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Children in the foster care system are exposed early in life to adverse experiences by living within dysfunctional families and specific facts have not changed. What has changed is the recognition of the need for the healthcare system to change its care for these vulnerable children to prevent the adverse effects that traumatic stress imposes on their physical and emotional development and well-being.
The number of children who live within the United States foster care system has remained constant at approximately 500,000 each year for more than 20 years.1 Additionally, specific facts have not changed. Children in the foster care system are exposed early in life to adverse experiences by living within dysfunctional families; are abruptly separated from family members when their home life is recognized as unsafe and chaotic; are burdened with a greater number of physical and behavioral health problems; and, upon aging out of foster care, continue to struggle in society. What has changed is the recognition of the need for the healthcare system to change its care for these vulnerable children to prevent the adverse effects that traumatic stress imposes on their physical and emotional development and well-being.
Two articles in this issue of Contemporary Pediatrics begin to enlighten primary care providers (PCPs) on the multiple issues these children encounter: Filling the medical gaps in foster care, by Pat F Bass III, MD; and Ms Tracy Halasz and Dr Elizabeth Wallis’ article, Trauma-informed care helps children in foster care. These articles provide resources to enable PCPs to serve as the medical home for children in foster care, equipping them to assess, screen, and implement care management plans using evidence-based practice guidelines to improve these children’s overall health outcomes. However, it is the application of the concepts of “trauma-informed” care in clinical practice that should attract the attention of all healthcare providers, including nurse practitioners.
What is trauma-informed care? Does it require a specialized body of knowledge or skill set? No. Trauma-informed care is simply the recognition and critical, clinical analysis by PCPs of the prior traumatic events the child has experienced, and then teaching problem-solving skills during primary care visits to enable the child to overcome the adverse impact of those traumatic events.
Halasz and Wallis provide an example of the trauma that can surround bedwetting. They describe the importance of talking with the foster care parents to understand the underlying reasons for a child’s behavior in order to understand how to intervene appropriately. As a PNP who has cared for children in foster care for over 20 years, I know with certainty that providing foster care parents with insights into children’s behavior is a critical factor in enabling the parents to help children confront their traumatic past and to thrive-both in the foster home and throughout their lives. I also know that enabling children to enhance their resiliency skills is critical to their success.2
Foster care parents play a critical role in shaping the outcome of the child’s emotional health and well-being. Foster parents need to welcome the children into their home “as their own children.” However, in order to be successful, foster parents need to clearly understand what trauma the child has experienced. All PCPs should proactively discuss ways to gently change a child’s anticipated behaviors based on prior adverse experiences before they occur in the foster home. Providing astute anticipatory guidance will benefit the foster parent/child relationship.
Foster children are resilient.2 Building the child’s resiliency skills is an essential role for all foster care parents and all healthcare providers. Understanding and implementing the concepts of trauma-informed care is a major first step to the successful physical and emotional development of children in the foster care system. All nurse practitioners should take time to reflect on the concepts of trauma-informed care and implement these behaviors in their clinical practices.
1. Hallas D. A model for successful foster child-foster parent relationships. J Pediatr Health Care. 2002;16(3):112-118.
2. Hallas DM. The attachment relationship between foster care parents and foster children. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2000;60(11-B):5432.