Delivering Health and Mental Health Care Services to Children in Family Foster Care After Welfare and Health Care Reform.
nearly 500,000 children are in the out-of-home care system, despite concerted federal and state efforts to prevent out-of-home placement over the past two decades [National Committee to Prevent Child Abuse 1997; Petit & Curtis 1997]. Although these children have high rates of health and mental health problems, they have difficulty accessing timely and appropriate health care services. Over a decade ago, the Child Welfare League of America (CWLA), in consultation with the American Academy of Pediatrics (AAP), published Standards for Health Care Services for Children in Out-of-Home Care to serve as a blueprint for developing effective service delivery structures for children in out-of-home care [Child Welfare League of America 1987]. More recently, the American Academy of Pediatrics Committee on Early Childhood, Adoption and Dependent Care issued a statement to pediatricians entitled Health Care of Children in Foster Care [American Academy of Pediatrics 1994].
Unfortunately, for a variety of reasons, these standards and guidelines have generally not been implemented. As America enters the next century, the organization, financing, and delivery of health care and welfare services to the poor are undergoing fundamental changes. At the federal level, social support programs, such as Aid for Families with Dependent Children (AFDC), are being restructured, and responsibility for the cost and delivery of basic services is being shifted to state governments. The creation of the Temporary Assistance for Needy Families (TANF) program and changes in the Supplemental Security Income (SSI) program for children with disabilities, as brought about by the Personal Responsibility and Work Opportunity Act of 1996 [P.L. 104-193], reflect a new policy environment [Green & Waters 1997].
In the area of health care, state governments are working hard to transfer the financial risk and responsibility for delivering services under Medicaid to private, managed care organizations (MCOs) [Henry J. Kaiser Family Foundation 1996]. To eliminate the ineffectiveness and limit escalating costs of these programs, policymakers are turning to "new approaches" that have no proven record of success with their respective "target" populations [Battistelli 1996]. Thus, the impact that welfare reform and health care reform efforts may have on children who enter the out-of-home care system in the next century is not clear.
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I believe that this needs to be taken more seriously. to many children are suffering in the foster care system I think they should find a way to implement this plan more effectively to safe all those kids.
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