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Health Care Services
Health Care Provisions Overview
  • Section 205 (p. 13 of the Act) requires States to develop a plan for the ongoing oversight and coordination of health care services for any child in foster care placement. Click here for more information.
  • Section 202 (p. 11 of the Act) requires the States to provide assistance and support for youth aging out of foster care; specifically, a transition plan must be developed during the 90-day period before a youth attains age 18 (or such greater age as the State may elect). The transition plan must include information about health care. Click here for more information.
Promising Practices and Policies from States and Tribes

Health Screening and Assessment Schedules

  • Monroe County, New York: Screening Foster Care Children Doubles Detection Rate of Potential Developmental Problems
    Starlight Pediatrics, a foster care clinic, found that when caregivers of foster children completed a brief, non-diagnostic screening questionnaire (Ages and Stages Questionnaires) prior to their pediatric visit, the rate of detection for potential developmental problems doubled (58% versus 29%). This University of Rochester Medical Center study, published in Pediatrics in January 2010, shows that universal screening is feasible in a busy pediatric practice. The questionnaires also teased out more delays in problem-solving, personal-social, and fine motor skills than had been detected previously.

Health Care Coordination

  • Maryland, Massachusetts, Nebraska, New Jersey, Pennsylvania: State Models of Health Care Coordination
    These five American Academy of Pediatrics (AAP) Chapters are participating in the Task Force on Foster Care-sponsored State Systems of Health Care for Children and Youth in Foster Care project. Chapter members are working within their states to plan for coordinated systems of health care for children and teens in foster care. Child welfare, judicial, pediatric, mental and dental health professionals, and foster parents work collaboratively in these efforts to respond to, manage, and improve the health and well-being of children and teens in foster care.
  • New York: Working Together: Health Services for Children in Foster Care
    The New York State Office of Children and Family Services developed this manual with the assistance and advice of voluntary agencies and county departments of social services. The policies, protocols, and legal footnotes are specific to New York State's locally administered, state supervised foster care system. However, it contains some more general information and serves as an excellent model. Chapter Four focuses on Health Care Coordination. (Updated 2008-2009)
  • Utah: Fostering Healthy Children Program (FHCP)
    The mission of FHCP is to ensure ongoing health, dental, and mental health care needs are provided for children in the custody of the Division of Child and Family Services (DCFS). The FHCP nursing staff work in partnership with the DCFS caseworkers to coordinate health care services (including medical, dental, and mental health) for Utah foster children. This PowerPoint presentation provides a comprehensive description of Utah’s Fostering Healthy Children Program.

Updating and Sharing Medical Information

  • New York: Working Together: Health Services for Children in Foster Care
    Maintaining the health records of children in foster care is critical to providing and monitoring health care on an ongoing basis. This manual chapter includes information about obtaining the child’s health history, the health file, the medical home health file, health information in the child welfare information system, the health passport, and documenting and monitoring health information. Chapter Eight focuses on Maintaining Health Records. (Updated 2008-2009)
  • Texas: Superior HealthPlan Network’s Health Passport
    Superior HealthPlan Network’s Health Passport is a web-based, secure health information tool built using core clinical and claims information to deliver relevant healthcare information when and where it is needed for the foster children in the state of Texas.
Continuity of Care/Medical Homes
  • Monroe County, New York: Starlight Pediatrics
    Starlight Pediatrics, a foster care clinic, is the oldest existing centralized medical home model for children in foster care in the country. In addition to providing comprehensive primary care services, Starlight Pediatrics provides all of the health care management services for children in foster family care. They have been awarded a $300,000 grant by the New York State Health Foundation to implement and compare a new enhanced model of care for managing health issues of children in foster care. The approach will address both the primary care and mental health needs of children in foster care by using evidence-based practice to deliver on-site mental health services and parent training. For additional information about the medical home model in Monroe County, see “Understanding Caseworker Perspectives on a Pediatric Medical Home for Children in Foster Care” in Illinois Child Welfare Journal, Volume 4, No. 1, 2008.
  • North Carolina: Children’s Services Practice Notes
    Practice Notes for North Carolina’s Child Welfare Workers, Volume 15, Number 2, explains on pp. 5-6 how to use the medical home approach to help improve the quality of health and mental health services received by families and children. (May 2010)

Transition Plan for Youth Aging Out of Foster Care

  • Utah: Guide to Medicaid After Leaving Foster Care
    This brochure describes how Medicaid works for the 18-21 year old already covered by Medicaid. It also provides information about where to find dental and mental health services.

Health Power of Attorney and Health Proxy

  • Nevada: Healthcare Power of Attorney
    Nevada has developed this informational brochure for youth aging out of the foster care system that explains legal terms such as healthcare power of attorney, durable power of attorney, living will, and health care directive. It also discusses who a youth might choose to be the agent and provides copies of legal forms.
  • New York: Health Care Proxy
    This link provides forms and information related to appointing a health care proxy in New York State. One of the FAQs (“Why do I need to appoint a health care agent if I’m young and healthy?”) responds directly to requirements in the Fostering Connections Act.

Planning for Needs Unique to Specific Populations of Children and Youth

Collaboration with Courts

  • Pennsylvania: Juvenile Court Rules 
    The Pennsylvania Supreme Court has adopted new Juvenile Court Rules that will require courts to thoroughly consider and address the health, education and disability needs of youth in the child welfare and juvenile justice systems.  Courts are directed to ensure that each child or youth’s health care and disability needs are identified, monitored, and addressed, and that children with disabilities are receiving necessary accommodations. Each child’s needs must be addressed, not only in court proceedings, but also in the court's orders.

Resources for Developing and Implementing Comprehensive Health Care Oversight and Coordination Plans
Resources listed in this section address more than one health care provision in the Act and may be useful to states as they develop and implement comprehensive and effective plans for ongoing oversight and coordination of health care services for children in foster care, including mental health and dental needs.

  • California: The Health Care Program for Children in Foster Care
    The Health Care Program for Children in Foster Care is a public health nursing (PHN) program located in child welfare agencies and probations departments in which PHNs consult and collaborate with the foster care team to provide multiple health care services such as planning, assessment, referral, coordination, medical education, and health passports.
  • New Jersey: Coordinated Health Care Plan for Children in Out-of-Home Placement
    In 2006-2007, the Department of Children and Families assessed the provision of health care services for children in placement. This report details the assessment and DCF’s plans for implementing improvements in its health care delivery system for children in out-of-home placement. (2007)
  • Utah: Fostering Healthy Children Program (FHCP)
    The mission of Utah’s Fostering Healthy Children Program is to ensure ongoing health, dental, and mental health care needs are provided for children in the Division of Child and Family Services (DCFS) custody. This is done by maximizing quality and timeliness of health care services and ensuring access to health care providers. Nurses and staff from the Utah Department of Health are co-located in offices with caseworkers from DCFS. They work in partnership to coordinate the foster child's health care while in custody.
  • Connecticut, Florida, Massachusetts, Maryland, Oregon, Pennsylvania, Tennessee, Wisconsin: Center for Health Care Strategies
    The Center for Health Care Strategies (CHCS), through a 3-year national collaborative, worked with managed care organizations in eight states to improve the delivery of physical and mental health care for children in child welfare. Provisions of the Fostering Connections Act such as oversight of prescription medications, providing continuity of care through the medical home model, coordination of health care, electronic health records, and the integration of data across health and behavioral health systems were addressed in this national collaborative. Summaries of the work in the eight states can be found on the CHCS website. 
T/TA & Web-Based Resources from NRCs, Children’s Bureau, & T/TA Network

Federal Laws

Resources and Guidance from the Children’s Bureau

  • Providing Health Care Oversight and Coordination
    This resource is part of a series of fact sheets for States and Tribes made available by The Training and Technical Assistance Coordination Center (TTACC). These two-page briefs describe available training and technical assistance (T/TA) from the Children’s Bureau to support implementation of the Fostering Connections and Increasing Adoptions Act of 2008 in eight key areas. Each fact sheet offers a brief overview of the Fostering Connections Act’s provisions in the topic area, the allowable funding and costs for that area under the Act, and examples of the free training and technical assistance that the Children’s Bureau’s National Resource Centers and Implementation Centers can give States and Tribes in that area.

  • ACYF-CB-IM-12-03: Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Care
    The purpose of this Information Memorandum (IM) is to serve as a resource to State and Tribal title IV-B agencies as they comply with requirements to develop protocols for the appropriate use and monitoring of psychotropic medications in the title IV-B plan. This IM defines the issues surrounding psychotropic medication use by children in foster care, highlights available resources for States to consider when developing their Annual Progress and Services Report (APSR), and encourages increasing access to clinically appropriate screening, assessment, and evidence-based interventions for foster children with mental health and trauma-related needs. (April 2012)

  • ACYF-CB-PI 10-10: Program Instruction
    This Program Instruction (PI) pertains to The Patient Protection and Affordable Care Act (P.L. 111-148); Title IV-B, subpart 1 of the Social Security Act; Title IV-E of the Social Security Act. It provides guidance to States and Territories, Indian Tribes, Indian Tribal Organizations or Indian Tribal Consortia on actions they are required to take to be in compliance with the requirements of P.L. 11-148. (June 2010)

Transition Age Youth

  • Charting a Better Future for Transitioning Foster Youth: Report from a National Summit on the Fostering Connections to Success Act
    This Summit (April 2010) addressed how the Fostering Connections Act affects youth and young adults involved in, and “aging out of”, the foster care system.  It produced a blueprint of recommendations for national and state leaders to implement new approaches for addressing the unique needs of youth leaving the foster system. See Chapter 5 for comprehensive recommendations related to health and mental health. The NRC for Permanency and Family Connections, the NRC for Youth Services, and the NRC on Legal and Judicial Issues collaborated in planning this summit.

Resources for Developing and Implementing Comprehensive Health Care Oversight and Coordination Plans
Resources listed in this section address more than one health care provision in the Act and may be useful to states as they develop and implement comprehensive and effective plans for ongoing oversight and coordination of health care services for children in foster care, including mental health and dental needs.

  • Meeting the Health Care Needs of Children in the Foster Care System
    In September of 2002, the Georgetown University Child Development Center completed a three-year study to identify and describe promising approaches for meeting the health care needs of children in the foster care system. In this study, health care encompassed physical, mental, emotional, developmental, and dental health. The study was funded by the federal Maternal and Child Health Bureau, and supported in part by the Children's Bureau, Administration for Children and Families. The study collected information on over 100 different approaches. The two study reports include strategies and approaches addressed in the Fostering Connections Act such as health care screening and assessment, monitoring and evaluation, managing health care data, and coordination of care.

Resources from Collaborating Organizations

Health Screening and Assessment Schedules

  • Healthy Foster Care America
    This initiative of the American Academy of Pediatrics and its partners seeks to improve the health and well-being outcomes of children and teens in foster care. It produced a health information form for children and teens in foster care that includes guidelines for preventive health care visits.

Continuity of Care/Medical Homes

  • National Center for Medical Home Implementation
    Guidance from the Children’s Bureau on the Health Care Oversight and Coordination Plan required by the Fostering Connections Act indicates that the Plan must include steps to ensure the continuity of health care services (which may include the establishment of a medical home for every child in care). Through a cooperative agreement between the American Academic of Pediatrics (AAP) and the federal Maternal and Child Health Bureau (MCHB), a National Center for Medical Home Implementation (NCMHI) has been established. The mission of the NCMHI is to ensure that all children and youth, including children with special needs, have access to a medical home. See the NCMHI Fact Sheet for a definition of “family-centered medical home” and information about how the NCMHI can assist in establishing medical homes. Additional resources from the American Academy of Pediatrics on the establishment of family-centered medical homes can be found here.

Transition Age Youth

  • Transition Toolkit
    Foster Club has created a Transition Toolkit, designed to help youth leaving foster care and their team of adult supporters to inventory their current assets, identify their resources, and map out a plan for the challenges after foster care. The Toolkit includes a section on self-care and health which includes a form to assess and plan for needed health care resources when living independently. (See pp. 12.)
  • Protecting Confidential Health Services for Adolescents & Young Adults: Strategies & Considerations for Health Plans
    The National Institute of Health Care Management (NIHCM) published this issue brief that reviews the legal protections in place to ensure confidential care delivery for adolescents and young adults, as well as challenges to delivering confidential care to this population. The brief asserts that adolescents and young adults are likely to forgo health care when they feel they lack access to confidential care. As the Patient Protection and Affordable Care Act of 2010 (ACA) expands access to private and public health insurance for adolescents and young adults, it may also raise challenges for ensuring confidential care is delivered to a newly insured segment of the adolescent and young adult population. (May 2011)

Planning for Needs Unique to Specific Populations of Children and Youth

  • American Academy of Pediatrics Committee on Native American Child Health
    This Committee develops policies and programs that improve the health of Native American children. Its website includes online publications and resources related to Native American Health Issues. The Committee members are committed to increasing awareness of the major health problems facing Native American children, and monitoring legislation affecting Native American child health. The Committee also conducts pediatric consultation visits to Indian Health Service (IHS) and tribal health facilities, and works to strengthen ties with tribes throughout the United States.

Resources for Developing and Implementing Comprehensive Health Care Oversight and Coordination Plans
Resources listed in this section address more than one health care provision in the Act and may be useful to states as they develop and implement comprehensive and effective plans for ongoing oversight and coordination of health care services for children in foster care, including mental health and dental needs.

  • CHIPRA Webinar: Psychotropic Medication
    This webinar is presented by the Center for Health Care Strategies (CHCS), a nonprofit health policy resource center, and funded by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The webinar provides overview of current efforts related to improving psychotropic medication management and prescribing practices for youth, particularly those involved with child welfare. Specific examples from Massachusetts and Wraparound Milwaukee are presented. (January 2012)
  • Fostering Health: Health Care for Children and Adolescents in Foster Care, 2nd Edition
    Developed by an American Academy of Pediatrics multidisciplinary panel of experts, Fostering Health is designed for use by medical, mental health, and developmental health care professionals, as well as foster parents, social welfare agencies, members of the legal community, health insurance agencies, and policy makers. Standards of health care for children and adolescents in foster care are detailed in 10 chapters.

  • Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions
    This GAO report discusses psychotropic use among children in foster care in five States. This testimony examines (1) rates of psychotropic prescriptions for foster and nonfoster children in 2008 and (2) state oversight of psychotropic prescriptions for foster children through October 2011. GAO selected Florida, Maryland, Massachusetts, Michigan, Oregon, and Texas primarily based on their geographic diversity and size of foster care population. Results cannot be generalized to other states. In addition, GAO analyzed Medicaid fee-for-service and foster care data from selected states for 2008, the most recent year of prescription data available at the start of the audit. Maryland’s 2008 foster care data was unreliable. GAO also used expert child psychiatrists to provide a clinical perspective on its methodology and analysis, reviewed regulations and state policies, and interviewed federal and state officials. By Greg Kutz. Access the Report, Highlights, and Podcast. (December 2011)

Evidence-Based Practice, Research, and Reports

Health Screenings and Assessments

Transition Age Youth

  • Policy Statement: Health Care of Youth Aging Out of Foster Care
    Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met. This article was published in Pediatrics, the official journal of the American Academy of Pediatrics. (2012)

Planning for Needs Unique to Specific Populations of Children and Youth

  • Health Care of Young Children in Foster Care
    This policy statement from the American Academy of Pediatrics gives specific suggestions for pediatricians and other health care professionals and child welfare agencies concerning the delivery of health services to young children in foster care. It addresses health screenings and assessment, the transfer of medical information, mental health and developmental evaluations, and the impact of foster care placement on children. (March 2002)