Children placed in the foster care system are among the most vulnerable members in our communities. They generally come from families with the fewest psychosocial and financial resources, and experience higher rates of serious emotional and behavioral problems, chronic physical disabilities, developmental delays and poor school performance. These difficulties are exacerbated by a lack of continuity in many areas of life, since children in foster care move an average of five times – and each move often means children are starting from square one, even with their pediatrician.
In line with our Mission and Values, SSM Health Cardinal Glennon Children's Hospital believes that all children should have access to continuous, comprehensive, coordinated, compassionate and culturally sensitive primary care. As a medical provider and resource for many state agencies, community coalitions, and foster and biological parents, SSM Health Cardinal Glennon is also uniquely positioned to improve the health and well-being of children in foster care. Recognizing this, in 2015, clinicians and social workers at SSM Health Cardinal Glennon teamed up to launch the Fostering Healthy Children program (FHC), which strives to provide medical care that will allow children in foster care to thrive.
"Because most of the kids come from chaotic social situations, their medical care has fallen to a lesser priority," said Donna Erickson, clinical coordinator for FHC." Most of our kids need to catch up on immunizations, vision and hearing screenings, dental visits and any other specialists needed. Many times all of their medical care has been in emergency departments and urgent cares, so there is very little continuity as far as wellness or basic medical records. We pull all of this together to give their current pediatrician a clearer picture of the child's health needs."
The program offers initial examinations upon entering into foster care, 30-day comprehensive assessments, and referrals and assistance scheduling appointments with specialists as needed, as well as assistance in compiling medical histories that may otherwise be missing or incomplete.
Shari Sullivan, RN, BSN, coordinator of medical services and foster care medical case manager for Our Little Haven in St. Louis, says this attention to ensuring complete medical histories is key to the well-being of children in foster care. "These kids deserve to have a traceable medical history," said Sullivan. "To have the all-important 30-day exam accomplished in one reputable location is critical in centralizing records, and since some of these kids enter into alternative care more than once, it is vital to have a central source for their medical history."
Improving the lives of children and families
Foster families often struggle to understand a child's health needs because they often don't have access to the child's medical history or caregiver education that was provided previously. "Many times the child's placement changes several times in the first few weeks or months of life," said Erickson.
With babies who have been exposed to opioids or who have been discharged from the NICU with other complex needs, a great deal of education and training is provided to caregivers about ongoing care – but if the child's placement changes, the new caregiver is left without the benefit of that teaching. For example, FHC recently provided care to a 15-month-old baby whose foster mother was very concerned about his development. She was unaware that he had been extremely premature at birth, and FHC was able to give her the support she needed to understand his needs and get him back on track with ophthalmology, cardiology and NICU follow-up he had missed out on due to the circumstances of his first year of life.
By researching medical histories of children who enter their care and then continuing to follow the child in case of new placements, FHC has dramatically improved outcomes – and has even saved lives. Erickson recalls a 10-year-old patient whose medical history was unknown when FHC staff first connected with his new foster family. Upon researching his medical records, they discovered he had a heart condition with potential for sudden death with exertion. He had been diagnosed early in life and should have been seen again within six months to discuss possible surgical repair – but after that appointment, he had been lost to follow-up care for six years. FHC staff provided an immediate referral to a cardiologist and educated his foster parent regarding proper follow-up care and management of the condition.
FHC also makes sure that with each change in placement, the new primary care doctor receives medical records and history. By fully understanding each child's health needs, FHC staff can create a comprehensive care plan that can be implemented and passed on to the child's primary care provider anywhere in the state of Missouri to ensure continuous care into the future.
Sullivan knows all too well the obstacles faced by children in the foster care system when it comes to receiving comprehensive, coordinated medical care. "This population of children are frequently overlooked, or get lost in a web of free clinics, multiple providers, or worse yet, no providers," said Sullivan. "And when it comes to more complex health needs, with so many providers involved along the way, you often have situations where the right hand doesn't know what the left hand is recommending or prescribing." Sullivan says FHC has been invaluable as a much-needed bridge for the children she serves when moving from a string of medical specialists and hospitals to the centralized, coordinated care SSM Health Cardinal Glennon is able to offer.
The program also provides specialized behavioral health programming designed for the specific needs of children in foster care. "Many children in foster care have behavior issues. Trauma often presents in very similar ways to ADHD, so caregivers sometimes mistake signs of trauma for ADHD and want us to prescribe medication – but we know that in most cases these children actually need long-term trauma focused therapy," said Erickson. As part of FHC, a psychologist provides mental health assessments for kids ages 4 and older and makes recommendations for trauma therapy or other treatment as indicated. The team also provides a great deal of education to foster families about trauma in children and helps them connect with additional resources in the community.
The impact in our communities
To date, FHC has accepted more than 1,475 referrals and continues to follow more than 1,000 children for medical case management. The program currently serves children under the jurisdictions of St. Louis city and county.
"Working with FHC has expedited my services to the children I serve, coordinated care in a more productive and organized manner, and guided me in how to be an advocate for their complex medical needs," said Sullivan. "They are a trustworthy wealth of information, and a live person always answers the phone. They really are indispensable in advocating for the unique needs of each child."
If you would like more information about the program or foster care/adoption, please call the Foster and Adoptive Care Coalition at 1-800-FOSTER3.
The Fostering Healthy Children program is just one of the many ways SSM Health is working to improve the health of our patients and our communities. In 2016, SSM Health invested more than $538 million in programs and services that have touched the lives of more than 1.8 million people. That's a community benefit equal to 12.8 percent of our system's total annual revenues.