Children who have been exposed to the foster care system comprise a high-risk, vulnerable, and potentially medically complex population that has both poor health and poor access to health care. This review with Texas as a case example aims to describe the health and health care issues impacting children in foster care (CFCs), the state and federal level mechanisms to ensure appropriate funding for the health care of CFCs, and recent legislative efforts to improve the health and health care access for CFCs. The review discusses potential solutions in regards to improving the health of CFCs through four main domains: facilitating integration of care through delivery mechanisms such as the medical home; understanding the role of trauma and toxic stress and consequently the impact of trauma-informed care on the health of CFCs; improving mental health screening efforts and tools; and enhancing access to appropriate mental health care services.

Key Take Away Points

  • Children in foster care represent a vulnerable and potentially medically complex population that continues to require the attention of federal, state, and local level policymakers and stakeholders.
  • Texas has attempted to improve the health and health care of these children by emphasizing integration of care, trauma-informed care, and improved mental health screening and access to therapy.
  • Texas, and the rest of the United States, could improve these efforts by utilizing quality improvement to enhance current efforts and utilizing technology to implement new strategies.

Author Biography

Nickolas T. Agathis MD MPH received his medical degree and Masters in Public Health from New York University. Following medical school, he completed a four year pediatrics and global child health residency at Baylor College of Medicine. He is board eligible in Pediatrics. He is currently completing a one year residency in Preventive Medicine at Rutgers New Jersey Medical School. Christopher Greeley MD MS is Chief of the Section of Public Health at Texas Children’s Hospital. He is Professor and Vice-Chair for Community Health in the Department of Pediatrics at Baylor College of Medicine. He received his medical degree from the University of Virginia in 1992 and complete internship and residency in pediatrics at Vanderbilt University. He received a Masters in Clinical Research from the University of Texas Health Science Center in Houston, with a special concentration on Comparative Effectiveness Research. He is board certified in General Pediatrics as well as Child Abuse Pediatrics, and is a member of the AMA and the AAP. He was elected to the American Pediatric Society in 2017. Jean Raphael MD MPH is the section chief of Academic General Pediatrics, the director of the Center for Child Health Policy and Advocacy, associate vice chair for community health, and associate professor in the Department of Pediatrics at Baylor College of Medicine. Dr. Raphael received his medical degree from Harvard University, completed pediatric residency at Boston Children's Hospital, and obtained advanced training in health disparities through the Commonwealth Fund Harvard University Fellowship in Minority Health Policy, concurrently earning a Masters in Public Health. He has also received a graduate certificate in healthcare management from Rice University. Nationally, Dr. Raphael serves on the Public Policy and Advocacy Committee of the Academic Pediatric Association. Dr. Raphael is also a member of the American Academy of Pediatrics and AcademyHealth.