Academic journal article Child Welfare

Delivering Health and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform

Academic journal article Child Welfare

Delivering Health and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform

Article excerpt

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.

Nearly 500,000 children are in the out-of-home care system, despite concerted federal and state efforts to prevent out-of-home placement over the past two decades [National Committee to Prevent Child Abuse 1997; Petit & Curtis 1997]. Although these children have high rates of health and mental health problems, they have difficulty accessing timely and appropriate health care services. Over a decade ago, the Child Welfare League of America (CWLA), in consultation with the American Academy of Pediatrics (AAP), published Standards for Health Care Services for Children in Out-of-Home Care to serve as a blueprint for developing effective service delivery structures for children in out-of-home care [Child Welfare League of America 1987]. More recently, the American Academy of Pediatrics Committee on Early Childhood, Adoption and Dependent Care issued a statement to pediatricians entitled Health Care of Children in Foster Care [American Academy of Pediatrics 1994]. Unfortunately, for a variety of reasons, these standards and guidelines have generally not been implemented.

As America enters the next century, the organization, financing, and delivery of health care and welfare services to the poor are undergoing fundamental changes. At the federal level, social support programs, such as Aid for Families with Dependent Children (AFDC), are being restructured, and responsibility for the cost and delivery of basic services is being shifted to state governments. The creation of the Temporary Assistance for Needy Families (TANF) program and changes in the Supplemental Security Income (SSI) program for children with disabilities, as brought about by the Personal Responsibility and Work Opportunity Act of 1996 [P.L. 104-193], reflect a new policy environment [Green & Waters 1997]. In the area of health care, state governments are working hard to transfer the financial risk and responsibility for delivering services under Medicaid to private, managed care organizations (MCOs) [Henry J. Kaiser Family Foundation 1996]. To eliminate the ineffectiveness and limit escalating costs of these programs, policymakers are turning to "new approaches" that have no proven record of success with their respective "target" populations [Battistelli 1996]. Thus, the impact that welfare reform and health care reform efforts may have on children who enter the out-of-home care system in the next century is not clear.

This article focuses on the health care status and needs of children in family foster care and examines how this group of vulnerable children has been affected by welfare reform, the growth in managed care, and other health care reform efforts over the past several years. It examines the significant role that Medicaid has played in meeting the health care needs of children in care and considers the impact of Medicaid managed care and other factors related to access on the ability of child welfare systems to meet the health care needs of children in the future. It concludes with recommendations that address the attributes of a health care system that must be in place so that children in out-of-home care will receive the critical physical, mental health, and developmental services they need, and their biological and adoptive families will have access to health care services on an ongoing basis. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.