Pediatricians Should Ensure Foster Children Get Needed Care
Reprinted with permission from the March 2005 issue of AAP News, the monthly magazine of the American Academy of Pediatrics.
by Shay Bilchik
In a child's mind and heart, the foster care system can be an intimidating world of strange people and strange places. Sometimes, these unfamiliar people and places come and go so quickly that it can be difficult for foster children to maintain a sense of who they are and where they belong.
To help fill the gaps in their histories and memories, many children and teens create life books with the assistance of social service workers and their foster and adoptive parents. These books can contain both good and bad memories, including their time in foster care or the time with their family before their placement. The books give children a sense of their background and history ¾ something that is uniquely their own.
It is important that those of us serving young people in foster care do our part to help fill these life books with as many good memories as possible. Physicians, in particular, have an opportunity to contribute to these life books and enhance the lives of children who, through no fault of their own, are forced to live away from their families.
This is easier said than done, however. Many children in foster care have a complex web of both physical and mental needs. They may have chronic and complex illnesses that can be challenging for medical professionals to identify and diagnose. Besides common childhood illnesses, many youth in foster care also are dealing with HIV, sexually transmitted diseases, pregnancy or mental illness.
Further complicating matters is the fact that many children's medical histories are incomplete or unavailable to physicians. In the shuffle from home to home, the children may rarely see the same physician. This can lead to illnesses remaining undiagnosed or medications not following a child as he or she moves.
On the other hand, some children receive medical attention for the first time in their lives while in foster care. And for those who have obtained incomplete and interrupted medical care, foster care can be the occasion for medical professionals to have a meaningful effect on a child's life. It can allow children to finally turn a page in their life book and take a step closer to improving their emotional and physical well-being.
Unfortunately, too many medical professionals remain unaware of the growing necessity and opportunities to provide care for children and youth in foster care. Helping create positive memories and outcomes for these children goes beyond giving them accessible, immediate and thorough medical attention. It also demands that physicians help recruit their peers to provide more services to children in foster care and to spread the word that these children desperately need and deserve medical services.
Physicians can begin by working with professional medical associations, such as the Academy, to learn more about treating children in foster care and then spreading this information. Specifically, physicians should encourage hospital residents, interns and professional medical association members to provide services to children in foster care through Medicare, on a pro bono basis or by volunteering at a health clinic.
Secondly, physicians need to collaborate with state child welfare agencies, foster care managers and foster parents to ensure that the highest quality medical care and attention is being given to children in foster care. Creation of medical home initiatives for children with special needs ¾ supported and defined by the Academy as "primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective" ¾ is an excellent example of how individuals within the foster care and medical systems can work collaboratively. Under the medical home approach, a pediatric clinician works in partnership with the family/patient to ensure that all medical and non-medical needs of the patient are met. It would be encouraging if more physicians pushed for similar approaches to medical care in their communities.
The federal government recently developed Child and Family Service Reviews (CFSRs) to assess states' ability to provide positive outcomes for children related to safety, permanency and well-being. Most states did not fair well in the CFSRs, and collaboration among agencies was one area identified as needing improvement.
Another key challenge uncovered by the CFSRs is that not enough doctors and dentists are willing to accept Medicaid reimbursement levels in many states. As a result, children in the welfare system often do not get the services they need. The states, under the guidance of the U.S. Children's Bureau, are working vigorously on how best to achieve more meaningful outcomes. But the aid of medical professionals also is needed in this effort.
Finally, one of the most important pieces to remember is that many of us cannot possibly understand what life entails for these children. For some children, medical visits can be the scariest aspect of the foster care experience. A physical exam can be awkward or embarrassing for any child. But it can be especially scary to a child who has never been on an examination table under bright lights and absolutely traumatic for a child who has been sexually abused. Medical professionals must do everything possible to ease that trauma.
In a sense, what foster children need is for someone to hold their hand as they experience the foster care system ¾ not just while undergoing a medical procedure. Through their concerted and thoughtful efforts, pediatricians can help to create a greater sense of security for foster children as well as more positive experiences and memories that are worthy of mention on the pages of a life history book.
Mr. Bilchik is president and CEO of the Child Welfare League.
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