Vol. 14, No. 2 • May 2010

How to Use the Medical Home Approach to Meet Children's Needs
What You Can Do to Improve Children’s Health

Health Concerns of Children in Foster Care
  • Nearly all (87-95%) of children in care have at least one physical health problem; more than half have more than one.
  • Health issues commonly experienced by children in care include growth delays, neurological impairments, vision and hearing deficits, malnutrition, anemia, respiratory problems, chronic ear infections, severe allergies, and failure to thrive.
  • Children in care also have high rates of developmental problems including language disorders, social skills deficits, delayed motor skills, learning disabilities, and cognitive impairments.
  • Children in care also have high rates of behavioral health issues. It is estimated that 50% to 80% require mental health services, compared to 20% of children not in foster care.
  • Children sometimes enter foster care with chronic health issues that have been poorly managed.
  • Problems in the provision of health care services to children in foster care include duplication, fragmentation, and gaps in services due to lack of continuity and coordination of care and poor communication among providers.

Sources cited in Sanchez, Gomez, & Davis, 2010

If you take care of a child or young person in foster care, the facts in the box above probably don’t surprise you. Chances are, you know from personal experience that many children in foster care struggle with a variety of physical and mental health concerns, conditions, and challenges. You may even know firsthand the frustration that sometimes comes with trying to help children get the services they need.

We are all concerned about the well-being of children in foster care. All of these children are at risk for special needs which can negatively affect them in a number of ways. Physical health issues left unidentified and untreated in childhood can have serious implications for functioning in adulthood (Sanchez, Gomez, & Davis, 2010). Unmet mental health needs among children in foster care, too, can lead to serious consequences later in their lives, including homelessness and incarceration (Kerker & Dore, 2006).

Fortunately, an increasing number of health care providers are aware of the challenges faced by children involved with child welfare and the problems that can occur in serving these children. To better meet their needs, many primary care providers are becoming “medical homes” to ensure children receive family-centered and coordinated health care services.

This article will tell you what you need to know about medical homes and suggest ways to ensure the children in your care benefit from this innovative approach to providing quality health care.

The Medical Home
In the simplest terms, a medical home is a partnership between the family and the family’s primary health care provider. Through this partnership, the medical home provides a single point of entry to a system of care that facilitates access to medical and nonmedical services, including social services. In a medical home, a physician leads a team which delivers and directs care that is comprehensive (sick and preventive/well care), compassionate, coordinated, continuous, culturally effective, accessible and family-centered. A medical home allows primary care providers (i.e., pediatricians or family physicians), parents, child welfare professionals, and other stakeholders to identify and address all of a child’s physical and mental health needs promptly and as a team.

Because children in foster care often have special health care needs requiring the services of many professionals, children in foster care really benefit from the coordination of care provided by a medical home.

Medical homes also benefit children who don’t have special health care needs. A medical home provides a consistent, ongoing relationship with a primary health care provider and team who know the child well.

This consistency is a particular benefit for children in foster care. A medical home preserves the relationship children have with their doctors and ensures that medical records don’t get lost, even when they return home or change placements. Other benefits provided by medical homes include:

  • Doctor visits that aren’t rushed
  • Improved quality of care, with fewer errors and preventable complications
  • Less parental worry and burden
  • Fewer hospitalizations and ER visits
  • Less missed school and missed time from work for parents
  • Easier access to specialists
  • More preventive health care

The medical home is supported by many prestigious physicians and organizations in North Carolina and across the country. The American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, National Association of Pediatric Nurse Practitioners, Family Voices, and the U.S. Maternal and Child Health Bureau endorse the medical home as the model for 21st century primary care for everyone, especially children with special health care needs, which includes children in foster care.

Endorsed by Federal Law
Use of the medical home approach with children in foster care is also strongly supported by federal law. In October 2008, President Bush signed into law the Fostering Connections to Success and Increasing Adoptions Act (HR 6893). Part of this law directs states to establish a medical home and oversight of prescription medication, including psychotropic drugs, for every child in foster care (Center for Public Policy Priorities, 2008; Children’s Defense Fund, 2008). The overall goal of this provision in the law is to ensure continuity of health care for all children in foster care.

What You Can Do
Although ensuring children in foster care have a medical home is ultimately the responsibility of their county DSS, there is a lot that foster parents can do to promote children’s health. Here are a few suggestions:

  • Ask your child’s social worker if the child is enrolled in Community Care of NC. If not, encourage the social worker to partner with the Medicaid staff in their agency to enroll the child with a provider in the CCNC network serving your county. To learn more about CCNC, see the box below.
  • Obtain and keep in a safe place all available medical records; make sure the child’s physician also has access to these records. Consider creating and carrying a portable medical record for your child that can be used by other caregivers and health care providers in an emergency.
  • Work with the child’s physician to determine the appropriate schedule for visits; the American Academy of Pediatrics recommends that children in foster care have more preventive health visits than other children.
  • During doctor visits, share any concerns or information you have related to the health and development of the child.
  • Be sure to ask questions that help you more fully understand the health and development needs of the child and what you can do to help.
Enrolling Children in Carolina Access and CCNC

One of the best ways to give children in foster care a medical home is to enroll them in Carolina Access, and specifically with a medical home provider who participates in one of the 14 networks within CCNC, or Community Care of North Carolina (formerly named Carolina Access II/III). As part of North Carolina Medicaid’s primary case management program, CCNC can provide children with a medical home that coordinates their medical care.

Enrollment in Carolina Access allows the child to be assigned to a regular primary care provider who will serve as the child’s medical home. Enrollment in CCNC gives the child access to a medical home and to additional potential care management services from local CCNC network staff members who work with medical homes.

Belonging to CCNC has advantages over just being enrolled in straight Medicaid:

You can choose a medical home for the child or continue to use the medical home the child has been going to in the past. A medical home will need to be chosen for each enrolled child if the child does not already have a medical home. Many pediatricians and family physicians are already enrolled as medical home providers with CCNC. Contact the Medicaid program in your local county department of social services (DSS) for a complete list of medical home providers participating in CCNC.

You can call your medical home for medical advice day or night, seven days a week. Check the child’s Medicaid ID card for his or her medical home’s daytime and after-hours phone numbers.

You may have a care manager who can help you manage the child’s health care and show you how to keep the child healthy, but only if the child is enrolled in a CCNC network. Ask your primary care provider for more information about working with the care manager who works with the medical home team at the practice.

The child will receive regular sick care and well care at his or her medical home. Care by specialists to address chronic conditions and special needs will be coordinated by the medical home.

Under federal regulations, children in foster care are designated as special needs. As such, their enrollment in CCNC is entirely voluntary. Because many families and child welfare professionals are just now learning about the benefits of medical homes, most children in foster care in North Carolina today do not have a medical home through CCNC.

Please ask your child’s social worker if the child already has a medical home. If so, try to continue to take the child to that provider. If that is not possible, try to keep the child in the same Community Care of NC network so that information from the previous medical home can be shared easily with the new medical home.

If your child does not have a medical home, encourage the social worker to partner with the Medicaid staff in their agency to enroll the child in Community Care of NC.

To Learn More
For tools and resources related to the medical home approach for families, youth, providers, communities, insurers, and states, select from the side bar at http://www.medicalhomeinfo.org/tools/index.html

Special thanks to Drs. Marian Earls, Gerri Mattson, and Emma Miller for their contributions to this article.

Copyright 2010 Jordan Institute for Families