Friday, October 21, 2011

Foster Parent Friday - More on Appointments...

Q: Do you have to do a ton of appointments right away because the kids are normally sick?

A: Yes we have a ton of appointments right away and yes the kids are normally sick. That being said, the “ton of appointments” isn’t usually related to the kids being sick. Let’s untangle all of that.

Kids are Usually Sick
My experience has been that kids entering foster care are often sick. Of my 8 kiddos, here’s how the sickness broke down:
#1 – Complained of “tee-tee” hurting and wouldn’t go to the bathroom. I think it was nerves and fear but I had to get it checked out. She also had a mild respiratory infection. Needed anti-biotics.
#2 – Double ear-infection & bad upper respiratory infection. Needed antibiotics and breathing treatments.
#3 – I don’t remember him being sick at all.
#4 – Many, many ringworms, bad diaper rash, upper respiratory infection, and ear infection. She also had several follow-up appointments for things related to her case including a sleep-study, an MRI, and a pediatric urologist. She didn’t need any of those things, that’s part of her case, but I had to take her anyway.
#5 – mild respiratory infection, allergy related
#6 – mild respiratory infection and pretty good reflux.
#7 – might have had a cough, but otherwise ok.
#8 – respiratory infection

So, yes, they often come into care ill. All of my cases have been neglect (vs. abuse) and so it goes to reason that their medical care had been neglected as well. That being said, all who were ill came to us with medication except #4, and even she had some nasty old medication, so they were getting some medical care. If anything I found that I couldn’t trust what they were prescribed. After visiting the doctor, I was able to cut out at least half of their “regular” medications because they weren’t necessary, or at least they weren’t necessary all of the time.

Ton O' Placements
Yes, you need to take them to the doctor if they are sick, just like you would your biological/adopted kiddos. But those appointments are not what I’d consider “placement appointments” which make up most of the work in the initial few weeks. Placement appointments for an emergency placement include:
  1. Initial placement with caseworker/investigator – Day 1 – takes about 30-60 minutes to do all the paperwork, get the kiddos situated, bring in their stuff, etc. 
  2. Initial parent visit – usually visits aren’t mandated by the court until after the 14 day hearing, but the caseworker often tries to schedule a visit before then. So in the first week on top of everything else you have to remember there will be at least one visit, probably two, and they will be either 1 or 2 hours each, depending on the kiddos.
  3. Initial doctor visit – 14-21 days – this has to be scheduled ASAP otherwise you can’t get into the doctor within that timeline. It’s 14 days for an infant, 21 days for all others. With that little notice at a Medicaid doctor you get what you get for appointments, you don’t necessarily get to choose a great one. With Medicaid there’s also an initial survey thing that has to be done at the doctors which takes a little while especially with trying to manage little kids in the waiting room. You also usually have no idea what to answer since you’ve known the kids for all of a few days. Things like “can they count to ten” – you end up asking the kiddo because otherwise you haven’t figured that out yet. Don’t forget the extra time involved in trying to track down the Medicaid number, shot records, and other medical history ahead of this appointment. That can be a beast.
  4. OH, speaking of Medicaid – you have to do the online intake Medicaid appointment. Someone from the Medicaid office calls and does a medical history interview with you. Again, you have no medical history usually so you take your best guess. They do an initial screening – what are your concerns, etc., then schedule for a deeper screening. Between the two of these you usually have at least an hour invested.
  5. Initial dentist – the child has to have a dentist appointment within 60 days of coming into care. This works just like the first doctor visit – you have to answer all their questions and usually have none of the answers. Also, if you have an baby from 6 months – 2 years old you usually get laughed at – most people don’t take their kids to the dentist that young, whether or not they should, so they’re not used to parents bringing in a toothless 6 month old. Thankfully I have a great dentist but there are still complications involved. 
  6. ECI – Early Child Intervention – Because we usually take preschool or younger, we often (always) have to do an early childhood intervention evaluation. ECI is great because they provide so many services the children in foster care often need to help delays often caused by neglect, like speech, developmental, or other delays. You usually have a 30-45 minute intake appointment where you fill out paperwork and express your concerns and then you have the evaluation, which often takes about 90 minutes. At these appointments again you get all the questions you don’t have answers to, like when they first sat up, etc., but at least they spend enough time with the kiddos to find out for themselves how advanced/delayed the kiddos are in a wide-variety of areas. You get a lot out of these appointments, so it’s worth it. Except that you get tired of the things they have to tell you and give you – I can’t tell you how many ECI booklets I have and how many times they’ve had to tell me that I don’t have to take the services and I can opt out at any time, that I can get an interpreter, etc. Once screening & evaluation happens, they often qualify and start receiving therapy – mine has usually been 1-2 hours per week, but they often do that at daycare.
  7. 14-day hearing – there is often a court hearing where the judge hears the evidence and confirms or denies temporary orders to give CPS temporary managing conservatorship. I like to attend these early hearings so I can meet everyone involved in the case, including the parents and their attorneys. It’s always worked out for me and the kiddos to do that. You as a foster parent don’t have to attend, but I recommend it.
  8. Initial permanency conference – this usually happens around the same time as the 14-day hearing and as a foster parent you are supposed to be notified and be able to attend, but I have had cases where I wasn’t notified or there wasn’t a permanency conference this early on. Highly, highly recommended to attend if at all possible. This is when everyone gets together to discuss what’s going to happen to the child while in care. You learn what the issues are in the case (at least some), what services the parents are attending, what everyone is thinking regarding permanency (which means you find out if there are kinship placements they are looking into), and you get to speak about what you know about the child – one of the few times you get to formally advocate for the child. There is often a follow-up permanency conference at 5 months.
  9. 9 – Initial ad-litem visit – how do you know there is a court-hearing coming up? The ad-litem calls to visit. Here I’m specifically talking about the AAL, the attorney ad-litem, which may or may not be the same as the GAL, the guardian ad-litem. I’m not going to get into that today. But, point is, the child’s attorney often wants to come visit early in the case to meet the child they’re representing and get to know the foster parent a little bit.
  10. 10 – Initial CASA visit – CASA is great but not available or assigned on all cases. I’ve had a CASA appointed to 2 of my 6 kiddos that were with me for awhile. I believe #5 & #6 had one, but they weren’t with us long enough to meet him/her. #1 & #2 along with #7 & #8 did not have a CASA, which in these two cases is a shame. They both could have used one. They were cases from the same county, and apparently in that county there is a shortage. I’ve heard CASA in that county is run differently than the other counties around – maybe that has something to do with it. The CASA visit is just like the initial AAL visit, but usually more warm and more in-depth. Depending on the county, CASA visits 1-2 times per month. I’ve loved our CASAs. By the way, per #9 – when a CASA is assigned that person is usually the GAL – guardian ad-litem.
  11. 11 – Initial legal CW visit - If it is an emergency placement, chances are you initially worked with a CPS investigator – this is the CW that placed the child with you and was involved in investigating the initial case. After the 14-day hearing, the investigator goes away and a legal caseworker is assigned. Both are CPS employees, they just serve different roles. So, usually the CPS legal-worker likes to begin his/her visits shortly after the 14-day hearing.
So yes, there are a lot of appointments to manage in the initial few weeks of a case. If you’re more experienced (or just organized in general) you can make many of them happen on the same day and just stack up appointments, which is helpful for a working mama. Also, when you get used to all of this you start knowing when you can push back on appointment requests to make things more manageable. It also helps when you’re more experienced because it’s likely you have a doctor, dentist, and even ECI team that you’re used to working with so they know you and the challenges you face in getting all these appointments scheduled in such a tight timeframe – they typically work with you. It makes it much, much easier that way.

#7 & #8 were not emergency placements - they came to us from another foster home, which meant several of these appointments were not necesary - that was nice.
If your child goes to daycare because you work full-time, there is a whole additional component that needs to happen. We’ll talk about daycare on the next installment of Foster Parent Fridays. I have a lot to say on foster-child daycare and a few of you have asked how that works.

See you next week!


Tammy (aka. "Mimi") said...

I always say that if I can just make it through the first two weeks after a new placement, it's all cake from there! Those first two weeks though... Hold on tight, cause it's a fast, bumpy ride! I'm very fortunate that I have an extremely understanding boss and co-workers. After six kiddos, I think THEY know the drill as well as I do. When I got my current little one, they just said, "We'll see you in a couple weeks!" ;-)

Dana Beam said...

Thanks for all the tips! That is a LOT to remember and manage, but I would imagine it does get easier after a few times. I would also imagine that support groups would be really helpful at this time, if for nothing else then resources on doctors and how to handle the craziness of the first two weeks.

Mama P said...

Wow...we don't have half of that! Out of five placements, I have only taken two of them to initial doctor visits, and that was because one was follow up from trauma, and the other was for an abscess in his private area.

We have never done paperwork to receive a placement (They just hand them to us, and usually mail or bring us a guardianship paper days later), and we have never met a single GAL or CASA.

Our state is so messed up, lol.