September 2009Vol. 10, No. 7DC's Office of Clinical Practice Cares for Children's Health

Since establishing its Office of Clinical Practice (OCP), the District of Columbia's Child and Family Services Agency has made remarkable strides in providing health assessments and medical care for children in the child welfare system. This progress was evident in the District's most recent Federal Child and Family Services Review (CFSR) when the CFSR item rating for "physical health of child" was deemed to be a strength, with a 94-percent rating. This was a step forward for the District, whose earlier (2001) CFSR had indicated that children's health was an area requiring improvement.

Established 8 years ago, the OCP brings together a cadre of professional consultants in health, mental health, special needs, acute care, education, substance abuse, mentoring, domestic violence, and more. They provide expertise in all facets of child well-being through their regular duties—including education and training—and on an as-needed basis for caseworkers and others. OCP staff are on call around the clock, carrying cell phones to ensure that someone is always available to social workers, foster parents, and foster care placement agencies.

Health-care OCP staff include the Deputy Director, Cheryl Williams, who is a pediatrician, as well as nurses, clinical psychologists, and other clinical and program specialists. Two of the nurses work exclusively with Child Protective Services, assessing the health and medical safety of any referred child (including infants who may have been exposed to drugs or alcohol in utero) and assessing the health and treatment of all children with special needs during the course of an investigation. Other nurses are available to provide medical expertise to caseworkers concerned about children in their caseload and to educate parents and other primary caregivers about children's medical needs.

In addition, the OCP oversees a program called DC KIDS (Kid Integrated Delivery System) that is contracted out to the Children's National Medical Center. DC KIDS conducts Early Periodic Screening Diagnosis and Treatment (EPSDT) health and developmental assessments for all who enter care. One clinic and two mobile unit locations are available exclusively for the EPSDT assessments. Two of the DC KIDS staff are co-located in the OCP office, where they schedule screenings and enter medical information from the screenings into FACES. (FACES is the District's child welfare data system and is used to document all health needs and services, although it does not constitute the actual physical medical record.)

The OCP has developed a number of relationships with providers in the community to ensure that children have access to dental care and any necessary specialists. Small Smiles provides dental examinations and care for children in the Medicaid Program. Specialty services are obtained at Children's National Medical Center, Howard University, and Georgetown University.

Despite this significant progress in providing health care for children involved with child welfare, staff in the OCP continue to face a number of challenges, including:

• Difficulties identifying all children in care who have medical needs
• Inability to maintain medical records electronically due to a lack of resources
• Lack of a sophisticated system for medical appointment alerts and tracking

Dr. Williams and her staff have begun a number of initiatives to address these challenges. An electronic medical "passport" is being developed that will consolidate all medical information for a child in one system to improve both record-keeping and tracking. In addition, prescreening and EPSDT screenings will soon be conducted at the OCP facility. This will provide a more child-friendly environment for the screening, allow information to be gathered from birth parents, and permit greater coordination of care. Referrals to the OCP are also being streamlined and automated so that caseworkers can more easily refer children to OCP staff when the children have medical or other issues.

For more information on the District of Columbia's CFSR results, visit the District's Child and Family Services Agency webpage:

http://cfsa.dc.gov/cfsa/cwp/view,a,3,q,643758.asp

Many thanks to Deputy Director Dr. Cheryl Williams, Program Manager Patrina Anderson, and Special Needs Liaison Melissa Eversley from the Office of Clinical Practice, who provided the information for this article.