Every six minutes a child is born with a disability in the United States. Throughout their lifetimes, many of these children will spend weeks, even months in the hospital. Most of these children will go home with their natural parents. However, for an increasing number of medically fragile children, placement in a skilled therapeutic foster home is the best, last hope.
Of the 500,000 children living in foster care in the United States, two-thirds of these children are considered to be medically fragile or to have special needs. Medically fragile children are those who have been medically determined to have a diagnosable, life-threatening condition, such as HIV/AIDS, cerebral palsy, or Down's syndrome. Medically fragile foster children come from environments that are often as complex and complicated as their medical conditions. Foster children have three to seven times as many acute and chronic health conditions, developmental delays, and emotional adjustment problems as children living in poverty who have not experienced placement in a foster home. Pediatricians, child welfare workers, and child care professionals acknowledge that foster children make up the country's most complex and underserved population in the United States. Child care professionals provide all families and children with valuable support and care. When providing care for medically fragile foster children, child care professionals should be aware of the special circumstances associated with these children and their foster parents.
In order to provide the most appropriate care, child care providers should get as much relevant information as possible about the child's physical and emotional needs. Because foster children may have lived in many homes, the best source of information is the child's social worker. The social worker can provide information about the child's current foster home and important contacts, such as the child's pediatrician. The pediatrician can address the child care professionals' questions and concerns regarding the child's care. Some children may require additional services, such as speech or physical therapy. Collaboration with specialists will enable child care professionals to include physically and developmentally appropriate activities. This will allow continuity of care between the home and the child care center. Of course, the children themselves are the experts regarding their own needs. Many children with special needs, if old enough, are quite skilled in providing much of their own care. Thus child care professionals should communicate with the children, and attempt to involve them in developing activities that will benefit both the program and the children. This is vital for foster children who often have little input on their foster care status and medical care. If the child has a CASA (Court Appointed Special Advocate), child care providers may want to exchange valuable information regarding the child's progress and development. This information can then be presented to the court.
It is important that child care professionals keep foster parents and social workers informed about the health of children in the child care setting. For example, families should be informed if there is an outbreak of chicken pox or flu in the child care center. This is particularly important if there is a foster child with HIV/AIDS in care since this child's immune system is already weakened.
Child care providers can provide children with a consistent and stable environment. This is particularly true in the case of medically fragile children. Medically fragile foster children are harder to place and may be at higher risk for multiple foster care placements. These children come into contact with foster parents, psychologists, social workers, and health care providers. Therefore, the need for a stable environment cannot be underestimated. Since some centers have a high turnover rate of child care providers and part-time staff, additional efforts should be made to place foster children with a full-time, consistent child care provider in the same room each day.
The scheduling and timing of activities is also important. Children living in foster care are constantly "waiting for the other shoe to drop." Very few aspects of the children's lives are under their direct control. This is particularly important for medically fragile foster children who may have to be removed from the child care setting at a moment's notice due to medical complications or have their schedule altered by appointments with their physicians. Maintaining a regular schedule of activities will help children have some stability in their daily routine. If the schedule must be changed, children should be informed as early as possible to prepare for the change.
Child care professionals should be especially sensitive when planning activities. For example, a common activity is to have children to draw their family portrait. This activity can be extremely traumatic for children living in foster care, increasing the child's sense of loss and grief. Instead, ask children to draw their friends or a favorite person.
A positive child care experience benefits all children, not just those living in foster care or those with special needs. Therefore, it is important to remember that regardless of the child's status (foster child, medically fragile or special needs foster child), the child is first and foremost an individual and should be treated as such. Children living in foster care often carry the burden of being labeled a "foster child" or as "sick." These labels further increase the feelings of isolation and rejection these children may experience. Educating staff and children about foster care and different types of special needs will enhance communication, break down stereotypes, and enrich everyone's child care experience.
References:
American Academy of Pediatrics Task Force on Pediatric Aids, 1992.
State of Connecticut Commission on Children, 1999.
State of Connecticut Department of Children and Families, 1999.
For Further Reading:
Pianta, R. C. (1999). Enhancing relationships between children and teachers. Washington, DC: American Psychological Association.
Silver, J. A., Amster, B. J., & Haecker, T. (Eds.) (1999). Young children and foster care: A guide for professionals. Baltimore, MD: Brookes Publishing.
Special education for children with disabilities (1996). The Future of Children, 6 (1).
Recommended Web Sites:
Children and Foster Care (Connect for Kids)
Foster Care and Adoption Statistics (U.S. Department of Health & Human Services)