March 13, 2018
Texas children suddenly
thrust into the state’s foster care system will receive a necessary health check
by a physician sooner, potentially addressing life-threatening issues. Senate Bill 11, one of four child
welfare reform bills the Texas Legislature passed during the 2017 session, requires foster kids to see
a physician within three business days of placement in foster care. Texas’ Child Protective Services (CPS) is expanding “community-based” foster
care throughout the state as part of the change.
Before the law went into
effect September 1, 2017, new foster children waited as long as 30 days to see
a doctor for a physical exam. For many children that meant delays before they
received help for medical problems tied to hunger, poor hygiene, and general lack
of medical care. James Lukefahr, MD, a pediatrician who works at the Division
of Child Abuse at The University of Texas Health Science Center at San Antonio, says the initial three-day
exam is for the child’s safety. “It's going to be more of a screening exam to make sure they don't
have any significant needs,” says Dr. Lukefahr. “We're looking for previously
unrecognized injuries and anything that needs to be treated and — especially
for older kids — looking at mental health screenings.”
For some children, the need
is urgent — even a matter of life and death. The March issue of Texas Medicine magazine reports that between 2010 and 2014, 144 Texas
children died while CPS investigated claims of abuse in their cases. Many other children in
state custody had to sleep temporarily in CPS offices for lack of suitable
homes. Meanwhile, problems such as low pay and high turnover among CPS workers
created instability. The new law standardizes child abuse and neglect
investigations, covers the cost of daycare services for foster children, and
requires CPS to notify a physician when the agency moves a child to a new home.
San Antonio pediatrician
Ryan Van Ramshorst, MD, a member of the Texas Medical Association Committee on
Child and Adolescent Health and UT Health San Antonio pediatric specialist, says the reform allows a “warm handoff” between
physicians. "Now I can call the new pediatrician or the new family
physician and let him or her know what's been going on with the care of that
child to make that transition a little bit more seamless," Dr. Van
It is unclear if the new three-day
rule will increase the number of foster children seen by pediatricians and
family practitioners. Texas covers foster kids under STAR Health, a Medicaid
program, so only physicians who accept Medicaid are likely to see children in
foster care. According to TMA's 2016 Physician Survey, only 41 percent of Texas
physicians accept new Medicaid patients, and just one in five accept some new
Medicaid patients (21 percent). Foster care children in some areas like rural
counties with physician shortages have greater difficulties seeing a physician.
The move to a three-day
deadline was successfully implemented in Dallas and Lubbock after the law went
into effect in September. For example, all of the newly placed foster care
children in Lubbock saw a physician within the three-day window. Statewide, the
transition to a three-day deadline will happen in stages. The entire state
should be in compliance by Jan. 1, 2019.
"It's really rewarding
to do something that makes you feel like you're going to have an impact on
[health care] systems," says Valerie Borum Smith, MD, a Tyler pediatrician.
"I think at the end of the day what we all want for children in foster
care is for them to be safe, for them to be healthy, and for them to have the
best outcomes possible.”
TMA is the largest state medical society in the nation,
representing more than 51,000 physician and medical student members. It is
located in Austin and has 112 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
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