Creating a Family: Talk about Adoption & Foster Care

Physical and Emotional Health Issues Common with Foster Kids

November 09, 2022 Creating a Family Season 16 Episode 45
Creating a Family: Talk about Adoption & Foster Care
Physical and Emotional Health Issues Common with Foster Kids
Show Notes Transcript

What are the common health issues foster parents and those adopting from foster care should expect? We talk with Christy Street, Program Director of Fostering Health NC, which is a program of North Carolina Pediatric Society.

In this episode, we cover:

  • Term “health” broadly to encompass physical, emotional, mental, behavioral, developmental, educational, and oral health.
  • Impact of trauma on kids physical and mental health.
  • Those areas of the brain most affected by trauma, especially early trauma, are those involved in stress response, emotional regulation, attention, cognition, executive function, and memory. 
  • An issue with foster care parenting is limited access to health care before entering foster care and lack of knowledge about previous health care. How does this impact care and what can foster or adoptive parents do?
  • The role of transience and uncertainty for kids in foster care provides challenges for foster parents and doctors in providing health care to kids in foster care.
  • Immunizations
  • Medicaid Care management
  • Foster kids often come to us with a bag full of medications that have been prescribed somewhere along the line and a host of diagnoses. What role can foster or soon to be adoptive parents play?  
  • What are psychotropic drugs and why are so many foster children on them?
  • What can foster parents do if they question the amount or type of medication their foster child is taking or even the underlying diagnosis? 
  • What role does a foster parent have in seeking a change in medication for their foster child?
  • What doctor do you take your foster child to? Your pediatrician? Their previous doctor, if they had one? The doctor that has prescribed the medication?
  • Pre-natal exposure to alcohol and drugs: impact, diagnosis. 
  • One of the most confusing aspects of caring for a child in foster care is identifying who has the authority to consent for health care on behalf of the child or adolescent. Varies by state (caseworker can tell you).
  • Sleep issues with foster children. What causes sleep issues? What can foster parents or parents adopting from foster care do to help children in foster care sleep better?
  • How common are weight issues in foster children? Why is obesity and being overweight an issue? What can foster parents or parents adopting from foster care do? 
  • Dental care for foster children. How much and how soon?
  • Coping with feelings of “why bother” when a foster child will return to the same chaotic household they came from.

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Welcome everyone to Creating a Family talk about adoption and foster care. I'm Dawn Davenport. I am both the host of this show as well as the director of the nonprofit creating a Today we're going to be talking about the physical and emotional health issues that are common with foster children. We'll be talking with Christie Street. She is the program director of the fostering health program in North Carolina. And fostering health is a program of the North Carolina Pediatric Society. The goal of the fostering health program is to help improve the health and the well being of children and youth in foster care. So Christy, we are so happy to have you with us to talk about this really important topic that really is that I think every especially parents, beginning foster parents, those at the beginning, are wondering about. So I do want to say at the beginning that we use the term health very broadly, we are encompassing physical, emotional, mental, behavioral, developmental, educational, and even oral health. So we are we use that term broadly. And I think that's important. And you know, when children come into your home from foster care, often they come with complex and serious physical, mental health and developmental and psychological issues that have been rooted in childhood adversity and trauma, and the impact of trauma on kids. It affects both their physical and their mental health. How does trauma affect the I'm not asking you to go into the brain structure and giving us an anatomy lesson here. But how does early childhood or any trauma really affect the brain?

Dawn, thanks for having me. Excited to talk about health care for children and youth in foster care. And so what they know from studies of aces or adverse childhood experiences, and not just specific to foster care, but trauma generally is that trauma can actually cause changes to our brains as they're developing, which can then cause a lot of different impact that can affect diseases, there can be diseases that are more prevalent for people who have experienced trauma that you wouldn't necessarily think would be associated with them like heart disease, diabetes, cancers, even Yes, cancer. Absolutely. Obviously, that increased stress and adversity can have an effect on their emotional health, behavioral health, the developmental health of children as they develop, and their brains change as a typical child, but especially those that have trauma. And then as well as those issues that are lifestyle issues of increasing smoking increase in early pregnancy and unplanned pregnancy, increasing suicide attempts and right. So just really, that whole body, like you mentioned, as healthcare being that really, really broad aspect, it really can impact every area for some individuals.

The research surrounding the adverse childhood experiences, Aces studies that began in California many years ago, but there has been continued research. It's absolutely fascinating. How and again, this was not specific to it was specific to traumas, but not specific to children who are in foster care. But even the traumas that that that people who are not in foster care, the long term impacts on as you point out every aspect of our health and certain we know our kiddos, who have been in foster care, across the board have high Asus scores, how could they not given their life experiences so it is it is so universal, and also things like aggression and hyperactivity, which is very common, impulsivity, inattention, all of those are impacted through the early experiences that our children have had and the traumas they have had. Absolutely. An issue with foster care parenting is limited access to health care information before the child entered foster care, and just a lack of knowledge about what previous care the child has had. How does this impact caring for a child? And what can foster or adoptive parents do?

You're so right, we hear that across the state those issues of not knowing much at all. And sometimes there's not much to know, because there hasn't been very good care, or the biological parents are upset, obviously, of a child being removed from their home and not divulging some of that information, or it could be so sporadic that they don't even have a good recollection of that information. And so it's hard to really put those pieces together to get comprehensive care for a child that's in foster care. It also can so it helped is sort of like private investigation of trying to figure out where do we where do we go to get medical records so DSS. I The county level needs to be seeking out medical records but often doesn't even know where to go for that, or there's a lot of places to go. Some people seek care at urgent care or at emergency rooms, which isn't good continuity of care. And so continuity of care is really important. And all of that is impacted by that. It also can lead to lapses and things. So that routine care that every child should get, their children that have enter foster care may not have gotten that. And so it's playing catch up, if you can figure that out. And then also it can lead to duplication of things. So if you don't know that was an immunization, they may be immunized again. And that's not the best care to get. It's not. Immunizations aren't fun for a lot of children. And it's not good health care. It's not good health care for cost, as well as for time spent seeking out that care when it's duplicative if things have already been been done, or those things have serious things that may not be known to DSS, and then to either agencies and or foster parents to follow up on information that maybe was learned and missed when the child was in the biological parent home, or whatever setting it was before they were in this placement. And it could be something serious that could be happening with a child that they need a specialist or some type of referral.

We hear often the question about immunization. I mean, sometimes kids come in, and they have had the continuity of care. And you can find out from the parents or grandparents, who their child's pediatrician is and you can get that information, but sometimes not. And so how do foster parents as well as the child welfare agencies, handle issues as routine as immunization, when you don't know whether the child has been immunized? You were saying tried to get become a detective and figure it out. And so that is one option. But often, as you point out, that's the children are not safe. They may have moved, obviously, you would start with the health department where the child is currently living, or if there is the pediatricians offices, but that may not happen many times the children either haven't gone or they've moved in, they've received immunizations elsewhere. So What should parents do? And or how can they help their child welfare agency and the caseworkers?

So I do think, you know, I think a lot of that does fall on as far as the seeking of information, formally seeking that falls on the DSS social worker, as they're the ones with the ability to even legally seek that information. But I do think that the foster parents can, you can try to find out information if a child is older that they may know some of that information of where they've been for care, sometimes they don't know the names of things. But I do think and working together with, you know, a private agency of one's involved and the DSS social worker, as well as care management. And so, and this is specific to North Carolina, if you're in another state seeking information from, you know, your state that's relevant to your state, but in North Carolina, we have care management through our Medicaid program. And so those care managers have information often from a system that they use, that can they can access Medicaid claims information, which can help put some of those pieces together. It's not a medical record system, but medical claims that help sort of point people in the right direction of what pharmacy has been used, what medical providers specialists, as well as an immunization registry against specific to North Carolina, that most providers enter immunization information and so that people can help put those those things together. And then otherwise, if there's not that information in the system, because maybe there wasn't great care, or that's not applicable in your state, I think really seeking the advice and expertise of the pediatrician, you know, or provider that the child is seeing regarding how to best assess what's going on, as well as determine what vaccinations you know, can be given regardless of whether they've gotten them, you know, before and what timeframe that would be and of course, in many states, including North Carolina, there are school requirements for what vaccines generally have to be, you know, obtained to attend school, public school,

right so you can go back to their previous schools which generally we do have knowledge of what school the child has attended or is currently attending when they are removed. And I think your points will take in it's called care management in some states but the Medicaid system itself has tracking mechanisms that can also be used by your agency to try to get more information about the child's previous health care. We are excited to offer you 12 free online courses on the creating a family ED dot board, online Parent Training Center. We want to thank our partners the jockey being family foundation for being able to offer you these free courses. They are terrific. I think you will really love them. You can find them at Bitly slash J B F support at Bi T dot L Y, slash jPf. Support. There's a variety of topics, including one how trauma impacts a child's development. So that fits beautifully with what we're talking about today, check it out. Another issue that we hear from foster parents is that often when children come into our homes, they come with a bag full of medication that had been prescribed somewhere along the line, and, and often a host of diagnoses as well. So what's the role of a foster or soon to be adoptive parent to play with the child, we're going to talk about over medication and well being stopped by that there's often a lot of medication these children are having. I often think, personally, it's because they haven't had advocates in it to begin questioning doctors and saying, Okay, you prescribe this last year, we're not seeing this problem anymore. Does this child still need to be having it? Is there a way that we can start cutting back down or whatever, but oftentimes, there has been a not a continuity of care in these kids lives, and there hasn't been an advocate for them. But what's the role of parents because they're given usually a bag, and that sometimes there's a list of, of what the kids should be taking. Oftentimes, you just have to pick up the the medication bottle and read on their hopes twice a day, or once a week or whatever. So what role should foster parents are or soon to be adoptive parents? If they're an adoptive placement? What is the what's their role in trying to assess what's necessary? What's should be taken? What shouldn't? Obviously they should not discontinue anything without a medical professional? But nonetheless, what's the role? What is their role and trying to become an advocate for this child?

Yes, so this is an issue of putting those puzzle pieces together. And especially when it comes to, to things like medications, which are obviously they alter behavior and alter thoughts and all of those things. And so, we do hear that, that children often come with that bag of medication. So I think the foster parents and or adoptive parent needs to become that advocate needs to become the person that they don't make the decision of whether they should stop, but getting to know a child, which obviously will take some time if they are a new placement. But that child spends the most time with that foster parent or that caregiver, compared to a social worker in child welfare or an agency provider if it's a private agency, or the or the prescriber, or the bio parent at this point. And so really figuring out what is the list of medications and what I would recommend is to if it's not on the list, sort of listing it out reading those bottles and listing it out to figure out what is the schedule and some states require medication administration records, or you know, charts of keeping that straight, especially if there are multiple medications, and tracking on what is what seems to be the baseline of behavior, as well as any types of changes. Obviously, if a child is new in placement, there, there are stressors that are going on are being changed in places, their behavior may be different than it would be once things calmed down a little bit, but really trying to figure out what is it that you're understanding as a foster parent of what the medications are, and then also using that primary care provider who is typically who they would see first, unless there's already an appointment scheduled with a behavioral health provider, but what we find is, if they've moved and they moved, maybe out of county, or further away, or for various reasons, there's not the ability to stay continuously with that mental health provider, it becomes that lapse in care. And what we also find is that not always, but as a child put on these medications prior to coming into care, to try to dole down some of those behaviors that the chaos of life in that family and this is true in foster care, or before coming into foster care, isn't to try to get symptoms to decrease those symptoms that are those outward symptoms that are annoying or problematic that cause placement changes or cause, you know, more more stress and chaos in the family. And so, is there a thorough assessment is a really big question. And that may not be something a foster or adoptive parent knows, but trying to figure out with the child welfare agency, as much as they can, was there a thorough assessment done by a mental health provider qualified to do that type of assessment? And when was that done? How long ago and some of that, like I mentioned before, depending on on your state, could be done through figuring out things with the care management and today's but to try to figure out who's prescribing it, make sure the prescribers know what the other prescribers are because what we find is primary care providers or pediatricians often, they can prescribe some things for the end. They often do prescribe psychotropic medications, especially for ADHD or for anxiety or depression. There's kind of lower level or lower severity behavioral health conditions, but then there could also be a psychiatrist involved prescribing something out and often in a perfect world, and we're all trying to move towards this is that people are communicating that comprehensive continuity of care and a team effort and a team not being all under one roof, but in all the rubes that everyone's providing this care. And that includes a foster parent and the social worker from child welfare, you know, being involved on that team to figure out what is going on around these medications. And, and really questioning that, and obviously, you know, an appropriate way of figuring out is there something else that we can do is this, the right side effect is the side effect, worse than what it's treating, you know, what a medication is treating, and really trying to track on that. So in regards to children and their psychotropic medications, it really is that team approach of not just the prescriber or prescribers which need to communicate, but the child welfare, social worker, the foster parent, anyone really involves, because it really does, there's a role to play for everyone that's involved in the child's care.

And I would say specifically, the foster parents have a central role, because as you pointed out, they are the ones who are spending the most time with the child. And quite frankly, they may be the only one who sees the totality of this is the this is the medication schedule, this child is taking this medication on this day this day. And that should be in the system, but it often isn't for our children. And so the foster parents play a crucial role. Now, you have mentioned psychotropic medications, what are psychotropic medications?

Sure. So that is a good question. We always assume everyone knows what that is. But it's a word that maybe people don't necessarily know. But obviously,

they don't. I mean, many foster parents have not had much experience with psychotropic medications. But anyone's been in this foster care system for very long. Anybody who has been associated with it. We'll know. We'll know that term. So yeah, what is it? What does it mean?

Yeah, so they are a type of medication or drug that can affect behavior, mood, thoughts, or perception. And so they're prescribed for people who are having concerns around that. And so we think of like our antidepressant medications, or anxiety medications, those that are for ADHD, that's a psychotropic medication, called a stimulant, antipsychotic medications and mood stabilizers, as well as sleep medications are the primary classes of medications under that psychotropic medication, umbrella,

you know, and something important to note is that research has found that children in foster care are prescribed psychotropic medications at three times the rate of other Medicaid enrolled children. And often they're taking more than one medication at once. And here's the problem, once psychotropic medications are prescribed, children in foster care are likely to be kept on them longer than and again, this study was comparing to other Medicaid enrolled children. And so kids once prescribed, they're often the prescription continues. And I think it's partly because no one has, is taking the authority to in order to assess is this why was it prescribed? Who prescribed it? Is it still necessary? What are the side effects? are the side effects worth? Is it working? Number one? Number two? What are the side effects? And how and how severe are they? It's, it's a mess, really, isn't it?

It really can be? And I think you're right, I think because there are so many what I call cooks in the kitchen. When it comes to children and youth in foster care. There are there are different aspects to consent. And that's also going to vary by state, there are different aspects of decision making. There are different aspects of that care who's owning the care of the medical care. And and who really does on that. And it really, it depends, I always tell my staff, I say it depends a lot because a lot of things just are not black and white, they're very gray. And I think you're right that they I think one reason they're probably kept on them longer is there's a lot of change that happens in children's lives that are in foster care, there's visits and there's reunification attempts or or plans, there's change in placements, their change in childbirth, or social workers or change in therapists or in psychiatrists. And all of that changes like to can be two steps forward, three steps back. And then also if it feels like the medication, whether it's working optimally or not, or working as well as something else might be, but it's not as bad as it was. It's may be that I have no date on this. This is my thinking of this that just sort of makes logical sense of is they're just leaving well enough alone. That doesn't seem to be hurting anything. So why, by right the boat, taking someone off, when it could change placement, it could cause disruption that no one wants to cause a disruption. But is it the best line of of treatment, you know, not everyone needs to be on a psychotropic medication their whole life. And then also these are growing bodies. And so changing bodies and things change with the level of stress or the level of different things that are going on in their lives based on so many aspects of how complicated all of our lives are, but especially young people who have those experiences,

I think you were spot on, and I liked your use of the word ownership, I think of it in terms of advocacy, but you're right, nobody, nobody is owning the totality. Whereas and whose role is that for other children, that is their parents, their parents, and in fairness, many birth parents are trying to and are aware of and are trying to own the responsibility. But oftentimes, children who have entered foster care, don't have parents who are able, at least at this time to be able to do that. And so it's, it becomes very, so what what is the role of a foster parent? In seeking, especially if they want to either change the medication or reduce the medication or even question, because we hear that they oftentimes don't feel like they have the power or the ownership in order to do that. And yet, as you and I've talked about, they are the ones who have the most knowledge. So what should a foster parent do? If they think that they're questioning any of this, the amount of the medication, the diagnosis itself, the side effects, or any of that? What should a foster parent do?

I think they absolutely should ask those questions. I think if they are the ones attending appointments with the youth, which we find that happens most often compared to, you know, others attending the appointments with them, I think asking the prescribers the questions of, you know, are there other interventions that can be used besides medication, or their lesser medications, lesser dose or lesser amount if there's a bag full of them, and involving that communication, because it's going to have to involve that child welfare worker, and ideally should involve that biological parent, if they are involved and at the table, and really trying their best to increase that communication and advocacy, because as we've talked about, they're the ones they're at bedtime, or in the middle of the night when a child is awake, or seeing that the child is gaining weight. And it's not, because they're just eating a bunch more, or because they're going through puberty, but because maybe it's a medication, and that's a common side effect of psychotropic medications is weight gain. And for for some children, that is not not the ideal situation to have, where they gain a lot of weight on those medications. And so I think really asking those questions, and we have several documents and resources on our resource library on our website, that a lot of things are in North Carolina specific, but there's some just general guidance. And there's one, one document in particular that could be used, as far as I'm remembering could be used, you know, across the country that really is for for laymen, it's not for prescribers, or pharmacist or psychiatrist it's for, for those of us that are not medically trained to look at what those medications are, that are psychotropic, it looks at what the potential side effects could be, as well as what needs to be monitored for psychotropic medications, which is something a lot of people don't know, needs to happen, as well as a question to ask the prescriber. And some of those are things we've already covered. But, you know, another is, how does this fit with the overall treatment plan? You know, what is what is the plan for this, you know, in, in this child's life, in this particular case, and making sure that trying to be that advocate, and it's not always easy, it's not as simple as well communicate and advocate, we know that there are barriers to that in certain situations. And I think that's really a key part though, because they do have so much they have so much valuable input, because they live they live with this child who they've had in their case, and, and really just trying to be that advocate, and seeking out, you know, more information. Yeah, absolutely tracking those things. I think because there are so many nuances of you know, behavioral changes or sleep changes, or things that could be not related to psychotropic medications at all, or maybe they don't, maybe they are and it's useful for those prescribers as well as others involved in the in the case to net

and we will link to that document so that everyone can can access it. If you are not a subscriber yet to our monthly e newsletter, you are missing out. Please go to Bitly slash C A F guide And subscribe now that's bi T dot L y slash, C A F guide. When you do, you're going to receive a free downloadable guide called parenting a child exposed to trauma, it is a terrific resource only available to you if you subscribe to our monthly newsletter plus you will get a creating a content delivered directly to your inbox every month. If you just want to try it out, don't worry, subscribe, it is super easy to unsubscribe. Another issue that comes up is what doctor what pediatrician do you take your foster child to? Sometimes it's an easy answer. Sometimes they you know who the child's pediatrician currently is. And obviously, if that pediatrician is within a decent driving distance, that would be where you would take the child. But sometimes you don't know that the child one may not have had a previous pediatrician or you may not know who it is. So how do you determine what doctor to take your child to pediatrician or other mental health professionals?

Sure, so when it comes to primary care provider, a pediatrician, the American Academy of Pediatrics says that the best practice is to keep that continuity of care to stay with the medical provider that they were seeing if they were seeing one, prior to coming into care. And that's the ideal world. But we live in reality that we know that and I'm assuming across the country, but we're in North Carolina children often move out of their county, when they're placed in foster care, or in a bigger County, they may move from one side of the county to the other. And it's not always feasible for a foster parent who, you know, maybe has more than one foster child in the home or has their own children to really go from place to place to place and trying to make it it's not easy to be a foster parents are not like that things aren't always easy to to be made easy, but but to make it realistic to be able to provide care for this child. And so, you know, I think that the first sort of layer we say is keep them at their provider if at all possible. If it if not possible, trying to find a provider who has availability to see them on a regular basis and quickly when they enter care. And that do comprehensive, comprehensive care that have an understanding of what children in foster care need compared to children not in foster care. And that's a lot of what the work we do here in North Carolina with fostering help and see. And obviously, that would differ from state to state of what that knowledge is. But the guidelines come from the American Academy of Pediatrics,

the American Academy Pictures has definite guidelines for pediatricians and working with children who are in foster care.

Yes, and they they're sort of motto is to be seen early and often too early, when they come into care as well as often it's and more often than our children who aren't in foster care about double about double what our children out of foster care are seeing. And that is so that they have that they are the most most sane person you see them more than you see a specialist you see them more than you see a lot of times more than you see a mental health provider. And And another issue that we have in North Carolina that I think is also a national issue is getting into behavioral health care is not always the quickest thing. And so that primary care provider can be that they're not always going to they're not experts in in psychiatric care or in behavioral health. But they can prescribe some things. And some of them are comfortable doing that and have that expertise. Or it can at least bridge the gap. Sometimes, if you have where there's for whatever reason, they can no longer see a behavioral health provider who was prescribing. And so they can't get a prescription, you don't want to abruptly stop that type of medication. And so getting those sort of bridging the gap. And so trying to get that into into a provider who you know, will see the child on an enhanced schedule to have that comprehensive comprehensive screenings, developmental screenings, social emotional screenings, behavioral health screenings, because not all of our children that enter foster care who are or who are already in foster care, or adopted, you know, have a behavioral health diagnosis or issue from the get go. It developed it can develop because of all kinds of reasons. And so, you know, screening that screening for suicides, screening for depression and for other behavioral health conditions, is something that primary care does do and can do. And that's sort of the front that's the front line because we're not all connected to behavioral health until there's an issue is and even ones with issues aren't always and so really having that preventive care and getting things getting to things before they become a crisis is the ideal and, and really where pediatric medicine lives out there. They do a lot of preventive care for all children, as well as for those in foster care. And so also in some in our counties in North Carolina, there are some and this would happen in other states as well. There are some clinics or providers who are set up to see children in foster care. And that may be what is the process for a kid Only on for a region in a state where the common practice of if a child comes into care, they're seeing this clinic and then maybe they transfer out to, you know, their regular provider, but there may be a foster care clinic is what we have. We have a couple of those in North Carolina, I think most

states do. The general rule of thumb is that you should ask your caseworker, this question. And if there is a clinic that specializes in treating children who are in foster care, they will let you know. But oftentimes, those are in not, um, not oftentimes, almost always, those are associated, sometimes with medical schools, but almost always in bigger cities. So what we see happening is that children who are within easy driving distance or sometimes go there for the first or so appointments, just for the general assessments. But unless you live nearby, of one of those major clinics, which, again, are are congregated in metropolitan areas, you would then need to be transferring over another issue that is, unfortunately, more common in our children, children who are in foster care, then in the general population, is prenatal exposure to alcohol and drugs. Depending on there's not really good statistics, although Dr. Ira chesnoff, has said that he believes in he has seen stats that would say over 70% of children in foster care have been prenatally exposed. As I said, there aren't really great statistics that we've been able to find on that. But we do know that it is more common. So I just want to put out there to foster parents, that I think it behooves all of us to learn the symptoms of things, we need to look for common behavioral common attitudes, common things that are associated, usually a cluster of symptoms that we can look for, that would indicate exposure to prenatal exposure. And also to bring that up to your pediatrician. Any thoughts, Christy, on the on the prenatal exposure, other than to be aware, and also to make your pediatrician aware? Because, sadly, not all pediatricians are as aware as they should be, of the symptoms of prenatal exposure, as well as best practices on working with these kids.

Yeah, I think you're right, Don, I think that this, you know, again, goes back to those foster parents are spending more time with that child than anyone. And so noticing those things, those developmental milestones, you know, and, you know, for younger children, and then, you know, for older ones that may be struggling, that maybe there's not a diagnosis and just thinking, you know, what do we know about any of that history? Which again, we don't always know,

almost never do, you know, prenatal exposure unless it's in their medical records, and that's usually only for drugs.

Right. And sometimes for for our babies, they may have known that, but you're right for that.

Medical, medical. neonatal abstinence syndrome is sometimes indicated in medical records. But quite frankly, oftentimes, the testing is not done. So we wouldn't know. Right? Alcohol has not picked up on those tests.

Absolutely. So I think really just trying to keep those communication lines open with the provider, seeing that provider, that's again, why those those visits that are recommended by AAP, being more often really can pick up on more of those nuances than, you know, once a year visits, which is what a child's not in foster care over the age of two, but typically be seen, and really just trying to, to make sure screenings are being done. And you're right, though there is there is room to grow in the pediatric community very broadly. And generally speaking, of that screening and have that expertise of, of exposure to substances.

Absolutely. So who has the responsibility, the authority to consent for medical care on behalf of a child or an adolescent? Who is in our lesson to who is in foster care?

So I mentioned before that my staff knows that I say it depends. And so there's a lot of variability. And I think that this would go back to whatever state you're in. There is a lot of variability from state to state as far as what the law is, it is typically state law or state statute. And it depends on what the what the consent is for. So just briefly, for North Carolina, for example, a child in foster care, the Department of Social Services, which is our child welfare agencies, they can consent to certain things, what they call routine or emergency care, but then there's a whole slew of things they can't consent to, without biological parent consent, or without a court order. And so again, that would vary from state to state as far as what that Looks like but it really does involve as far as the legal aspect. I think that the foster parent obviously plays that role. They're often the one taking the child to the appointment and here in North Carolina are often given the, and I'm guessing this would happen in other states as well, given some type of letter or something stating that this is the foster parent who can come and provide and be involved in that health care, but they're really not legally consenting to things.

How common are weight issues, either underweight or overweight, and foster children.

You know, don't have any statistics on that I do know that weight issues are in the United States can be there's issues with overweight for a lot of our population. And so I don't know specific to the foster care population. But do know that that's something that the pediatricians look at and and, and want to want to address in the best way that they can, because of the risk factors that happen in childhood as well as going forward into adulthood with with being overweight, or being in the obese category. And I think

if foster parents have a concern, we often say that children once they are in a stable environment do tend to gain weight. As you pointed out the psychotropic medications, this can be a side effect as well. So it's worth bringing up to the pediatrician. If you are noticing a change in the way either going up or going down. Let me pause here to thank this that Del Mar, they have one of our wonderful partners that help us bring you this show. They are a licensed nonprofit adoption agency with over 65 years of experience helping to create panels. They offer home study only services as well as full service, infant adoption, international home study and post adoption, as well as a foster to adopt program. You can get more information at their website, this step del Thanks, Vista Del Mar. Let's talk a little about dental care for children in foster care. This is an area where it is not uncommon for us to have children come into our homes that have had very little dental care, even less dental care usually then than other medical care. So how is that one of the questions is many children who have not have not had much experience? Or maybe have had negative experience with dentists? How much should you do and how soon because on the other hand, you'd also don't want to traumatize children.

Right. So and I think that's one of those things that a lot of people if you polled a lot of us, you know, dental care isn't isn't the favorite place to be for a lot of people. But so important because it really does play a role in overall health care as well as, you know, the social aspects of it. And being very vulnerable population being a child in foster care, and things that can happen with being made fun of if dental care, you know, or isn't art, you know, teeth aren't typical looking or you know, things like that it's a really important, the American Academy of Pediatrics says that children in foster care should be seen by a dentist within 30 days of entering foster care, it's gonna vary by state what the child welfare policy would be, or by county depending on how states are set up. But that's the recommendation. And that would be if they hadn't been seen, you know, in the past six months prior to entering foster care, but really having that good health care. And then the American Academy of Pediatric Dentistry recommends that that all children not just children in foster care are seen every six months for a cleaning just like most of us believe that's adult care as well, to really make sure they're having that comprehensive care. And having those cleanings and assessment for cavities and other other concerns. And knowing that history again, is one of those things where if you know a child went in April and the child enters foster care in June, and there's not an obvious problem, you if it's a stressful environment for the child, you don't really want them to have to go again in June, but but often because of that lack of connection of what the history is so, right, right, right. And there aren't enough dentists, at least in North Carolina, and I'm assuming everywhere because there's less of them then, and pediatric dentist especially. And one thing we found, which I assume would be all over the country is that COVID really impacted dental care, and hopefully they're on that catch up kind of thing, but because things were shut down. A lot of dental practices can't really do telehealth for dental care. And so they were playing and I haven't heard lately, but at least earlier in 2022 they were really trying to play catch up because they had not been able to see people for that routine. The routine cleanings and things like that, during the height of the pandemic, when when so many things were closed. And so really trying to just figure out out in the area that you live in, where are the providers that that can see children that also take Medicaid, which becomes the smaller and smaller number who have availability to see them? Because it's so important.

Yes. And I'm so glad you raised that is where as the numbers are, as we start off with the universe, of dentist, and you're trying to find a dentist, and you may not be able to find one who specializes in children, pediatric dentists. But then when you start narrowing it to those who accept Medicaid, you're getting your your pool of options is getting smaller and smaller with each criteria that we're putting in. One of the things that we suggest is that, as a foster parent, let the dentist know that this may be you may not know if the child has gone to a dentist before, but let the dentist know. And don't make the first appointment. A fact usually they don't fill cavities and stuff at that point. But you may want to just do a mild cleaning to there that you want the first appointment to be more of a get to know you not an overwhelming appointment for a child, particularly if you have a reason to believe that the child is going to be hesitant or fearful, and not try to do everything at once. Usually, as I say fillings are never seldom done at the vet appointment anyway. But the whole point is to start establishing relationships with a child is not afraid.

Absolutely. And really trying to, you know, ideally, you know, having that, you know, even an appointment that not much happens at all, you know, sitting in the chair would be really ideal. I don't think it's the world we live in at this point. But I think, you know, trying to find that, especially for a child that you know, hasn't, you know, has anxiety, or diagnosed with something like that, that that's really going to or you know, there's a you know, just, they can tell you, they stress out with going to the dentist, you know, and just trying to be otherwise it becomes a waste of time, if everybody jumps right into it, because then it becomes an appointment cut short, or some kind of trauma happens. And it just becomes a stressful time anyway,

exactly. Let's talk on another common issue of kids entering care or sleep issues. We know that all children who are in foster care have experienced some type of trauma, just the fact of being removed from their parents is traumatic if nothing else. And and trauma impacts sleep, the medication that children are often on can impact sleeps, for all those reasons sleep issues are, are not uncommon. So what can foster our foster parents or parents who are adopted from foster care do to help children who that are kept come into their homes sleep better?

You're so right, that it definitely sleep, I think is something that happens to a lot of people when there's stress when there's trauma when there's adversity. And so, obviously that's, you know, right up the alley of children in foster care. So yeah, I think of those. Yeah, I think trying to sort of monitor what's going on, obviously, having a everything's gonna be that supportive environment that really trying to figure out, you know, what's going on, if the child is able, you know, at the age to be able to, to verbalize what's going on, or what they're having trouble with, in regards to sleep, going to sleep, staying asleep, you know, whatever it may be, and really trying to track on that a bit talking with their provider, their pediatrician, or their psychiatrist, if it if it could potentially be, or even if it's not, you know, it could be a medication issue, to figure out is it related to they take this medication, and here's, you know, in this amount of time, they're not able to sleep or they're sleeping during the day, and so they're not sleeping, yeah, you know, and able to sleep at night. So I think always, you know, going to the, to the professionals on that, but then also having a bedtime routine, I think a lot of children come into foster care, without routine and without structure. And, and most of us need some structure, having a bedtime routine of, you know, all the experts are talking about, we're all on screens a lot of times now. And so having that period of time ahead of time, where they're not on a TV or a tablet, or a phone or whatever, to really just kind of calm that our eyes and our brains down to be able to go to sleep, having a good quiet place, obviously a bedroom is is something that is required for someone to be in foster care and foster placement. And so having that, you know, comfortable environment to sleep in, you know, being calming and comforting to that child to figure out talking out, you know, if there are stressors, or is it something that seems like is it in relation to a visit that has happened recently, or an appointment that has happened recently, or something going on school starting or any of those types of changes that could be happening? And then another thing we have a resource on that same resource library I mentioned on our website, that's a suggestion is to talk about three good things. Three good things that have happened in the day or two good thing or even one one thing and really just kind of calm down, you know reading a book or something. There's all kinds of apps for this kind of calming things, to really just kind of decrease that level of activity that happens during the day and happens after school and all of that kind of activities that happen in our lives. And there's few hours, there's not many after school between school and bedtime, but really have in that period of time before bedtime to calm down,

have a routine that you're following that will be conducive to unwinding, and sleep and that that routine needs it. It needs to begin in theory, hours before bedtime, not that the actual routine is but you're decreasing screens, you're decreasing activity, you're everything is beginning to calm down. And it's following the same pattern as much as possible. Until you get to the actual routine, which can be whatever fits into your family, but usually involves things like brushing teeth, putting on pajamas, reading a book or even elev, with older children reading out loud or letting the child read a book or whatever. So gearing the hours before bedtime, towards the ultimate goal of a calm environment when the child is trying to go to sleep. Absolutely. Something that we hear we hear about it, but honestly, we hear about it more on the side, from foster parents. But there is this feeling of why bother, you know, a foster child is coming into your home for ideally a short period of time, the child is hopefully going to be reunified with birth family with birth parents or extended family. And even you may not know that that's going to happen. But you oftentimes are assuming. So everything we've talked about becoming an advocate, tracking, doing all of this stuff takes effort. And if the child is is going to be leaving your home shortly, there's a temptation to think somebody else is going to deal with this problem. It's, you know, I know, we're not going to probably have enough time to even deal with this problem. So how do we combat that logical I mean, a common and understandable feeling that foster parents may have?

I think that's a valid point. And I think it's probably something that that those that have that probably aren't on their first placement, our first child plays with them that are more seasoned maybe, or maybe are on their second one might think that but may not verbalize that to people, because they feel like they shouldn't say that. But it's a valid thought, because they may not be with you very long. But I think that what I thought of when when, when we talked about this was what if you do make an impact? Maybe it's not a big one, right? I think and in our world, we have to think of those small things like what if it's one thing that went right, that prepares them for whatever's next, and maybe it's a placement change, or a move to kinship or, or reunification or adoption, whatever it may be, or they age out? What if it does make that in impact that the they talk about that it takes one caring adult to make an impact in the life of a child involves one. And it could be anybody it could be you as a foster parent, often, I think it would be just because of the time again, like we've talked about the time spent. And it's sort of like there's that story, the starfish story. And if you don't know that you can Google the starfish story. I'm sure it will come up. But it talks about, you know, someone's on a beach and they see all of these starfish that have washed up onto the beach that are not going to make it I guess, because they can't live on the beach. And so it looks daunting, like how do I get all these starfish back into the ocean? Well, you can't get them all back into the ocean. So you take one, and you put it and so I think that's where the broader sort of landscape of being a foster parent, but also for that particular child, there may be a lot of starfish or a lot of problems, or a lot of challenges about this particular child. But if you start with one thing, because you're gonna start with dentists, get them into a dentist or start with a bedtime routine. And yes, it may change. And yes, maybe it's two steps forward, three steps back. But your job right now your role right now is to be that person, and hope you're that person who makes that impact. And I think that that's easier said than done as a not as a non foster parents to say that obviously I don't live that life, but seeking that support from other foster parents and associations and organizations to have support of you to keep fostering that in you, as well as those that are part of the team, you know, in this child's care. Because you know, that there's small nuggets of change, I think really are shaping these children's lives of people that people have to care, you know, people have to care and and fake it till they make it not faking, caring, but faking, getting things done, even if you may think the shelf may leave me next week or this child may leave me next month. You know, it's still there's 24 hours in a day, you know, and it adds up and I think it really can, having that mindset of it. It may just be one little thing that I'm changing or one thing that makes this child happy today or decreases that stress level, I think it's how you have to think of it in those small things. Because the big is too big.

There was a, we were working with this a bit a while ago, but a family that was had, I think it was a 14 year old. And she was feeling that way. But the one thing she did was she made a list of and the list that was she that the child had on the child's record, or the young person's record, when she came into the home was incomplete of the medication that child was taking. So she made a list of all the medication. And she made sure that the child that caseworker was aware of how much medication the child was taking. She made sure that it was the pediatrician that she took the child who but also the PD, she took the child to the pediatrician the child had seen in the past as well. And it turned out that a lot that that that no one had seen the total picture of how much medication the child was taking. Shah was only with her for a short time, just a couple of months at most. But she said afterwards, that that was the one thing that she felt like that she was because after they realized there were actually medications that were actually competing, there are medications that should have been stopped. But no one had stopped them because a new medication had been given. And no one had caught that no one had paid attention enough to the totality. So she was saying afterwards. Well, that is the one thing. This kid is down from 10 medications to four medications right now she goes okay, I didn't. I didn't have much impact. But I had that. And I thought, well, that's a huge impact. Yeah. You were able to because you cared or the for that month thing. So as you say, that was her one starfish that she Yeah.

When if you think about you know, these are medications that, you know, there is a lot to take just even like swallow 10 pills a day or however he feels it is to go down to four of them or, you know, and on all a lot of different aspects. And so I really do think that, you know, really breaking that down that she couldn't fix it all. Nobody can fix it. All right. It's it's not a one person thing. And really that sort of one by one. I think that's sort of how I how I think about the work that we do. And I think also in that role that a foster parent, you know, plays in on the team is really those those starfish.

Thank you so much, Christy st for being with us today to talk about the physical and emotional health issues that are common with foster kids. We appreciate your time. Thank you

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