1 ‘Healthy Futures’ ProgramCASA of San Mateo County Introduces our ‘Healthy Futures’ Program Developed By: Carrie Schartenberg, Grants Manager Patricia Miljanich, Executive Director
2 Dr Janet Chaikind, Director of Pediatrics San Mateo Medical CenterCASA OF SAN MATEO ‘HEALTHY FUTURES’ PANEL Dr Janet Chaikind, Director of Pediatrics San Mateo Medical Center Dr Tricia Tayama, Medical Director of Keller Center for Family Violence Intervention Dr Harvey Kaplan, CASA Board, Retired Pediatrician Lori Sterling, RN, MSN, PHN
3 CASA ‘Healthy Futures’ PROGRAMOverview of ‘Healthy Futures’ and Introduction of Panel (Dr. Kaplan) Recommended Preventive Care Guidelines and Immunization Schedules per AAP Bright Futures (Dr. Tayama) The Medical Home—What is it and what can you expect from your health care provider (Dr. Chaikind) Public Health Nursing Support of Children in Foster Care (Lori Sterling, RN, MSN, PHN) Additional Needs of Foster Youth and Early Childhood Trauma (Dr. Tayama) Adolescent Confidentiality and Health Issues (Dr. Chaikind)
4 CASA ‘Healthy Futures’ PROGRAM (continued)Panel Forum: What can the CASA and Foster Parent do to help their child enjoy a healthy life, develop their own strengths to deal with past and present challenges and prepare for a successful future? This is an interactive discussion and all appropriate questions and concerns will be addressed by the panelists. Time will be available toward the end of the presentation for the audience to meet and confer individually or in small groups with the panelists. Suggestions about topics for future presentations are very welcome.
5 Learning Objectives for ‘Healthy Futures’The Goal of the Healthy Futures Program is to ensure that all children in the foster care system with CASA Volunteers receive their age-appropriate annual health and dental evaluations, with follow-up care as needed. The Goal of this Health Training is for CASA Volunteers, Foster Parents and Caregivers to have a more complete understanding of the physical, mental and oral health needs of their foster children, and thus to become more effective advocates on their behalf.
6 Special Health Care Needs“Data from the last 30 years demonstrating the the high prevalence of health problems have led the American Academy of Pediatrics (AAP) to classify children in foster care as a population of children with special health care needs.”
7 Harmon Hall Presidio of San Francisco‘Operation Babylift’ April 2-May “The significant unmet health care needs of children and adolescents in foster care are rooted in their complex trauma histories and compounded by their poor access to appropriate health care services” AAP Policy Statement, October 2015
8 Health Status of Children Entering Foster CareOverall, 30% to 80% of children come into foster care with at least 1 medical problem and one third have a chronic medical condition (often undiagnosed and untreated) 80% of children and adolescents enter FC with a significant Mental Health need 40% have significant Oral Health issues 60% of children younger than 5 have developmental health issues More than 40% of school age children have educational difficulties Physical and Sexual Abuse, Neglect
9 “All Children in Foster Care have Psychosocial issues Related to Family Dysfunction”Young adults who were in foster care as adolescents experience high rates of mental health problems, unemployment, homelessness, low educational attainment and PTSD Early childhood trauma/toxic stress especially if frequent and unremitting and not tempered by by responsive, nurturing caregiving, adversely affects the neurobiology of the developing brain Early childhood trauma has been correlated with poor emotional regulation, aggression,hyperactivity, impulsivity, attention and attachment problems, and the inability to associate thought and mood Foster parents remain the major therapeutic intervention of the foster care system (CASAs too)
10 Recommendations for Clinical CareInitial exam at time of placement (0-72 hours) to document health status including signs of abuse and to treat illness or trauma Comprehensive evaluation of the child’s medical, mental health,developmental, educational and oral health status within 30 days of placement-ideally in the child’s medical home The results and recommendations of the comprehensive assessments should become part of the child’s court approved social service case plan Follow-up health assessments including referrals for specialty care are needed to ensure that the the multiple health needs of children and adolescents in foster care are addressed
11 Barriers to receipt of adequate health care in foster careReceipt of health care is often fragmented and crisis-oriented rather than planned and preventative Incomplete or unavailable health information Diffusion of authority to consent for health care on behalf of the child Inadequate resources for evaluation and treatment
12 What can the CASA/Foster Parent do?Identify the social, emotional, physical and developmental needs of foster children Ensure at least yearly medical and dental check-ups Ensure that illness and trauma are treated in a timely manner Ensure that the reproductive health needs of youth are addressed
13 What can the CASA/Foster Parent do?(continued) Maintain the foster child’s wellbeing and safety in their home Communicate concerns and facilitate information sharing among professionals Include health information in court reports to better inform judges Monitor the foster child’s health status
14 Medical Director, The Keller Center for Family Violence InterventionRecommended Preventive Care Guidelines and Immunization Schedules for Children and Adolescents Tricia Tayama, MD MPH Medical Director, The Keller Center for Family Violence Intervention
15 Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition
16 Periodicity Schedules
17 Example: 10-year-old visit
18
19 Visit
20 Immunization Schedules
21 Example: 10-year-old visitEnsure child is caught up on all early childhood vaccines, including Hepatitis A, Hepatitis B, Pneumococcal, Polio, Measles/Mumps/Rubella, Chickenpox, and Tetanus/diptheria/pertussis Give annual flu vaccine during flu season Consider risks; may offer Human papillomavirus, meningococcal vaccine
22 What is a “Medical Home” and what you can expect from your Health Care ProviderJanet Chaikind MD Medical Director of Pediatrics and Adolescent Medicine San Mateo Medical Center
23 The Medical Home The Medical Home also known as the Patient-Centered Medical Home (PCMH), is a team-based health care delivery model led by a health care provider that is intended to provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes
24 Why is a Medical Home so important for foster care children and adolescents?
25 Qualities of a Medical HomeA medical home for a child or teenager in foster care ideally offers high quality comprehensive , coordinated health care that is easily accessible, continuous over time, compassionate, culturally competent, trauma informed, family centered and child focused
26 Additional Features Competency in surveillance for abuse and neglect2) Understanding of the effects or abuse, neglect, trauma and removal 3) Collaborative relationship with Child Welfare and Legal System 4) Coordination with other community based services-school, mental health, dental, child care and Head Start 5) Team based care 6) Mental Health Integration
27 What can your health care team do for your foster care child and you?Evaluate overall health Treat health issues Monitor health Assist with referrals Coordinate care Provide ongoing support
28 How to make the most of the health care visitMake a list of your questions in advance Ask if you don’t understand Ask for a written summary of the visit (a visit summary) Ask for informational handouts that support what was discussed
29 Children and Family ServicesWhat is the role of the Public Health Nurse in supporting children and youth in the foster care system? Lori Sterling, RN, PHN Public Health Nurse San Mateo County Children and Family Services
30 Children and Family Services Public Health Nurses (PHNs)Public Health Nurses are available: To connect children/youth to medical/dental resources Provide contact information for doctors and dentists who accept Medical Make referrals to resources for other health care needs
31 Children and Family Services Public Health Nurses (PHNs)Public Health Nurses are available (cont): To support children/youth related to their medical/dental needs Answer questions/concerns about the health needs of children and youth Provide follow up on health conditions found during health and dental examinations Do developmental screenings for children 0- 5 years old
32 Children and Family Services Public Health Nurses (PHNs)Every child/youth in foster care, in San Mateo County Children and Family Services, is assigned to a Public Health Nurse (PHN) whether the child/youth is placed in San Mateo County or in another county.
33 Keeping in touch
34 Additional Needs of Foster Youth and Early Childhood TraumaTricia Tayama, MD MPH
35 “Assume that all children who have been adopted or fostered have experienced trauma.”
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38 Response to Trauma: Development and LearningAge Impact on Memory Impact on Control of Inhibitions Impact on cognitive development School-aged child Difficulty with acquiring new school skills Losing details can look like lying May be in trouble at school for fighting or disrupting Trouble organizing May look like ADHD or learning disabilities
39 “Do not take the child’s behavior personally.”The child’s medical home may be a great resource for addressing these concerns.
40 Adolescent Health Care and ConfidentialityJanet Chaikind MD
41 What is an adolescent?
42 Why single out adolescents in this presentation?
43 What happens at an adolescent health care visit?Provider spends time with the teen alone and with the parent/guardian and teen together Discussion of health history and concerns, as well as nutrition, diet and exercise, sleep, school, alcohol, drugs, sexual identify, sexual activity, mood, depression and suicidality Physical Exam including BP, hearing, vision, exam including private areas as indicated and with permission Blood and or urine tests, Immunizations
44 Adolescent ConfidentialityTeens can see a health care provider without their parent/guardian’s consent about mental health issues(12 years and older) drug and alcohol use (12 years and older) sexually transmitted diseases (12 years and older) birth control, pregnancy, abortion In cases of abuse, assault, or possible suicide the care cannot remain confidential. The health care provider will have to contact / notify others for help.
45 Tips for Talking with TeensListen Be honest Share your ideas and opinions Respect their opinions Stay calm Keep talking Don’t be afraid to ask for help ahwg.net
46 Panel Forum What can the CASA and Foster Parent do to help their child enjoy a healthy life, develop their own strengths to deal with past and present challenges and prepare for a successful future?