Health home meets foster care’s complex needs
A new, multifaceted model of care focuses on improving the well-being and long-term health outcomes of foster care children in Texas.
An integrated health home in North Texas aims to fill disparities in physical and mental health, educational attainment, and special healthcare needs for today’s children in foster care.
The Rees-Jones Center for Foster Care Excellence at Children’s Health, housed on campuses in Plano and Dallas, Texas, is a healthcare model providing pediatricians, nurse coordinators, therapists, psychiatrists, early childhood specialists, and child protective services for about 1400 children a year. That’s close to 5500 visits among all those providers for children the experts there say are among America’s most vulnerable.
“Like most pediatricians, I was serving any child who needed help and support,” says the Center’s Director Anu Partap, MD, MPH, who is also assistant professor of Pediatrics at the University of Texas (UT) Southwestern Medical Center, Dallas. “When I came to Children’s Medical Center in 2009, I started working with children in foster care and was struck by how their complex needs exceed what most of us can do by ourselves in a pediatric practice.”
Children in foster care, she says, have health issues related to histories of abuse and neglect, and often have special healthcare needs that require specialized medical attention. They have the emotional trauma of not being with their families anymore and living in a new community. Then, they likely have mental health troubles, which can be long term.
As a practicing pediatrician, Partap says she’d try to address the children’s issues but wasn’t providing the quality of care they needed. The new model of care helps her provide that quality, she says.
“We know that children who grow up in households with abuse, neglect, domestic violence, parents with addiction, and more will go on to have much higher rates of heart disease, diabetes, obesity, mental illness, and addiction,” Partap says. “When you look at children in foster care, they likely have the highest risk compared to the population of victims of abuse or neglect. Their trauma histories are potentially shaping their entire lives, unless we intensively treat them when they first come in.”
A new idea
The Rees-Jones Foundation provided a grant in 2014 for the 25-year-old foster care medical home in Dallas to transform into a multifaceted Center with locations in Dallas and Plano, focused on improving the well-being and long-term outcomes of foster care children in Texas.
There are about 15 other centers scattered around the United States that address healthcare needs in the foster care community. However, the Rees-Jones Center is among the most comprehensive, providing care even as children transition out of foster care and partnering with organizations and the government to make life better for these children. Many of the Rees-Jones Center providers have faculty appointments at UT Southwestern Medical Center, according to Partap.
Foster care in America
Most pediatricians will care for children in foster care, according to Partap.
Nearly 1% of US children spend time in foster care annually. About 6% of children spend time in foster care at least once between birth and age 18 years, and most children in foster care are victims of abuse or neglect.1
Researchers have found these children to be in poor mental and physical health, compared with children outside the foster care system. Their physical and mental vulnerabilities are, in part, a result of early life circumstances.1
Chances are good that children’s healthcare utilization was fragmented and sporadic before they entered foster care, resulting in a high prevalence of undiagnosed or under-treated chronic medical problems once they get to foster care.2
About half of children who are in foster care have chronic physical problems, such as asthma, anemia, visual loss, hearing loss, and neurological disorders. About 1 in 10 are medically fragile or complex, many were born prematurely or have a history of prenatal maternal substance exposure.2
The toxic stress these children often experience can lead to lifelong physical, mental, and behavioral issues. Studies have shown that neural connections in the brain can be disrupted or damaged during periods of extreme and repetitive stress even in infancy, according to the American Academy of Pediatrics (AAP).3
“Toxic stress, epigenetics, and adverse childhood events really drive the need for us to do things differently,” Partap says.