Impact Feature Issue on Children with Disabilities in the Child Welfare System

Children in foster care have a disproportionate percentage of health and developmental problems that are often missed or not treated properly. This well-known fact was the impetus for the creation of foster care clinics throughout Connecticut during the early 1990s exclusively dedicated to the health and development of foster children. The State of Connecticut Department of Children and Families (DCF), operating under a court-ordered mandate, requires that all children entering foster care for the first time receive a comprehensive examination completed by a multi-disciplinary team of pediatric professionals within 30 days, pursuant to an order of temporary custody or commitment from the court.

The Foster Care Multi-disciplinary Screening Program at the Connecticut Children’s Medical Center (CCMC) is one of the state’s oldest and largest contracted providers of the Multi-disciplinary Exam (MDE) through their Foster Care Clinic. Though the program at CCMC ended in August 2005, for the past 15 years it has been very effective in its dedication to promoting healthy development for children in foster care, advocating for each child’s individual adjustment and well-being, and supporting and empowering foster families.

Program Description

Children referred to the program, who typically range in age from newborn to 17 years, commonly have one or more of the following health-related problems:

• Lack of health history.

• Incomplete health records missing documentation regarding primary care provider, immunization status and serious allergic reactions.

• Heath conditions requiring treatment from specialists in Endocrinology, Cardiology, Orthopedics, Genetics, Gastroenterology, Ophthalmology, ENT, Neurology, Dermatology, Pulmonology, and Gynecology.

• Medical complexities and multiple health problems requiring immediate coordination of services and resources through the hospital’s Center for Children with Special Needs.

• Prenatal drug/alcohol exposure, HIV, or sexual abuse requiring follow-up by many of the specialty health programs at CCMC.

• Speech delays and chronic ear infections requiring comprehensive Speech / Language and Audiology assessments and services.

• Hypertonia/hypotonia and motor skills delays requiring Occupational Therapy and Physical Therapy.

• Rampant dental caries requiring pediatric dental treatment.

• Medication assessment and prescriptions.

• Asthma without necessary treatment.

• Fragmented adolescent health care.

• Substance abuse and sexual activity.

The MDE program at CCMC has five goals in relation to these children:

• To identify health, mental health, developmental, and educational needs of children through an MDE at the point of entry into foster care.

• To document the exam outcomes with specific recommendations for further evaluation or interventions and treatment.

• To provide written reports of outcomes and recommendations to DCF and foster care providers, and advocate for emergency intervention and treatment when needed.

• To distribute educational materials and resource information to foster care providers and offer training and consultation to DCF staff in areas of children’s health, mental health, and development.

• To collaborate with community initiatives advocating for and promoting the health and well-being of children in foster care placement.

These goals are carried out by a multi-disciplinary team consisting of the following positions:

• Pediatric nurse practitioner who completes a health assessment for each child, consults with the team and foster care provider regarding identified health problems, documents findings and recommendations for appropriate medical treatment and services.

• Clinical social worker/ team coordinator who coordinates team operation and consultation, obtains case history from DCF, conducts a psychosocial and mental health assessment (including interview with foster care provider) documenting specific findings and recommendations for further interventions or treatment, and incorporates all team findings and recommendations into a summary report for each child that is forwarded to DCF and the foster care provider.

• Dental hygienist who completes a dental assessment for each child to identify any dental problems, consults with team, and documents findings and recommendations for dental treatment.

• Developmental testers who administer a standardized developmental screening tool to identify developmental delays and educational needs, consult with the team, and document findings and recommendations for necessary services.

This team of licensed professionals convenes once a week and examines an average of 12 children over a 4-hour time span. Last year over 600 referrals were received and processed and approximately 550 children received an MDE.

When a child is referred to the program, their foster care provider is contacted by phone and an appointment for the Foster Care Clinic is immediately scheduled to meet the 30-day deadline. Foster parents are strongly encouraged to accompany their child to the appointment and stay with them as they proceed through each component of the assessment; this is an opportunity for foster parents to discuss concerns and receive feedback from each member of the team. The biological parent is not directly involved with this particular process because the focus of the program is aimed at the needs of the child in the context of their foster care placement.

Upon arriving at the clinic, each child is welcomed by the team coordinator and a representative from the Connecticut Association of Foster /Adoptive Parents (CAFAP) who distributes resource materials and information, and offers support to the foster parents during down-time in between each portion of the MDE. First, the child is weighed and measured and then examined by the dental hygienist who conducts a simple dental assessment in order to minimize the child’s anxiety. Foster care providers are offered information regarding dental hygiene and dental treatment resources in the community. Then they move onto the developmental screening test and a tester administers the appropriate test based upon the child’s age range. Foster parents are invited to exchange information and concerns regarding their child’s development and may receive recommendations and advice from the tester. The health assessment is next and each child and foster parent meet with the nurse practitioner for a health exam and discussion regarding health status. Since the emphasis is upon assessment, no medical interventions or procedures are conducted. Children are referred to a primary care provider to assure continuity of care. Upon completion of all three parts of the MDE, a team consultation and brief wrap-up take place to identify problems and make recommendations. The team first meets briefly to review their findings and the psychosocial information and then recommendations are presented verbally by the clinical social worker to the foster care provider prior to leaving the clinic. Any foster parent concerns or questions regarding the exam, or follow-up services, or DCF policies can be addressed at this time.

A copy of the summary report is sent to both DCF and to the foster care provider documenting specific recommendations and an action plan for each identified problem. It is the responsibility of DCF to then coordinate with the foster care provider and to pursue the recommended treatment and follow-up services. In cases where immediate action is required, DCF is contacted by phone directly from the clinic to initiate urgent procedures.

Program Effectiveness

Over 80% of the children referred to the program present developmental deficits requiring follow-up through community programs such as Birth to Three or through special education services. Approximately 65% have other types of disabilities or chronic health/mental health needs that must be addressed, and roughly 70% have acute health care needs. The rationale for this child welfare initiative is self-evident: it is in the best interest of this high-risk population to obtain necessary services and treatment as soon as possible. This program has successfully demonstrated a cost-effective approach to achieving positive outcomes and better futures. The foster care clinic minimizes fragmentation of services through a seamless network which allows care coordination and access to desperately needed services that promote healthy child development.