Virginia Initiative for Foster Care Improvement - PowerPoint PPT Presentation

West Virginia Initiative for Foster Care Improvement • www.aap.org/fostercare & www.aap.org/traumaguide • Szilagyi, M. The Pediatric Role: The Care of Children in Foster and Kinship Care. Pediatrics In Review 2012;33: 496-508

WVIFCI Goals 1. Build parent-directed state-wide organization for support and advocacy 2. Implement screening for trauma-based problems and give foster parents tools for change

4,475 children in WV were in Foster Care in 2011  607 children in foster care (13.6%) were between the ages of 0 and 1; Nationally: 13.6%  1,046 children in foster care (23.4%) were between the ages of 2 and 5; Nationally: 24.4%  1,181 children in foster care (26.4%) were between the ages of 6 and 12; Nationally: 27.5%  1,640 children in foster care (36.7%) were between the ages of 13 and 21; Nationally: 34.5%

WV Foster Care Caseload by Race/Ethnicity in 2011  3,824 children in foster care (86.0%) were non- Hispanic white; Nationally: 41%  324 children in foster care (7.3%) were non- Hispanic multiple races or ethnicities; Nationally: 5.5%  211 children in foster care (4.7%) were non- Hispanic black; Nationally: 27.5%  64 children in foster care (1.4%) were Hispanic (any race); Nationally: 20.8%  16 children in foster care (0.4%) were unknown race or ethnicity; Nationally: 2.2%

Number of Different Placements for a Child in WV Foster Care  2,038 children in foster care (45.5%) experienced just 1 placement; Nationally: 37.6%  1,094 children in foster care (24.4%) experienced just 2 placements; Nationally: 24.7%  540 Children in foster care (12.1%) experienced just 3 placements; Nationally: 13.3%  803 children in foster care (17.9%) experience 4 or more placements; Nationally: 24.2%

1,474 West Virginia Children were Waiting for Adoption 2011  233 children in foster care (15.8%) were waiting to be adopted between the ages of 0 and 1; Nationally: 13.0%  441 children in foster care (29.9%) were between the ages of 2 and 5; Nationally: 31.1%  495 children in foster care (33.6%) were between the ages of 6 and 12; Nationally: 34.5%  305 Children in foster care (20.7%) were between the ages of 13 and 17; Nationally: 21.5%

Where did WV Children Go After Leaving Foster Care in 2011?  3,030 children in West Virginia exited foster care in 2011  1,858 children (61.6%) were returned to their parents; Nationally: 51.7%  690 children (22.9%) were adopted; Nationally: 20.5%  345 children (11.4%) left to live with relatives or via guardianships; Nationally: 14.7%  45 children (1.5%) ages out of foster care at 18 or older; Nationally: 10.0%  79 children (2.6%) left for other reasons (ran away, transferred, died, emancipated before age 18); Nationally: 3.1%

Childhood Trauma and Risk Factors for Placement  >90% CPS investigation for child neglect  70% maltreatment (adolescents for disruptive behavior)  >50% at or below poverty level  85% exposed to significant violence in home or community

Parent Characteristics  84% significantly impaired parenting skills  16% mental health problems  48% substance abuse  12% Criminal involvement or cognitive impairment  33% personal history of childhood abuse/neglect or spent time in foster care

Children T end to Enter Foster Care in a Poor State of Health  Exposure to poverty  Poor prenatal care  Prenatal maternal substance abuse  Perinatal infection  Inadequate preventative health interventions  Family and neighborhood violence  Parental mental illness

Children Coming into Foster Care have Multiple Physical Problems  Failure to thrive: 10-50% with growth retardation  Up to 80% have one chronic medical condition  Nearly 25% have 3 or more chronic conditions  Increased likelihood of delays in cognitive, language, and fine and gross motor skill development  Children with multiple chronic problems at entry are more likely to remain in foster care.

Health Issues of Children and adolescents at Entry to Foster Care Health Problem Percentage of Population Chronic medical problems 30%-45% Complex medical/developmental 10% Mental health 48%-80% Developmental delay 60% of children <6 years old 45% in special education or individualized Educational issues educational plan Dental problems 35% Family Dysfunction 100%

The Impact of Childhood Trauma The Foster Care System 1. Case Workers 2. The Legal System 3. Foster Parents

Unique Processes in Foster Care  Visitation  Critical Junctures  Recidivism  Adoption Out of Foster Care  Aging Out of Foster Care

Federal, State, and AAP Foster Care Initiatives  Fostering Connections to Success and Increasing Adoption Act of 2008 (Public Law 110-351) requires states to develop health oversight and coordination plan  Five Year Child and Family Service Plans for Fiscal Year 2010-2014: federal guidance 2009 to incorporate plans  AAP Department of State Government Affairs: constructed table of state plans  AAP Council on Foster Care, Adoption, and Kinship Care ( COFCAKC) in 2013 awards foster care improvement grants to WV, MN, SC, UT, WI, CO, GA, OH, RI, CT

Current WV DHHR OMCFH Foster Care Objectives  Establish a primary care provider for every child  Assure that every child receives a medical exam 72 hours after their placement  Track tobacco and BMI status for all children and evaluate effective intervention  Implement Ages and Stages Screening (ASQ-3) testing  Reduce the use of urgent care centers for routine health care.

WVIFCI Activities and Objectives Recruit three foster care parent/pediatrician leadership teams across the state 1. Meet with key WV foster care directors and stakeholders in a Foster Care 2. Improvement Conference Address current foster care state plan deficits and develop a blueprint for the 3. future Survey WV Chapter AAP pediatricians to assess needs and knowledge 4. Build an effective WV Chapter AAP Foster Care Committee focusing on 5. education and parent collaboration Establish a WV Chapter of a national foster parent association 6. Hold a joint WV Chapter AAP Annual Meeting in association with the WV 7. Chapter of a national foster parent association in May 2014.

WVIFCI T eams-Parent/Pediatrician Charleston • Bob and Rita Boyles Huntington – Parents  Melinda and Robert Shelton • Sharon Istfan – Parents • Ann Lambernedis  James Lewis • Sophia Khan  Brian Dunlap • Christy Robinson Morgantown • Tammy Bradford-Parent • Marilyn Foster-Parent • Maggie Jaynes • Melissa Alleman

WVIFCI Partners  P .P .I.E.  Mission WV ◦ Shellie Mellert ◦ Rachel Kinder ◦ Marci Osburn  CPS-Huntington  Family Voices ◦ Angela Seay ◦ Todd Rundle  WV DHHR OMCFH  NECCO ◦ Christina Mullins ◦ Jennifer Graham  NFPA ◦ Irene Clements

WV Chapter AAP Advisors  Raheel Khan, President  John Phillips, Vice-President  Traci Acklin, Secretary, Treasurer  Jeri Whitten, Executive Director  Amelia Beatty, Staff Coordinator

AAP Guidelines Fall 2013  “Helping Foster and Adoptive Families Cope with Trauma”  “Parenting After Trauma: Understanding Your Child’s Needs – A Guide for Foster and Adoptive Parents”  “Visit Discharge and Referral Summary for Family” www.aap.org/traumaguide

Foster Care-Specific Health Visits Age of Child Timing or Frequency Admission health screen Ideally within 72 hr of placement Comprehensive health assessment Within 20 days of entry to foster care Follow-up health visit 60-90 day after entry to foster care Monthly (between preventive health-care Infants to 6 mo visits) 21 mo Extra visit at age 21 mo Semiannual (between annual preventive health- 2 to 21 yr care visits)

Response to Trauma: Bodily Functions FUNCTION CENTRAL CAUSE SYMPTOM(S) 1. Difficulty falling asleep Stimulation of reticular Sleep 2. Difficulty staying asleep activating system 3. Nightmares 1. Rapid eating Inhibition of satietycenter, 2. Lack of satiety Eating anxiety 3. Food hoarding 4. Loss of appetite 1. Constipation Increased sympathetic 2. Encopresis Toileting tone, increased 3. Enuresis catecholamines 4. Regression of toileting skills

Response to Trauma: Behaviors MISIDENTIFIED MORECOMMON RESPONSE AS AND/OR CATEGORY WITH COMORBID WITH • Females • Depression • Detachment • Young children • ADHD inattentivet • Numbing Dissociation • On going trauma/pain ype • Compliance (Dopaminergic) • Inability to defend self • Developmental delay • Fantasy • ADHD • Males • Hyper vigilance • ODD • Older children • Aggression Arousal • Conduct disorder • Witness to violence • Anxiety (Adrenergic) • Bipolar disorder • Inability to fight or flee • Exaggerated • Anger management response difficulties

Scripts for Helping Families Understand Trauma and Impact  Affirmation that trauma response is a healthy response to unhealthy threat  Describe pathophysiology of trauma response  Help caretaker recognize feeling of trauma  Help caretaker extrapolate own experience to situation of toxic stress  Explain brain response