Tuesday, March 13, 2018

Quicker Physician Exams of Foster Children Could Save Young Lives

Texas children suddenly thrust into the state’s foster care system will receive a necessary health check by a physician sooner, potentially addressing life-threatening issues. Senate Bill 11, one of four child welfare reform bills the Texas Legislature passed during the 2017 session, requires foster kids to see a physician within three business days of placement in foster care. Texas’ Child Protective Services (CPS) is expanding “community-based” foster care throughout the state as part of the change.

Before the law went into effect September 1, 2017, new foster children waited as long as 30 days to see a doctor for a physical exam. For many children that meant delays before they received help for medical problems tied to hunger, poor hygiene, and general lack of medical care. James Lukefahr, MD, a pediatrician who works at the Division of Child Abuse at The University of Texas Health Science Center at San Antonio, says the initial three-day exam is for the child’s safety. “It's going to be more of a screening exam to make sure they don't have any significant needs,” says Dr. Lukefahr. “We're looking for previously unrecognized injuries and anything that needs to be treated and — especially for older kids — looking at mental health screenings.”

For some children, the need is urgent — even a matter of life and death. The March issue of Texas Medicine magazine reports that between 2010 and 2014, 144 Texas children died while CPS investigated claims of abuse in their cases. Many other children in state custody had to sleep temporarily in CPS offices for lack of suitable homes. Meanwhile, problems such as low pay and high turnover among CPS workers created instability. The new law standardizes child abuse and neglect investigations, covers the cost of daycare services for foster children, and requires CPS to notify a physician when the agency moves a child to a new home.

San Antonio pediatrician Ryan Van Ramshorst, MD, a member of the Texas Medical Association Committee on Child and Adolescent Health, says the reform allows a “warm handoff” between physicians. "Now I can call the new pediatrician or the new family physician and let him or her know what's been going on with the care of that child to make that transition a little bit more seamless," Dr. Van Ramshorst said.

It is unclear if the new three-day rule will increase the number of foster children seen by pediatricians and family practitioners. Texas covers foster kids under STAR Health, a Medicaid program, so only physicians who accept Medicaid are likely to see children in foster care. According to TMA's 2016 Physician Survey, only 41 percent of Texas physicians accept new Medicaid patients, and just one in five accept some new Medicaid patients (21 percent). Foster care children in some areas like rural counties with physician shortages have greater difficulties seeing a physician.

The move to a three-day deadline was successfully implemented in Dallas and Lubbock after the law went into effect in September. For example, all of the newly placed foster care children in Lubbock saw a physician within the three-day window. Statewide, the transition to a three-day deadline will happen in stages. The entire state should be in compliance by Jan. 1, 2019.

"It's really rewarding to do something that makes you feel like you're going to have an impact on [health care] systems," says Valerie Borum Smith, MD, a Tyler pediatrician. "I think at the end of the day what we all want for children in foster care is for them to be safe, for them to be healthy, and for them to have the best outcomes possible.”

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