Health Care Professionals

Health Liaison Officers (HLO) assist child welfare staff with meeting the health needs of children in foster care.  HLOs can assist with questions about Medicaid coverage and prior health history.  HLOs are assigned to a county or a number of counties depending on the local/regional population of children in foster care.

To locate your local HLO click here: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Adult-and-Childrens-Services/Child-Welfare-and-Well-Being/HLO-List.pdf

Primary care providers are often the first point of contact when children are experiencing mental health problems. Screening for emotional and behavioral problems is important for all children, and particularly so for children served by child welfare. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) standards for routine comprehensive “well-child” examinations include the following recommendations for the health history segment of the examination: “Comprehensive health and developmental history that assesses for both physical and mental health, as well as for substance use disorders.” The Michigan Department of Health and Human Services Medical Services Administration’s Medicaid Provider Manual references the American Academy of Pediatrics Bright Futures Periodicity Schedule. The AAP recommends a “psychosocial/behavioral assessment” at each examination. Surveillance, screening or an assessment meet the requirements for this activity. Given the higher likelihood of emotional and behavioral problems in children in foster care, careful attention should be paid to indicators of such problems. If these indicators are present, provide assessment and/or treatment or refer for mental health care. The links below provide general information about mental health needs of children.

• Mental Health Surveillance Among Children — United States, 2005–2011 – Centers for Disease Control and Prevention
• National Child Traumatic Stress Network
• Healthy Foster Care America: American Academy of Pediatrics
• American Academy of Child & Adolescent Psychiatry
• MC3: Providing Psychiatry Support to Primary Care Providers in Michigan who are Managing Patients with Behavioral Health Problems

Additional information will likely be available through your state and local professional organizations. Michigan’s Department of Health and Human Services website has information about mental health services for children covered under Medicaid. Private and Medicaid insurance health plans can provide information about their covered services.

Children in foster care are at a higher risk for health and mental health problems. A number of factors may account for this risk generally and might be present in an individual child, including: limited access to primary health care, including preventative services, in utero exposures to substances, family/genetic history of mental health and substance use disorders and the impact of trauma and toxic stress. The following resources provide information on these risks and how to address them in the primary care setting.

• Healthy Foster Care in America - Mental and Behavioral Health – American Academy of Pediatrics
• Healthy Foster Care in America – Physical Health – American Academy of Pediatrics
• Systems of Mental Health Care for Youth in Foster Care - American Psychological Association
• American Academy of Child & Adolescent Psychiatry
• MDHHS trauma and toxic stress site

Children in foster care are at a higher level of risk for both health and mental health problems. Some data have shown that surveillance alone can result in a failure to identify children in need of mental health assessment and treatment. The American Academy of Pediatrics Task Force on Mental Health and Healthy Foster Care America have recommended screening using standardized, normed and validated tools as a better way of identifying successfully children in foster care who are in need of mental health services. Below are some resources that may help identify and incorporate screening into office practice.

• California Evidence-Based Clearinghouse for Child Welfare, Child Welfare
• Center for Health Care Strategies, Clinical and Functional Well-being Assessments: Technical Assistance Tool
• National Child Traumatic Stress Network, Assessment of Complex Trauma
• U.S. Substance Abuse and Mental Health Services Administration, Identifying Mental Health and Substance Use Problems of Children and Adolescents: A Guide for Child-Serving Organizations
• American Academy of Pediatrics - Mental Health Screening and Assessment Tools for Primary Care  
• Ages and Stages Questionnaires
• Pediatric Symptom Checklist

Exposure to adverse experiences including child maltreatment is now recognized as a risk factor for a number of health and mental health problems. The following resources will help understand the public health and neuroscience aspects of these relationships and offer ideas for addressing these in health care settings.

• Supporting Youth in Foster Care in Making Healthy Choices: A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications
• Coping with Traumatic Events - National Institutes of Health
• Toxic Stress and the Science of Early Brain and Child Development: American Academy of Pediatrics
• The Impact of Early Adversity on Children’s Development: Center on Developing Child, Harvard University
• The Adverse Childhood Experiences Study
• TED talk – Dr. Nadine Burke Harris

The primary care setting is often the point of first contact for children and families seeking help for mental health problems. Under many circumstances mental health problems can be successfully assessed and treated in the primary care setting. The resources below provide some information that will help with communicating with children and families about mental health problems and treatment approaches, including the use of psychotropic medications. Professional organizations; i.e. the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Child and Adolescent Psychiatry each have practice guidelines for specific mental health problems and for approaches to assessment and treatment.

• Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care
• State of Michigan: Psychotropic Medication in Foster Care
• Mental Health Medications: National Institute of Mental Health
• Supporting Youth in Foster Care in Making Healthy Choices: A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications
• Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care
• Child Welfare Information Gateway  
• WebMD
• American Academy of Pediatrics
• American Academy of Family Physicians
• American Academy of Child and Adolescent Psychiatry