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
• rganization 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

• r 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

• lder; 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 Educational issues 45% in special education or individualized 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

1.

Recruit three foster care parent/pediatrician leadership teams across the state

2.

Meet with key WV foster care directors and stakeholders in a Foster Care Improvement Conference

3.

Address current foster care state plan deficits and develop a blueprint for the future

4.

Survey WV Chapter AAP pediatricians to assess needs and knowledge

5.

Build an effective WV Chapter AAP Foster Care Committee focusing on education and parent collaboration

6.

Establish a WV Chapter of a national foster parent association

7.

Hold a joint WV Chapter AAP Annual Meeting in association with the WV Chapter of a national foster parent association in May 2014.

WVIFCI T eams-Parent/Pediatrician

Huntington

 Melinda and Robert Shelton

– Parents

 James Lewis  Brian Dunlap

Charleston

• Bob and Rita Boyles

– Parents

• Sharon Istfan
• Ann Lambernedis
• Sophia Khan
• Christy Robinson

Morgantown

• Tammy Bradford-Parent
• Marilyn Foster-Parent
• Maggie Jaynes
• Melissa Alleman

WVIFCI Partners

 P

.P .I.E.

• Shellie Mellert
• Marci Osburn

 Family Voices

• Todd Rundle

 NECCO

• Jennifer Graham

 Mission WV

• Rachel Kinder

 CPS-Huntington

• Angela Seay

 WV DHHR OMCFH

• Christina Mullins

 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 Infants to 6 mo Monthly (between preventive health-care visits) 21 mo Extra visit at age 21 mo 2 to 21 yr Semiannual (between annual preventive health- care visits)

Response to Trauma: Bodily Functions FUNCTION CENTRAL CAUSE SYMPTOM(S) Sleep Stimulation of reticular activating system

• 1. Difficulty falling asleep
• 2. Difficulty staying asleep
• 3. Nightmares

Eating Inhibition of satietycenter, anxiety

• 1. Rapid eating
• 2. Lack of satiety
• 3. Food hoarding
• 4. Loss of appetite

Toileting Increased sympathetic tone, increased catecholamines

• 1. Constipation
• 2. Encopresis
• 3. Enuresis
• 4. Regression of toileting

skills

Response to Trauma: Behaviors

CATEGORY MORECOMMON WITH RESPONSE MISIDENTIFIED AS AND/OR COMORBID WITH Dissociation (Dopaminergic)

• Females
• Young children
• On going trauma/pain
• Inability to defend self
• Detachment
• Numbing
• Compliance
• Fantasy
• Depression
• ADHD inattentivet

ype

• Developmental delay

Arousal (Adrenergic)

• Males
• Older children
• Witness to violence
• Inability to fight or flee
• Hyper vigilance
• Aggression
• Anxiety
• Exaggerated

response

• ADHD
• ODD
• Conduct disorder
• Bipolar disorder
• Anger management

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

WVIFCI Q.I. Screening and Treatment Project

 Start small – Continuity clinics, WVIFCI pediatricians, other  Pretest knowledge on diagnosing and treating traumatic

stress effects

 Educational program  Create and implement trauma screening form  Create and implement foster parent instructions  Determine effectiveness from foster parents and

pediatricians

 Posttest knowledge  Implement WV Chapter AAP MOC QI program on health

screening and parent treatment of trauma in foster care 2015

Pediatrician’s Role

 Learn neurophysiology of traumatic stress  Identify effects of trauma on body functions,

behavior, development, and learning by:

• Review of existing diagnoses
• Review of symptoms FORM
• Use of screening tools

 Teach foster parent to be therapist –

Instructions

 Follow-up care  Collaboration with all partners including

birth parents

Invitation

 Join the WVIFCI team pilot

trauma screening and treatment project

 Support development of

the WV Chapter of the National Foster Parent Association

 Participate in conference calls  Action meeting with WV

foster care stakeholders and DHHR OMCFH

 WV AAP Spring Meeting

Friday morning combined parent meeting

 Implementation of MOC Part

4 credit for trauma screening and therapy

Resources: www.aap.org/fostercare www.aap.org/mentalhealth www.aap.org/medhomecev www.healthychildren.org www.nctsn.org www.childtrauma.org www.samhsa.gov/nctic

VISIT DISCHARGE AND REFERRAL SUMMARY FOR FAMILY (part 1)

VISIT DISCHARGE AND REFERRAL SUMMARY FOR FAMILY (part 2)

WVIFCI Process

• 1. 3 Conference calls – T

eam recruiting, sharing, goal-setting

• 2. Summit Meeting with WV DHHR,

OMCFH, Medicaid, State Government

• fficials, CPS
• 3. Joint Meeting with Annual WV Chapter

AAP

• Moring Workshop – Goals and plans
• Afternoon session with WV AAP members

for presentation, introductions, initiation

WVIFCI GOALS

• 1. Screening form for children entering

foster care

• Initial AND 30 day follow-up
• 2. Build parents of children in Foster Care

partnerships

WVIFCI Process

WV EPSDT (Health Check) implemented AAP Visit Discharge and Referral (screening) Form and AG in pilot practice

WVIFCI Future Plans

• 1. Analyze data form pilot program –

pediatricians, parents, WV EPSDT and OMCFH

• 2. Revise form and develop training
• 3. Implement form and AG with 3 continuity

clinics and 3 pediatric practices

• 4. Develop MOC modules for WV AAP

members

• 5. Institute Annual joint WV AAP/Parents of

C9SHCN

• 6. Build State Foster Parent Association