Foster Care Physicals

Trauma Columnist · Mar 5, 2015

After reading this thread, I'm thinking you all are posting about foster PARENTS.

I am referring to CHILDREN who are taken out of their homes and placed in foster care by DCFS (Dept of Child and Family Services).

allnurses Guide · Mar 5, 2015

I very rarely get these, and I am often very upfront with the perspective foster parents that if they have no regular PCP and are rushing to establish one for the purpose of getting a foster child then I have some reservations up front.

I do a comprehensive H&P and I do a review of their pharmacy record. If there are red flags I refuse to sign and refer/defer. If there are no red flags then I will sign off under documentation that this is my first time meeting the patient. I am always hesitant to do that as I feel most responsible perspective parents have invested in their own health as well.

Sent from my iPhone.

automotiveRN67 · Mar 8, 2015

Really? Thank you for the quick recap of my first assessment class ever. My question was ethical in nature and pertained to what to do if faced with a patient who you felt was not giving the full story in regards to their health history. Not only that, but then being asked to sign a form verifying the patient is mentally and physically fit to serve as a foster parent. We do a lot of this type of work in our clinic and I wanted to see how other providers handled the situation if they were concerned about a new patient. I see you work in hospice-last time I checked hospice NPs don't perform foster or DOT physicals. Keep the condescension to yourself.

The purpose of the foster care physical is to evaluate the physical condition of a child. This is very important for the unfortunate child, and the system in general.

The automatic assumption that foster parents are losers is disgraceful. Most are caring people who have taken a child from a bad situation.

You are not being asked to "sign off" or give any kind of warranty. You are expected to use your clinical judgement, and look for red flags that are cause for concern.

As the parent of 2 foster children in 15 years, I am really saddened by you lack of support for this system.

I guess the world can't count on you to help out, huh?

automotiveRN67 · Mar 8, 2015

I see you work in hospice-last time I checked hospice NPs don't perform foster or DOT physicals. Keep the condescension to yourself.

As for this comment. Hospice is much more than DOT physicals. Death brings out the best and worst in many people. Families are always under stress. Some don't handle providing complete care for the dying loved ones very well. The risk of abuse and neglect is high, and sometimes it is innocent. My radar is always on.

automotiveRN67 · Mar 8, 2015

For anyone who is interested in the responsibilities of seeing children in foster families, the American Academy of Pediatrics has a wonderful website that is helpful. Here is an exerpt:

Children and teens have often received only fragmentary and sporadic health care prior to entering foster care. Typically they enter foster care with a high prevalence of undiagnosed or under-treated chronic medical problems, often due to being without necessary medications or equipment. Fractures, infections, burns, bruises, and other acute illnesses are also prominent and often a result of abuse. Of the children and teens entering foster care:

About 50% have chronic physical problems (eg, asthma, anemia, visual loss, hearing loss, and neurological disorders)
About 10% are medically fragile or complex
Many have a history of prenatal (maternal) substance exposure and/or premature birth

Some physical health issues may worsen during times of distress for children. For example, children or teens with asthma may experience more frequent flare-ups during times of transition or when there is increased chaos and unpredictability. When a child with a chronic health problem has a worsening course, the pediatric clinician should inquire about changes or stressors in the child's or family's life that may be impacting the course of an illness.

Even after entering foster care, children and teens may not receive all necessary health care because of a variety of barriers to good care. To assist in this effort, the American Academy of Pediatrics and Child Welfare League of America have published standards for health care for children and teens in foster care. These standards are designed to help professionals from all disciplines understand the complexity of health problems of this population, specifying the parameters for high-quality health care.

Download the Health Information Form.

For information, tools, and resources aimed to educate professionals and others about the physical health issues and needs of children and teens in foster care, visit the Resource Library and search by the topic "Physical Health".

coast2coast · Mar 8, 2015

The purpose of the foster care physical is to evaluate the physical condition of a child. This is very important for the unfortunate child, and the system in general.
The automatic assumption that foster parents are losers is disgraceful. Most are caring people who have taken a child from a bad situation.
You are not being asked to "sign off" or give any kind of warranty. You are expected to use your clinical judgement, and look for red flags that are cause for concern.
As the parent of 2 foster children in 15 years, I am really saddened by you lack of support for this system.
I guess the world can't count on you to help out, huh?

I believe Midwest and I are referring to foster PARENT physicals, not the children themselves.

you seem to be making this personal, and your last statement is both inflammatory and unconstructive. You have no idea where Midwest works or what she/he does. Personally I work in an FQHC and specialize in homeless healthcare, which I like to think counts as "helping out."

Let's keep the discussion focused on the professional issues at hand.

automotiveRN67 · Mar 9, 2015

How do you handle new patients that are coming to see you strictly for a foster care physical? I feel like I am asked to sign off that they are physically and mentally fit to care for a foster child without really knowing them at all. This happens frequently at our clinic due to the high number of patients on state assistance in our area of town. I of course do a complete H&P but there are no labs drawn at the visit or prior health records to look over. Some of the patients that come in for foster care physicals are clearly in poor health but deny any health problems-mental or physical. Obviously they can lie and tell me whatever they want. There is that line on the foster care form that asks how long you have known the patient...5 minutes??! It just doesn't seem right. They may or may not have a PCP elsewhere but come to us because we are pretty good about working new patients in for things like this. The same goes for DOT physicals when you don't know the patient. How do you handle things like this where you are asked to certify the health of a patient that you barely know?

No, I am responding to someone who would write something like this. This is someone who is saying "why should I have to put up with this?"

The reason is because you are being asked to use your skills to assess the patient. Not act like this.

This person makes it clear that anyone on "state assistance" is the same person who will "Obviously they can lie and tell me whatever they want."

So who is more professional? Someone who acts like foster care physicals put them in contact with undesirable people, or someone who calls them on it?

Trauma Columnist · Mar 9, 2015

Back to the original topic.

I do apologize as I seem to have made this thread go off topic. I sincerely thought you were discussing the potential foster children not the potential foster parents.

I apologize that this took it off topic.

automotiveRN67 · Mar 11, 2015

In part, I was talking about the children. The foster care system requires multiple levels of protection.

If you don't support the foster parents, you don't have anywhere for the foster children to go. Most foster parents are good, kind people who take these children in. They shouldn't have to face this pre-judgement by someone this unprofessional.

This nurse practitioner works in a clinic that cares for indigent people. He/she needs to reserve judgement and treat everyone with respect. If he/she cannot reserve judgement, that person should work in a different setting.

That's what professionals do.

yellow_crayon · Apr 2, 2015

I feel like I am asked to sign off that they are physically and mentally fit to care for a foster child without really knowing them at all. This happens frequently at our clinic due to the high number of patients on state assistance in our area of town. [...] Some of the patients that come in for foster care physicals are clearly in poor health but deny any health problems-mental or physical. Obviously they can lie and tell me whatever they want.

As a person who is both not an NP and not American, my opinion may not be very helpful here. BUT, as a former foster child who lived in multiple foster homes with people from various backgrounds, I feel that I may be able to offer my thoughts.

As a kid with a traumatic background looking for stability and acceptance, the last guardian I would want to have is someone who mentally and physically couldn't take care of me. The second part to this is that I wouldn't want a guardian who also couldn't take care of their own health because they couldn't do something as simple as maintain a relationship with a primary care practitioner. I understand that in the US many people have to pay for primary care, but if they can't afford health coverage I'm confused as to why they think they could afford to be a foster parent. Aside from that, I think simply "going with your gut" (with very little medical info) on someone you don't know could be potentially dangerous for the child. You might be impeccable at reading people, but 5 mins still just isn't enough. Like you said, people lie.

In the end you seem to be apprehensive about the whole process, and I think that's a good thing. Again, since I'm not an NP, I can't give advice on how to handle it on the job. I can only speculate on what I would do if I were in your position given my experiences being directly in the system. If it were me, I would just refuse to sign the papers at all. If they really want to become a foster parent, they will have to take the steps needed to be eligible, such as establishing a long term relationship with a health professional. It's the very least they could do to prove that they are a productive, healthy adult when the responsibility they are taking on is so serious.

Sorry for the wall of text!