A working knowledge of the healthcare system may help child welfare professionals maintain an essential medical routine for their clients. The family centered tips for caseworkers below will guide professionals through the healthcare system, whether their client needs a simple check-up, or has illness or injury.
Caseworkers should routinely obtain medical records for the children in their care. Physicians rely heavily on an individual’s past medical history for their decision-making about diagnoses and treatment – having records available is crucial to a child’s health.
Seek appropriate authorization for the release of the following records. (In some states authorization rests with the state or county child welfare authority, while in other states the biological or adoptive parent has the authority.)
- For infants and toddlers under 3 years old, obtain the birth discharge summary from the maternity hospital. The medical record will be in the mother’s name and you will need the child’s date of birth.
- For any hospitalizations the child has experienced, request the discharge summary.
- If the child has chronic conditions, find out what medical specialists treat the child and request records.
- To obtain primary health care and immunization records for children in elementary through high school, the school nurse may be a source for immunization records.
You may need to be persistent. Obtaining medical records from hospitals can be challenging and may require repeated efforts. When a medical setting or practice cites the HIPAA privacy rule restrictions, you can seek a court order, which overrules HIPAA.
Whenever a case is new to you, routinely gather basic health history information to share with the healthcare team.
This information should be sought from several sources: family members, current and former foster parents. Some questions can also be asked of the foster youth. Other useful sources of a child’s health history include baby books, shot records, letters from specialists, and bottles of medications. Birth parents are a key 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.
A basic health history includes the following:
- What is known about the child’s birth?
- Pregnancy complications
- Prenatal exposures to drugs, medications, alcohol
- What is the child’s history of illness, injury, treatment?
- Hospitalizations, Surgeries, Emergency Room visits
- Ongoing illnesses
- Does the child take any medications?
- If so, what are they and in what doses?
- Does the child use any medical equipment (e.g., nebulizers and spacers for asthma, eye glasses, hearing aid, wheel chair)
- Does the child have any allergies?
- Drug, food, or environmental allergies
- Who were the child’s last health care providers?
- Primary care physician or nurse practitioner
- Medical specialists
Working from the foundation of a solid health history, caseworkers can help the child with fears, worries, and traumatic stress related to past and current traumatic experiences, medical events, and medical treatment. Be sure that you are well-informed about medical traumatic stress and children involved in the child welfare system.
The healthcare professional will have questions that can only be answered by an adult caring for the child and not a caseworker or other staff person. Health care providers often need to know about the child’s response to diet, elimination patterns, sleep behaviors, etc. Children need the presence of their caregiver to cope with the stress of a medical visit. Those who are deprived of support and soothing from a trusted adult during medical visits experience much greater distress.
When contact is not restricted, encourage birth parents to attend their children’s medical appointments. By attending the appointments the parent learns directly from the healthcare professional what their child needs, has the opportunity to ask questions and can develop a relationship with the healthcare provider. Any guidance the healthcare professional provides at the appointment can help build the parent’s capacity to better care for their child following reunification. In turn, the birth parent can provide the health care provider with important information, such as the family health history.
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. 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.
Any tension between birth parents and resource parents 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.
Before the appointment
- Help the child and caretaker(s) to articulate their concerns or questions. Work with them to make a written question list to bring to the appointment. Encourage the child and caretaker(s) to present these concerns or questions early in the health care visit so they are not forgotten in the rush of the appointment.
- Coach resource parents to prepare a child for medical examinations / treatment by:
- explaining the general process
- exploring the child’s feelings and worries about medical visits
- providing reassurance and learning what helps the child when s/he is scared
During the appointment
- It can be helpful for the child welfare professional to attend a visit with the primary healthcare provider when a child is new to placement, and to attend visits with specialists.
- Provide any paperwork or forms that the doctor needs to complete at the start of the visit to ensure its timely completion.
- Encourage the resource parent and birth parent to ask questions.
After the appointment
- Review the visit with the child and caregivers. Is anything confusing or unclear? Seek clarification as needed via a follow-up call to the practice to speak with the physician or a nurse.
- Ensure that resource and birth parents have the support and information they need to attend to the child’s medical needs.
- Secure referrals and consents for recommended care.
- Plan with caregivers and child: When and who will follow up on each of the healthcare provider’s specific recommendations?
- Track completion of the plan. Request documentation that the resource parent or birth parent completed any recommended health care visits or follow-up appointments.
As you are aware, foster and pre-adoptive parents are not legal guardians and cannot give consent for medical procedures. Consent guidelines vary from State to State; check with your local 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.
The child advocate attorney may be helpful when there is a delay in obtaining consent or when medically necessary procedures are disputed.