• September 2009
  • Vol. 10, No. 7

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New Standards Lead the Way to Better Health Services in Idaho

Improvements in meeting children's health-care needs resulted in stellar marks for Idaho on Item 22 (physical health of child) of the State's 2008 Federal Child and Family Services Review (CFSR). Five years earlier, after its first CFSR, Idaho's Department of Health and Welfare knew that providing health-care services was an area where the State could make improvements. "We needed a better foundation," remembers Shirley Alexander, the State's Child Welfare Program Manager, "so we began by developing new standards for child well-being." Using this and other new standards as a base, Idaho was able to improve health-care services for children involved with the child welfare system. The State's success showed in the jump from 77 percent for Item 22 on the first CFSR to 98 percent on the second CFSR.

As part of Idaho's 2004 Program Improvement Plan, a workgroup was convened to develop the new standard for child well-being. The new standard outlines how health, mental health, and education issues must be addressed in order to meet the needs of children in Idaho's child welfare system. It covers such areas as protecting child well-being in in-home and out-of-home cases; consent for medical treatment; medical screening and coverage; dental, vision, and hearing care; mental health services; and education services. It also mandates that information on child well-being be monitored and tracked through the State's data system, FOCUS. Once the standard was developed, supervisors across the State's seven regions were trained through a teleconference. Supervisors, in turn, trained caseworkers, and the standard was incorporated into the Child and Family Services (CFS) Practice Manual.

Across the State, regions then needed to apply the new standard. In urban areas, such as Boise, a foster care clinic was created with contracted service providers. The clinic is open several times a month to see children for medical exams and other screenings. Other regions contracted with nurses or health departments to provide needed services, and they helped families access the services by providing transportation or gas vouchers. Other ways that regions met the new standard included:

  • Developing resource inventories of health-care providers and working with communities to fill service gaps
  • Using medical teleconferencing to access specialists across the State
  • Training foster parents in accessing medical care

A partnership between CFS and the State's Infant/Toddler Program (ITP) resulted in another new standard as well as fruitful cross-training between the two groups. Being co-located in the State offices led to a natural collaboration on the standard for mandatory referral to developmental screening of all children, birth to 3 years, involved in substantiated cases of abuse or neglect. Once the standard was developed, both CFS and ITP conducted cross-trainings around the State. The collaboration also led to shared data reports on this young population.

Going forward, Idaho CFS plans to continue to improve health-care services for children in the child welfare system. The biggest challenge to this commitment is the rural nature of Idaho, which has a dearth of specialized providers, problems with distance and transportation, and issues with cultural norms and lack of anonymity. A new standard for service delivery addresses these issues head-on by listing rural service principles that can be implemented. These include recommendations for reliance on kinship care, taking a generalist approach to helping families, and recruiting nontraditional networks of community members to ensure the safety of children.

Clearly, Idaho's pattern of developing and implementing standards has led to improved services for the State's children. To learn more about Idaho's child welfare standards, visit the Idaho Department of Health and Welfare website:


Many thanks to Shirley Alexander, Idaho's Child Welfare Program Manager, for providing the information for this article.

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