Vol. 19, No. 1 • November 2014

What Is Fostering Health NC?

by Adam Svolto

Fostering Health NC is a statewide initiative focused on improving health outcomes for children and youth in foster care. This effort, which is led by the NC Pediatric Society, is working to ensure every child in foster care has a medical home and that their healthcare aligns with standards recommended by the American Academy of Pediatrics (AAP).

What is a medical home?
A medical home is a doctor's office--typically a pediatric or family medicine practice--that serves as a central place where all of a child's medical records can be maintained and periodically reviewed. The idea is to have as many health care decisions as possible made by one office to ensure children get coordinated care.

There are many benefits to this approach. By taking children to the same doctor for check-ups, vaccinations, and sick visits, you help the doctor build a complete picture of the child's health, which can help detect changes that need attention. Repeat visits strengthen the relationship you and your child have with the doctor, leading to greater trust and comfort.

How often should visits occur?
Children should be seen by a doctor early and often upon entering foster care. The purpose of these visits is to assess their physical, emotional, and behavioral health needs.

The American Academy of Pediatrics standards recommend children have an Initial Visit within 72 hours of entering care to quickly assess their condition, make referrals, and fill needed prescriptions.

The Academy's standards also call for a Comprehensive Visit within 30 days of the child's entry into care. This visit should include a full physical health evaluation along with the following:

• A mental health evaluation
• A developmental health evaluation (for children under age 6)
• An educational evaluation (for children over age 5)
• A dental evaluation

After these early visits, children in foster care need check-ups (or Well Visits) twice as often as other children. Here is a summary of the AAP-recommended check-up schedule:

• 0-6 months of age: every month
• 6-24 months of age: every 3 months
• 2-21 years and times of significant change: every 6 months

Why is the medical home model important for children in foster care?
Social workers and health care providers often have a hard time finding health records for children in care. This sometimes leads to poorly coordinated care.

For example, the NC Pediatric Society Board President, Dr. John Rusher, tells of a child in foster care who received seven Tdap (tetanus, diphtheria, & acellular pertussis) shots because previous caregivers had no record of the child's immunizations. That's six too many shots.

Frequent check-ups also help children cope better with trauma. On top of the maltreatment they have suffered, research shows that children experience significant stress when they are removed from their homes or switch foster homes. By closely monitoring the child's health and assessing the relationship between the foster parent and child, a doctor can identify early signs of problems and provide prescriptions, referrals to other services, and take action to prevent crises.

What does this mean for foster parents?
As Fostering Health NC expands, foster parents will likely be asked to attend more doctor visits than in the past. In addition, you may be asked to take children to specialty visits, such as mental health providers.

Though time-consuming, these visits will do much to protect and promote children's well-being. What's more, frequent doctor visits have been shown to reduce health crises requiring hospitalization.

How can you help?
There are a number of ways you can support good care coordination for the children you foster. For those already in your care, confirm with the case worker that the child is assigned to a medical home. For children who have recently entered care, ensure they have completed the Initial Visit and Comprehensive Visit described above. Ask the child's medical home provider for a copy of the treatment plan and any notes for foster parents and school personnel.

Once the child has a medical home, work with providers there to meet the AAP-recommended check-up schedule. If you need to seek urgent care or emergency room care for the child, make sure a copy of the records for that visit are sent to the child's medical home.

Where can you learn more?
You may find more information about trauma, social-emotional and mental health evaluation, and symptoms to watch for in the NC Pediatric Society's Best Practices for Parents document, which can be found in the Fostering Health NC online library: www.ncpeds.org/_literature_211914/Best_Practices_for_Parents

Adam Svolto ([email protected]; 919/673-2768) is Program Director for Fostering Health North Carolina.

 

~ Family and Children's Resource Program, UNC-CH School of Social Work ~