Timely medical care for foster children in state slips, data indicate

Timely medical care for foster children in state slips, data indicate

BY CHARLOTTE TUBBS

Posted on Sunday, July 9, 2006

URL: http://www.nwanews.com/adg/News/159975/

Fewer Arkansas foster children, who tend to have more medical needs
than other youths, receive timely health care now compared with past
years, according to state
data.

Administrators of the state’s foster-care program attribute the delays
to a variety of factors, including staff shortages.

Others who have worked to connect foster children with health care say
they are concerned that children’s health needs are going unmet and
say administrators at the
state Department of Health and Human Services’ Children and Family
Services Division have not responded to their concerns.

When children enter foster care, they often are “medically needy,”
said Barbara Brooks, a former Children and Family Services Division
nurse who worked for the division
in Bentonville until May 26.

Brooks said children may be developmentally delayed, lack up-to-date
immunizations or be underweight. They may have never visited a
dentist.

Arkansas faces potential financial penalties by the U. S. Department
of Health and Human Services if it fails to meet federal standards.

Division administrators say the situation is not as bleak as it is
portrayed and is showing improvement. Although they acknowledge not
always meeting their goals for
providing timely health care to foster children, the state is meeting
those health needs, they say. For example, an evaluation of a sampling
of foster-care cases shows that
the state met the medical needs in nearly all of the cases examined
last year.

Jennifer Ferguson, operations and legal director for the Little Rock
nonprofit Arkansas Advocates for Children and Families, said the
declines in children receiving timely
care need examination. An independent assessor could determine if
children actually aren’t receiving timely care or if staff members
aren’t entering data on time, she said.
“They’ve done better in the past, and they can do better now,”
Ferguson said.

CARE BY THE NUMBERS The division has set goals to provide timely
medical care to children when they enter foster care. Depending on the
level of any suspected
abuse or neglect, children must receive initial health screenings
within 24 hours or 72 hours.

The division’s goal is to provide timely initial health screenings to
95 percent of all children who enter foster care.

From July 2005 through March 2006, 81 percent of 366 children who
required screenings within 24 hours received them on time, and 80
percent of 2, 324 children who
required screenings within 72 hours received them on time.

Data have not been released for the last quarter of fiscal 2006, which
ended June 30, but if averages remain the same, they will be the
lowest in 10 years.

The human services agency also aims to provide comprehensive health
assessments to 95 percent of children within 60 days.

From July 2005 through March 2006, 86 percent of 1, 225 children
received those assessments on time.

While the average so far this year is slightly higher than 2005, it is
lower than 2001-04.

Another statistic is maintained by a University of Arkansas for
Medical Sciences program that coordinates the health assessments. The
division requires that
recommended services, such as counseling or speech therapy, be
completed within three months after the assessment. From July 2005
through February 2006, 69 percent
of the 3, 218 recommended services were completed within three months,
a decrease from 2003. Rosemary White, a division assistant director,
attributed the slipping
numbers to staff vacancies, although state staffing numbers have
increased this year. As of June 30 this year, 83 percent of 980 field
positions were filled, up from 76
percent as of July 31, 2005.

ONE REGION’S PROBLEMS One western Arkansas area had the lowest monthly
completion rates of recommendations. The region also had the highest
staff vacancies.

In Area Two — which consists of Scott, Yell, Logan, Sebastian,
Crawford, Franklin and Johnson counties — a monthly random sampling of
five to 10 foster children’s
recommendations showed that in every month since November 2004, fewer
than half had their recommended services completed within the three
months.

As of June 30, only 69 percent of the 95 positions were filled in Area
Two. As of March, caseworkers averaged 55 cases each, far above the
state average of 33.

Janet Bledsoe, an attorney who represents foster children in Sebastian
County, said that sometimes she relies on a judge to order
recommendations when they are not
being completed.

In one instance, several months ago, a child who needed dental care
and complained of pain went several weeks without dental care. After
numerous calls to the child’s
caseworker proved fruitless, Bledsoe asked a judge to order the dental
care.

“For the most part, people at DHS try really hard to do what they need
to do,” she said. “I just know they’ve been very short-staffed for a
long time now.”

State Sen. Sue Madison, a Democrat from Fayetteville, said the
declines in children receiving timely care are “disappointing,” adding
that the effects of staffing shortages
persist even as more positions are filled.

Madison said it would be prudent for the division to request
additional caseworker positions from the Legislature to decrease
caseloads and retain workers.

Another factor White cited in an e-mail as affecting the timeliness of
foster children’s health care is the population growth in Benton,
Lonoke and Washington counties.

Caseloads have increased because of children coming from homes where
methamphetamine labs operated and because of Garrett’s law, which
requires hospital staff
members to report any newborn’s mother who is suspected of using
illegal drugs during her pregnancy.

White said staff shortages, new hires who cannot immediately take full
caseloads and staff members on medical leave affect the progress of
providing timely health care.

Susan Scott, an administrator of the UAMS Arkansas Foster Project,
said staff vacancies can delay completion of recommendations, but some
supervisors put more
importance on completing services than others. She said she sends
monthly reports to the division, often noting areas struggling to
complete the recommended services,
but she has not received a response from the division.

MEDICAID PATIENTS A 2000-01 federal review of Arkansas’ foster-care
program found that it was one of 32 nationally that did not meet
standards in addressing the
physical needs of children. Federal reviewers will examine the state
system again later this year and impose financial penalties if it does
not meet standards. Pat Page, an
assistant Children and Family Services Division administrator, said
the state reviews of a sampling of foster-care cases each year in a
process similar to the federal
review. Last year, the state review showed that nearly all foster
children’s physical and mental health needs were met.

Several recent division quarterly reports have identified a lack of
doctors in Northwest Arkansas who treat Medicaid patients and a
decrease in the total number of
Medicaid patients they will accept as a barrier to providing timely
care.

In recent years, in Benton County the number of doctoraccepted
Medicaid patients dropped as the number of Medicaid patients rose.

As of July 1, 2003, there were 33, 411 doctor-accepted Medicaid
patients and 10, 789 Medicaid patients in Benton County. As of June
30, 2006, the number of
doctor-accepted Medicaid patients had dropped to 19, 376, and there
were 18, 907 Medicaid patients.

Washington County saw a similar drop in doctor-accepted Medicaid
patients and an increase in Medicaid patients, but as of June 30,
there were 10, 000 positions unfilled.

“What we don’t know at this point is, are we properly utilizing all of
those resources,” said state Health and Human Services Department
spokesman Julie Munsell.

White said the Medicaid division is working with the Children and
Family Services Division to resolve the issue.

Brooks, who worked as a nurse for Children and Family Services for
five years, said in her resignation letter that she was leaving, in
part, because medical
recommendations and a physician’s orders for foster children were
ignored.

“I refuse to ‘flower up’ what to me is a dangerous situation when it
comes to medical needs of foster children... being ignored and my
professional opinion and advice
ignored,” she wrote to White and Page.

White said children are not in dangerous situations.

Brooks cited a foster child taking cardiac medication whose foster
parents had incomplete information regarding the child’s medical
condition.

The child did not suffer any adverse effects, however, from the lack
of information, Brooks said.

Brooks said the division has been “fortunate” that the problems she
identified have not caused harm to foster children, but she predicts
that at some point, a child will be
severely affected.

Years ago, an Arkansas foster child died after incomplete information
was given to his foster parents regarding his asthma and medications.

Now, a “medical passport” containing all of the child’s medical
information, from medication to behavior problems, is required to
accompany every foster child to each
placement. Brooks and Scott said these documents are not always
complete.

White said Brooks’ claims are being reviewed and that medical
passports are monitored by caseworkers, supervisors and health-care
workers.
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