WHO IS ACCREDITED?

Private Organization Accreditation

Heartland for Children is the not-for-profit agency responsible for the foster care system in Polk, Highlands, and Hardee Counties.
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ORGANIZATION TESTIMONIAL

Orange County Government, Youth & Family Services Division

Rodney J. Hrobar Sr., LMHC, CPP, Quality Assurance Manager

As the lead agency in Orange County, providing the safety net for children and families, it is reassuring that our clients can be confident that their needs will be addressed in accordance with the most stringent standards of public, as well as private, accountability as monitored and reviewed by the Council on Accreditation. 
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Purpose

Children in Family Foster Care and Kinship Care live in safe, stable, nurturing, and often temporary family settings that best provide the continuity of care to preserve relationships, promote well-being, and ensure permanency.

FKC 11: Physical and Mental Healthcare

Children receive comprehensive healthcare services within appropriate timeframes to promote optimal physical, emotional and developmental health.

Note: See FKC 12 for additional expectations around healthcare provisions for expectant and parenting youth. 
 

Research Note: Children in foster care are more likely than other children to have significant medical and mental health needs. Research suggests that despite regulations and policies requiring the provision of comprehensive and routine healthcare, many children do not receive routine and specialized services.

NA The organization does not provide case management services for children.

Rating Indicators
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (HR 6.02) and training (TS 2.03); or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • A number of client records are missing important information  or
  • Client participation is inconsistent; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Initial health screening procedures
    • Procedures for the coordination and provision of physical and mental health care services, assessments, and services
    • Procedures for the transfer of health care information, services, and insurance at case closing
    • Documentation of the qualifications of health care professionals 
    • Informational health and wellness materials provided to children and youth
    • Interview:
      1. Program director
      2. Relevant personnel
      3. Resource parents
      4. Parents
    • Review case records

  • FP
    FKC 11.01

    Prior to or within 72 hours of initial entry into the child welfare system children receive an initial health screening from a qualified medical practitioner to:
    1. identify health conditions that require immediate or prompt medical attention; and
    2. identify health conditions that should be considered in making placement decisions.

    Interpretation: Conditions that require immediate or prompt medical attention include, but are not limited to: acute illnesses, chronic diseases requiring therapy, signs of abuse or neglect, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances. 

    The American Academy of Pediatrics recommends that the initial health screening occurs within 24 hours of the initial placement out of the home. When possible the screening should be performed by the child’s primary care physician who has knowledge of the child’s medical history or a physician that can serve as the child’s medical home while in foster care. The screening may be completed by a nurse practitioner, registered nurse, or physician’s assistant if a physician is unavailable. 

    The local child welfare authority is often responsible for ensuring that the initial health screening occurs and, in this case, the foster care organization would maintain documentation of the screening in order to ensure response to all conditions that affect placement decisions and conditions that require follow-up.   The screening may be included in the assessment that occurs when a child is taken into custody following treatment at a hospital, clinic, or medical office. 

    The initial screening should include a developmental component to determine the need for further developmental assessment for children under six.

    Interpretation: The initial health screening for children entering the foster care system, as recommended by the American Academy of Pediatrics, can only be conducted by a qualified medical practitioner. For a rating of a 2, appropriately qualified and trained professional staff can administer a brief screening tool to determine if more immediate medical care is needed. The organization must demonstrate that:
    • the screening tool was developed in collaboration with a qualified medical practitioner; 
    • the tool and its administration are appropriately designed to be within the scope of the staff’s qualifications;
    • staff are trained on administration of the tool and related procedures; and 
    • procedures outline criteria for determining the need for and accessing medical care.

    Note: While this standard is not required when children are in in the temporary legal custody of kin, COA does still recommend that children with these living arrangements receive an initial health screening as per the standard.

    NA The organization provides kinship care only.


  • FP
    FKC 11.02

    Services are centrally coordinated for children to ensure: 
    1. continuity of care; 
    2. receipt of comprehensive healthcare services; 
    3. appropriate communication and coordination among healthcare providers, mental health providers, social service providers, other professionals, and children, families and resource parents; and 
    4. that children, families and resource parents receive needed information and support.

    Interpretation: The receipt of comprehensive services includes both healthcare and mental healthcare, as well as educational and support services that promote social and emotional well-being and development. Children should have a medical home, or health home as appropriate, where care is provided by professionals with expertise on the issues of children and adolescents in foster care.

    Interpretation: When possible, American Indian and Alaska Native children should receive health services from qualified professionals who have experience working with the tribe and knowledge of tribal customs and practices. Organizations that have the responsibility for placing Indian children should be aware of healthcare services that the child may have access to through tribally contracted health facilities or through the federal Indian Health Services. The organization should work with the tribe or a local Indian organization to ensure they have access to needed medical information.

    Research Note: A study of resource parent retention suggests that the difficulty some resource parents have accessing medical providers and dentists who accept Medicaid contributes to resource parent turnover. Other research has demonstrated the challenges that kinship caregivers face in accessing medical care for the children in their care.


  • FKC 11.03

    Relevant information about children’s health and mental health, including family medical history when available, is recorded in an efficient and secure system and shared with providers and resource parents, as appropriate.

    NA The organization provides kinship care services only.


  • FP
    FKC 11.04

    Qualified professionals provide children with age-appropriate health services including: 
    1. comprehensive medical examinations within 30 days of entry into foster care and according to well child guidelines; 
    2. dental examinations within 30 days of entry into foster care and every 6 months; 
    3. developmental screenings within 30 days of entry into foster care and according to well child guidelines to identify the need for further assessment; 
    4. alcohol and drug abuse screenings within 30 days of entry into care, and when indicated to identify the need for further diagnostic assessment; and 
    5. any services needed to address issues or conditions identified during health screenings, assessments, or examinations.

    Interpretation: See Recommendations for Preventative Health Care for children in foster care published by the American Academy of Pediatrics. Medical assessments should include, as appropriate to children’s ages and circumstances: lead exposure, tuberculosis testing, and HIV/STD risk assessment screening. 

    Interpretation: Dental exams should be provided for children over age three and occur every six months, and more frequently for children with dental issues based on clinical need. The organization can receive a rating of 2 if there is an annual preventive exam and evidence that recommendations from the dental care provider indicate children are not in need of more frequent care.

    Research Note: Due to the prevalence of complex health and quality of care issues present within the foster care population and the potential for distress and transition related to family separation to trigger or exacerbate chronic conditions, an advanced health care schedule is recommended for children and youth in foster care. Guidelines issued by the American Academy of Pediatrics and Child Welfare League of America recommend that children receive a follow-up assessment 30-60 days following the comprehensive medical exam, and periodic preventive monthly from age 0-6 months, every three months from age 6-24 months, and semiannually from age two years on.

    The experience of maltreatment and the trauma of being separated from their families places children at risk of psychological and developmental problems. Children in foster care are more likely than other children to have significant medical and mental health needs. 

    Research suggests that despite regulations and policies requiring the provision of comprehensive and routine healthcare, many children do not receive routine and specialized services.
     


  • FP
    FKC 11.05

    Children receive:

    1. mental health screenings within 30 days of entry into the child welfare system, and when indicated thereafter, to identify the need for further diagnostic assessment; and
    2. diagnostic mental health assessments, as needed.

    Interpretation: Initial screenings can be conducted by trained caseworkers, but follow-up mental health assessments must be provided by qualified mental health professionals in accordance with applicable state or local regulations. Screenings should include attention to trauma exposure and symptoms, and trauma-focused assessments should be provided when needed. When a child is in treatment foster care the diagnostic mental health assessment must occur within 30 days prior or subsequent to placement.


  • FP
    FKC 11.06

    Qualified mental health professionals provide:

    1. any needed mental health services, including evidence-based psychosocial services and pharmacological treatments, as appropriate; and
    2. appropriate oversight of psychotropic medication use, including close supervision and monitoring of children receiving medications for off-label uses.

    Note: See FKC 10.09 regarding additional expectations for connecting children who have experienced trauma to trauma-informed services.
     
    See the Note at FKC 12.01 regarding oversight of psychotropic medication use for pregnant youth. 

    Research Note: Research suggests that children in foster care are prescribed psychotropic medications at a higher rate than the general Medicaid child population. Some literature cautions against the overuse of psychotropic medication for children, noting that pharmaceutical treatment is generally recommended when psychosocial treatment alone is not effective, or when pharmaceutical or concurrent treatment is more effective than psychosocial treatment. Concerning practices include prescribing too much medication, prescribing too many medications, and prescribing medication at too young an age.


  • FP
    FKC 11.07

    Children receive age and developmentally appropriate support and education regarding: 
    1. proper nutritional and exercise;
    2. substance use and smoking;
    3. personal hygiene;
    4. safe and healthy relationships;
    5. sexual development;
    6. family planning and pregnancy options;
    7. pregnancy, prenatal care, and effective parenting; 
    8. prevention and treatment of sexually transmitted infections/diseases; and
    9. HIV/AIDS prevention. 

    Research Note: Research indicates that youth in the child welfare system have both higher rates of sexual activity and lower understanding of contraceptive methods. School-based sexual and reproductive health education may not be a dependable source of information for children in out-of-home-care, who are more likely to miss out on thorough sexual health education due to placement instability, which causes attendance and curriculum continuity issues, and/or cultural views of caregivers or caseworkers against receiving such education. Organizations should therefore assess and supplement, if appropriate, the sexual health awareness that an adolescent has received. 
     
    Rates of sexual violence victimization are also especially high among youth involved with the child welfare system. Studies on the prevalence of sexual abuse and assault among youth in foster care have identified percentages ranging from 25 to 50 percent. As such, education on sexual and reproductive health should also address sexual violence including commercial sexual exploitation, sexual consent, incest, the consequences of perpetrating sexual violence, and reporting sexual violence.

     


  • FKC 11.08

    Prior to transitioning from care, children receive assistance to maintain or obtain: 
    1. health insurance; 
    2. health and mental health records, including the names and addresses of children’s doctors, as well as information regarding any special needs and appropriate treatment; 
    3. needed medical, dental, developmental, mental health, and substance use treatment services; and 
    4. needed medication.

    Interpretation: The organization should provide assistance to ensure access to coverage, including coverage provided through the child’s tribal affiliation when one has been established. The organization should also work directly with state Medicaid agencies to connect eligible individuals to benefits, and it is recommended that direct service personnel be trained on their states’ Medicaid eligibility requirements and healthcare options for youth transitioning out of the foster care system.

    Research Note: The Affordable Care Act (ACA) requires states to provide Medicaid coverage for individuals under age 26 who were in foster care at age 18 and receiving Medicaid. Youth are eligible for full Medicaid benefits which include Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services. 

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