Because the majority of families involved with child protective services struggle with poverty, they have often depended on hospital clinics with an ever-changing panel of providers, or relied on emergency rooms for sick care. Emergency rooms do not provide optimal pediatric preventive care, nor the continuity that is critical for growing children. This fragmented medical care can delay prompt identification of health problems. However, when child welfare and medical professionals work together, they can provide effective and timely comprehensive health care for children in foster care.
Access to Care
The law requires that children in foster care receive comprehensive health care services to address their physical, dental, developmental, mental and emotional health needs. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. All children adjudicated dependent and placed in out-of-home care are eligible for the federal Medicaid program. Medicaid pays for all medically necessary treatment for enrolled children, and it is the most comprehensive program through which children can obtain health services.
Standards for Health Care of Children and Youth in Foster Care
The American Academy of Pediatrics (AAP) Task Force on Health Care for Children in Foster Care has defined the standards of comprehensive health care delivery and management for the complex needs of children in foster care: Fostering Health: Health Care for Children and Adolescents in Foster Care.
An Identified Primary Healthcare Provider and Providing a Medical Home in Child Welfare System
Children placed in foster care should have a consistent primary healthcare provider for routine care. Consistency supports the child or adolescent in developing a relationship with his/her healthcare provider, which is so critical for developing trust. Familiarity with a healthcare practice, its staff and a team of trusted healthcare providers can help decrease the child’s anxiety regarding health care. These factors are fundamental for children who have been traumatized. Whenever possible, efforts should be made to maintain children in the same healthcare practice even after changes in placement.
All children in substitute care need a Medical Home. This model of care extends routine pediatric care with strategies to ensure that children receive comprehensive health care that is coordinated, accessible, family-centered and culturally effective. Ideally, the primary healthcare provider should understand trauma and foster care.
A medical home:
- allows a child to develop a bond with the provider
- improves communication, record-keeping, and coordination of healthcare services
- provides care coordination, for the complex needs of kids involved with the child welfare system
- facilitates long-term relationships and collaboration among team members
- is emphasized by the Child Welfare League of America (CWLA) and the American Academy of Pediatrics
Increased Need for Specialty Care
Children in foster care have much higher rates of chronic conditions and need continuity of care by the specialists who treat their often complex conditions. Specialty care doctors include neurologists, ophthalmologists (eye doctors), orthopedic surgeons, allergists and numerous others. Allied health specialists include audiologists (addressing hearing loss), speech therapists, physical and occupational therapists, and others. Children with chronic illnesses or developmental disorders often have these conditions monitored by specialty care providers, however, their preventive and routine care, health guidance, and treatment of acute illness continue to be delivered by the primary care provider. When children who change placements have to change primary health care providers, whenever possible they should continue to see the medical specialists who have been monitoring their condition.