for transportation to the
    base school

39
  • Every Tuesday a man comes and gets me out of
    social studies and we go to a room and talk about
    it all. ..He spread out pictures of flat bats for
    me to comment on. I mostly saw flat bats. Then
    I saw big holes a body could fall right into.

40
Mental Health Assessment
  • Review mental health history and prior MH
    services/assessments.
  • MH evaluations for all children ages 4 18 years
    if not currently in treatment
  • MH evaluation may include observation of child in
    the home, daycare, or office setting along with
    collateral contacts with those working with child
  • Complete a Doctors order for services and
    provide level of care information for indicated
    therapeutic services

41
  • ..he tells me Im scared. I used to be but I am
    not now….I might be a little nervous but I am
    never scared.

42
Plan of Care
  • Summary of each of the assessments findings
  • List of referrals made
  • Recommendations including primary care provider
    and other follow up recommendations
  • Program coordinator reviews the POC with the
    caseworker.
  • Copies of POC sent to PCP and foster parent.

43
Lessons Learned
  • Health care and child welfare agencies have a
    significant responsibility to assure
    comprehensive care for children in foster homes.
  • Families and DSS staff prefer regionalization of
    services.
  • Protocols (skeletal surveys, developmental
    screening, etc.) need to be followed.

44
Lessons Learned
  • More children were found in need of developmental
    and/or mental health services than DSS had
    previously anticipated. (DS-17 MH-50)
  • Children are receiving services in a timelier
    manner than previously.

45
  • Sometimes …I count up what I like about the way
    Im living now. ….And the best one number four
    is my new mama saying good morning to me like she
    means it.

46

47
  • The CHDP has offered comprehensive health
    services to all children entering foster care
    each year. The program has offered a resource
    that was not available previously and assures an
    individual plan of care addressing health,
    development, behavioral, and mental health needs.
    Foster children generally come from a background
    of poor or inconsistent health care records are
    frequently scarce. The CHDP is invaluable in
    providing a complete and thorough health view of
    these children who may be vulnerable to delays,
    emotional problems or other medical concerns.
  • Elaine Rakouskas, WCHS Program Manager for
    Foster Care Services
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