Newly released data reveals that more than a quarter of California children in foster care don’t receive timely medical or dental exams, increasing their risk of having health problems that go unaddressed.
Just 73 percent of foster children under age 18 had received their required medical exams as of March 2019, according to data released by Kidsdata.org last month. These exams include physical health exams, developmental screenings, psychosocial evaluations, nutritional assessments and vision and hearing tests. Even fewer children in foster care—67 percent—had received dental exams on time.
The data is taken from the California Child Welfare Indicators Project, an initiative run by the University of California at Berkeley and California Department of Social Services, which tracks information about children in the state’s child welfare system. The data shows that the March 2019 figure for timely medical exams has dropped since its peak in 2017, when 78 percent of children received the exams on time.
“Foster children have experienced abuse, neglect and other adverse child experiences that are shown to negatively impact their health,” said Jessica Haspel, associate director for child welfare policy with the children’s health advocacy group Children Now. “It’s really critical that we are making sure they are getting in and getting seen by doctors, and that any needs that exist are being identified so there can be follow-up and they can get whatever services and supports they need to help them heal.”
Access to timely preventive care has fallen short for many children in California, not just those in the foster care system. Only about half of children enrolled in Medi-Cal, the state’s low-income health program, received all preventative care services annually between 2013 and 2018, according to a California State Auditor report.
But foster children can be especially vulnerable if they don’t receive timely medical screenings. And because they are in the custody of the state, California has a legal responsibility to make sure foster children receive all medical care they are entitled to.
Foster children are three to six times more likely than children in the general population to experience mental health issues, research shows. Up to a third enter foster care with a chronic health condition, and 20 percent with a significant dental issue, Haspel said.
Exactly why so many foster kids aren’t getting timely exams remains unclear. The reasons are likely multifaceted, said Carol Brown chair of the Statewide Foster Care Task Force, which convenes public officials and health care workers biannually to discuss problems with the foster care system and identify solutions.
One problem may simply be holes in the data collection process, Brown said. She believes most children do get the required exams, but it’s not always documented in a timely manner. Public health nurses that work with foster children collect information about children’s medical exam history largely on paper forms submitted by foster parents and doctors, she said. But sometimes these forms don’t get filled out or aren’t submitted on time. On some occasions, nurses have difficulty obtaining information from clinics and private foster care agencies, Brown added.
Another problem may be that foster parents are so busy taking children to specialist appointments for already-diagnosed health issues, they don’t get around to preventive care. Kids in the foster system sometimes have complex physical and mental health problems, so taking care of their medical needs can be time-intensive. On top of that, families frequently struggle with transportation and financial issues that make getting to appointments complicated, she said.
“They go to so many appointments, and for mental health too, that prevention takes a back seat,” she said.
Additionally, frequent foster placements can complicate getting timely medical care, Brown said. If a child moves to a foster home in a different county, they often have to change medical plans. That can lead to delays in seeing a doctor, she explained.
Brown agreed that ensuring foster children receive medical exams on time is important.
“Physicals are for a reason. You’re trying to catch things early, you’re trying to see that they’re developing normally and that there’s no problem that you missed, so they can be treated early and have better outcomes than waiting down the road a year or two,” she said. “Early intervention is what it’s about.”
Beyond medical exams, the foster system needs to work on improving timely access to services for foster children in general, Haspel said. She applauded a new state initiative called California Advancing and Innovating Medi-Cal, or CalAIM, that seeks to find more effective ways to deliver care to children enrolled in Medi-Cal. As part of this process, the state Department of Health Care Services has proposed forming a workgroup specifically focused on how to better serve foster children.
“There’s a recognition that children in foster care have unique needs and challenges,” Haspel said.
Kidsdata and the California Health Report are both funded by the Lucile Packard Foundation for Children’s Health, however the California Health Report maintains editorial independence.