The job of caring for foster children officially falls to state and county child welfare agencies. But in a new policy statement, the American Academy of Pediatrics is asking physicians to take a more active role in ensuring the wellbeing of foster kids in their care.
The majority of children who enter the foster care system are placed there after suffering abuse or neglect at home. A growing body of evidence points to the long-term health effects of that trauma – effects like PTSD, and a higher likelihood of developing substance-dependence and chronic illness.
A statement, published in the journal Pediatrics this month calls on pediatricians to give extra time and attention to children and teens in foster care– and work with sensitivity to trauma. The authors write that health care for foster children is “often fragmented and crisis-oriented rather than planned, preventive, and palliative.”
“The message for pediatricians is ‘If you see a child who is in foster care, assume that they have more complicated needs, and that they have a history that demands your attention,’” says Sarah Springer, a pediatrician in Pittsburgh, and a member of the group that authored the document. The statement recommends that children see a doctor immediately upon being placed in foster care, and frequently thereafter –about twice as often as the recommendation for children outside of the foster care system.
Springer says the policy shift is a reflection of the mounting evidence that early intervention with traumatized children can make a huge difference later in life. “There's so much information now about the really significant mental and physical health effects for adults who've had early childhood trauma. If we figure out how to get these needs addressed and to help them heal, we can change that trajectory,” she says.
The physician group’s recommendations include screening all foster children for mental illness, and examining them for signs of emotional, physical and sexual abuse.
“See them early and often” is a familiar message for doctors working with foster kids, but this is the first time the AAP has made it official policy. Springer says that’s significant, because it provides a basis for doctors to push health insurers to pay for the care this population needs.
And that coverage is important to physicians, because proper care of foster children requires more work but pays less than seeing other children with less complex needs. That’s because the most common insurer for foster children is Medicaid, which reimburses doctors at lower rates than private insurance companies. “It does require far more extensive resources and time and effort to provide the high-quality care,” says Springer. “But it is what kids need, so we need to raise that as the standard of what's expected, then we can work on getting it paid for.”
Another AAP recommendation: Doctors should develop systems for communicating with caseworkers and foster parents. That’s important because children in foster care often show up at the doctor’s office without medical records, and may be accompanied by adults unfamiliar with their medical histories. “There's a whole lot of detective work involved in figuring out where a kid's been and what's been done for them before,” says Springer.
The historic lack of coordination between child welfare and healthcare systems makes providing care a challenge. A 2008 law called the Fostering Connections to Success and Increasing Adoptions Act requires state welfare agencies to work with healthcare professionals to coordinate care. But according to Springer, it’s a work-in-progress in most states. “Having that as the letter of the law is helpful, but unfortunately there are no penalties for not doing it well,” she says.
According to the policy statement, pediatricians even have a role to play as advocates in the legal system that oversees a child’s foster placement.
Springer once advocated for a patient– a girl who had been through extreme trauma, but now was living with foster parents Springer knew, and doing well in her placement. The family was heading out-of-state on vacation, and they wanted to take the girl with them, but a judge’s prior ruling prevented her from traveling out-of-state. Springer decided to talk to the child’s caseworker, and to the judge—and was able to convince them to let the child go. “I think having a doctor say this would actually be good for this kid, you need to not leave her at home with a babysitter and yet another different care provider, you need to let her be part of this family... It was important for this kid's mental health,” says Springer.