children’s health & development program wake county human services raleigh, north carolina...
TRANSCRIPT
Children’s Health & Development Program
Wake County Human ServicesRaleigh, North Carolina
Jean C. Smith, [email protected]
CityMatCHAlbuquerque, NM
September 22, 2008
“When I was little I would think of ways to kill my daddy. …But I did not kill my daddy. He drank his own self to death the year after the County moved me out.”
Ellen Foster
Background/Purpose
Health Needs of Children in Foster Care
Children and adolescents in foster care have higher prevalence of -
Physical Developmental Dental & Behavioral –
health conditions
“…my teacher noticed a bruise he put on my arm and they all had a field day over it in the school nurse’s office. Calling in everybody but the janitor to look at it. I had rather nobody saw my business.”
Health Status of Children & Adolescents Entering Foster
Care
More than 90% have abnormality in at least 1 body system
Vision & hearing problems common Suboptimal growth 5 times expected
(Large cohort study of children entering foster care - Baltimore, MD)
Health Status of Children & Adolescents Entering Foster
Care
< 20% had NO medical conditions >20% had growth abnormalities 30% had neurological disorders 16% had asthma (~3 times national
ave.)
(Large cohort study of children in foster care in Oakland, CA)
Health Status of Children & Adolescents Entering Foster
Care
High incidence of anemia High incidence of infectious
diseases Increased risk for vertically
transmitted infections (HIV, hepatitis B & C, syphilis, herpes simplex)
“I try not to leave her by herself with him.”
Other problems >80% exposed to domestic and/or
community violence High risk behaviors in adolescents in
foster care with risk for STD’s, etc. No cohesive system of care for this
vulnerable population Little tracking or monitoring of care
that does exist.
“When they came back in they said they had decided what to do with me. It’s about time I thought. Yes Lord it’s about time.”
Fostering Health: Health Care for Children & Adolescents in Foster
Care
Task Force on Health Care for Children in Foster Care
American Academy of Pediatrics, 2005
Child Welfare League of America
Standards for Health Care Services for Children in Out-of-Home Care
Washington, DC: Child Welfare League of America; 1988
Evaluating Quality of Care for Children in Foster Care
-CWLA
Seven criteria1. Access to care
2. Appropriateness of services
3. Comprehensiveness of care
4. Coordination
Quality of Care Criteria Continued
5. Continuity
6. Relation to the community
7. Family-centered service
Health Care Delivery Models for Children in
Foster Care
Agency-based care
Specialized foster care clinics
Community-based care
“Since my first day here all I felt is luck coming my way. I never thought I could have it this good.”
Components of Health Care Services
Initial health screening
Comprehensive health assessment
Developmental & mental health evaluation
Components of Health Care Services
Primary health care and monitoring health & developmental status
Transfer of medical information
“All I did was wish him dead real hard every now and then. And I can say for a fact that I am better off now than when he was alive.”
Children's Health and Development Program: A collaboration of John Rex Endowment and Wake County Human Services
Wake County Human Services (WCHS) is a consolidated agency including health, mental health and social services.
Children's Health and Development Program Staff
Assessment Coordinator – BSW,QMHP 1.0 FTE
Developmental Specialist – BA,MA 0.5 FTE
Pediatric Nurse Practitioner – 0.5 FTE
Mental Health Specialist – LCSW-P 0.5 FTE
Pediatrician Director – 0.05 FTE
Objectives of CHDP
Provide medical, mental health, and developmental assessments for children birth to 18 years of age entering foster care and children 3 to 10 years of age in CPS treatment in Wake County.
Share assessment information and plans of care with those responsible for the child’s care and well being
Identify health, developmental and behavioral problems and/or needs of children in foster care and CPS treatment.
Objectives of CHDP(2)
Develop individualized plans of care with recommendations for each child
Identify the medical home for each child to provide continuity of care and monitoring of ongoing health and developmental care and needed services.
Assist DSS, guardians, and families in accessing appropriate referrals or services for children.
Program StandardsThe Children’s Health & Development Program
uses: State of the art screening and
assessment tools and community referral networks for early intervention services including Child Service Coordination
Incorporates best practices in developmental and behavioral screening into each assessment
Assists parents/foster parents in anticipation of strengthening of their children’s developmental skills
Program Standards(2)
Collaborates with families to strengthen ties and or link families to medical home
Assists families and medical home in securing developmental and behavioral services outlined in the plan of care
Provides assistance in continued monitoring of health and development
“..there have been more than a plenty days when she has put both my hands in hers and said if we relax and breathe slow together I can slow down shaking. And it always works.”
Methods
1. Children come into DSS care
2. Court Day One conference
3. Appointment for medical assessment
Completed for all children unless a CME (Child Medical Exam) or SICC exam (Special Infant Care Clinic) is done.
Methods(2)
4. Appointment for developmental assessment
(Completed for all children 10 years and under.)
5. Appointment for mental health assessment(Children 3 mos. – 4 years with concerning
score on ASQ-SE are assessed. All children ages 4 – 18 get a screening or review of current mental health services.)
Methods(3)
6. Complete needed referrals
7. Develop Plan of Care (POC) with team
6. Review POC with Social Worker
7. Assure follow-up services are secured.
Services
A comprehensive health assessment within a month which will include gathering and reviewing all past medical records, school/child care information, immunization status, etc.
A developmental and mental health evaluation (which may occur in the home)
* A review of all medical, school, and mental health records are done for children not receiving direct assessment by the CHDP.
A plan of care to include identification of a medical home, special health needs, specific behavioral/developmental concerns, and assistance for families in securing needed referrals.
Medical Exam Review all medical history and
request records for review Full comprehensive PE Required state DSS PE form sent Assess if HIV testing or other lab
work needed Skeletal survey done per protocol
for children < 2 years of age
Developmental Assessment Review developmental history, school
history, and any interventions including IFSP/IEP
Developmental screening for all children less than 5 years of age
Neurodevelopmental screening for school age children who have not had psychoeducational testing at school.
Review school records for those children with IEP’s to determine the need for changes and/or updating.
Mental Health Assessment Review mental health history and prior
MH services/assessments. MH evaluations for all children ages 4 –
18 years if not currently in treatment MH evaluation may include observation
of child in the home, daycare, or office setting along with collateral contacts with those working with child
Complete a Doctor’s order for services and provide level of care information for indicated therapeutic services
“Every Tuesday a man comes and gets me out of social studies and we go to a room and talk about it all. ..He spread out pictures of flat bats for me to comment on. I mostly saw flat bats. Then I saw big holes a body could fall right into.”
“..he tells me I’m scared. I used to be but I am not now….I might be a little nervous but I am never scared.”
Features of CHD Program: Direct Benefits
Comprehensive and Coordinated screening and treatment plan for children in foster care or in families in need of child protective services.
Coordinated individualized plan of care to increase parents/caregivers understanding of their children’s developmental and mental health status.
Assist parents/caregivers to use resources in medical home and early intervention programs to optimize their children’s development.
Features of CHD Program: Health Care Management
Information gathering Ensuring appropriate medical consents Coordination of health care services Educating child welfare staff, courts,
GALs, foster & birth parents, educators, and health care professionals
Ensuring Plans of Care are provided to all medical homes and child welfare staff
Referrals & Secured Care
January 2004 through December 2005
All children are referred to a medical home for ongoing health care - 412
Medical referrals (specialized) – 27 Developmental referrals – 90 Mental Health referrals – 158
Outcomes
January 2007 through December 2007
Medical/Physical Exams – 132Developmental screenings – 105Mental Health evaluations – 79
(foster care only – no CPS)
Outcomes
Totals for 4 years of program:811 children seen670 referrals1,879 assessments
Lessons Learned Public health and child welfare
agencies have a significant responsibility to assure comprehensive care for children in foster homes.
Families and DSS staff prefer regionalization of services.
Protocols (skeletal surveys, HIV screening, etc.) need to be followed.
Lessons Learned
More children were found in need of developmental and/or mental health services than DSS had previously anticipated.
Children are receiving services in a timelier manner than previously.
“The CHDP has offered comprehensive health services to all children entering foster care each year. The program has offered a resource that was not available previously and assures an individual plan of care addressing health, development, behavioral, and mental health needs. Foster children generally come from a background of poor or inconsistent health care; records are frequently scarce. The CHDP is invaluable in providing a complete and thorough health view of these children who may be vulnerable to delays, emotional problems or other medical concerns.”
Elaine Rakouskas, WCHS Program Manager for Foster Care Services
“Sometimes …I count up what I like about the way I’m living now. ….And the best one number four is my new mama saying good morning to me like she means it.”
