Montana Medical Home Portal

Introduction

The Questions and Answers that follow aim to provide an introduction to foster care for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.

Note that we use the term doctor to refer to physicians, nurse practitioners, physician assistants, and other licensed clinicians who may care for your child.

More information about many topics relevant to children with foster care and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Foster Care module. See also Foster Care of Children with Special Needs for information about becoming a foster parent.

What is foster care?

Parents of children in foster care provide shelter and care for children who are removed from their homes. Parents sometimes end up adopting the children they care for, but many times the situation is temporary. Children, youth, and adults who have been in the foster care system may have transitioned to reunification with their biological families or may have been placed in kinship placements such as with grandparents. They have often had inconsistent and inadequate care in their family of origin and may have previously undiagnosed health and mental health disorders.

Children in foster care are more likely to have, or have had at some point, in-utero exposures to alcohol and other substances; developmental delays; malnutrition; vision and hearing problems; dental caries; behavior problems; problems in school; and other medical problems. Adolescents in foster care have often engaged in high-risk behaviors resulting in acquired infectious, sexually transmitted diseases, and injuries. They may have experienced multiple separations from multiple caregivers and may have behavioral problems due to lack of trust or testing of new caregivers. They have often experienced multiple traumas, or adverse events, including being the victim of abuse, exposure to domestic violence, exposure to community violence, exposure to parental substance abuse and criminal behavior, and/or witnessing parents or loved ones in life-threatening situations.

Untreated conditions, especially emotional, behavioral and symptoms related to traumatic experiences, are the most common reasons for foster placements to fail, leading to further disruptions in care, school, and community for the child.

How do I work with the medical home?

Caregivers of children in foster care can let the primary care clinician know that the child is in foster care or has been in foster care. The caregivers and primary care clinician can work together to advocate for maintaining continuity of care or share information with a new provider when continuity of care is not possible. Regular care in a consistent medical home can help the primary care clinician recognize changes/symtpoms and complete assessments that might reveal underlying medical, dental, or mental-health problems.

What screenings do children in foster care need?

Children in foster care are at greater risk for various medical, dental, and mental-health conditions. All screenings recommended by the American Academy of Pediatrics should be performed. See 2020 Bright Futures Periodicity Schedule (AAP) ( PDF Document

119 KB). The following pages contain additional information about screeing: See Foster Carea. Screening & Prevention.

What is the prognosis for children in foster care?

The goal for children in foster care is a legal, permanent home through either reunification with their home of origin or placement with a home prepared to adopt. Many children are reunited with their parents but some children are in the foster-care system for a number of years and "age out" of foster care at age 18 without a permanent family. Adolescents aging out of the foster care system are at high risk to abuse substances, to be incarcerated, or to become homeless or dead by young adulthood. See Permanency Planning for Youth & Young Adults (NRCYD).

The effects of child abuse and neglect often have long-lasting adverse consequences for survivors. The Adverse Childhood Experiences (ACE) Study demonstrated that child abuse, neglect, and other circumstances that disrupt the child-parent relationship are significantly associated with many leading causes of adult death, such as strokes, cancer, and heart disease, and are associated with heavy health service utilization. Stressful childhood experiences lead to higher rates of depression, suicide, cigarette smoking, diabetes, obesity, hypertension, and alcohol and substance abuse. See The Adverse Childhood Experiences (ACE) Study [Felitti: 1998]

What is the risk for other conditions?

Of particular relevance for the family of origin would be a history of mental illness. The foster family’s history and experience with special needs children may also be important to understand how familiar or comfortable they will be with managing medical or mental health problems in the foster child.

What treatments/therapies/medications are recommended or available?

Caregivers who accompany the foster child can assist the primary care clinician by providing medical records and information about the child's history in addition to the describing the immediate problem. Caregivers and caseworkers can provide the medical home with documents that identify the child's custodians. The primary care clinician will need to provide information about treatment options and seek consent for treatment from the legal custodians. Because of their multiple risk factors, children in foster care will often benefit from more frequent visits than otherwise healthy children.

Treatment options will depend upon the specific diagnoses but may include treatment for medical conditions; behavioral and medication therapies for mental-health conditions; and other therapies for any developmental delays. Since children in foster care are often very sensitive to transitions and separations, the medical home, caregivers, and caseworkers should work collaboratively to plan for any transitions such as transitions in placements and transition to adulthood.

How will my child and our family be impacted?

Welcoming a child in foster care into a family can be a stressful situation. Families will need to work with the child to help the child feel welcome, maintain developed routines, and access needed services while providing a stable and predictable family environment. The extra time needed to care for the child in foster care may create jealousy or other issues among siblings. The entire family may benefit from participating together in activities from recreation to counseling.

Why does my child in foster care need more visits?

Children in foster care may have missed well-child visits, immunizations, and screenings at recommended times and may need to catch-up on those health services. Also, they are at risk for additional medical, dental, and mental-health problems from changes in living situations, behavior issues, or traumatic experiences.

How do I find a doctor or get medications refilled?

The caseworker for a child in foster care can help the foster family access medical records and get in touch with the child's primary care clinician and other providers. These last providers can either provide new prescriptions or transfer medical files to new providers if it is not practical to keep the same providers.

How can I get help for my foster child with behavior problems?

Behavior issues are common for children in foster care since they have often been exposed to traumatic experiences and have had multiple caregivers. The child's caseworker can help the family find medical and mental-health providers that accept Medicaid. Additionally, support groups may help families learn strategies to address common behavior challenges. Foster parents that suspect substance use should talk to the child's caseworker and primary care clinician about screening, treatment, and support groups.

What effects might be caused by prenatal exposures to alcohol and other substances?

Children in foster care may have been exposed to alcohol, tobacco, and other substances in utero and during early childhood. Alcohol has been shown to cause specific birth defects and developmental delays. Alcohol is the most harmful of the various substances. Smoking in pregnancy can increase the risk of low birth weight while children exposed to second-hand smoke are at increased risk for developing asthma. Marijuana use, depending upon the frequency of use, in pregnancy can increase the risk of low birth weight. Cocaine use in pregnancy can increase the risk for low birth weight and premature births. Opioid (heroin, methadone, oxycodone, hydrocodone, fentanyl, etc.) use throughout pregnancy, rather than intermittent use, can result in neonatal abstinence syndrome or withdrawal once the infant is born. For all addictive substances, the patterns of use may result in poor nutrition, improper weight gain, altered sleep patterns, and increased stress in pregnancy which may increase the risk of low birth weight and premature birth. Premature and small infants are at greater risk of medical complications and developmental delays. Substance abuse by the mother often places the infant at risk for impaired maternal-child bonding and traumatic situations such as neglect and abuse.

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

Support

Foster Care Alumni of America
Connects the alumni community and works to transform policy and practice to help ensure opportunity for people in and from foster care.

Foster Care to Success--Aging Out Institute
Nonprofit organization with resources, programs, and research to help youth age out of foster care and into independence successfully.

National Alliance on Mental Illness (NAMI)
Provides information about mental illnesses, links to state chapters, information about conferences, and links to additional resources.

National Organization on Fetal Alcohol Syndrome
This nonprofit organization provides a wealth of information and links to local resources and summer camps for children with FASDs.

General

Children in Foster Care (How Kids Develop)
Information for parents and professionals about how to identify healthy development, typical reactions and adjustment issues for children in foster care, and when to be alert that a problem needs further investigation and intervention; developed by the First 5 Commission of San Diego.

Time for Reform: Aging Out and On Their Own (PEW Charitable Trusts)
Challenges of adolescents aging out of foster care systems with no permanent home or support.

Time for Reform: Preventing Youth From Aging Out On Their Own (PEW Charitable Trusts)
Recommendations for policy-level changes to enhance the success of those transitioning out of foster care.

Improving Outcomes for Youth Transitioning out of Foster Care (Hawai'i Kids Count) ( PDF Document 2.7 MB)
Strategies, such as supporting educational success, providing employment and affordable housing opportunities, and ensuring access to health care, to improve outcomes for youth transitioning out of foster care.

Helping Youth Transition to Adulthood: Guidance for Foster Parents (CWIG) ( PDF Document 680 KB)
Discusses the critical role of foster parents, laws, and programs supporting transitioning youth; Child Welfare Information Gateway.

Healthy Foster Care America (AAP)
Resources for children and teens in foster care and foster parents; American Academy of Pediatrics.

National Foster Care & Adoption Directory Search
A database of adoption and post-adoption resources that is searchable by state and region.

Trauma-Informed Patient Education (Children's Hospital of Philadelphia)
Downloadable patient education to help: parents help their children cope, children and teens cope with injury and pain or dealing with traumatic stress reminders, and siblings cope with their brother's or sister's hospitalization, illness, injury, and recovery. Also includes workbooks for coping with hospitalization.

FosterClub
FosterClub is a national network for youth in foster care. This site has excellent resources for youth in foster care, including: entering foster care; message board; topical information about things like foster families, court, your caseworker and the agency, school, friends and relationships, health, and leaving foster care; and state-by-state information and resources.

The Adverse Childhood Experiences Study (CDC)
One of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being; Centers for Disease Control and Prevention.

MotherToBaby
MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding.

Tools

Four Steps to Reframing Worksheet ( PDF Document 94 KB)
A tool for children that helps breakdown problems into smaller steps. Adapted from the Surviving Cancer Competently Intervention Program – Newly Diagnosed (SCCIP-ND) manual; site developed by The Center for Pediatric Traumatic Stress and The Children’s Hospital of Philadelphia.

Services for Patients & Families in Montana (MT)

Service Categories	MT	NW		ID	NM	NV	RI
Adolescent Health Transition Programs	3	2	2	2	2	2	7
Adult Education	52		94	171	50	17	90
College Disability Centers	2	2	2	30	2	11	18
Community Advocacy Organizations	29	11	64	173	48	57	31
Crisis Mental Health Care	13	9	65	108	42	12	42
Dental Care Expense Assistance	2		4	13	3	2	7
Developmental - Behavioral Pediatrics	8	1	2	2	3	11	8
Developmental Assessments	13		135	234	3	33	49
Disability Awareness Programs	57	52	79	201	88	56	105
Early Childhood Education/Preschool	22		10	232	31	7	76
Early Intervention for Children with Disabilities/Delays	28	2	148	156	30	14	55
Educational Advocacy	8	2	2	31	2	7	17
Family Support Services	41	14	36	214	82	42	40
Financial Education & Counseling	11	6	19	69	41	6	38
Foster Care/Kinship Care	15	2	50	33	10	11	39
General Counseling Services	146	1	201	96	174	32	456
Head Start/Early Head Start	98	1	72	72	56	14	54
Homeless Shelters	17	1	74	65	57	1	36
Mentoring Programs	8	1	29	24	19	6	45
Neuropsychiatry/Neuropsychology	3		3		7	6	11
Nutrition Assessment Services	1		1	84	14	3	8
Occupational Therapy	39		27	298	21	11	41
Outpatient Mental Health Care	15		18	76	69	10	324
Pediatric Sleep Medicine	4		3	1		1	3
Prescription Drug Patient Assistance Programs	38	30	47	81	50	30	55
Psychiatry/Medication Management	18		20	14	41	78	64
Sexual Assault Counseling	3	1	21	20	15	2	23
Speech - Language Pathologists	52	3	67	377	22	24	74
Substance Use Disorder Assessment and Testing	1		30	21	21		58
Substance Use Disorder Education and Prevention	6	4	51	22	45	4	45
Temporary Financial Assistance	9	1	4	44	9	3	9
Vocational Education	32	2	79	336	56	12	88

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Foster Care (clinicaltrials.gov)

Authors & Reviewers

Initial publication: April 2014; last update/revision: November 2015

Current Authors and Reviewers:

Author:

Medical Home Team

Page Bibliography

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.
Am J Prev Med. 1998;14(4):245-58. PubMed abstract
Describes the relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.