Texas Children’s Foster Care Clinic: Supporting children and families in foster care

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When I began my career in pediatrics, I was determined to advocate for the thousands of underserved children in Houston and across the state, with the understanding my obligation as a pediatrician would extend far beyond the science of medicine to serve this community at large. Over the years, I’ve focused my attention on a vulnerable population: children and youth in foster care.

In the U.S., there are more than 400,000 children in foster care. About 30,000 of these children are in Texas and close to 8,000 are in Harris County. Children in foster care are a vulnerable population with mental health and developmental needs due to high rates of trauma that arises from adverse childhood experiences that may occur prior to and sometimes while in foster care.

When a child is taken into foster care, oftentimes, there’s no detailed history on the child. You don’t know what brought them into the foster care system. You have very little information on their trauma and their medical, developmental and behavioral history. And, the information you are given may not always be accurate. Many of these children have gone through multiple homes – some as many as 30 placements – in the foster care system. Since many people have given up on them, these children are hyper vigilant when placed with a new family.

When I was recruited to the section for Public Health Pediatrics at Texas Children’s in 2016, I was tasked with developing a clinic to support children in foster care and to provide resources to support foster care families as they take on this role. It’s been four-and-a-half years since the Foster Care Clinic opened at Texas Children’s in Jan 2017. In collaboration with our physicians, nurse practitioners, social workers, and many other partners, we are able to support our foster families with medical and mental health assessments, care coordination, and assessments for signs of abuse/neglect. When a child has transitioned from one placement to another, my team and I meet with the new caregivers to discuss the information about the child. This helps the child’s transition and may prevent break down. 

When a child is referred to our foster care clinic, the first step is to meet with the people who are directly involved in the child’s case. Often times, these meetings will include the child’s direct care providers, a caseworker from Child Protective Services, an attorney and a court-appointed special advocate (CASA). When I work with families in the Harris County Substance Abuse Court, the birth parents are included because the goal is to reunify the child with his or her birth biological parents down the road.

This initial meeting helps me gather helpful information about the child so our foster care team can direct the caregivers to the appropriate resources and services to meet that child’s needs. We need to know, “What are the child’s medical needs? What are their mental health care needs? Are they currently on medications? What needs of the child, if any, are currently unmet?” Every party shares a different perspective. A caregiver might know the child for two weeks, while others have known this child a lot longer. Nevertheless, each party provides a different piece of the puzzle. My job is to put these puzzle pieces together as best as possible and provide a recommendation on how to best meet the child’s needs with the available information.

Our team collaborates with our psychology, psychiatry and developmental pediatrics partners to assist children in foster care with mental health services. We also partner with Texas Children’s Pediatrics (TCP). Even if children are transitioned from home to home, there is a TCP nearby where they may receive regular medical care. If a child needs specialized care, we can recommend subspecialty referrals within Texas Children’s. These efforts help us better establish a history of the child’s medical, behavioral and developmental profiles.

Additionally, our clinic provides support to families who are taking care of children in foster care. Since many of these children have faced different types of trauma, we offer parent management training to teach parents how to respond to their child’s disruptive or aggressive behaviors due to their trauma.

Diane Kaulen, a senior community initiative coordinator for Public Health Pediatrics at Texas Children’s, helps us provide community outreach on child abuse and maltreatment, and childhood trauma. Two years ago, she and her husband became foster parents to a teenager who had been in foster care for many years. She shares what inspired her family to open their home to a child who didn’t have a family:

A few years ago, my husband and I felt a calling to open our home to a child who was in need. Since we had two teenagers at the time, it was important for us to take their feelings into account. We had the expectation that they support this child the same way they care for each other. We were upfront with them on how challenging this could be. Their servant’s hearts took over, and they said yes. From that moment on, this process has been a walk of faith every step of the way.  

After almost a year-long process of paperwork, home studies, trainings and waiting, we welcomed a young teenage boy into our home. At the time, we didn’t know much about his medical, developmental and behavioral history. Most of what we were told does not match the child we know today. When you bring in a child into your family from birth, your family molds and changes over time. When you bring a child in the foster care system into your home, your family must mold instantly to meet their individual needs. We can’t expect the child to fully adapt and change to our lifestyle. We have to also be willing to change. Even words that we take for granted as having a particular meaning can have a different meaning to this child. It takes time and patience to learn their cues and find new ways of moving forward.

Children in the foster care system have experienced trauma that they often cannot put into words so their behaviors sometimes do the talking. They have experienced rejection, especially if they have been in the foster care system for some time. Due to the number of placements some of these children have, they haven’t had the gift of time to develop quality friendships and even lasting relationships with teachers and school mates. They often have been separated from siblings, which increase their isolation.  They have not been afforded the opportunity to develop meaningful connections and give and take relationships. The relations they come from are often give or take, not the mutual connections most of us experience.

This is where we, as foster and adoptive parents, must start. No matter how challenging things can get, we must continue to show up every day. We must model unconditional love and support, even when that is not returned. Every day, I have two goals with my son: 1. Did I do the best I could to make a connection with him?; and 2. Did I continue to show up for him? No matter how challenging the day is, if I can say yes to those two question, I feel like I did my best for him, for my other children, my family and myself.

Most days the rewards are small. Sometimes they are so small, they are hard to see. But then you have moments like the other day when I said goodnight to him after a tough day. “No matter how tough things are, I will still be here to say goodnight. He responded to me saying, “You’re right, you always show up.” Those infrequent moments are important to hold on to.

It is challenging as a parent to see the progress you are making. You live in a tunnel of daily experiences that prevent you from seeing the big picture. It is important to hold on to those people around you and your child, to help you see beyond your daily life. This is where your CASA workers, CPS workers, doctors and therapist can be of great support. They can guide, educate and help when you can’t see through the clouds. During our recent visit with my son’s CASA worker, he reminded me of the growth he has seen in our son. Some of that growth comes with age, but some of that growth comes from the unconditional love and genuine kindness we work to show him every day. It comes from us always showing up.

Diane’s testimonial, like so many others, reinforces the reason why I chose to dedicate my profession to helping families make a positive difference in the lives of children in foster care. Through our Foster Care Clinic, we have the experts who understand children who have been impacted by trauma. They have a passion for supporting them and their families to ensure these children have the best success possible.

Click here to learn more about our Foster Care Clinic.