by Melissa Jimenez M.D. and Lauren Maltby, Ph. D.
Deonte Jameson* was 11 years old when he first came to the Kids In the Dependency System (K.I.D.S.) Clinic at Harbor-UCLA Medical Center last fall. His teacher had noticed belt marks on his arms and alerted Los Angeles County Department of Children and Family Services (DCFS), the county’s child protective agency. In 2015, Deonte was one of 28,000 children under DCFS’ supervision, one of the largest child welfare systems in the country.
April is National Child Abuse Prevention Month, and for more than four decades Harbor-UCLA Department of Pediatrics has been at the forefront of caring for maltreated children and working with community partners to improve child well-being. Harbor pediatricians have also been working to develop tactics for prevention, such as screening new moms for post-partum depression at their babies’ checkups. Identifying at-risk families and intervening before any abuse occurs is clearly the best strategy. Unfortunately, too many children like Deonte come to attention after a traumatic event.
While Deonte was undergoing a medical exam including the marks on his arms, his mother, Mary Jameson met with Dr. Lauren Maltby, the K.I.D.S. team’s clinical psychologist. Jameson began crying as she explained how Deonte’s behavior had always been difficult, but recently had escalated to include school truancy and failing grades. She was scared for him—that he would become another statistic in the system. She had used the belt in a last-ditch effort to get control of Deonte, and of her own fear. She just didn’t know what else to do. Jameson was not alone in her desperation.
In 2014, more than 700,000 children in the U.S. had evidence of maltreatment following reports to protective services. Child maltreatment can take many forms, including physical, emotional, and sexual abuse, as well as neglect. Nearly 1 in 8 children will experience some form of maltreatment by the time they reach 18 years of age. The reality is, that number is likely higher because of incomplete data due to the lack of standardization among child welfare reports. Every individual case emphasizes the need for quality care – and more importantly, prevention.
K.I.D.S. Clinic is one of six dedicated clinics for children under DCFS supervision, and annually they provide care to more than 2,000 children and teens. The multidisciplinary team includes psychologists, social workers, nursing staff, pediatric nurse practitioners and physicians with specialized training in evaluating and treating victims of maltreatment. The clerical staff also has training to be sensitive to the “extra” emotional needs of traumatized kids. The children undergo comprehensive physical, psychological, academic and social-emotional evaluations to assess for abuse or neglect, identity their health care needs and receive linkages for indicated services, working in partnership with DCFS.
More than 400,000 children reside in foster care each year in the U.S. The American Academy of Pediatrics (AAP) summarizes pediatric care of foster children as, “Pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services in the context of a medical home, and health care coordination and advocacy on their behalf.” The K.I.D.S. team provides such on-going, comprehensive care for these special needs children. Health care for foster children requires a specialized team, because many of the kids have had incomplete or sporadic medical care prior to entering protective services.
Not uncommonly, the children have lived in deprived, chaotic environments for significant periods of time and even their basic needs, such as adequate food and shelter, have not been provided. Their health care needs are known to include complex medical, mental, and even dental needs. About 50% of children entering foster care have chronic medical problems, such as asthma and anemia, and up to 10% are considered medically fragile. However, psychological and developmental problems remain the largest categories of unmet needs - nearly 80% of the children have behavioral problems, and as many as 60% have developmental delays. Providers who care for these children should have knowledge not only about common childhood disorders, but also the health effects of trauma and adverse childhood experiences.
Deonte’s evaluation revealed similar missing pieces to his care. During Jameson’s interview, it became clear that some of Deonte’s school problems were attributable to an undiagnosed learning disorder. Maltby worked with the family to initiate an evaluation at school to identify the full scope of Deonte’s academic challenges and to get him the necessary support. Deonte’s medical evaluation revealed previously undiagnosed asthma. Intermittent wheezing had kept Deonte from participating in sports and appropriately expending some of his energy. Unable to play like the other kids and not learning at the same pace was very frustrating, and at 11 years of age, he didn’t have the words to express his anguish. Acting out became the outlet for his frustration and the fuel for his mom’s exasperation. Fortunately, with support, Deonte was able to remain with his mother.
The K.I.D.S. Clinic often becomes the medical home for the foster children with extensive health care problems. As such, the children have the opportunity to develop a consistent relationship with familiar health care providers. They experience a continuity that is deeply needed, as they navigate the many disruptions and uncertainties of foster care.
Three months after his initial visit, Deonte and his mom returned to the K.I.D.S. Clinic for a follow-up. They were in therapy. Deonte’s grades were improving, he was participating in an afterschool sports program, and his mother was learning new methods of safe discipline. Happily, the Jameson’s were learning to live together safely and were building a stronger, healthier relationship – always the treatment goal for children under care at the K.I.D.S Clinic.
For additional information or to make donations to the K.I.D.S. Clinic, please call 310-222-3567.