Pediatricians and Foster Children.
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| Title: | Pediatricians and Foster Children. |
|---|---|
| Language: | English |
| Authors: | Simms, Mark D., Kelly, Ronald W. |
| Source: | Child Welfare. Jul-Aug 1991 70(4):451-461. |
| Peer Reviewed: | Y |
| Page Count: | 11 |
| Publication Date: | 1991 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Agency Cooperation, Child Health, Foster Care, Foster Children, Handicap Identification, Medical Services, Physicians, State Agencies |
| Geographic Terms: | Connecticut |
| ISSN: | 0009-4021 |
| Abstract: | Discusses problems with pediatric care of foster children that were identified in a survey of pediatricians in Connecticut. Reviews recommendations of the Health Advisory Committee to the Connecticut Department of Children and Youth Services. Describes several solutions that have already been implemented in Connecticut. (BB) |
| Entry Date: | 1991 |
| Accession Number: | EJ429088 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEX8qrftMaLvl8zI48v0tQIAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDF7GH2TlH_Yw_9VXUAIBEICBmg_NVFw7AdE-d43pWlGdJWJmVWuhSkTPHZkLOYwCUv4gHhePHlqNFMU92WpPODi3LCPnAKH69RNNa7ZrypPm4BTrYNsjChlww3oaVZz5jms3XyNNTyZIYCN38YDcvka25WCsutCSKWZJy-itABgacMeUPygsmg78t6wazQgPT3DGdAQuCRZd0EviTU55X4ZQkuRiz7qBMN520nM= Text: Availability: 1 Value: <anid>AN0024229013;cwf01jul.91;2007Mar05.14:22;v2.2.460</anid> <title id="AN0024229013-1">Pediatricians and Foster Children </title> <rj>In 1986, pediatricians were invited to assist the Connecticut</rj> <rj>Department of Children and Youth Services to improve the health care of</rj> <rj>foster children. A questionnaire seeking the experience of pediatricians</rj> <rj>caring for foster children was sent to 470 members of the American</rj> <rj>Academy of Pediatrics in Connecticut. The results of this survey were</rj> <rj>used to make recommendations to the agency and are detailed in this</rj> <rj>article.</rj> <p>Although provision of needed services to children and families is one of the basic goals of foster placement, surveys of the health status of these children consistently reveal high rates of acute and chronic medical problems (Simms 1989; White and Benedict 1986; Moffatt et al. 1985; Kavalerand Swire 1983; Schor 1982]. Studies of this issue suggest medical neglect before, and in many instances, during foster care placement (Schor 1982], and widespread lack of planning by child welfare agencies for coordinated health care to children in their custody [Child Welfare League of America 1988; American Academy of Pediatrics 1987].</p> <p>Clearly, physicians should play a central role in the overall care children receive while in placement. The physicians who care for foster children have not been surveyed, however, to determine the problems they encounter in delivering health services to this special population. Although all legally committed children in federal (Title IV-E) foster care programs are eligible for Medicaid, it does not provide for the special health needs of foster children through increased reimbursement to physicians who treat foster children. Nationwide, pediatricians have been limiting or closing their practices to patients in the Medicaid program because of restrictions on the types and amounts of services, and built-in financial disincentives [Yudkowsky et al. 1990). Thus, there is reason to believe that foster children have been hard hit by these changes. Halfon and Klee [1987] studied the organization and delivery of health services to foster children in 14 California counties. They noted that, in addition to the lack of agency policies and inconsistent approaches across counties, many social workers and foster parents felt that physicians were insensitive to the special needs of foster children and discriminated against them. Low reimbursement rates, increased paperwork and reporting requirements, together with potential involvement in adjudication proceedings, were mentioned as probable reasons for physicians' reluctance to see foster children, although physicians were not interviewed as part of the study.</p> <p>Since 1984, Connecticut's Department of Children and Youth Services (DCYS) has made an effort to improve the organization of health services for children in its care. At first, pediatricians were recruited to serve as medical consultants to each of the five regional offices of the agency. Then, in 1986. a statewide Health Advisory Committee was established to recommend medical policies for foster children throughout the state. The committee felt that input from the state's pediatricians was an important initial step in formulating recommendations to the agency. A questionnnaire was developed to determine the problems physicians encountered in caring for these children, based in part on the findings of the Halfon and Klee study, but allowing the physicians to expand on any particular issues. The committee collaborated with the Connecticut chapter of the American Academy of Pediatrics in carrying out the survey.</p> <p>This article cites the problems identified by the survey, reviews the recommendations of the Health Advisory Committee to the agency, and describes several of the solutions that have already been implemented in this state.</p> <hd id="AN0024229013-2"> Methodology </hd> <p>Although no information is available on the source of medical care for foster children in the state of Connecticut, it was assumed that the experience of physicians caring for this population could be assessed through a survey of the state's primary care pediatricians. According to the State Health Department, 755 physicians were listed as specializing in pediatrics in 1986. A review of the American Academy of Pediatrics fellowship listing for the same year found 679 members in Connecticut. The authors identified 209 Academy members as retired, full-time subspecialists, active in the armed services, or residents in training. Thus, 470 individuals appeared to be engaged in general pediatric practice; 423 pediatricians were known to have had contracts with the State Department of Income Maintenance, which administers the Medicaid program. A survey questionnaire (figure 1) was developed and sent to 470 chapter members in August, 1987.</p> <hd id="AN0024229013-3"> Results </hd> <p>One hundred forty-two responses were received (30%). Of these. 31 were from retired members, or pediatricians who practiced only a subspeciality, so their responses were not included in the final analysis.</p> <hd id="AN0024229013-4"> Demographics </hd> <p>Of the 111 responses tabulated, 35 (32%) were from solo practitioners, 60 (54%) from physicians in group practices, and 16 (15%) from individuals in institutional settings. These pediatricians were widely distributed across the state and represented 45 towns. One hundred and two respondents (92%) reported seeing foster children. Of these, 28 (25%) saw fewer than five per year, 40 (36%) saw between five and 10 per year, and 32 (29%) saw more than 10 per year (three respondents reported seeing more than 100 foster children per year). Taken together, these pediatricians estimated seeing approximately 1250 foster children. During this same period, data from DCYS indicated that 3531 children were in out-of-home placements. Thus, survey respondents accounted for approximately 35% of the children in foster care. Analyzed by practice type, 300 children (24%) were seen in either hospital-based or HMO settings, 400 (32%) by solo practitioners, and 500 (40%) by group practices.</p> <p>One hundred and three respondents (93%) accepted payments from Medicaid, but 30 (26%) indicated that they tried to limit the number of Medicaid patients in their practice.</p> <hd id="AN0024229013-5"> Types of Problems Encountered </hd> <p>Table 1 lists the frequency of problems pediatricians reported encountering in taking care of foster children. Low reimbursement was the most frequently cited (37%). followed by lack of medical information about the children (32%), excessive paperwork (20%), complicated medical and social issues (19%), poor communication with DCYS (13%), and risk of court appearance (10%), Some additional comments were revealing. For example, lack of compliance with medical care, lack of continuity with the children, and the inadequacy of some of the foster parents were mentioned by several pediatricians. One commented: "Lack of medical information is definitely a problem. I don't feel 1 can deal with medical and social issues anywhere near adequately when 1 don't have a complete medical history." Another wrote: "Frequently, the foster parent does not come with the child (brought by the social worker), hence the child is fearful, and there is no information about his current functioning." Regarding low reimbursement for services, comments included: "Complicated issues and frequent inadequate previous care demand longer than usual appointments. Frequently the time invested is not for a long-term relationship. Payment for these long appointments is inadequate"; "1 see foster children, not hesitantly, but knowing that eventually it is a losing proposition under current Medicaid reimbursement schedules"; "The reimbursement does not even cover overhead, and then the paperwork burden and nonsense from Medicaid are almost abusive." Despite these problems, the respondents indicated that they accepted the children, treated their problems, and did the best they could under the circumstances.</p> <hd id="AN0024229013-6"> Screening and Referral for Handicapping Conditions </hd> <p>Since most pediatricians informally assess the growth, development, and emotional status of children during well-child care visits, the term screening is generally used to indicate the application of a structured assessment technique whose purpose is to clarify which children require further evaluation and/or treatment. In this questionnaire, pediatricians were asked to indicate if they perform a screening assessment or if they refer children for evaluation when problems arc suspected. Seventy-seven pediatricians (69%) indicated that they screened foster children for developmental problems, 74 (67%) for social problems, 63 (57%) for mental health problems, and 55 (48%) for educational problems.</p> <p>Fifty-nine pediatricians (53%) reported that they referred, for further evaluation, children with mental health problems, 58 (52%) with educational problems, 50 (45%) with social problems, and 46 (41%) with developmental problems. Only 20 (18%) indicated that they encountered no problems making referrals for foster children. The majority of respondents indicated that, because of Medicaid funding, it was difficult to find consultants to see referred patients. Additionally, many pediatricians stated that mental health services were hard to obtain for their patients in general. Other comments indicated that frequent moves of the children and failure to appear for appointments added to the problem of obtaining specialty care for foster children.</p> <hd id="AN0024229013-7"> Responsibility for Screening and Referrals </hd> <p>Pediatricians were asked who they thought should take the primary responsibility for screening and referring foster children for handicapping conditions. Eighty-one (93%) indicated that the physician should have primary responsibility; 21 (19%) stated that they also considered this to be the responsibility of DCYS.</p> <hd id="AN0024229013-8"> Willingness To See Foster Children </hd> <p>The physicians were asked if they would accept new referrals of foster children living with families not currently in their practice. Seventy-five (68%) indicated that they would accept new foster children, and 73 (66%) even offered their names and addresses to facilitate this process. Only 22 (20%) indicated that they would not be interested in acccepting more foster children into their practice.</p> <hd id="AN0024229013-9"> Discussion </hd> <p>In questionnaire surveys of this nature, response rates arc generally low. Responses are most likely to come from those who arc deeply interested or involved in the issue being investigated. The fact that 92% of the respondents reported seeing foster children supports this assertion. However, the wide geographic distribution of respondents, the diversity of practice types, and the large number of children reportedly seen, suggest that these results reasonably reflect the experiences of pediatricians who provide care to foster children in this state.</p> <p>Analyzing the responses, one can conclude that these pediatricians saw approximately 35% of the children in foster home placements in Connecticut in each year. It is difficult to judge the accuracy and nature of this figure because no data are available to indicate where, how often, and for what reasons foster children receive health examinations or treatment. The National Center for Health Statistics [1983] estimated that only half of the nation's children receive health care from pediatricians. Unfortunately, this figure was not broken down by state, so it is not possible to estimate what percentage of foster children are seen by pediatricians in Connecticut, as opposed to family or general practitioners. Studies of the entry and exit patterns of foster children have shown that nearly half of the children return home within one month [White and Benedict 1986]. It is likely that many of these children do not come to the attention of physicians during their short placement. Additionally, many school-age children and adolescents do not receive yearly well-child examinations; thus, a 35% sample of foster children may represent a substantial portion of the children actually seen by physicians for health care in a given year.</p> <p>The responses and comments clearly indicate that many problems are encountered while caring for this special population. Inadequate reimbursement, bureaucratic annoyances, difficulty in obtaining medical histories, and complex medical and social problems make this a challenging, and often frustrating, group of children to serve. Despite these problems, most practitioners appear to accept the difficulties and try to do the best job under the circumstances. It is clear, however, that the negative factors may become intolerable unless steps are taken to address them. In fact, it is not clear how many of the physicians who did not respond to the questionnaire have chosen not to see foster children mainly because of the problems associated with their care.</p> <p>Nearly three-quarters of the respondents felt that physicians should take primary responsibility for screening and referral of foster children with handicapping conditions. Not all pediatricians directly assess the children for these problems, however, despite previous reports suggesting that the underidentification of emotional, developmental, and educational problems is a major deficiency of the medical care that foster children receive [Halfon and Klee 1987; Frank 1980]. Furthermore, nearly half of the respondents do not make referrals for children with mental health, educational, social, or developmental problems. Perhaps they assume that someone else caring for foster children (e.g., the social worker, teacher, or foster parent) will seek help for these problems. Yet, even when they did refer, many respondents complained of difficulty in obtaining appropriate referral sites.</p> <p>Far from discriminating against foster children, two-thirds of the pediatricians who responded indicated a willingness to see more foster children, even if the foster family did not already have children in their practice. They offered to have their names distributed to foster parents to facilitate these referrals.</p> <p>Although 93% of the pediatricians accept Medicaid, 27% reported that they were limiting the number of Medicaid patients in their practice. Since the survey indicated that the majority of foster children receive care from private pediatricians, this trend has significant implications for their access to health services.</p> <hd id="AN0024229013-10"> Recommendations of the Health Advisory Committee </hd> <p>On the basis of the survey results, the following formal recommendations from the Health Advisory Committee were submitted to the agency on the problems of lack of clear standards of health care of foster children: inconsistent identification and referral of children with developmental, emotional, social, and educational problems; poor communication between the agency and physicians; and low reimbursement to physicians by Medicaid.</p> <p> <bold> 1. Adoption of clear standards of health care for use by both agency staff and physicians caring for foster children: </bold> The committee chose the Guidelines for Well-Child Care of the American Academy of Pediatrics, including the schedule of frequency of visits, procedures, and screening activities for each age. Foster children should be seen by a physician within 48 hours of placement and a comprehensive assessment of the child's medical, developmental, emotional, and educational needs should be performed within one month of placement. This provides an opportunity to assess the status of many children who pass rapidly through the foster care system in a short time.</p> <p> <bold> 2. Consistent assessment of foster children for the presence of handicapping conditions: </bold> In 1985. we developed a community-based, multidisciplinary, and multiageney evaluation clinic that has proved useful as a means of ensuring comprehensive evaluations of foster children while working cooperatively with the children's primary care provider [Simms 1989]. The involvement of community agencies that provide therapeutic services for the children and foster parents in the evaluation process facilitates referrals for further treatment. Funds were recently obtained from the legislature to replicate this program in each region of the state.</p> <p> <bold> 3. Improved documentation and communication among DCYS. </bold> primary care physicians, and specialty providers through the use of a medical passport (available on request): This abbreviated health record is initiated by the case worker at the time of placement, kept by the the foster parent, and updated at the time of each health care encounter. Although not a new concept [Morley 1973], the use of a home-based health record can play an important role in linking vital information and thus assisting in the care of foster children [Child Welfare League of America 1988; American Academy of Pediatrics 1987]. The medical passport also provides an opportunity to determine accurately the utilization patterns of foster children.</p> <p> <bold> 4. Increased reimbursement for health services to foster children through changes in the Department of Income Maintenance and the Medicaid system: </bold> The current low rates of Medicaid reimbursement act as a financial disincentive to practitioners. Extra time and effort are required by practitioners to gather data, perform examinations, and submit paperwork to document the children's needs. This time and effort should be recognized and compensated as a legitimate activity of primary care providers. Furthermore, foster children should be exempt from limitations on medical, rehabilitative, and mental health service utilization.</p> <p>Although the first three recommendations have been accepted and implemented by the agency, the fourth will require specific strategies to accomplish because financial reimbursement schedules to physicians are determined by a different state agency, the Department of Income Maintenance. As indicated by the responses to this and other surveys [Yudkowsky et al. 1990], low reimbursement to physicians for the care of Medicaid recepienis appears to be creating restricted access to health care for this very needy segment of the population.</p> <hd id="AN0024229013-11"> Summary </hd> <p>The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable.</p> <p>Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.</p> <p>The authors would like to sincerely thank Commissioner Amy Wheaton, Ph.D., and Robert Gossan, M.D., from the Connecticut Department of Children and Youth Services, for their leadership and support in our efforts to improve the care of foster children. Maurice Wakeman, M.D., and Leonard Krassner. M.D., of the Connecticut chapter of the American Academy of Pediatrics, gave valuable assistance in conducting the study. Paul Dworkin. M.D., reviewed the manuscript and Benjamin Berliner, M.D., kindly provided editorial comments.</p> <p>(Address requests for a reprint to Mark D. Simms. The Waterhury Regional Department of Pediatrics, St. Mary's Hospital. 56 Franklin Street, Waterbury, CT 06706.)</p> <hd id="AN0024229013-12">Figure 1 Questionnaire: Health Care for Children in Foster Care</hd> <ct id="AN0024229013-13"> 1. Is your practice solo? ----- group? ----- (number of partners) ----- Other ----- (Answer questions for your practice only.) 2. Town of practice ----- 3. Do you see foster children in your practice? ----- Yes ----- No 4. How many each year? ----- None ----- Less than 5 ----- 5 to 10 ----- Other ----- 5. Do you accept Medicaid patients in your practice? ----- Yes ----- No -----6. Do you limit Medicaid patients in your practice? ----- Yes ----- No ----- 7. What percentage of your patient visits are paid by Medicaid? ----- 8. Are there problems which make you hesitate to see foster children such as: ----- a. lack of medical information available about the children; ----- b. low reimbursement by Medicaid; ----- c. complicated medical and social issues; ----- d. risk of court appearance; ----- e. excessive paperwork; ----- f. poor communication with DCYS; ----- g. other problems: Comments: ----- 9. Do you screen or refer foster children for: mental health evaluation and/or treatment? ----- Screen ----- Refer ----- developmental evaluation? ----- Screen ----- Refer ----- educational assessment? ----- Screen ----- Refer ----- social problems? ----- Screen ----- Refer ----- 10. What problems do you encounter when making these referrals? ----- 11. In your opinion, who should take the primary responsibility for screening and referral of foster children for problems listed above? ----- 12. Please indicate if you have a genuine interest in foster child care and would accept new referrals of foster children living with families not currently in your practice. Name: ----- Address: ----- Telephone: ----- Will accept ----- Prefer not to accept ----- Thank you.</ct> <hd id="AN0024229013-14">TABLE 1 Frequency of Problems Encountered in Providing Health Services to Foster Children Reported by Pediatricians (n = 111)</hd> <ct id="AN0024229013-15"> Legend for Chart: A - Type of Problem B - # Reporting C - Percent A: Low reimbursement by Medicaid B: 41 C: 37 A: Lack of medical information about children B: 35 C: 32 A: Excessive paperwork B: 22 C: 20 A: Complicated medical and social issues B: 21 C: 19 A: Poor communication with DCYS[*] B: 14 C: 13 A: Risk of court appearance B: 11 C: 10 A: Other B: 6 C: 5 *Departmeni of Children and Youth Services</ct> <p>© 1991 Child Welfare League of America</p> <ref id="AN0024229013-16"> <title> References </title> <blist> <bibl id="bib1" type="bt"></bibl> <bibtext>American Academy of Pediatrics: Committee on Early Childhood. Adoption, and Dependent Care. "Health Care of Rosier Children." Pediatrics 79. 4 (April 1987): 644-646.</bibtext> </blist> <blist> <bibl id="bib2" type="bt"></bibl> <bibtext>Child Welfare League of America. Standards for Health Care Services for Children in Out-of-Home Care. Washington. DC: The Child Welfare League of America. 1988.</bibtext> </blist> <blist> <bibl id="bib3" type="bt"></bibl> <bibtext>Frank, G. "Treatment Needs of Children in Foster Care." American Journal of Orthopsychiatry 50. 2 (April 1980): 236-263.</bibtext> </blist> <blist> <bibl id="bib4" type="bt"></bibl> <bibtext>Halfon, N., and Klee, L. "Health Services for California's Foster Children: Current Practices and Policy Recommendations." Pediatrics 80. 2 (August 1987): 183-191.</bibtext> </blist> <blist> <bibl id="bib5" type="bt"></bibl> <bibtext>Kavaler, F., and Swire. M. R. Foster-Child Health Care. Lexington. MA: U.C. Heath and Co. 1983.</bibtext> </blist> <blist> <bibl id="bib6" type="bt"></bibl> <bibtext>Moffatt, M. E. K.: Peddic, M.: Stulginskas. J.; Pless. 1. H.; and Steinmetz, N. "Health Care Delivery to Foster Children: A Study." Health and Social Work 10 (1985): 129-137.</bibtext> </blist> <blist> <bibl id="bib7" type="bt"></bibl> <bibtext>Morley, D. Paediatric Priorities in the Dveloping World. London: Butterworths, 1973.</bibtext> </blist> <blist> <bibl id="bib8" type="bt"></bibl> <bibtext>National Center for Health Statistics, Cypress, B. K. "Patterns of Amhulatory Care in Pediatrics. The National Amhulatory Medical Care Survey, United States, January 1980-December 1981." Vital and Health Statistics. Series 13. no. 75. DHHS Pub. no. (PHS) 84-1736. Public Health Service. Washington. DC: U.S. Government Printing Office. 1983.</bibtext> </blist> <blist> <bibl id="bib9" type="bt"></bibl> <bibtext>Schor, E. L. "The Foster Care System and Health Status of Foster Children." Pediatrics 69. 5 (May 1982): 521-528.</bibtext> </blist> <blist> <bibl id="bib10" type="bt"></bibl> <bibtext>Simms, M. D. "The Foster Care Clinic: A Community Program to Identity Treatment Needs of Children in Foster Care." Journal of Developmental and Behavioral Pediatrics 10. 3 (June 1989): 121-128.</bibtext> </blist> <blist> <bibl id="bib11" type="bt"></bibl> <bibtext>White, R, and Benedict, M. Health Status and Utilization Patterns of Children in Foster Care: Executive Summary. Washington. DC: Administration for Children. Youth, and Families. U.S. Department of Health and Human Services Grant #90-PD-86509. 1986.</bibtext> </blist> <blist> <bibl id="bib12" type="bt"></bibl> <bibtext>Yudkowsky, B. K.; Cartland, J. D. C.; and Flint. S. S. "Pediatrician Participation in Medicaid: 1978 to 1989." Pediatrics 85. 4 (April 1990): 567-577.</bibtext> </blist> </ref> <aug> <p>By Mark D. Simms and Ronald W. Kelly</p> <p></p> <p>Mark D. Simms. M. D., M.P.H, is Medical Director. Pediatric Ambulatory Care Unit, Waterhury Regional Department of Pediatrics, St. Mary's Hospital, Waterbury. CT.</p> <p>Ronald Kelly. M.D., is in private practice, pediatrics, in Willimanlic, CT.</p> </aug> |
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| Items | – Name: Title Label: Title Group: Ti Data: Pediatricians and Foster Children. – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Simms%2C+Mark+D%2E%22">Simms, Mark D.</searchLink><br /><searchLink fieldCode="AR" term="%22Kelly%2C+Ronald+W%2E%22">Kelly, Ronald W.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Child+Welfare%22"><i>Child Welfare</i></searchLink>. Jul-Aug 1991 70(4):451-461. – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 11 – Name: DatePubCY Label: Publication Date Group: Date Data: 1991 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Agency+Cooperation%22">Agency Cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Health%22">Child Health</searchLink><br /><searchLink fieldCode="DE" term="%22Foster+Care%22">Foster Care</searchLink><br /><searchLink fieldCode="DE" term="%22Foster+Children%22">Foster Children</searchLink><br /><searchLink fieldCode="DE" term="%22Handicap+Identification%22">Handicap Identification</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Services%22">Medical Services</searchLink><br /><searchLink fieldCode="DE" term="%22Physicians%22">Physicians</searchLink><br /><searchLink fieldCode="DE" term="%22State+Agencies%22">State Agencies</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Connecticut%22">Connecticut</searchLink> – Name: ISSN Label: ISSN Group: ISSN Data: 0009-4021 – Name: Abstract Label: Abstract Group: Ab Data: Discusses problems with pediatric care of foster children that were identified in a survey of pediatricians in Connecticut. Reviews recommendations of the Health Advisory Committee to the Connecticut Department of Children and Youth Services. Describes several solutions that have already been implemented in Connecticut. (BB) – Name: DateEntry Label: Entry Date Group: Date Data: 1991 – Name: AN Label: Accession Number Group: ID Data: EJ429088 |
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| RecordInfo | BibRecord: BibEntity: Languages: – Text: English PhysicalDescription: Pagination: PageCount: 11 StartPage: 451 Subjects: – SubjectFull: Agency Cooperation Type: general – SubjectFull: Child Health Type: general – SubjectFull: Foster Care Type: general – SubjectFull: Foster Children Type: general – SubjectFull: Handicap Identification Type: general – SubjectFull: Medical Services Type: general – SubjectFull: Physicians Type: general – SubjectFull: State Agencies Type: general – SubjectFull: Connecticut Type: general Titles: – TitleFull: Pediatricians and Foster Children. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Simms, Mark D. – PersonEntity: Name: NameFull: Kelly, Ronald W. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 1991 Identifiers: – Type: issn-print Value: 0009-4021 Numbering: – Type: volume Value: 70 – Type: issue Value: 4 Titles: – TitleFull: Child Welfare Type: main |
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