Health Concerns in Child Welfare

Children in foster care are a medically vulnerable group. On average, they have greater healthcare needs than most kids yet they usually received inconsistent health care before entering placement. As a result, children often enter placement with unidentified and unmet health problems. Even after placement many do not receive adequate and timely healthcare.

Neglect, physical and sexual abuse, exposure to violence, and other psychosocial and environmental challenges further impact the well-being of kids in foster care. These difficult life experiences increase the likelihood that a child or youth has experienced traumatic stress, and intensify the risk for medical traumatic stress.

The Adoption and Safe Families Act (ASFA) of 1997 mandates that child welfare agencies ensure that children in foster care have access to quality health care to promote their healthy well-being.

Children in Foster Care are Children with Special Health Care Needs (CSHCN)

Why do we consider children and youth in foster care as having special health care needs?

  • High rates of chronic medical, developmental and emotional/behavioral health conditions
  • High rates of emotionally traumatizing experiences
  • Multi-system involvement underscoring the need for care coordination
Confused about job titles and who does what in the health care system? Check out who’s who in the health care team.

The federal Maternal Child Health Bureau (MCHB) define children with special health care needs (CSHCN) in a non-categorical way that cuts across different types of diseases and medical conditions. These are children and youth who

… have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally…

McPherson M, Arango P, Fox HB, A new definition of children with special health care needs. Pediatrics. 1998; 102: 137-140.

This category is suitable for all children and youth in foster care.

Understanding there are special health concerns in child welfare, that children entering foster care have more unmet health needs and require greater health surveillance, the American Academy of Pediatrics (AAP) has specific recommendations for this vulnerable group:

  • Health assessment within 72 hours of placement
  • Comprehensive physical, mental health, and developmental evaluation within 1 month of placement
  • More frequent health status monitoring
  • Child welfare case plans should include health assessment results and incorporate physician recommendations
  • Participation in all federal and state entitlement programs to which they are entitled (e.g., EPSDT, Early Intervention Services, WIC)
  • Collaboration between child welfare agencies and health care providers to ensure necessary health information sharing