Special considerations for the health supervision of children and youth in foster care

Question 1

How many children and youth are in foster care in Canada?

Answer 1

> 76 000

Question 2

What is foster care?

Answer 2

The provision of care and supervision by a family other than a biological parent or guardian, and is approved and arranged by a child welfare authority

Question 3

What are some risk factors for foster care?

Answer 3

1. Drug and alcohol addiction
2. Extreme poverty
3. Family history of mental health disorders
4. Homelessness
5. Violence
6. Previous involvement with the child welfare system
7. Prenatal drug and/or alcohol exposure
8. Severe behaviors or complex medical problems
9. Cognitive or functional impairment of parents with little resources or support

Question 4

What percentage of foster children are Aboriginal?

Answer 4

~40%

Question 5

What is Jordan’s Principle?

Answer 5

A proposal to the federal government to resolve jurisdictional disputes affecting services to First Nations children. This is a child-first principle that ensures the needs of the child are met by the government of first contact until the jurisdictional dispute is resolved.

Question 6

What are some recommendations for health supervision of children in foster care?

Answer 6

1. Initial medical visit within 24h of placement
2. A comprehensive f/u visit within 30 days of placement
3. Routine screening for development, mental health, dental health, STI

Question 7

What are some common health care issues that arise on admission to foster care?

Answer 7

1. Poor hygiene
2. Underimmunization
3. Dental neglect
4. Contraceptive needs for adolescents

Question 8

What percentage of children investigated for child abuse and neglect have physical, emotional or cognitive problems?

Answer 8

34% at least one physical, emotional, or cognitive health problem
15% LD
10% Developmental delay
3% Substance abuse related birth defect
2% Physical disability
13% ADHD

Question 9

What are the recommendations regarding foster care?

Answer 9

1. Physicians should recognize that children and youth in foster care have a higher incidence of special needs including chronic medical conditions, mental health disorders, and developmental and academic delays.
2. Physicians should collaborate with child welfare professionals, foster parents, group home staff and, when appropriate, parents and family members to determine the urgency for assessment and to provide optimum health care to foster children and youth in Canada.
3. On placement in foster care, children and youth should have an initial medical visit, including a physical examination, to screen for and treat health conditions requiring prompt medical attention such as acute illness, infection, pregnancy or chronic conditions requiring medication and significant developmental delays or mental health disorders. The need for vision, hearing and dental screening should be assessed.
4. During the initial assessment, physicians should evaluate the infant, child or youth’s need for screening tests such as complete blood count, ferritin, lead level, HIV, hepatitis B and C titres, b-hCG, cervical or urethral swabs for sexually transmitted infections, and Papanicolaou smear on a case-by-case basis. Routine ordering of tests is not recommended.
5. A follow-up medical visit should be arranged to review the medical history including immunization status, perform a complete physical examination, complete or review referrals for developmental and mental health assessments as required, and ensure dental follow-up has been arranged. Laboratory investigations that were part of the initial screen should be reviewed.
6. Physicians should be aware of and sensitive to the unique cultural, emotional, spiritual and physical needs of children and youth of all ethnic groups, including Aboriginals.
7. Physicians should evaluate the need for referral for psychoeducational assessment and support on admission and throughout foster care placement. This could include liaising with teachers, principals, special educators and tutors.
8. Physicians should partner with child welfare professionals to establish and maintain thorough medical records to provide consistent care and follow-up. Health care records should follow the child or youth throughout and beyond foster care placement.
9. Children and youth who are either currently or have previously been placed in foster care should be monitored more frequently than the general paediatric population.
10. Physicians should advocate for permanency planning including placement stability and personal intervention plans which establish a child or youth’s long-term life goals.
11. Physicians should be aware of community resources to assist the fostering caregivers in the care of these special needs children and youth