II. Definitions

  1. Foster Care
    1. State facilitated temporary service for children who cannot live with their parents
  2. Kinship Care
    1. Care of a child by relative or close friend as mediated by U.S. child welfare system

III. Epidemiology

  1. Foster Care system in the U.S. provides services for 675,000 children each year
  2. 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)

  1. Child Abuse (neglect, physical abuse, Child Sexual Abuse)
  2. Inadequate housing
  3. Incarcerated parents
  4. Parental Illicit Drug use

V. Associated Conditions

  1. Toxic Stress and Post-Traumatic Stress Disorder
  2. Learning Disorder
  3. Developmental Delay
  4. Mental health disorder
  5. Oral Health disorder
  6. Chronic medical conditions (80% of children)

VI. History

  1. Demographics
    1. Identify authority for healthcare decisions
    2. Collect case worker's contact information
  2. Emergent or Urgent Concerns
    1. Suicidal Ideation
    2. Homicidal Ideation
    3. Violent Behavior
    4. Pregnancy
    5. Acute abuse-related injuries
  3. Past Medical History
    1. Immunization Status
    2. Hospitalization history
    3. Mental Health Trauma History
  4. Neuropsychiatric
    1. School performance and Learning Disorders
    2. Developmental Delay
    3. Mental health disorders
  5. Other screening
    1. See Adolescent Health
    2. Sexually Transmitted Infection
  6. Current Foster Status
    1. Good fit (e.g. significant religious or cultural differences)?
    2. Caregiver stress
    3. Case worker concerns

VII. Exam

  1. Growth and development
  2. Vital Signs
  3. Vision Screening
  4. Hearing Screening
  5. Dental Exam
  6. Nonaccidental Trauma evaluation (including genitalia)

VIII. Management

  1. Initiate regular medical evaluations with additional visit time allotted (AAP)
    1. Within 24 to 72 hours of initial foster placement
    2. Monthly medical evaluations for the first 3 months (and up to age 6 months)
    3. Continue periodic reevaluation
      1. Every 3 months until age 2 years, then every 6 months
      2. Also include standard Well Child Visit evaluations
  2. Consultation and Referral
    1. Pediatric Dentist
    2. Mental Health Evaluation and Counseling
    3. Developmental Delay evaluation and management as indicated
    4. Government Assistance (most age <5 years qualify for SNAP and WIC in U.S.)
  3. Preventive Health
    1. Update Immunizations
      1. HPV Vaccine starts at age 9 (high risk population)
    2. Teen Healthcare
      1. See Adolescent Health
      2. Sexually Transmitted Infection Screening
      3. Pregnancy screening
      4. Contraception and safe sex discussion
      5. Substance Abuse
    3. Other topics
      1. Mental health Trauma
      2. Good touch, bad touch and safe adults

IX. Resources

  1. National Child Traumatic Stress Network
    1. https://www.nctsn.org/
  2. Child Welfare Information Gateway
    1. https://www.childwelfare.gov/
  3. National Foster Parent Association
    1. https://nfpaonline.org/
  4. Books for Caregivers
    1. Keck (2014) Parenting the Hurt Child
      1. https://www.amazon.com/Parenting-Hurt-Child-Adoptive-Families-ebook/dp/B00IDHW63G
    2. Purvis (2020) Connected Parent: Real Life Strategies for Building Trust and Attachment
      1. https://www.amazon.com/Connected-Parent-Real-Life-Strategies-Attachment/dp/0736978925

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