Published on in Children's View
The 6-year-old boy came in for his appointment, accompanied by his foster mother. As the nurses and doctors reviewed his records, they found he had severe asthma and a nut allergy.
The foster mother hadn’t known. For months, he had been without an inhaler or EpiPen®.
They walked out that day with those necessary medicines — and one other lifesaver: a summary of medical history and other critical information that would follow the child wherever he went, from then on.
When children are removed from their homes to be placed in foster care, the priority is to provide a safety net, often with little time for planning. So they must often leave behind important things: clothes, toys, even medicines.
In the following days, as foster parents help the children adjust to a new home, they must sort through a maze of health questions: Does my foster child have a pediatrician? Insurance? Prescriptions? Have they been immunized? If so, where are the records, so that I can register them in school?
Because of a well-intentioned but overburdened child welfare system, answers are slow in coming. Serious health issues remain unaddressed, compounding suffering caused by neglect or physical or sexual abuse. And foster parents often don’t know where to turn.
Now they can turn to Children’s Hospital of Philadelphia. The Fostering Health Program at CHOP has become a resource when adversity is the norm.
“The obstacles a foster parent faces in just trying to provide the basic supports for a child to succeed in life are daunting,” says program founder Philip Scribano, DO, MSCE, a pediatrician specializing in issues of child abuse. “The child’s health is one key piece. Our program is designed to help lighten the load in navigating the child’s health needs.”
The program, which includes pediatricians, a nurse coordinator and an occupational therapist, has served more than 200 children in its first year.
Pediatricians or caseworkers refer children to the program, or the foster parent makes an appointment directly. Before the visit, coordinator Judy Dawson, RN, BSN, searches databases, painstakingly assembling the child’s health history.
After records are assembled, the child comes in for a comprehensive evaluation, seeing the nurse, a pediatrician and an occupational therapist to assess literacy and motor skills. The team also includes a fellow, a pediatrician being trained to provide care for this vulnerable population.
Findings are heartrending, and some issues life-threatening: Children with burns or other marks of abuse. Teenagers who need help completing a form that measures exposure to trauma, because they have difficulty reading. A 13-year-old so depressed that the team immediately sent him to the emergency room, where he was admitted.
One of the program’s most important functions is mental health referrals; more than 40 percent require it.
“Society has failed them,” says Kristine Fortin, MD, MPH, a pediatrician on the team. “They’ve been abused or neglected and have risk factors for poor health. And then they go through the traumatic stress of being removed from the place they know and placed in another environment.”
Jennifer has fostered 23 children in 11 years. Once a 1-year-old was delivered to her in the middle of the night, skull and clavicle fractured. Another time she took in a baby whose mother was heroin-addicted, and it took days to figure out that there were no records because he hadn’t been born in a hospital.
She understands how difficult — and important — it is to assemble a paper trail and a medical team for victimized children. She now brings her foster children to the program and recommends it to others. “This program is a blessing,” Jennifer says.
Better days are possible
On a recent morning, Ella Ward arrived at the Buerger Center for Advanced Pediatric Care located on the Raymond G. Perelman Campus with three brothers she is fostering: Tyler, 11, Jeremiah, 12, and Edward, 13. After carrying Tyler from the car (he has a genetic condition that mimics cerebral palsy), she settled him into a wheelchair in the lobby and pushed him to the elevator, with his brothers at either elbow.
Dawson, the nurse coordinator, met them on the seventh floor and with a friendly greeting began to shepherd them through the evaluations. Dawson is positive and intent, invigorated to be on a team helping children she describes as “incredibly resilient.”
The program is searching for funding to reach more of them. “There are more than 6,000 children in foster care in Philadelphia,” Dawson says. “We’ve seen 200.”
Later that day, Fortin sat with Ward to review the roadmap (sometimes called a foster care health passport) the team had created for each boy. Every child who comes through the program gets this summary of important information including medical history and needs and key contacts in the child welfare and healthcare system. The document is invaluable to pediatricians and specialists who will manage the children’s health, and is a bulwark against deterioration of communication and services for children who will experience numerous foster-care placements.
For Ward, the team provided referrals to three specialists and set in motion the fulfillment of other needs: a primary care pediatrician closer to home; physical and occupational therapy for Tyler; and insurance clearance for a wheelchair — Ward often carries Tyler because his current chair isn’t the right size.
Ward, who has fostered close to 100 children in 18 years, feels fortunate to have CHOP by her side as she provides stability and love to the three boys. She feels lucky they came into her life. “All of us are extremely close now,” she says. “What I admire about Eddie and Jeremiah is they have unity for Tyler. They are very loving.” She has begun the process of adopting them.