II. Definitions
- Foster Care
- State facilitated temporary service for children who cannot live with their parents
- Kinship Care
- Care of a child by relative or close friend as mediated by U.S. child welfare system
III. Epidemiology
- Foster Care system in the U.S. provides services for 675,000 children each year
- More than half of children in the foster system will spend at least 1 year in the Foster Care (or Kinship Care)
IV. Indications: Foster Care (or Kinship Care)
- Child Abuse (neglect, physical abuse, Child Sexual Abuse)
- Inadequate housing
- Incarcerated parents
- Parental Illicit Drug use
V. Associated Conditions
- Toxic Stress and Post-Traumatic Stress Disorder
- Learning Disorder
- Developmental Delay
- Mental health disorder
- Oral Health disorder
- Chronic medical conditions (80% of children)
VI. History
- Demographics
- Identify authority for healthcare decisions
- Collect case worker's contact information
- Emergent or Urgent Concerns
- Suicidal Ideation
- Homicidal Ideation
- Violent Behavior
- Pregnancy
- Acute abuse-related injuries
- Past Medical History
- Immunization Status
- Hospitalization history
- Mental Health Trauma History
- Neuropsychiatric
- School performance and Learning Disorders
- Developmental Delay
- Mental health disorders
- Other screening
- Current Foster Status
- Good fit (e.g. significant religious or cultural differences)?
- Caregiver stress
- Case worker concerns
VII. Exam
- Growth and development
- Vital Signs
- Vision Screening
- Hearing Screening
- Dental Exam
- Nonaccidental Trauma evaluation (including genitalia)
VIII. Management
- Initiate regular medical evaluations with additional visit time allotted (AAP)
- Within 24 to 72 hours of initial foster placement
- Monthly medical evaluations for the first 3 months (and up to age 6 months)
- Continue periodic reevaluation
- Every 3 months until age 2 years, then every 6 months
- Also include standard Well Child Visit evaluations
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Consultation and Referral
- Pediatric Dentist
- Mental Health Evaluation and Counseling
- Developmental Delay evaluation and management as indicated
- Government Assistance (most age <5 years qualify for SNAP and WIC in U.S.)
- Preventive Health
- Update Immunizations
- HPV Vaccine starts at age 9 (high risk population)
- Teen Healthcare
- See Adolescent Health
- Sexually Transmitted Infection Screening
- Pregnancy screening
- Contraception and safe sex discussion
- Substance Abuse
- Other topics
- Mental health Trauma
- Good touch, bad touch and safe adults
- Update Immunizations