Table 3.

Health-Care Management

Health-care management is the ultimate responsibility of the foster care agency, but requires health expertise, as well. These are several key components.
1. Consent and confidentiality. Child welfare should obtain appropriate medical consents and releases of information from the birth family, provide copies to the pediatrician, and educate health providers about the foster care agency’s guidelines regarding consent and confidentiality. Psychotropic medication administration and adolescent health issues, such as pregnancy, sexually transmitted infections, birth control, and substance abuse, are governed by separate confidentiality laws in most states.
2. Obtaining health information. The gathering of health information often is a time-consuming, difficult task that occurs over time. Both the child welfare agency and the pediatric professional have a role in attempting to access health records from previous health-care providers, schools, child care settings, and immunization registries.
3. Health-care standards. Health providers and child welfare should attempt to provide health-care services in accordance with health-care standards set forth by the American Academy of Pediatrics for this special needs population.
4. Care in the context of a medical home. The primary care pediatric professional may serve as the point of access to mental health, dental, developmental, and subspecialty care. Timely referrals and care coordination, including communication with child welfare agencies, are crucial to ensuring that children in foster care receive adequate health-care. The pediatric professional should have some knowledge about child abuse and neglect and the impact of trauma, losses, transitions, and foster care on the child and caregivers.
5. Education of caregivers, youth, and child welfare personnel. Pediatric professionals are in a unique position to counsel foster, kin, and birth parents; other professionals; and youth about the child’s health needs and the impact of early trauma on child behavior and development.
6. Health-care plan. Health information should be shared with child welfare personnel in language that ensures that the health-care plan for the child is incorporated into the child welfare permanency plan.