Comprehensive health care for children in foster care
- Sandra H Jee, MD, MPH
Sandra H Jee, MD, MPH
- Associate Professor of Pediatrics
- University of Rochester
- Moira A Szilagyi, MD, PhD
Moira A Szilagyi, MD, PhD
- Professor of Pediatrics
- University of California at Los Angeles (UCLA)
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Marilyn Augustyn, MD
Marilyn Augustyn, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Associate Professor
- Boston University School of Medicine
Children and adolescents who spend time in foster care have often been exposed to multiple adverse childhood experiences, including child maltreatment, as have many children whose families are involved with the child welfare system and those living away from their parents in informal placements with relatives.
An understanding of the structure, goals, and mandates of the foster care system, as well as the unique health, mental health, developmental, and educational problems of children and adolescents in foster care, facilitates provision of appropriate comprehensive care to this vulnerable population [1,2].
Comprehensive health care for children and adolescents in foster care will be discussed here. The epidemiology of foster care and an overview of the foster care system in the United States are presented separately. (See "Epidemiology of foster care placement and overview of the foster care system in the United States".)
Overview — Children in foster care are a uniquely vulnerable population. They are classified as children with special health care needs by the American Academy of Pediatrics because of the high prevalence of chronic medical, developmental, and mental health problems, most of which predate placement in foster care [3,4]. Most children in foster care have at least one chronic medical problem (table 1); one-fourth have three or more [2,4-9]. (See "Children with special health care needs".)
Throughout this topic, the concept of health encompasses physical (including dental), mental, behavioral, developmental, and educational health. The potential health problems of children in foster care include, but are not limited to [2,4-8,10,11]:
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- HEALTH NEEDS
- Complex childhood trauma and toxic stress
- - Mental health issues
- Manifestations of mental health issues
- - Exposure to violence
- Development and education
- HEALTH CARE PROVISION
- - Health information gathering
- General principles
- Models of delivery
- - Medical home model
- INITIAL SCREENING
- COMPREHENSIVE HEALTH ASSESSMENT
- Foster care history
- Immunization status
- Chronic conditions
- - Routine screening
- - Infectious diseases
- - Mental health
- - Exposure to maltreatment
- Education and support
- FOLLOW-UP VISIT
- RECOMMENDED HEALTH SURVEILLANCE SCHEDULE
- PRIMARY CARE PROVIDER'S ROLE