A grandparent recently given guardianship of two of her grandchildren contacts your office to inquire about support services. Later that day, you see a child in foster care who is exhibiting signs of depression and anxiety over the lack of contact with her younger siblings. Her foster mother also states the child is performing poorly in her new school due to the disruptions.
Pediatricians frequently are confronted with these clinical and social challenges and the complex issues that are common in caring for children in foster care, kinship care or adoptive homes. An updated AAP clinical report describes many of the challenges these unique patient populations face and offers pediatricians practical guidance and resources.
The report, Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care, from the Council on Foster Care, Adoption and Kinship Care, is available at https://doi.org/10.1542/peds.2020-034629 and will be published in the December issue of Pediatrics.
Special concerns, protections
Children in foster and kinship care and adopted children have unique needs, along with an increased incidence of physical, developmental and mental health concerns. Therefore, early identification and coordination of services with members of child welfare services can assist pediatricians in developing treatment recommendations that support caregivers in meeting their child’s physical and mental health needs while anticipating future concerns.
Early documentation of issues also may aid in establishing the need for financial subsidies and other services that support the child and permanency planning.
Pediatricians can support families of fostered or adopted children and attend to their health care needs by becoming knowledgeable of supportive federal and state legislation.
The report includes information on the Family First Prevention Services Act, which was signed into law in 2018. The act reforms the federal child welfare financing streams to provide trauma-informed, evidence-based services, including mental health services, substance use treatment and in-home parenting training, to help keep families together.
It also is important for pediatricians to be aware of legislation that supports continuity of school placement and academic success.
Effective conversations, transitions
Caregivers often seek guidance on how to discuss reasons for initial foster care placement or adoption. Pediatricians can counsel caregivers about the need to understand the child’s questions in the context of his or her development stage and encourage honest, nonjudgmental communication using positive language. This approach fosters the relationship between the caregiver and the child or adolescent while building trust and a feeling of security.
Pediatricians also can provide support and resources to caregivers as they have conversations with their children related to grief and loss.
Another role is to help caregivers acknowledge racial and cultural differences and support children and adolescents in their effort to understand those differences and how they relate to youths’ identity and sense of security.
Additionally, pediatricians can advocate for patients as they transition into adulthood.
In summary, the report highlights how these simple interactions can have dramatic influences on child and adolescent resilience.
Recommendations for pediatricians
- Consider use of an interdisciplinary team to help maximize the well-being of children and adolescents in the child welfare system with multiple health care needs.
- Provide surveillance and screening using validated tools to identify children at greater risk of neurodevelopmental disorders.
- Counsel parents on the current and potential medical, developmental and behavioral problems that often arise during periods of transition.
- Facilitate mental health referrals as needed, especially given the complexity of losses that may be experienced by children as well as by foster, adoptive and birth parents.
Drs. Jones, Schulte and Waite are lead authors of the clinical report. Dr. Waite is a member of the Council on Foster Care, Adoption and Kinship Care Executive Committee, and Dr. Jones is a former member. Dr. Schulte is a former member of the council.