Medically Fragile Children in Foster Care - Research Paper Example

MEDICALLY FRAGILE CHILDREN IN FOSTER CARE of Introduction Medically fragile children are those neglected, abused, frightened and rejected children that not only needs warmth and guidance but love and support as well. These children not only loose their pleasures of childhood and love and support of their parents but are faced with medications, shots, doctor visits, physical therapy, physical limitations and often surgeries that make their life a living hell (RNformation, 2005). These medical fragile children are born with serious medical problems, but many among these face severe medical difficulties such as chronic lung disease, head injuries, HIV exposure/ infection, cerebral palsy and seizures. While some technological dependant children that are born with serious medical conditions require extensive specialized services such as bronchio pulmonary dysplasia requires oxygen support and breathing machines. Every year number of children enters into protective custodies like foster homes where they are given not only medical treatment but also love and support. These foster and adoptive homes are survivors for these medically fragile children who meet the needs of these children (RNformation, 2005). Thus in order to properly meet the needs of these children it is advisable that more and more foster and adoption homes should be opened so that their needs can be satisfied. Despite medical intervention services and various other technologies the aggregate number of children who are medically fragile is also increasing. As according to the 1989 finding, it is reported that approximately 10-15 % of the children in United States have chronic health conditions and 1 million of these children face disabling and costly conditions. Furthermore 17000 to 100,000 children are technological dependent (Cernoch, 1992). But there is a growing trend as now there are larger numbers of medically fragile children who avail the services of foster homes. All over the world this care has risen, as in 2005 there were 625 children in Washoe County’s Foster Care in the month of March but in April and May four children with Type 1 diabetes came into care (RNformation, 2005). Thus there is special need for more and more foster homes because they medically fragile children need these specialized services for their betterment and for their living. Need/ Purpose for the Program To cater to the needs of these medically fragile children intensive foster care, clinical services and other specialized programs should be initiated that would provide treatment services. These children exceptional needs should be well catered through utilization of comprehensive evaluation programs and intensive case management services. The basic purpose or needs of these kinds of programs are very necessary because these children and youth have medical, developmental and emotional disabilities. Thus through these programs their emotional and social functioning are enhanced and different therapeutic placement help them in social well being. They not only help them morally and financially but these institutions and programs build a confidence among these children. They protect them, help them to become economically self supporting & self-sufficient and they also arrange certain appropriate services which acts in the best manner for them. Thus government entities, community programs, hospitals, private insurance companies and different other institutions both private and public are realizing the importance of this program. Even though these topic hold a lot of importance in the social sector but still there are less number of care services emerging today. But the need for this program is gaining importance day by day and now it has been stated that many states and communities are establishing different care services and respite options for families of children who are medically fragile (Cernoch, 1992). Eligibility for Services As mentioned earlier that different organizations both public and private are providing foster care services to the medically fragile children. But every country, state, and all organizations that are working for this social service have different eligibility criteria. But for most of these organizations the eligibility criteria for foster care and adoption program are only limited to certain age group individuals. Within some organization the child should be under age of 18 years, while in some other the age limit is extended to 21 years. Further, the child who wants to avail the service should live in the residing areas of the service providing organization. For example Medically Fragile Children’s Program (MFCP) allows children to avail the services of the program if they live in Charleston, Berkeley or Dorchester countries and they should be less than 21 years old (MFCP, 2009). While on the other hand in the Department Of Human Services, Seniors And People With Disabilities Division (SPD) the child should be US citizen, should be under the age of 18 years, and he should be capable of being served safely in the family home. Similarly, there are also ineligibility criteria, where the child is not eligible to avail the MFC (Medically Fragile Children) services if he has any resource provider available than they can cater to his need. These resources can be government, community or family based. Further if the child comes under any of the mentally retarded facilities than also he can not access the services of the MFC. Then under the eligibility criteria, redetermination, transition and waiting list are also mentioned. In the SPD program, after every six months or whenever a child’s status changes the program redetermines the child’s clinical criteria. Thus after the child has catered well to all the laws and regulations of the criteria or eligibility to avail the service then he has to under go a 60 days transaction period. Within these 60 days transaction period if the child needs decreases or the score on the clinical criteria falls below 30 than he may no longer avail the MFC services. All these eligibility criteria’s are the basic rules and regulations that the individuals have to follow if they want to receive any of these foster or clinical services (Medically Fragile Children, 2010). There are also some eligibility criteria’s and standards for the service providers that they should follow. They should be at least 18 years old, provide a drug-free environment, should not be indulged in any criminal records, and should sign a Medicaid provider agreement where it is their righteous obligation to provide all the IHDC services to its clients. Further the provider should not be an employee of DHS or any government body regulation and thus would not be eligible to attain any state benefits or immunity programs. They should make sure that the security of the citizens and in case of any unusual circumstances or any case of accident. The provider should immediately report to the parents and should ensure their emotional, physical or mental well being. While in case of child abuse, the provider should report to the local DHS or police and should take serious actions against any such malfunctions (Medically Fragile Children, 2010). Thus overall it can be stated that not only is their eligibility criteria for clients but service providers and nurses also have to follow a desired set of standard and certain rules and regulations. Social Service Block Grant (SSBG) program works also for medically fragile children but the individuals who want to attain the service of the program have to follow a three-step process. This three-step process determines whether an individual is really eligible for the service or not. Firstly the applicant should be a member of one of the target groups, and then secondly the income level of the applicant is assessed. If the applicant has a total family gross income of more than 200 percent of poverty guideline then the applicant is disqualified for the desired seat. While in case of a child the applicant should have an income below 150 percent of poverty level and the child should be employed either in school or in some form of training. And only those children will be catered who are below the age of 13 years but in some cases he should be below 19 years of age. Finally in the last step the applicant’s need is assessed, he should not only determine the need for the specific service but he should also meet the criteria for the target group (Hayes, 2010). Waiting Lists Waiting lists becomes effective when the numbers of seats are fully accommodated while on the other hand there are more children who demand the foster care services. Then in this case on the basis of the date of referrals a waiting list is issued by the company or organization. SPD issues waiting list on the basis of the date of referral when the demand for accommodation exceed desired level. Thus to provide accommodation to all at times when Medicaid Services are not available then instead State Plan Services are issued to the children (Medically Fragile Children, 2010). Waiting lists are often offered by organizations so that the potential candidates can be facilitated properly. But in some other organization this action is not practiced. Laws and Regulations There have been different rules and regulations associated with social services because social services is critically important in today’s world. Different governments of different states have passed different set of regulations for the well being of the citizens. Federal public law 97-35 mentions some of the laws related to social services. Under this law it is prohibited to provide any medical care while family planning services, rehabilitation services, initial detoxication of an alcohol and treatment of drug-dependent individuals is permitted. It is also prohibited to provide social services but except those services that are provided by the employees of any hospital, skilled nursing facility, immediate care facility, or any individual who has been under has been in prison or any such institution. Further more it is prohibited to pay for any child care services but this prohibition is restricted to those services that meet the standards of state and local law. Civil Rights Act of 1964, section 504 of rehabilitation act of 1973 and regulation at 45 CFR parts 80 and 84 is another important act that is helping the medically fragile children attain a respectable position in the society. This act assures that no individual or citizen should be discriminated on the basis of race, color, national, origin or handicap. Further this act ensures that all individuals should receive the same set of medical and clinical services and care. The Social Services Block Grant in Caroline thus assures that every program or activity should be operated in accordance with the rehabilitation act of 1973. The act itself does not comply with the social service sector but it is incorporated with different amendments so that the best result can be achieved (Hayes, 2010). There are similar forms of laws and regulation pertaining in all parts of the world which are practiced by different institutions and organizations. These laws are mostly same but some characteristics may vary with the nature of the organization. Credential Necessary/ Variables Required To establish a program for medically fragile children there are certain variables and characteristics that need special importance. These variables hold a special importance in establishing a respite program for families of children who are medically fragile. Thus building such programs is purely a very difficult task and it is in pure manner challenging and requires great experience. Some of the variables required are community and family needs assessment and licensing and standards. Community and family needs assessment means that to conduct a research regarding the needs of the families, current community resources that are available to the perspective families and then to check the feasibility of collaboration and coordination with the existing services in the community. To make a program successful it is suggested that family makes a contribution in the design and structure of the program (Cernoch, 1992). To build a foster care Licensing requirements and standards are required for every organization. The organization has to sign and check the licensing requirements such as licensing regarding to facility use, staffing, training, health standards and medical collaborations (Cernoch, 1992). Limitations There are certain limitations that are associated with different medically fragile children services and programs, such as the services are intended to support not supplant and the natural supports is supplied by the primary care giver. This primary caregiver provides at least 40 hours per week of the child’s care but the services that are provided by the caregiver cannot be replaced in any manner. Even though these services accommodate the needs of the child and it acts as consistent with the child’s plan of care but it is limited with only three main factors. In-home daily care, environmental accessibility adaptation and goods, services and supplies are the three basic limitations. Within the in-home daily care services its extent may vary built the extent of this service is limited to a certain level. Further, IHDC services are limited to the following services such as basic personal hygiene, toileting, bowel and bladder care, mobility, nutrition, skin care, respiratory, cardiovascular, and neurological and other nursing and personal care tasks. Some other limitations associated with them are that the plan of care should use only the most cost effective services for safely meeting the child’s needs. Then there are some desired service levels and the services associated with them should only be according to the average monthly service budget. Further more there are also certain limitations that are linked with the payment services as well. Challenges State education agencies in US help to serve the medically fragile children, thus in 2005 they reported some of the challenges. Among the survey conducted there were total of 27 SEAs researched among them 15 stated that balancing least restrictive environment (LSE) and safety needs is extremely difficult. While 12 among them complained about the lack of funding and increased costs of services and equipment. 11 SEAs stated that that they face a lot of difficulty in assessing the Medicaid funds and thus it becomes extremely difficult to cover the costs of services to medically fragile children. Another set of 11 SEAs complained providing accommodation during transportation to and from school in another challenge they face. While 10 SEAs stated that there are a lot of shortages pertaining in this field especially there is lack of specialized nursing staff. Some also stated that they face difficulty in providing services in the rural and remote areas. There were some other challenges reported too, they SEAs stated that they face issues while determining medical verses educational services, handling not-resuscitate orders, (DNR), accessing the fund sources and free appropriate public education (FAPE) is difficult to ensure. Further more, progress on the goals and objectives of the students with generative conditions are difficult to assess and there is air conditioning transport option is not available. . While 3 SEAs also stated that no were no challenges that could serve the medically fragile children with US, and four SEAs reported that there was no availability of data within the population that could pertain to these set of challenges (Muller, 2005). Conclusion Foster homes and care services are gaining a lot of importance in today’s world. Due to this now there is more foster home that is providing the services to medically fragile children. These children are those neglected and complex part of the society where not their own parents have stopped to support them. These children not only are deprived of the basic necessities and of living a normal life but they are also deprived of the basic love and tender that every child attains during his/ her childhood. Thus to support these medically fragile children, different foster homes are established that not only support them in providing them the basic necessities of life but they also support them with care and provide them with love and tender. To build these foster homes is a real difficult and complex task because all over the world different laws and regulations are associated with them. These laws and regulations define the basic rules that are needed and should be followed by all individuals who are either directly or indirectly associated with them. The service provider and the service taker both have to cater to the eligibility criteria. There are also certain limitation and challenges associated in building a foster care service program for medically fragile children but these can be ignored because every new organization forms a program with different characteristics. Thus various state officials and government regulatory bodies highly encourage different organizations to establish foster care service programs. These medically fragile children not only require support from the programs and certain regulatory bodies but instead they require support from all the individuals especially the general public. REFERENCES Cernoch, Jenifer, 1992, Respite Care For Children Who Are Medically Fragile, accessed February 24, 2010 from http://www.archrespite.org/archfs11.htm Hayes, Kathleen M, 2010, South Caroline Social Services Block Grant Program Plan For Federal Fiscal Year 2010, accessed February 24, 2010 from http://childcare.sc.gov/main/docs/SSBGPlan2K10.pdf Rnformation, Nevada, 2005, Medically Fragile Children Awaiting Adoption: How Can Nurses Help? accessed February 24, 2010 from http://findarticles.com/p/articles/mi_qa4102/is_200508/ai_n14850596/ Medically Fragile Children, 2010, accessed February 24, 2010 from http://www.dhs.state.or.us/policy/spd/rules/411_350.pdf Read More