Carol Lewis, MD - Chair

Rhode Island American Academy of Pediatrics

Foster Health Committee

In 2010 in Rhode Island, there were 2,223 indicated investigations of child abuse and neglect involving 3,414 children. The vast majority (79%) of child maltreatment cases involved neglect. The greatest contributors to neglect are poverty, parental substance abuse and/or mental illness.¹

As of December 31, 2010, there were 2,293 children under age 21 in the care of Rhode Island Department of Children, Youth and Families (DCYF) who were in out-of-home placement. The overwhelming majority of these children are placed in non-relative/private agency foster care homes, relative foster homes, group homes and residential facilities. 1

Placement stability is a significant concern for children in foster care in Rhode Island and nationally. Changes in foster care placement jeopardize continuity of medical care and nurturing relationships. Barriers to optimal health care results from lack  of information regarding foster children’s medical histories and the sharing of health information between social services, physicians, foster parents, biological parents and children represent an additional challenge and can lead to miscommunication.

In summary, children and adolescents in foster care have more intensive service needs as compared to the general pediatric population or even other children who are poor. As children with special health care needs, children in foster care suffer from significant difficulties in getting the care they need.

Fostering Connections to Success and Increasing Adoptions Act of 2008

The Fostering Connections Law of 2008 is the most comprehensive federal legislation passed regarding the care of children and adolescents in foster care for more than a decade. This law recognizes that the health of children in foster care is a priority and that there must be up to date health records for children in care. The new law strengthens requirements that Rhode Island provide a plan to coordinate health services for children in foster care.

The law requires that Rhode Island develop a system for the ongoing oversight and coordination of heath care services for children in foster care. Rhode Island must ensure the identification and response to these children’s health care needs, including behavioral, mental and oral health and the coordination of those services. In addition, the plan, developed in consultation with medical experts, is to outline a schedule for initial and follow up health screenings, address how health needs identified through screenings will be monitored and treated, describe how medical information will be updated and appropriately shared, discuss how health care will be continuously and collaboratively  provided and address the monitoring of prescription medications. The mandate is unfunded, but its inclusion and specificity in the Fostering Connections Act underscores the importance of health care for

children in foster care.

In response to the Fostering Connections Act, Rhode Island Department of Children Youth and Families (DCYF) has partnered  with Rhode Island American Academy of Pediatrics. A work group has been developed with the goal of improving access to and provision of healthcare for children in care. This is a cross-systems collaboration between DCYF, RI AAP, Department of Human Services, KidsCount and Neighborhood Health Plan of Rhode Island

There are four broad goals that this group has undertaken to ensure that the health care needs of all children and youth involved in DCYF are met:

• Create an effective sharing of comprehensive health care information that is timely and addresses legal and confidentiality concerns.

• Establish consistent, timely access to comprehensive health care evaluations and to stable and coordinated services (continuity of care) that meet national best practice standards for children and youth, particularly for those in out-of-home care.

• Develop and implement a more reliable and integrated system for collection and analysis of outcomes and claims data and in depth robust evaluation system(s) in order to more effectively monitor health status, health care quality, access, timeliness and outcomes for DCYF involved children and youth, including youth who have aged out of care.

• Align policies and practices (not limited to DCYF) with national best practice standards for children and youth, particularly for those in out-of-home care.

Healthy Foster Care America is an invaluable resource for all pediatrician and providers who care for children and youth in foster care. It is an initiative of the AAP and its partners to improve the health and well-being outcomes of children and teens in foster care. The AAP Task Force on Foster Care has provided the resources and tools for providers who care for children in foster care.

http://www.aap.org/fostercare/

1. 2011 Rhode Island Kids Count Factbook, (2011). Providence, RI: Rhode Island KIDS COUNT. Pp.102-107. www.rikidscount.org Accessed June 10, 2011