Montana Medical Home Portal

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Foster Care module, which is written for primary care clinicians but also may be of help to parents and family members. 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 2017 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
Provides information about mental illnesses, links to state chapters, information about conferences, and links to additional resources.

NAMI Utah
Utah Chapter of the National Alliance on Mental Illness; provides advocacy and information about mental illnesses.

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
The National Foster Care & Adoption Directory (formerly the National Adoption Directory) offers adoption and post-adoption resources by state.

Parent Education Materials for Post-Trauma Children
Tips, questions, and answers for things parents can do to help their child after a trauma; from the Center for Pediatric Traumatic Stress at The Children's Hospital of Philadelphia.

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.

Fostering Healthy Children Program (UDOH)
Program nursing staff works in partnership with the Utah Division of Child and Family Services caseworkers to coordinate health care services (including medical, dental and mental health) for Utah foster children; program of the Utah Department of Health.

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.

Patient Education

SEEK Parent Handouts
Information for parents about depression, substance abuse, discipline, stress, intimate partner violence, and food insecurity. Includes lists of national hotlines and other resources. Customizable space to include local resources; University of Maryland School of Medicine.

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

College Disability Centers

We currently have no College Disability Centers service providers listed; search our Services database for related services.

Crisis Intervention Mental Health

See all Crisis Intervention Mental Health services providers (4) in our database.

Dental Care Expense Assistance

We currently have no Dental Care Expense Assistance service providers listed; search our Services database for related services.

Developmental Assessment

See all Developmental Assessment services providers (9) in our database.

Developmental Pediatrics

See all Developmental Pediatrics services providers (3) in our database.

Disability Awareness Programs

See all Disability Awareness Programs services providers (6) in our database.

Early Childhood Education/Preschool

See all Early Childhood Education/Preschool services providers (15) in our database.

Early Intervention for Children with Disabilities/Delays

See all Early Intervention for Children with Disabilities/Delays services providers (22) in our database.

Emergency Financial Assistance

See all Emergency Financial Assistance services providers (6) in our database.

Family Support Centers/Outreach

See all Family Support Centers/Outreach services providers (9) in our database.

Financial Counseling

See all Financial Counseling services providers (3) in our database.

Foster Care

See all Foster Care services providers (13) in our database.

Head Start/Early Head Start

See all Head Start/Early Head Start services providers (13) in our database.

Homeless Shelters

See all Homeless Shelters services providers (8) in our database.

Local Support Groups, Addiction

See all Local Support Groups, Addiction services providers (2) in our database.

Local Support Groups, Child Abuse

See all Local Support Groups, Child Abuse services providers (1) in our database.

Local Support Groups, Disability/Diag

See all Local Support Groups, Disability/Diag services providers (3) in our database.

National Support Services, Disab/Diag

We currently have no National Support Services, Disab/Diag service providers listed; search our Services database for related services.

Occupational Therapy, Pediatric

See all Occupational Therapy, Pediatric services providers (32) in our database.

Outpatient Community Mental Health Agencies

See all Outpatient Community Mental Health Agencies services providers (1) in our database.

Pediatric Sleep Medicine

See all Pediatric Sleep Medicine services providers (2) in our database.

Pregnancy-related, Other

See all Pregnancy-related, Other services providers (15) in our database.

Prescription Drug Patient Assistance Programs

See all Prescription Drug Patient Assistance Programs services providers (3) in our database.

Psychiatrist, Child-18 (MD)

See all Psychiatrist, Child-18 (MD) services providers (17) in our database.

Psychologist, Child-18 (PhD, PsyD)

See all Psychologist, Child-18 (PhD, PsyD) services providers (11) in our database.

Sexual Abuse Counseling

See all Sexual Abuse Counseling services providers (3) in our database.

Social Workers

See all Social Workers services providers (10) in our database.

Speech - Language Pathologists

See all Speech - Language Pathologists services providers (44) in our database.

For other services related to this condition, browse our Services categories or search our database.

Studies

Foster Care (clinicaltrials.gov)

Authors & Reviewers

Initial Publication: April 2014; Last Update: November 2015

Current Authors and Reviewers (click on name for bio):

Authoring history

(Limited detail is available on authoring dates before 2014.)

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer

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.