The authors propose using common language to make sure the needs of medically complex children are met

Approximately 428,000 children are in foster care in the United States and represent a socially vulnerable patient population. Since 2015 all children in foster care have been categorized as children with special health care needs using the expansive 1998 definition of the Maternal and child Health Bureau as children who have or are at risk for “chronic physical, developmental, behavioral, or emotional conditions” and require services beyond those required by children generally. While all children in foster care are a high risk population, children with medical complexity who are placed in foster care are at additional risk and are especially vulnerable given their myriad medical as well as social issues. This article highlights the lack available data regarding children with medical complexity in foster care and uses several states as examples of the divergent medical and social services offered to these children and their foster families. By way of illustration, the authors note that children in Florida with any type of additional medical need from insulin administration for well controlled type 1 diabetes to a child with spastic quadriplegia, severe cognitive delays, and significant technology dependence would all be classified as “medical foster care”. In contrast, a tiered system exists in the state of Michigan which categorizes children who are “medically fragile” into four levels of medical complexity based on their health care needs.  

This article stresses the importance of clear language in order to identify children with medical complexity in the foster care system as they navigate between two essential agencies in their care: the child welfare system and the healthcare system. The article builds a convincing argument that if clear language is not used, then these children run the risk of becoming invisible as their healthcare needs and outcomes are not tracked leading to a lack of data to drive policy decisions which would have serious implications for this patient population. The authors suggest that an important first step in caring for this uniquely vulnerable patient population—children with medical complexity in the foster care system—needs to involve the use of ICD-10 codes as well as the universal application of a validated care needs assessment tool in order to appropriately identify these children before any steps can successfully be taken to improve their care and well-being.

Nicki Brodie, MD Special Needs Clinic, St. Christopher’s Hospital for Children

Williams EP et al. Language Matters: Identifying Medically Complex Children in Foster CarePediatrics. 2017;  Oct 140(4)