TMA Testimony by Valerie Smith, MD
Senate Health and Human Services Committee
In Support of Senate Bill 11
Jan. 2, 2017
Submitted on behalf of:
- Texas Pediatric Society
- Texas Medical Association
- Texas Association of Family Physicians
Chairman Schwertner and Committee Members,
My name is Valerie Smith, MD and I am a pediatrician from Tyler, Texas working primarily with children in foster care. I am testifying on behalf of the Texas Pediatric Society, Texas Medical Association, and the Texas Academy of Family Physicians. Additionally, our recommendations are endorsed by the Children’s Hospital Association of Texas. Our organizations are testifying in support of provisions in the committee substitute for Senate Bill 11 and its goal to ensure a child’s timely access to care when they enter the foster care system and the continuity of that care as they move within it.
Children in Foster Care are More Medically Fragile and Experience Higher Rates of Trauma
One in three children who enter care have a chronic medical condition and 80 percent of children entering care have a significant mental health need. Children entering care are less likely to have received routine preventative health care than their non-foster care peers. Children in foster care are twice as likely as their counterparts to experience developmental delays, asthma, and obesity. These children are five times more likely to have anxiety and seven times more likely to have depression compared to children who are not in care. While children in foster care fall across a broad spectrum of need, it is safe to say that the population as a whole is at increased risk for poor health outcomes that negatively affect not only their childhood, but also their successful transition to adulthood.
Texas physicians greatly appreciate the efforts of the Legislature, DFPS and HHSC to improve quality and continuity of care for children in foster care. Senate Bill 11 builds upon this good work by:
- Ensuring children have an initial health exam within three days of entering care, and
- Notifying a child’s primary care physician and treating specialists when the child changes foster care placements.
Best Practice Health Care Delivery for Foster Care Children includes an Initial Health Exam
The initial health exam is a best practice recommendation from the American Academy of Pediatrics. Currently, in Texas, the earliest most children are seen by a medical professional is within one month of entering care for the comprehensive well-child exam. Senate Bill 11 also aims to help the state reach compliance with this 30-day Texas Health Steps requirement.
However, for a child population of which 70 percent have a documented history of abuse, neglect, or trauma, a month is too long to go without seeing a medical professional. The initial health exam serves to identify any physical or mental health needs that may, and in my experience often do, fly under the radar before the 30-day mark. Additionally, this initial exam can serve to assist the state in its effort to reach compliance with the one-month deadline for a well-child visit by establishing an early connection with a physician who would not only identify any medical or behavioral health needs, but also recommend the 30-day Texas Health Steps exam as follow-up.
Continuity of a Child’s Primary and Specialty Care is Essential in Placement Transitions
Once in the foster care system when a child changes placements, they also often change physicians or medical teams. In Texas, one in five children have high special health care needs indicated in their CPS record. These same children on average change placements twice as often as children without this high health care needs designation. If notified when a child changes placements, a child’s treating physicians can help ensure children transition with appropriate attention to their medical and mental health needs by informing the transfer of durable medical equipment, answering questions about currently prescribed medications or treatments, and coordinating with the new treatment team to ensure the child’s needs are met.
Thank you for the opportunity to speak in support of the health care components of the committee substitute for Senate Bill 11. All children deserve the best chance at health, safety, and success – and with our help, they can have that chance.
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