Struggling to Navigate Healthcare: Advice for Foster Parents

Children often come into foster care with some type of health issue or concern that has been previously untreated. We know that trauma and adversity impact overall health. Overall, 30% to 80% of children come into foster care with at least 1 physical health problem, with one-third having a chronic health condition according to the American Academy of Pediatrics.

Foster parents are then tasked with caring for these children well, navigating the healthcare system, and trying to advocate for the resources and services that will help these children thrive.

Today on #FosterFridayLive, Rachel, a Nurse Educator at Lander University is going to share ways that foster parents can support the health of children in foster care. Rachel is a foster parent herself – fostering for around two years. She has a three year old son named Jac. They are in the process of adopting their first foster son who is also three years old. They are very excited about that. She hopes to clear up some of the confusion about navigating healthcare for children in foster care.

It’s hard for foster parents who don’t have any healthcare background to know how to go through the healthcare system with insurance and records and all the different things that you have to know to support a child’s health.

What are some of the most common health issues that children are coming into foster care with?

So many kids come in with at least one physical health problem- that might be something more mild like an allergy or it could be complex like a chronic condition. The unfortunate thing about these conditions with kids coming into foster care is that their conditions may have never even been diagnosed yet or even if they have, they may have been left untreated because of neglect. The family just may have had a lack of access to healthcare- financially or not having transportation.

But in addition to physical health problems, many children in foster care will have dental issues – sometimes a significant problem that will take multiple visits. There are also psychiatric issues and that’s something that we’re seeing more and more in foster care – some due to higher awareness. There may be some skin conditions as well- dermatitis from coming into contact with something that irritated them or insect bites. It may be something as simple as the child just needs a bath, running water, proper nutrition, a safe place to sleep. A lot of health related issues may clear up by the child coming into care and having a safe stable environment. Some children coming into care will not have had any immunizations or will be behind. Another thing foster parents may see is healing of physical abuse or sexual abuse – abnormal bruising. That is something that needs to be dealt with by a medical professional as well. 

How can foster parents do a good job of navigating the healthcare system for their children?

The first thing a foster family should do before they actually receive a placement and the case worker leaves is ask about:

• Allergies
• Health and related issues
• Developmental issues
• Toileting
• Medications the child may have already been on (although they may not come with the medications)

Those are things to get answered right away so that you can start the process of properly caring for their overall health. I remember when I had a placement of a four-year-old boy and I just assumed they would be in a certain size underwear, but he was actually in a much bigger size pull-up. Sorting through those things even before a child gets to your home can be helpful.

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There is a document called the Passport for Health and Education which is something that should come with the child. If it does not, you definitely want to ask for that. That passport will often have different medical history and the immunization record attached. Of course the information in the passport is only the information that has been made available to DSS so they may not have everything, they may not have anything yet. Still, it’s something to ask for. If the immunization record is not attached, that is something the case worker can request from the local health department. Any immunizations that child has would be housed there on a health department record. With new technology like the electronic documentation system Epic, many larger healthcare systems have easier access records, but the foster parents still won’t be able to access that themselves. They’ll have to work with the case worker or the pediatrician.

When you go to appointments for dental or health-related issues, you have to have your foster parent contract. The office may not let you do anything medical-related for that foster child without that contract. Some other things you may need are a social security number, date of birth, Medicaid or any other insurance card the child may have. I will tell you though, that usually doesn’t come with the child. That is something you want to work on from day one- getting that in your possession. When you go to the appointment and fill-out the new client paperwork, just explain to the staff that this is all you have. It is a child in foster care so hopefully they will understand if you don’t have all the documentation at the initial visit, but you will still need the foster parent contract at minimum for you to be able to receive services. If you don’t have a social security number, it may make it more challenging. That is something the case worker should be able to get relatively easily. It may not be the actual card but at least the number. The same with the Medicaid number. And then take that to every visit with you. 

What are some of the most common challenges that foster parents face as they try to care for children with minor or significant health concerns?

One thing is the medical records which we’ve touched on already. You just really have to ask, ask, ask for those things and make sure you get them. What I do is keep a folder for each child as I collect their information and keep it all together. 

Another challenge is our inexperience with the issues that these children come into care with. For me, if it is anything like a physical problem like a rash or a wound, I’m good with that because I have a nursing background. But a developmental delay or a mental health issue, I’m lacking experience. I would definitely recommend leaning on resources like the Foster Parent Association, organization like Care2Foster where you can get in contact with people who have had more experience. You don’t even know what you don’t know and that can begin to feel overwhelming.

For new foster families or families just considering getting started, what are some things that you might encourage them to do as they prepare?

I have some recommendations from my nursing background and my personal experience. One thing that is going to be important to do before you ever even know you’re getting a placement, maybe even before you get your license, is go ahead and find the pediatrician and the dentist you will use because you’ve got to make sure they will accept any foster children and make sure they will accept Medicaid. There are places that will not file Medicaid so you’re not going to be able to use that as your healthcare facility. Even if you can’t fill out the paperwork, you can have an understanding with facility. Some providers are more foster friendly than others. That goes back to finding your community (local foster parents) that you can ask, “what do you use?”

We are lucky in our Foster Parent Association to have a pediatrician who is also a foster parent. She understands the experience of the foster parents, she understands the issues that children are coming into care with, and she also knows where to refer you to. Even if you don’t have a pediatrician in your foster community, a lot of times your pediatrician that sees your bio kids will be willing to see your foster child. Or the people you’re in contact with can give you recommendations on where to go if you don’t know. Find your providers as far in advance as possible. Sometimes you do have to be demanding – explain your situation to get seen quickly. This is not the traditional patient. You want someone who is going to be understanding. 

Other advice:

• Stock over the counter children’s medicines – Children’s Tylenol and Motrin, Children’s Benadryl
• Have some good lotion for dry, itchy skin
• Buy very gentle soap because you don’t know what these children will be able to tolerate (non-scented soap)
• Start a stock of diapers, pull-ups, overnights because you may get a child with little notice. You may think a child is an age they should be potty-trained, but they are not.

Foster parents don’t get traditional baby showers so those are things you can ask your co-workers or friends for, or do a diaper shower. Consider a Foster Care or Home Study Shower. Just make sure you ask for a variety of sizes. Everyone needs wipes and cleaning products, Lysol. But definitely think about non-scented lotion, laundry detergent for kids who may be sensitive. 

There is a new Secondary Consenter policy for foster parents. Any advice for foster families trying to understand this as it is rolled out?

There have always been DSS policies on medical care like how to consent for foster children. There is a newly updated policy and procedure that DSS is implementing regarding Psychotropic Medication Informed Consent and Designated Secondary Medical Consenter Responsibilities.

 The basics are that the child’s DSS case worker is always going to be the primary consenter. If they are able to make decisions, they are the primary consenter. But a lot of times the foster parent becomes the secondary consenter because we are the ones handling routine stuff. Just know that routine medical care does not include surgery, anesthesia, and things like that. You’d have to take that to the primary consenter for approval. And as a side note, case workers are supposed to consult the family when appropriate. There will be communication with the family with medical issues. They are the ones who know the medical and family history.

 There are some new trainings and certifications that come with this new policy. Some families may have received notification via mail regarding these changes and the instructions for completing the online training webinar that will allow you to be designated consenter for routine medical care and psychotropic medications for foster children. You can direct questions regarding the policy to Gwynne Goodlet, Director of the Office of Child Health and Well-Being at (803) 898-2788 or Gwynne.Goodlett@dss.sc.gov

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Watch the full interview with Rachel on Youtube.