Doctors and nurses can use the tips below to have more effective interactions when working with foster care children and child welfare professionals.
Try the private provider caseworker first
Keep in mind that many cases have both a State/County caseworker and a private provider caseworker. Private provider workers are usually more directly involved in children's day-to-day placement experiences. If it becomes necessary to contact a caseworker about a child's medical needs, start with the private provider caseworker, if there is one. That person can, in turn, involve the State/County worker or other team members, as necessary.
Ask about the child welfare goals for your patient
Government intrusion into the family is a sensitive issue. To protect the rights of all involved, the child welfare system is highly regulated, and the work of child welfare professionals is governed by strict legal guidelines. If at times it seems difficult to reach agreement with child welfare workers on specific issues (e.g., keeping birth parents involved in a child's medical care), ask about the child welfare goals and mandates involved and help negotiate a plan to meet everyone's needs.
Contact supervisors when necessary
Caseworkers often have very high caseloads and may be overburdened. If they do not return calls or emails right away, gentle reminders often work well in producing a response. If an immediate response is required or a caseworker fails to communicate despite reminders, proceed up the chain to the caseworker's supervisor.
Learn who can provide consent for treatment
Be aware that foster and pre-adoptive parents are not legal guardians and cannot give consent for medical procedures. Consent guidelines vary from State to State, and it is important to check with your local child welfare authority regarding the specifics of consent. Generally, approaches to consent follow the patterns below:
- Consent for routine medical care (e.g., annual physicals, dental check-ups, eye exams, immunizations) is typically granted by statute or obtained from birth parents when a child enters the system.
- For any medical care beyond routine care, consent is required from the birth parent, the child welfare authority, or the Court, depending on the circumstances of the case (e.g., if the birth parent cannot be located) and whether or not parental rights are terminated. When in doubt, contact the child's caseworker for guidance.
- The child advocate attorney may be helpful when there is a delay in obtaining consent or when medically necessary procedures are disputed. You may work with the child's caseworker, attorney and larger team to resolve consent issues.
- The following resource can be accessed online and provides additional information about consent for treatment where foster children are involved. See especially Chapter 6: American Academy of Pediatrics. (2005). Fostering Health: Health Care for Children and Adolescents in Foster Care, 2nd Ed.
Involve birth parents when possible
When contact is not restricted, birth parents are encouraged to attend their children's medical appointments and may display varying levels of involvement, cooperation, or ability. Understand that birth parents often have their own trauma histories and may feel guilt and anger related to the removal of their children from their care. Most birth parents hope to regain custody of their children and respond well to a warm, respectful approach that involves speaking to them directly and involving them in discussions and decision-making. Also remember that birth parents are an important source for child and family health history. Some may be more comfortable having a private discussion with the child's healthcare professional regarding these matters. While most birth parents will be cooperative, be prepared to set limits for those who become disruptive and upset their children during medical visits or inpatient stays.
Encourage cooperation between birth parents and resource parents
Sometimes there is tension between birth parents and resource parents, particularly when a child is first placed in a foster home. This tension can occasionally be reduced by involving both in discussions of the child's medical needs and encouraging cooperation and mutual support in meeting them. A hospital social worker may be a good resource for promoting good working relationships between birth parents and foster parents.
Request team meetings or conference calls
Consider using team meetings or conference calls to address concerns related to medical care. For example, if birth parents are disruptive at medical visits, plan with the team who should attend medical appointments and how the parents can be supported in changing their behavior. Contact the child's caseworker to arrange the meeting or call.
Ensure continuity of medical care
When children are discharged from the hospital or transferred to another primary care provider, request a team meeting or conference call to discuss the child's medical needs and ensure continuity from hospital to placement or from one primary care physician to the next. Again, this type of meeting or call can be arranged through the child's caseworker.
Learn more about working with child welfare professionals and earn continuing education credit by completing For Health Care Professionals: Pediatric Medical Traumatic Stress (PMTS) and Working with the Child Welfare System (1.0 CEU)