CASANYS Initiatives - Healthy Development Project

ENSURING THE HEALTHY DEVELOPMENT OF CHILDREN IN FOSTER CARE
The Permanent Judicial Commission on Justice for Children

The role of a Court Appointed Special Advocate in Family Court is to gather information about the child, family and permanency options and prepare reports for the judge. CASAs help to facilitate service delivery, monitor court orders, and ensure that children and families are receiving the prompt, complete help that they need.

As such, CASA was a natural fit for the Healthy Development project, and has been fortunate to receive funding from the Permanent Judicial Commission to facilitate our involvement. Our volunteers utilize the Commission's Healthy Development Checklist to ensure that all of the health and developmental needs of the children have been addressed. Two counties, Erie and Westchester, completed year-long pilot projects.

Across the state, CASAs have confirmed research by the Commission that there are huge gaps in compliance with state laws and administrative directives in this area, and that many of the children who come in to care do not receive the health services and screening to which they are entitled. Additionally, once gaps are identified, it can prove very difficult to obtain the needed services, particularly in counties such as Erie that lack a centralized health care facility for children in foster care.

Subsequent to the pilot project in Westchester County, CASA noticed improved compliance with initial assessments within 48 hours of entering foster care, and increasing referrals for Early Intervention, mental health services, and dental care. Linkage to follow-up services when an illness is identified has also improved. However, CASA has noted a continued lack of screening for lead exposure, communicable disease, and hearing and vision screenings. CASA also has seen that asking the questions on the checklist has assisted parents and foster parents in clarifying what they need to be doing for their children regarding their health, developmental, mental health needs.

In Erie County, CASA found wide variations depending on the case worker regarding compliance with required health assessments and services. The pilot project found that in those cases where multiple items on the checklist had not been addressed, it was often difficult and time-consuming to make arrangements for those needs to be met. Part of the issue in that county is a lack of a centralized service delivery system, as well as the sheer size of the case burden.

CASA's mission is to facilitate the safety and permanence of children. The Healthy Development project provides us with concrete tools and the background research necessary to provide intensive advocacy for children in an area that was not sufficiently covered in the past. It also provides an opportunity for judges and the community to see the potential benefits of the CASA program in a quantifiable way. We are honored to be a part of this important initiative, and grateful for the Commission's support.

The following are representative examples of CASA impact on particular cases:

Erie County: A child in foster care had been referred to a neurologist for testing. Many of the same tests had previously been administered at another hospital, but the current case worker was unaware of that and the results had not been forwarded to the neurologist. CASA procured the records, preventing added expense to the county and unnecessary re-testing of the child.

Erie County: A child with seizures was placed in foster care, and no information regarding the seizures was provided to the foster parents. CASA spent hours tracking down all of the relevant medical information, provided it to the foster mother and new doctors for appropriate evaluation.

Erie County: A child's placement with a grandparent was deemed inappropriate when the judge was notified by CASA that the child required an intensive regimen of whirlpool therapy for his burns. The grandmother worked full time and would not have been able to take the child for therapy. A more appropriate placement that supported the child's medical needs was found.

Orange County: CASA's insistence that complete and thorough medical evaluations be done on a two-year-old girl in foster care revealed a tumor behind her eye that had been previously undetected. The tumor was operated on, and was found to be benign, but was growing at a rapid rate and would have caused vision problems if left untreated.

Albany County: A child who came into care with repeated sinus and ear infections continued to suffer from these in foster care. At one point, a doctor had recommended surgery but the issue kept being postponed due to changes in caseworker, difficulties in obtaining permission from the child's mother, and logistical complications. CASA raised the issue repeatedly, and finally brought concerns to the Family Court judge who ordered from the bench that the child's surgery take place. Her surgery was successful, and her infections have cleared.

Westchester County: A 5-year-old girl was placed in foster care upon her mother's incarceration. Her initial physical indicated she had high blood pressure. Weeks later, CASA learned there had been no follow-up and brought this to the judge's attention, who ordered it to occur. At the follow-up exam, the child was referred to a cardiologist for an apparent heart condition.

Westchester County: Two children were placed in foster care after witnessing domestic violence and the stabbing of a police officer called to the scene. CASA learned neither child had been issued a medical card, preventing the foster mother from procuring medical care to treat an intestinal problem that the five-year-old had developed. CASA reported this to the judge, who ordered the caseworker to procure cards and bring the child to a doctor immediately. The child was successfully treated.