Filling medical gaps in foster care
With more than a half million children in foster care every day in the United States, chances are that some of these vulnerable kids are your patients. How you meet their many healthcare needs can make a great difference in their lives.
Transitioning from foster care
In many transitions out of foster care, adolescents are essentially expected to become an adult overnight, often without the benefit of families or other social support networks to fall back on. This population is highly vulnerable and outcomes are poor with high rates of unemployment, homelessness, and lack of adequate healthcare.15
Many of these youth report being ill prepared for the transition, and significant numbers experience unwanted outcomes such as victimization, sexual assault, and problems with the law.
The Patient Protection and Affordable Care Act of 2010 addresses some of these young adult issues by making children aging out of foster care eligible for Medicaid until age 26 years.16 Other legislation allows for the use of federal funds to help provide housing for youth aging out of foster care.15
Recommendations for serving foster children
Because these children are victims of abuse, neglect, or trauma, they may not have appropriate advocates. The pediatrician can advocate not only individually but also for community development of services to better serve this vulnerable population.
To create a better medical home for the foster child, the pediatric practice should calibrate health needs, developmental and educational needs, dental health, anticipatory guidance, and office systems for the specific healthcare needs of children in foster care.1,3,4,8,16
Caring for foster children can be challenging, time consuming, and difficult, but it also can be tremendously rewarding. Doing so provides the pediatrician with the opportunity to advocate for their own patients as well as advocate on a local or state level to improve the overall care for this vulnerable population.
1. Deutsch SA, Fortin K. Physical health problems and barriers to optimal health care among children in foster care. Curr Prob Pediatr Adolesc Health Care. 2015;45(10):286-291.
2. Bruskas D. Children in foster care: a vulnerable population at risk. J Child Adolesc Psychiatr Nurs. 2008;21(2):70-77.
3. Council on Foster Care, Adoption, and Kinship Care; Committee on Adolescence; Council on Early Childhood. Health care issues for children and adolescents in foster care and kinship care. Pediatrics. 2015;136(4):e1131-e1140.
4. Jee SH, Tonniges T, Szilagyi MA. Foster care issues in general pediatrics. Curr Opin Pediatr. 2008;20(6):724-728.
5. Burns BJ, Phillips SD, Wagner HR, et al. Mental health need and access to mental health services by youths involved with child welfare: a national survey. J Am Acad Child Adolesc Psychiatry. 2004;43(8):960-970.
6. Zito JM, Safer DJ, Sai D, et al. Psychotropic medication patterns among youth in foster care. Pediatrics. 2008;121(1):e157-e163
7. dosReis S, Tai MH, Goffman D, Lynch SE, Reeves G, Shaw T. Age-related trends in psychotropic medication use among very young children in foster care. Psychiatr Serv. 2014;65(12):1452-1457.
8. Szilagyi M. The pediatric role in the care of children in foster and kinship care. Pediatr Rev. 2012;33(11):496-507; quiz 508.
9. Task Force on Health Care for Children in Foster Care. Fostering Health: Health Care for Children and Adolescents in Foster Care. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2005. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Fostering-Health.aspx. Accessed March 28, 2017.
10. Hagan JF Jr, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008. Available at: https://brightfutures.aap.org/bright%20Futures%20Documents/BF3%20pocket%20guide_final.pdf. Accessed March 28, 2017.
11. Stone LL, Otten R, Engels RC, Vermulst AA, Janssens JM. Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4- to 12-year-olds: a review. Clin Child Fam Psychol Rev. 2010;13(3):254-274.
12. Goodman R, Ford T, Simmons H, Gatward R, Meltzer H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry. 2000;177(6):534-539.
13. Gleason MM, Zeanah CH, Dickstein S. Recognizing young children in need of mental health assessment: development and preliminary validity of the early childhood screening assessment. Infant Ment Health J. 2010;31(3):335-357.
14. Ahrens KR, Richardson LP, Courtney ME, McCarty C, Simoni J, Katon W. Laboratory-diagnosed sexually transmitted infections in former foster youth compared with peers. Pediatrics. 2010;126(1):e97-e103.
15. Reilly T. Transition from care: status and outcomes of youth who age out of foster care. Child Welfare. 2003;82(6):727-746.
16. Council on Foster Care, Adoption, and Kinship Care; Committee on Early Childhood. Health care of youth aging out of foster care. Pediatrics. 2012;130(6):1170-1173.