Children and youth in foster care enter custody with many challenges for child welfare social workers, healthcare providers, and caregivers to understand their overall health and well-being needs. Most children enter foster care due to allegations of neglect and may have been unable to access or attend necessary healthcare, dental, developmental, and\/or behavioral health care prior to being placed in foster care. As a result, a complete understanding of their healthcare needs may not have been available during the CPS assessment. A smaller percentage of children and youth enter foster care due to allegations of physical or sexual abuse which may include ongoing medical evaluations and treatment, some of which may not be identified at the time of placement as the medical evaluations are ongoing. A growing percent of children and youth entering custody due to dependency includes children and youth whose caregivers are unable to meet the child\/youth\u2019s mental health needs for differing reasons. <\/p>\n\n\n\n
Recommended Healthcare Visit Schedule for Children and Youth in Foster Care<\/strong> <\/p>\n\n\n\n Given the complex\u00a0well-being needs of children and youth in foster care, the\u00a0American Academy of Pediatrics\u00a0recognizes them\u00a0as a population with special healthcare needs.\u00a0As such,\u00a0children and youth in foster care are recommended to\u00a0be seen early, often and comprehensively.\u00a0\u00a0<\/p>\n\n\n\n Best practice includes children and youth receiving healthcare in a trauma-informed medical home, a primary care practice that is structured to provide enhanced surveillance to ensure both identification of well-being needs and access to care meeting those needs. Children and youth in foster care follow an enhanced frequency of visits as compared to children and youth not in foster care. <\/p>\n\n\n\n North Carolina DHHS, Child Welfare section recognizes the importance of this structure and has adopted\u00a0some of\u00a0the American Academy of Pediatrics\u00a0requirements into policy. In North Carolina, children and youth newly entering foster care are to be seen at the following frequency:\u00a0\u00a0<\/p>\n\n\n\n Additional enhanced visit types supported by the American Academy of Pediatrics include the following. The caregiver, permanency placement social worker and healthcare provider will also be expected to adhere to any general as well as chronic disease specific guidelines. <\/p>\n\n\n\n Expected healthcare screenings <\/strong> <\/p>\n\n\n\n Upon entry to foster care, there are standard laboratory and healthcare screenings, similar to other preventive healthcare visits. These include specific developmental, mental health, behavioral health screenings as well as laboratory evaluations. <\/p>\n\n\n\n A caregiver who has recently begun caring for a young child may not have enough time with the child to understand their developmental or behavioral healthcare needs. Ensuring adherence to the recommended frequency of visits greatly assists with improved understanding of any concerns. Pediatric medical providers will use structured and validated screening tools at healthcare visits, to ensure understanding of any needed referrals for ongoing assessment and intervention. For developmental screenings, the pediatric medical provider will be looking for concerns in speech and language, gross and fine motor as well as social concerns and Autism. For school aged children, understanding any specific learning concerns will occur as upwards of 45% of children and adolescents in foster care are reported to have educational challenges resulting in need for support. <\/p>\n\n\n\n Adolescent health screening will follow the same structure for adolescents not in foster care, including honoring adolescent confidentiality rules in North Carolina. It will be expected that the pediatric medical provider will spend time with the adolescent outside the presence of the caregiver. <\/p>\n\n\n\n\n
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