Over the last few years, states have witnessed widespread failings within agencies charged with overseeing the well-being of children in foster care. And in many states, the tragedies have placed increased attention on how we care for foster children, who are among the most vulnerable members of a community. State and local agencies are struggling to show the public that they are able to provide quality care and safe homes for children in foster care and this extends to the health care they receive.
The unmet health needs of children and youth in foster care are rooted in their complex trauma histories and are compounded by the barriers to appropriate health services. Children and youth in foster care need more intensive and comprehensive care due to the additional challenges they face in physical and mental health, development, oral health and psychosocial adjustment. The American Academy of Pediatrics (AAP) is now weighing in on the issue, highlighting the need for more robust and deliberate attention to these children in the health care home.
The foster care population has demonstrated a significant disparity in health outcomes. According to the American Academy of Pediatrics’ 2015 policy statement:
- 30 to 80 percent of children come into foster care with at least one medical problem
- One-third of children in foster care have a chronic illness
- Up to 80 percent of children and adolescents enter foster care with a significant mental health need
- Nearly 40 percent of children in foster care have significant oral health issues
- 60 percent of children under age 5 in foster care have developmental health issues.
The data illustrates a clear need to reevaluate the health care practices when working with children and youth in foster care and to rethink how to provide high quality care.
One of the largest barriers to quality and comprehensive health care for these children is the lack of care coordination. The transient nature of life as a child in foster care and the shared and transferred authority among caregivers and professionals leads to fragmented care. Additionally, the health care services they receive are often reactive instead of preventive.
As the health industry begins to rethink delivery systems and quality of care, there is an opportunity to change our approach and provide more holistic care for children in the foster care system. One part of quality health care for children and youth in foster care is creating a “foster care-friendly office.” Ensuring that pediatricians and caregivers have a comprehensive understanding of childhood trauma is incredibly important and all of the adults in the child’s life need to focus on providing a trauma-informed environment. Additionally, pediatricians should be using appointments to screen for signs of child abuse or neglect as this small adjustment has the potential for positive changes for the children.
Advocates can address these barriers by calling change in the training and education of our pediatricians and caregivers. Additionally, advocates can partner with child-focused agencies that support the needs of foster children, educating them on the importance of the provider visit and important screenings required by Medicaid.
As advocates shift the conversation to health system transformation and delivery system reform, we should not lose sight of the critical needs of children experiencing trauma. Advocating for comprehensive training, care coordination and active communication between caregivers, pediatricians and professionals will help improve the health care services for children and youth in foster care.
-Katherine Fukumoto, Intern, New England Alliance for Children’s Health