Alisa H. Hoffman, M.D., medical director of the Family Place Pediatric Practice at the University of Alabama at Birmingham, knows first-hand the challenges and frustrations of providing quality health care to children in foster care. When she became director of the program in 1999, Hoffman found that about 30 percent of Family Place patients were foster children, and she saw the barriers that their transient lives put in the way of good care.

"I see children who are in foster care once or twice," Hoffman says. "They are brought in by their foster parents, a social worker or a case aid, and usually the person who brings them in doesn't know why they are coming in or what kind of medical history they have."

Searching for a Solution
To address the problem, Hoffman—who is also an assistant professor in the Division of General Pediatrics at the University—is working hard to create a medical home for children in foster care, one that uses a multidisciplinary approach to serve the special needs of these children. In 2001, she applied for a Healthy Tomorrows Partnership for Children grant, a collaborative program of the American Academy of Pediatrics and the U.S. Department of Health and Human Services' Maternal and Child Health Bureau.

Hoffman's proposal—aimed at providing continuity of care for up to 150 foster children in Jefferson County, Alabama—was awarded $250,000 to be paid over five years beginning in 2001. The grant requires matching funds of $100,000 each for years two, three, four and five. Dr. Hoffman has lined up $25,000 for year two from the Touch 'Em All Foundation, a private organization in Littleton, Colo., co-founded in 1999 by musician Garth Brooks.

The Jefferson County Department of Human Resources identified 25 of the county's 970 foster children to participate in the program in 2001, says Sarah Smith, the county's program coordinator for child welfare. Children in the new program are expected to stay with Dr. Hoffman throughout the program's five-year period.

"It will help us also to have continuity with the doctor," Smith says. "We can be assured the doctor is very familiar with the child and she can let us know if there is anything else we can do to support the foster family with regard to the child's medical needs. Also the doctor will know what supports we have in place."

Patients at Family Place come from all economic levels, but the majority are Medicaid or very low-income families. Dr. Hoffman and other health care providers at Family Place believe that a multidisciplinary, collaborative practice is essential to meeting the needs of all children, but is particularly important for those who live in low- and very low-income families.

Lost History
Foster parent Freda Williams has cared for close to 30 children in the past six years, most recently taking them to the Family Place for all their health care needs, from check-ups to asthma.

"Family Place has been a blessing," says Williams, who lives in Irondale, Alabama. "They check out the children, do what's needed to be done and answer all my questions."

Williams plans on taking all of her foster children to Family Place. The trouble is, she won't always have the same children in her care. When they move on, they'll usually have to go to new doctors and new medical facilities, and they may lose their records in the process.

For children who arrive without records, Hoffman has no way of knowing why a foster child is taking medications such as Ritalin or Zoloft. She doesn't know who wrote the last prescription or why it was written. She's forced to work without records of immunizations and other services such as speech or physical therapy.

Hoffman and other Family Place staff work hard to construct charts for their foster children patients. They hunt down records from various health departments and doctors' offices. Sometimes this means sending multiple requests, and waiting weeks only to find that, by the time the information arrives, the child's connection to the Family Place has ended.

A Medical Home
"It's obvious that these kids have enough disadvantages living in as many as ten homes each year," Dr. Hoffman says. "One thing they could have is a single place to come for health care and a set of medical records, so that when they come in for an exam, and it's time to get undressed, at least they won't be scared and might be willing to talk about their problems."

On the five-person Family Place staff are two nurse practitioners who visit schools to discuss their foster child patients' behavioral problems. They also work with principals, teachers and parents on individual education plans. Dr. Hoffman often refers patients to a clinic located in the same building, for a wide variety of services including dentistry, optometry, speech and language and physical therapy.

Referrals work both ways. Many foster parents whose children are seen at the clinic for emotional, behavioral and developmental problems are referred to the Family Place for general pediatric care.

The Real Thing
Crystal became a foster child in Tennessee after abuse at home resulted in head trauma. The little girl couldn't walk or speak, was hearing impaired, had seizures and needed a feeding tube. Eventually her grandparents in Alabama were appointed as her foster parents.

The grandparents learned about the Family Place from their social worker. Dr. Hoffman arranged for Crystal to be evaluated by a nutritionist on staff who changed the girl's feeding regimen and taught her grandmother how to feed her. Dr. Hoffman also connected Crystal with Sparks Clinics for occupational therapy and physical therapy, and for neurology and hearing evaluations. Arrangements were made with surgeons to improve the placement of her feeding tube.

"It's been two years since we met Crystal and she continues to see us," Dr. Hoffman says. "Her grandmother is very comfortable coming here now."

With Dr. Hoffman's new program in place, it's likely that many more foster parents and children will feel the same.

Janice Rosenberg is a Chicago freelance writer. This is her first article for Connect for Kids.