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State Aims to Fix 'Fragmented' Health Care System for Kids

Bureau of Milwaukee Child Welfare
Erin Toner

The state of Wisconsin says it will soon roll out a new health care system for children in foster care. They often have far more serious medical and mental health needs than peers, yet people involved with the children say, too often, their needs are not met. In the first of a two-part series, WUWM’s Erin Toner reports on a big shortcoming of the current health care system for foster children – their medical records are scattered and incomplete. What the state plans to do to address the problem, is create for each child, a “medical home.”

Niki and her husband live in West Milwaukee. They have two energetic toddlers who love to watch “Super Why” on public television and sing. The adorable brother and sister are 2 and 4 and they are adopted. Niki and her husband signed up to be foster parents shortly after they were married, and last spring, the children were placed in their care. Six months later, the couple permanently became mom and dad.

“I tell everyone when they ask me, I say, my house has never been more messy, I’ve never been more tired, and my heart has never been filled with such joy. We didn’t know what we were missing out on by not being parents,” Niki says.

The experience has also been challenging. Niki says there was a “honeymoon period” at first, when the kids were so excited to have new toys, they couldn’t even sleep. Then, about a week later, she says two things happened – the children began to comprehend their new situation and started to trust it.

“And that was the most difficult part for us as foster parents because once they started to feel safe they let their suppressed emotions come out and so they cried a lot, they were crabby one minute and hyper the next and just feeling all of those emotions that, since they trusted us, they knew they could feel,” Niki says.

The children had been through a lot. Their biological mother and father walked away. Then the kids lived with their grandmother who eventually proved too poor to take care of them. Niki says she understood that guiding the young brother and sister through yet another transition required a delicate touch. At the very least, she and her husband wanted to keep the children healthy, but the couple could not get its hands on the siblings’ medical records.

“It’s very challenging as foster parents. You’re asked to take care of these children like they’re your own, but you don’t have access to a lot of the history that you need,” Niki says.

Niki says the couple waited six months to receive the kids’ medical records, and in the meantime, went ahead with the recommended vaccination schedule for their daughter. They found out after receiving her records, they had unknowingly double- and triple-immunized the 2 year old.

Niki says while waiting, they also noticed their daughter had a persistent cough and brought it to the attention of the child welfare system.

“When we talked about that with our caseworkers, it just was kind of like whatever, chronic cough, you know, a lot of people have that. But once we got the birth records we saw that she had been to the emergency room several times for pneumonia and she had a documented chronic cough since birth, and all of these things that pointed to the fact that she really does have some lung issues,” Niki says.

Niki says her daughter’s been diagnosed with a type of asthma that also triggers a severe skin rash.

“It’s just sad to me to know that she was going through something and I didn’t know, but I could have known,” Niki says.

In this case, the children were born in Minnesota, and that state would not release records until the adoption was final. There are other reasons why foster families don’t receive comprehensive medical background or, not right away.

For one, foster care is a big, bureaucratic system, so multiple people may manage a child’s care. There can be delays in sharing information, including among the many doctors who may treat the child along the way. Sometimes there are privacy issues, or a biological family refuses to release information.

“Foster care children are now in a health care system that really doesn’t serve them as well as it could,” Bove says.

Fredi-Ellen Bove is an administrator with the state Department of Children and Families. She says within six months, it will launch its new medical home program, first, for 2,500 kids in southeastern Wisconsin.

“The medical home provider will have a team that’s assigned to each foster child, which includes the child welfare worker, the pediatrician and includes the care coordinator, will be developing a plan that reflects the child’s unique needs and then arranging the services to make sure that the child gets those services,” Bove says.

The care coordinator will make sure everyone who needs the information, gets it. Bove says right now, those responsibilities often fall on caseworkers.

“However, the child welfare caseworker doesn’t have medical training, a medical background, so what the benefit of the medical home team will be, a comprehensive and coordinated look at the child’s physical, mental health and dental needs,” Bove says.

There is startling data on just how great the needs of foster care children are.

Dr. Lisa Zetley is a pediatrician at Children’s Hospital’s Downtown Health Center in Milwaukee.

“As least half of children in foster care have at one chronic health condition and 25 percent of them have three or more. There are 10 percent of youth in foster care that we consider medically complex or medically fragile, so there are lots of kids with health problems,” Zetley says.

Zetley says when it comes to mental health, six of every 10 foster children need care, and up to 40 percent have dental problems so severe they suffer daily toothaches. Some have gone without treatment, because there are too few pediatric psychiatrists and many dentists don’t accept Medicaid patients, saying its reimbursement rates are inadequate.

The state’s new medical home program aims to bring in more providers, and ultimately improve health outcomes for children.

Dr. Zetley says the program also will ensure that a child keeps the same doctors and health records remain in one place.

“Whether they move to a different foster home, we have their records, we know what’s happened to them. If their case worker changes, we can tell them what has happened,” Zetley says.

State officials say the switch to a medical home model for foster care is expected to save money by reducing emergency room visits and hospitalizations. It also aims to cut down on duplicative services.

Mom Niki in West Milwaukee says the new program will be a huge help for parents trying to navigate the child welfare and health care systems at the same time.

“Sometimes you don’t even know what you’re looking for, so that would be great,” Niki says.

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