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New Health Care Model for Kids Seeks to Better Identify Abuse, Neglect

Erin Toner

We now continue our series on Wisconsin’s efforts to improve the health of children in foster care. Child welfare officials admit the existing system is not meeting many kids’ needs. As we reported Tuesday, the children’s health records are often incomplete and scattered among the many caregivers and doctors who’ve passed through the kids’ lives. To address the problem, the state plans to roll out a “medical home” program that would centralize each child’s care. Today, WUWM’s Erin Toner highlights another state initiative – a sharper focus on helping children heal from trauma and abuse.

Seventeen-year-old Amanda is reaching a turning point in her life. In six months, she’ll age out of foster care.

“Very scared, just because, if I mess up I can’t be like, hey, I don’t have any money, help me. I don’t have any food, can you buy me some? I’m not going to be able to do that,” Amanda says.

Amanda plans to go off to college in Minnesota, but unlike many other kids, she won’t be able to call mom and dad, if things get tough. She has never really felt that sense of support.

“My mother was on drugs and could not take care of her kids and her husband was abusing us so I was left in a hotel room at 5 and it just got really complicated from there and I ended up with my stepdad’s brother in Milwaukee and I was adopted by them,” Amanda says.

If you have a hunch this was not a happy ending, you’re right.

Amanda says the stepdad’s brother, the man the child welfare system made her foster father, was also abusive. She says he began sexually assaulting her and her foster mom beat her. Yet Amanda does not recall doctors ever asking whether anything bad was going on at home. Plus, she says whenever she had medical appointments or meetings with child welfare workers, her new foster parents were always present, so she was too afraid to mention the abuse.

“That they were hitting me, that they were sexually abusing me. They would lock me in my bedroom for hours with nothing, so it was just a really bad situation and I didn’t have the opportunity to get out before I was adopted,” Amanda says.

Amanda says the abuse continued for years. Finally, when she was 14, she started crying uncontrollably in her high school ROTC class.

“Because my…I was maturing more, like my body was maturing more, I was growing in ways that I wasn’t growing before. I was getting more and more terrified of what was going to happen, and I just couldn’t take it anymore,” Amanda says.

Her high school teacher reported the abuse, and once again, Amanda was back in foster care. Her adoptive parents were never charged, and because they did not terminate their rights, they remain Amanda’s legal guardians.

We’ll get back to her story in a moment, but here’s what could have happened to prevent Amanda from suffering an entire childhood filled with violence and neglect.

Susan Conwell is executive director of Kids Matter, a non-profit that advocates for children in foster care in Milwaukee.

“If we’re really looking at how trauma impacts kids, we have to be looking at, where are we placing them?” Conwell says.

Conwell says it makes no sense that a system that knew Amanda’s stepdad was sexually abused her, would send her to live with his brother. Secondly, Conwell says child welfare workers are required to speak to children privately about what’s going on their new homes, so it’s unclear why Amanda was never pulled aside. Conwell says the 17-year-old might have disclosed the abuse sooner, been removed from the home and given treatment.

Conwell says many foster kids suffer in silence for years.

“We know that there’s a lot of consequences – physically, mentally and what we want to do is help heal those things, right? So the best place to start would be that if we’re doing really good assessments, that are comprehensive…I mean it’s great to have the medical, but we also need the behavioral, psychological, so that we can be assured that we’re looking at the right things,” Conwell says.

Bureau of Milwaukee Child Welfare
Credit Erin Toner
The Bureau of Milwaukee Child Welfare, run by the state, will be a partner in the new medical home program.

Conwell applauds the state for creating a new “medical home” program for children in foster care. It’s scheduled to be up and running in six months for kids in southeast Wisconsin. The medical home providers will be required to practice what’s called “trauma-informed care.” It seeks to identify and create treatment plans for children who’ve been abused or neglected.

Sadly, those kids are in the majority.

Dr. Lisa Zetley is a pediatrician with Children’s Hospital of Wisconsin and treats many kids in the child welfare system. She says up to 70 percent of youth in foster care have mental health needs, so doctors must question and look for signs of trauma.

“Mental health conditions are sometimes very difficult, particularly in younger children, to identify. And so, we look to see how children are living their basic life, their eating, their sleeping, their school performance, even interacting with adults, socialization, their development. And then from there, we would refer on to appropriate providers,” Zetley says.

The new medical home program will also centralize foster kids’ medical records so they follow children, and so doctors have comprehensive information when making diagnoses and writing prescriptions.

Dr. Zetley says those improvements will help address a big problem – the overprescribing of drugs to treat mental health conditions, such as depression and mood disorders. Zeltey says kids in foster care are on so-called psychotropic drugs for twice as long as their peers not in foster care.

“Unfortunately, oftentimes children are seen by multiple mental health providers and sometimes they carry multiple diagnoses with them and any child psychiatrist can only make a diagnosis based on the history that they’re given at the point in time they’re seeing the child,” Zetley says.

Zetley says one of her biggest hopes with the new medical home program is that it gives kids bounced from family to family some consistency.

“I’ve had the experience where I am the person that they trust because I’ve been the only constant in their life. And that’s really sad, but it’s very powerful and so it only takes one adult that this youth knows cares about them, they care about what happens to them. I mean I don’t have the answers and I can’t take them home, but I can help them access resources,” Zetley says.

Back to 17-year-old Amanda, who was sexually abused by two men who were supposed to serve as her dad, she did finally find an adult she could trust. It was a social worker at a group home in Milwaukee.

“She told me how to express myself, she gave me a journal I had to write in every night, she taught me ways to cope, like, they got me into crocheting and that really helped and that’s what really helped me grow up and kind of learn, well it happened now I need to learn how to deal with it,” Amanda says.

Amanda says she was also placed with a wonderful foster mother during the past year, and now she has a future. She plans to study forensic psychology at college next fall.

“I want to help people, I want to help kids who are in my situation and I want to help them see like, hey, there’s a light at the end of this dark tunnel,” Amanda says.

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