Partnerships in fostering: a newsletter of the Georgia DHR Foster Care Unit, Spring 2000

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The Medical Side of Fostering

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A NEWSLETTER OF THE GEORGIA DHR FOSTER CARE UNIT
Loving Babies
10 Health

Children With FAS
Kids With Medical Conditions
From Hospital to Foster Family
spring BE FOSTER PARENTS

Where can babies go when they are discharged from the hospital but are too fragile for a normal foster home? Savannah's Open Arms Home provides them with a haven.
These infants suffer from lifethreatening problems such as prenatal drug and alcohol exposure,
HIVI AIDS, premature delivery,
chronic lung disease, heart problems, low birth weight and infections. Open Arms provides six infants with round-the-clock medical staff to operate the machines they need to survive and to administer medication. Also approximately 40 volunteers provide love.
"We feed them, change them, bathe them, take them out for walks and to doctors' appointments, and a lot of times we're playing with them and having fun with them," said Eloise Wardell, who has volunteered one afternoon a week for the nine years since the home opened. "A lot of our babies come to us with drug addiction or fetal alcohol syndrome, and they need stimulation to get their minds active. Others need a lot of soothing. They're easily startled and can't tolerate loud noises, so they need to be held and soothed and rocked a lot to settle them. This helps them develop and mature."
Open Arms is a homey threebedroom bungalow with brightly colored murals painted on the walls, a living room with big toy boxes, and a back yard where infants can swing or sit in the sunshine.

"It's a wonderful feeling to be able to take care of them and give them the normalcy they deserve," Wardell described. "We give them the chance at a good start in life. You can't help but learn to love those little guys. We've lost four over the years. It's almost like losing one of your own. I remember the last funeral when the minister asked for the immediate family to stand, and 40 volunteers and staff stood up. That baby had to be in the hospital for her last month, and one of our volunteers arranged for someone to be with her almost all that time. She was being held when she died."
To care for such infants, hospitals cost approximately $900 a day, and Open Arms costs $95 a day while also providing the loving nurturance which helps the infants heal faster.
"There are so many medically fragile children in Georgia who need a place like Open Arms," Wardell stated. "There are many willing people out there who would really love to volunteer to help children who need this kind of care. We need more people around the state to take the initiative to start homes like this."
Open Arms is a joint project between Lutheran Ministries of Georgia, Memorial Health University Medical Center and Georgia DFCS. It is funded through donations, contributions and grants from individuals, businesses, government and charity organizations along with stipends from the state of Georgia.

IEloise Wardell volunteers to care for medically fragile infants.
For further information write: Lutheran Ministries of Georgia Coastal Area Office 10 West 31st St. Savannah, GA 31401

How to Do the
Medical Side of Fostering

Their child patients call the Gotliebs "Dr. Ed" and "Dr. Jackie." These Stone Mountain pediatricians offer the following advice about the medical side of fostering children.

are placed with foster families in their own county, so their previous doctor's office probably won't be very far away, though a lot of children entering foster care haven't received previous medical

talk with the physician. Dr. Ed said, ''We spend a lot of energy trying to guess abo~t kids, ':hen _we can simply ask them. Ask the child questions h~e, 'You're dragging-what's happening? Tell me m

nasal congestion, fluid behind the eardrums and other reasons." Dr. Jackie added, "A child may keep misbehaving at school, and the foster parent and teacher may assume he simply needs to be

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1cal.

As soon as reasonably possible after children enter care, foster parents should take them for a wellness visit where they can be examined medically and developmentally. Dr. Jackie said, "Most

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care."
Have up-to-date medical information.
With the case plan, the case manager should provide foster parents with pertinent medical information about the child, including immunization information and copies of medical records relating to more serious health conditions. Foster parents should bring this inforrna:ion to each n~w medical provider who sees the child. Each physician's office can photocopy this information as needed, to keep on file.
Prepare e Hd.

your words what's going on with you right now.'"
Notice paHerns.
Because parents spend more time with children than anyone else, they can notice patterns that could help a physician make a diagnosis. Dr. Ed noted, "Some kids keep getting hurt- twisting their ankle, falling off the swing and so forth. Parents and the busy doctor might not notice this pattern, just seeing each injury as a separate . mishap. But this pattern might indicate the child has neurologic problems or is depressed or selfdestructive or has poor balance from an inner-ear condition or has attention deficit disorder or is reenacting their previous hornelife where someone often hurt them. Other kids have the pattern

disciplined. But maybe the child has a problem with auditory processing-can't understand a lot of what's being said. So the child finds himself in a classroom with a teacher saying a lot of what sounds like gibberish. It's easy to understand how that child would feel confused and restless and would start acting out. The average kid with an attention deficit disorder misses about 50 percent of what's presented in a classroom. When problems keep happening with a child, parents sometimes will need a professional's advice about what may really be going on and how best to help the child."
Don't ex eel bad things.
Sometimes children corning into care have

,
Ed and Jackie Gotlieb are pediatricians in Stone Mountain.
pediatricians and many health departments are able to do that. Family practitioners may or may not be able to do it, depending on what services their particular office provides."
ind a ~me al ome."
Children benefit from what the American Academy of Pediatrics calls a "medical home,"

Orienting the child can help the child feel more relaxed and engaged in the process of getting medical help. Dr. Ed said, "Before a medical appointment, parents can say, 'The doctor's going to check your body to make sure everything is OK. He'll look in your mouth, put a strap around your arm and listen to your heart. ' You can prepare younger kids by acting out these things with them." Dr. Jackie added, "You can prepare kids for shots by saying, 'Sometimes we have to get shots and we don't like it very much, but it's over very quickly. If we hold still, it gets over even faster, and I'll give you a hug after!' It can sound less scary to say prickies and stickies instead of finger pricks and shots. Some of these kids haven't had immunizations, so they come to a new doctor the very first time and get three or four shots, which is scary. So you can help them to understand that 'sometimes there are things we don't like a lot, but we can handle it.' /1

of having a lot of different pains- headaches, belly aches, chest pains, leg pains. The parent may help the doctor's thinking by mentioning such patterns."
Adiust if necessary.
Some lifestyle adjustment may be necessary for children's medical needs. Dr. Ed said, "For example, if a kid has seven ear infections, he's probably having repeated allergic reactions. The cause might be smoking in the household. The chances of ear infection are triple for children living in households with one smoker and six times as high in households with two smokers. The incidence of bronchitis for kids is 50 percent higher in households with smokers. In these cases, the children's health depends on adults quitting smoking, or at least smoking outside or away from the children."

medical issues related to their abuse or neglect, but falsely assuming a child has a certain problem can make matters worse. First, foster parents probably will always be "walking on egg shells," worried about the child's supposed condition. Second, the child will probably sense the parents are thinking "something is wrong" with him or her, which may have an unsettling or even a negative influence on the child. Dr. Jackie said, "Even if 30 percent of children in care have problems, that still leaves a vast majority who are healthy, normal kids who are simply corning from an unfortunate situation. We need to remember kids are extremely resilient. Often they deal with things much better than older people, and many of these kids are going to blossom as soon as they get into a safe environment."

Don't assume.

which is a consistent medical caregiver for the child's checkups and sick visits. Dr. Ed explained, "Every time you take children to a clinic, they may have a different physician, so the child doesn't form a comfortable, trusting relationship with any one doctor. When a child goes to the same doctor over time, that doctor is more likely to notice changes and patterns with the child. Most kids

Help the chi d describe.the illness.
Medical visits will be more effective when the physician has the best information. Before the visit, foster parents can coach the child in describing symptoms so the child will be better able to

Foster parents should avoid making firm assumptions about children. Dr. Ed explained, "You might feel frustrated that a child is being disobedient and willful by ignoring your voice. But it may be the child doesn't hear you well because he has a temporary or permanent hearing loss. Hearing can be affected by allergies, chronic

2

3

Putting the Pieces Together:
Ev uating Children's Needs

Some children in foster care have a range of issues. Some need help with physical or emotional difficulties. Others fall behind normal ages in developing skills and maturing. Others need help in all these areas. The first step in helping is to evaluate them.

Cathy Taylor and her husband, Mark, testify to how evaluations led to vast improvements for Jay. Jay entered their foster care four years ago, when he was 5. The Cherokee County couple recently finalized adopting him.

"When we first got Jay, he couldn't even run without falling down," Taylor recalled. "We were told he didn't learn to walk until he
was older than 2 1I2 .
He talked in two-word sentences, and it was hard to understand him. In his behavior, he was like a fire cracker just ready to blow up at any minute."

The right services have dramatically helped Jay, says Cathy Taylor.

The Taylors' case manager arranged for Jay to be evaluated at Atlanta's Marcus Institute.

"The Marcus Institute gives you a whole list of therapists," Taylor explained. "I called around and got on some waiting lists. A few weeks later, spaces opened up, and Jay started his therapies. Two years ago whenever he talked to strangers or would go to the doctor, I'd have to translate what he was saying. Speech therapy helped him so I don't have to do that anymore."
Recognizing Needs
At first Jay's inability to make himself understood frustrated him, so he would act out.
"But the speech and other therapies help his self-confidence and self-esteem, so he's much better behaved now," Taylor noted. "Physical therapy helps his gross motor skills. Some days he might just use the trapeze, and other days it might be the scooter board. His upper strength has built up so much. He doesn't suffer from muscle deterioration any more. At first he looked sickly and frail. Now he's still small, but he's solid muscle."
At first, Jay could not throw a ball, but physical therapy helped him improve enough to join baseball and soccer teams.
"Last year when Jay was 8, the doctor at the Marcus Institute said he was on the level of a 6year-old, so he fit in fine when he played soccer and baseball with 6-year-olds," Taylor said. "He did soccer for one season at the YMCA. We tried it because he loves to run, and he's never tired. He got to where he was kicking the ball and controlling it. The soccer coach's son had disabilities, so he was good with Jay."
Targeting to Heal

"We stayed there the whole day and went back several times," Taylor described. "They did an MRI, EEG and EKG. Jay was seen by a developmental pediatrician, an occupational therapist, a physical therapist and a speech therapist."
Jay was diagnosed with fetal alcohol syndrome, attention deficit hyperactive disorder and having developmental delays (functioning on the level of a 2-year-old, although he was 5 1/2).

The Taylors also signed Jay up for a season of baseball.
"He got to keep the game ball for three games by making runs," Taylor happily noted. "Sometimes he would be having so much fun, he'd get over-stimulated and just lose it. We'd have to talk to him to calm him down, and sometimes we just had to take him home. We did that a few times, and everyone understood and accepted it. Playing sports is like him getting extra physical therapy,

4

and playing with other kids builds up his selfconfidence."
Jay also receives occupational therapy to help develop fine-muscle control so he can better do such things as writing, coloring and using scissors. Improving in such skills also helps him better focus his attention, which helps him in following directions in school and in participating in games.
The Marcus Institute also diagnosed Jay as needing psychological counseling to help him deal with emotional issues related to previous maltreatment.
"Jay can't really talk about feelings going on inside him," Taylor described. "He needs someone trained to help him let that out. I remember what a breakthrough his third play therapy session was. The psychologist's office has lots of toys in it, and Jay took toy handcuffs and handcuffed the stuffed animals and put them under the couch. That was

his safety. It was like he was putting the scary things in jail. He did that at every session for a few months. Then one day, he felt safe enough to turn them loose. I've never seen anything like it. It was just like lifting a blanket off him. Now whenever things are stressing him out, he handcuffs the stuffed animals and feels better."
All of Jay's therapists maintain contact with the Marcus Institute, and the Taylors continue to bring Jay there twice a year to monitor his progress.
"We've taken classes at the Marcus Institute and learned lots of tactics for dealing with Jay's behaviors," Taylor described. "They also connected us with a support group for parents of children with fetal alcohol syndrome, where we've made friends we can call up to trade parenting tips. Jay really enjoys his life now. He loves camping and can sit and fish for hours. He still has deficiencies to overcome, but he's a real worker!"

Getting

Quickly

"Without a Medicaid card, foster parents are hindered in getting a child medical help," emphasized Nell Gamble, DFCS policy consultant. "Children in foster care need their Medicaid cards quickly."
Sometimes delay occurs when case managers postpone filing for Medicaid. For example, some case managers prefer to finish gathering all information needed for both IV-E eligibility and Medicaid, to complete both applications at the same time. But this leaves the child without a Medicaid card during this whole process, even though only minimal, easy-to-obtain information is needed for a Medicaid application. Applying for Medicaid should be on every case manager's checklist of first things to do when a child enters care.
Most of Georgia's counties have smooth, fast systems for getting children their Medicaid cards.

This is especially true in smaller counties where DFCS case managers and Medicaid eligibility staff often have offices across the hall from each other, so they get to know each other personally and form responsive working relationships.
"The process can be less smooth especially in larger counties where DFCS staff and eligibility workers may be on different floors and don't know each other," explained Gamble. "In these counties, administrators need to encourage a spirit of teamwork between DFCS staff and eligibility workers, to help them understand they share responsibility for ensuring the medical security of children in state custody."
It is important to remember that if Medicaid approval is delayed or if a child's necessary medical treatment is not covered by Medicaid, the treatment can be funded through DFCS under unusual medical expenses.

Kids with F
What are they like?

Raising Children With Serious Medical Conditions

What is FAS? Some children are born with the condition called fetal alcohol syndrome (FAS), resulting from their mother drinking during pregnancy. FAS causes both mental and physical symptoms and disabilities. Many children with FAS enter foster care.

Following are symptoms of FAS:

Unusual facial features, including a thin upper lip, lowset ears and flattened mid-face.

Low birthweight and continued small size.

Minor medical problems such as infections, allergies and asthma.

Feeding problems,

such as difficulty

grasping a nipple in

'ii
m

infancy and later
decreased appetite
and sicknessI

queasiness from

eating.

Learning disorders at school age, with better performance in reading and language and poorer ability in math.

Foster parents can make a huge difference for children with FAS, says Claire Coles.

Mild mental retardation.
Sleeping problems, such as having trouble going to sleep and sleeping restlessly.

Judgment problems, such as failure to learn from experience or to develop logical approaches to problems.

Claire Coles is a nationally recognized FAS expert, carrying out FAS research and clinical treatment for 20 years with Atlanta's Marcus Institute and the Emory University School of Medicine.

Following are key things to keep in mind about FAS, according to Coles.

The odds are in the child's favor: "When we know a birth mother's history of drinking, we may mistakenly believe the child will automatically have FAS," Coles explained. "I certainly agree with the Surgeon General that women shouldn't drink during pregnancy, but it's important to understand FAS doesn't result from occasional drinking-the mother has to do a lot of heavy drinking. Even then, of the women diagnosed with severe alcohol problems who drink through pregnancy, only about 35 percent have children with FAS. Probably another 20 percent have children with some of the symptoms of FAS. So there's a fairly good chance that a mother who is an alcoholic may have a child who has no noticeable FAS symptoms."
Foster parents can make a tremendous difference: "Children with FAS can make huge progress in a good environment," Coles emphasized. "The brain is very flexible, and development for any child- 'normal' or otherwise-is within a range. The average person under normal circumstances has an IQ of about 100, but that same person in a poor environment might have an IQ of 85 and in a very stimulating environment have an IQ of 115. In the same way, a child with FAS can make great strides with the support of foster parents and appropriate services. Though some will do better than others, some of these children go on to graduate from high school and college. Some who look very bad in infancy can do beautifully over time."
Don't jump to conclusions that a child has FAS: "It can hurt the child to assume he or she has FAS," Coles emphasized, "because when we believe a child has a lower IQ or has physical problems because of FAS, we might influence that child to believe he or she has those limitations, whether it's true or not. With babies in their first six weeks who cry all the time, I've seen foster parents who assumed the baby was in withdrawal or was alcohol-exposed prenatally (during the pregnancy). But what's usually going on is the baby has colic, like all babies. With some older children, foster parents may know the mother drank and assume the child probably has some brain damage, which is proba~ly untrue."

6

Evaluate the child: Coles said, "If foster parents notice a child shows some symptoms of FAS, they should let their case manager know so
f the child can receive a comprehensive evaluation
l by medical professionals. This is the only way to know whether a child has FAS and to plan how to meet the particular child's needs." For an overview of evaluations see "Evaluating Children's Needs" on Page 4 of this newsletter.
Don't stereotype: "There are guidelines about what children with FAS are like and how to care for them, but we need to remember there is a lot of variety among these children," Coles said. "The mother may have drunk during the first trimester and not after that. She may have drunk all the way through pregnancy. She may have drunk through the second and third trimester. Children will be affected differently by these different exposures. So it's very hard to say, 'Every child with FAS is like such and such.' Rather than trying to work with a child according to guidelines out of a book, it's best to work with the child where that particular child is."
FAS may not be a child's only challenge: "While a child will need help and support in dealing with FAS, it's important to remember the FAS may be only one of many things the child needs help with," Coles stated. "Every child who comes into foster care is different and will have different needs. If we work with the child as if all his or her needs relate to FAS, we probably won't help the child very effectively. Children are more individual than that. For example, some of the child's behavior and symptoms may come from neglect,
l maltreatment or some genetic problems which need to be addressed."
i FAS Resources
Emory Outreach (at various sites across Georgia):

Atlanta Area FAS Support Group:

or

3

Internet Resources:

Maternal Substance Abuse and Child Development

National Organization on FAS

If you ever fostered a child with a serious medical condition, perhaps you felt hesitant, guilty or overprotective when it came to disciplining the child. Take a moment to answer this question: Tamika (age 9) should not have to clean up her room because she has A) Diabetes, B) HIV, C) Sickle Cell Anemia or D) None of the above; Tamika has to clean her room.
The correct answer is D. To become competent, successful adults, all children need discipline and structure as much as empathy and love. Following are four tips for raising a child with a serious medical condition.
Rules, discipline and privileges will be different for different children: No parent treats every child the same way. If Joseph is mentally retarded, you should not feel guilty when the other children argue "it's not fair" when you help Joseph with his homework while they have to work independently. Latisha may have cerebral palsy and can only set one place at the table while the other children can set the entire table in the same period of time.
Get information to know what you can and cannot expect from a child: You need to know about your child's medical status, treatment and prognosis (future progress of his/her condition). Consult with your child's health professionals about your child's needs. Join parent support groups (in person, by mail or via the internet) so you can network with other parents raising children with your child's medical condition.
Don't be manipulated: Some children use their medical condition to manipulate caregivers. Some refuse to take their medicine. Some purposefully cause an asthma attack by exciting themselves. Others deliberately eat the wrong foods. For many children who repeatedly bring about medical crises, it is sometimes helpful to predict the behavior in advance. For example, the parent might say, "Timmy, I know you're going to throw a fit when I tell you to clean up your room. Since every time you throw a fit you have an asthma attack, let's get your inhaler ready beforehand." Then tell Timmy to clean up his room. You will need to be prepared to rush a child to the emergency room if an asthma attack or other emergency occurs every time you set limits. Keep emergency supplies and medicine available. Of course, when a child is sick, you need to provide love and care, but, after the emergency, parents should return to the normal rules and expectations. Do not attempt this approach without the approval of the child's case manager and physician.
Use your judgment: Twenty years ago, experts told parents that children with Down's syndrome should be institutionalized for life. The professionals were wrong! You need to be open to new ideas and approaches suggested by your case manager and other team members. However, because professionals sometimes disagree, you may need to use your own judgment about what is best for a particular child. Consult with your case manager if you have questions about appropriate discipline.

From Hospital to Foster Family:
Planning the hild ischar e

Children are helped by a smooth transition from the hospital, says Kathy Sanocki.

When a child is discharged from the hospital into foster care, planning and good communication are essential. Case managers and foster parents need to partner with hospital staff so the child will have a safe and smooth transition into foster care.
Following are some key points to help with this transition.
Sometimes foster parents need special training: Kathy Sanocki from Lilburn has fostered medically fragile children for the past six years, so she is used to receiving special training for each child who is discharged into her care. Sanocki said, "When I agree to foster a medically fragile child, the hospital staff teaches me how to do the things that child needs. Then when I bring the child home, nurses make home visits to make sure I know how to do everything the right way. They'll come as many times as needed until you feel comfortable doing the procedures on your own. For different children, I've been taught how to use different kinds of pumps, feeding tubes and

IV lines and how to take care of where they connect to the child's body. I've learned how to do sterile procedures for changing dressings. I've learned CPR and how to recognize infections."
Don't hesitate to call for help: "I don't care how much you think you know when you walk out of that hospital with the child, that first week is going to be tough because you're going to have all kinds of questions," Sanocki emphasized. "It really helps to call the nurses who cared for the child in the hospital because they've really gotten to know him-whether it's pretty normal for him to throw up a lot or to make funny noises while he sleeps. Some parents might hesitate to call because they think they should know everything, but if they have a question they need to call. Recently I called the doctor about a child who woke up a little congested, with a little cough and a slight temperature-in other words, pretty mild symptoms. The doctor said bring him in. The hospital admitted him because he had three different infections in his IV line. It's a good thing I called!"
The written plan helps: "The hospitals I've worked with give you good written instructions for each child's medications, diet and general care," Sanocki noted. "The paperwork has the child's diagnosis and all the specialists' phone numbers. Most of the time, they've already scheduled the first follow-up appointment for you with each of the child's doctors. Of course, you can call if you need to change the appointment to fit your schedule. If the child has been working with a physical therapist, occupational therapist, speech therapist or some other therapist, the paperwork includes a written a report on the work each one of them has been doing with the child, so the child's new therapists will know where to start. They'll even connect you with a pediatrician, and I feel like it's good having a pediatrician associated with the hospital because they'll probably communicate well with each other."
Sometimes meetings help: Ann Hunter, who oversees discharge planning at Children's Healthcare of Atlanta, said, "To plan for the child's discharge, sometimes we schedule a conference with key people involved in the child's care, including nurses, hospital social workers and the

8

foster parent. Sometimes doctors and the DFCS case manager attend. Everybody at the table talks about what we think the child's discharge needs are going to be and how to meet them; for example, will this child need an apnea monitor at home or aerosol treatments every six hours throughout the day?"
Explain the child is in foster care: "We say discharge planning begins on admission into the hospital," explained Hunter. "During admission, it helps if the foster parent or case manager tells us the child is in foster care. Sometimes a child in DFCS custody is placed with a relative, so the relative may feel like the child's guardian, when technically they're not. If a grandmother tells us she's the guardian when we need permission for surgery, legal problems arise. It gets complicated when we're admitting a child to the hospital, and foster parents say they're the child's

parents, even though they feel that way. Dttring the child's stay until discharge, we need to know who to get permissions from. If the child is infoster care, DFCS is the legal guardian."
Provide contact information: "There are times when discharge planning is at a standstill because we can't reach the case manager," Hunter described. "It helps with both the child's hospital stay and discharge if the foster parent or case manager gives us contact information. Case managers have huge caseloads and busy schedules, so it's not always possible for them to come to the hospital with parents. But case managers can really help by giving foster parents their card to give to us so we know where to call when we need to. Having the case manager's pager number is especially helpful. It also helps if the case manager can give us the names and phone numbers of people to call if he or she is unavailable."

According to federal regulations, case managers should provide foster parents with the following medical information (when available and accessible) about a child entering their care:
Names and addresses of the child's current health providers
A record of the child's immunizations
The child's known medical problems
The child's medications
Any other relevant health record information appropriate to share with the foster family
Case managers should obtain as much of this information as possible by the time the child is placed with the foster family. Georgia policy states case managers should provide foster families with

hospital and other

medical records for

newborn infants or

very young children.

Beginning in February

1999, DFCS began

requiring comprehen-

sive child and family

assessments for all chil-

dren entering care,
including gathering medical history. Foster

~
_.,,,,

parents and case man-

agers can obtain this

information at chil-

dren's multi-disciplinary staffings in order to put

together a better picture of the child's current and

past medical and developmental needs.

One Case Manager's Story:
When a Child an't Be Saved

Margaret Dawe poses with the file of "Trinease," a 3year-old who died in care.
10

Many DFCS staff are heroes because of their commitment. Perhaps this is most true when they continue working hard for those babies and children whose chances of survival are lowest. Many of us do not understand how challenging a case manager's work can be.
Margaret Dawe, a Dekalb County case man~ger, usually has several medically fragile infants m her caseload. "Trinease" (as this article will call her) was one such infant whom Dawe watched over for the final year of her three-year life.
Trinease was born without a brain, having only a brain stem. She was reported to the agency by a mechanic who noticed Trinease's parents (whom this article will call the "Jordons") loudly arguing at a bus stop near his garage. After the father set down a duffel bag, the two parents walked away in angry dispute. The mechanic noticed the abandoned duffel bag contained a baby. After several minutes, the Jordons returned for their baby; however, DFCS discovered the Jordons were struggling with substance abuse and were homeless and panhandling to support themselves. The initial case manager took Trinease into state custody, placing her with a foster mother who had been trained to care for medically fragile children.

Scarcity of Trained Foster Families
"Trinease stayed there almost two years," Dawe recalled. "This foster mom bonded with her as if she were her own baby. Trinease grew stronger, even though doctors estimated she probably wouldn't live more than a year. But that foster mother was caring for three medically fragile children, which I think became too stressful for her, and she stopped fostering ."
Dawe searched in vain for another foster family trained and willing to care for Trinease. When none were available, she began contacting nursing homes for children, all of which were filled to capacity. After an exhaustive search, Dawe finally connected with a nursing home two and a half hours away. The nursing home agreed to accept Trinease in a month's time. After additional searching, Dawe located an emergency foster home willing to take Trinease in for the intervening month. When the month passed, Dawe arranged for an ambulance to transport Trinease to the nursing home.
"By then the agency had lost touch with Trinease's parents," Dawe explained. "It was hard to track them down because they were still without a home. But I wanted to include them every step of the way with Trinease. I finally found them and offered to arrange transportation for them to visit Trinease's nursing home. For the 10 months Trinease was there, they visited her four times. The staff at the nursing home were always nice to them. The Jordons were pleased Trinease was there."
During those 10 months, Dawe made the fivehour round-trip four times to check on Trinease personally, also checking regularly by telephone with the nursing staff.
Partnering With Medical
Professionals
Dawe recounted, "During that time Trinease didn't have any unusual medical problems, until a Friday afternoon when a nurse called me. I'll never forget the weekend that followed. I learned Trinease had developed a sudden respiratory infection and her white blood cell count was rising

dangerously. She'd been rushed to an acute care hospital in a neighboring city."
Dawe was able to contact Mrs. Jordon, who at that time was estranged from her husband. Ms. Jordon said she had her own car and would drive to the hospital. Dawe would later learn Ms. Jordon's car broke down on the outskirts of Atlanta and, instead of telephoning for help, she would set out on her own hitchhiking. That Friday evening and the following day, Dawe maintained contact with Trinease's nurses and the hospital chaplain, as well as trying to discover what had become of Mrs. Jordon.
"I was planning to drive to the hospital the next day," Dawe remembered, "but at 8:40 p .m . on Saturday, the doctor called to let me know Trinease had passed away. At 10, the chaplain called, and we talked about how to locate Trinease's parents. At 11 :30, the hospital called me to let me know Ms. Jordon had been hitchhiking from Atlanta and had only just arrived. It was tragic because she was only a few hours too late. But she was able to hold her daughter."
Dawe arranged for Mrs. Jordon to take the bus back to Atlanta the following morning. At 10:30 p.m. that Sunday, Mrs. Jordon telephoned Dawe in a panic She said she had located her husband and they had bitterly argued about where Trinease would be buried. He had threatened to go to the hospital to claim the body.

Dawe stated, "With children like Trinease, you know they're on borrowed time. I was able to get her parents back in her life for her last nine months. I think that was important. She was comfortable and well cared for, and we had her in the best place she could be. This system provided that for her. Her parents weren't able to."
Dawe's caseload averages 30 families, including 35 to 50 children. National child welfare agencies recommend case managers carry no more than 17 cases. Dawe's current caseload includes six medically fragile children.
Doris Walker, manager of the DFCS state foster care unit, said, "Governor Barnes is asking the legislature to increase funding for the child welfare

Many of us do not understand how challenging a case manager's work can be.

Working With Birth Parents
"I calmed her and assured her the body couldn't be moved except by ambulance or the funeral home," said Dawe. "I explained DFCS could subsidize the funeral expenses and that it would be best for her and her family to plan the funeral service. She and her husband were able to work out their disagreements and make the funeral arrangements. I arranged for the funeral home to send me DFCS's portion of the bill, and Mrs. Jordon's relatives paid the remaining $200. Monday morning when I got to the office, I telephoned the DFCS attorney, who prepared an order informing the court that-in the standard legal phrasing-the state 'extinguished claim' to Trinease. That week I attended Trinease's funeral in Canton."

system. Georgia's child protection workers earn the fourth-lowest starting salaries in the nation. In fiscal year 1999, the turnover rate among Georgia's child protective services workers was 39 percent. We need smaller caseloads to avoid burning out dedicated staff and to provide adequate supervision for at-risk families. Many medically fragile children require foster parents who can provide full-time supervision, so we need funding to enable these foster parents to stay home fulltime rather than having to work a job outside the home. We need more foster homes and additional training to prepare more foster parents to be able to care for Georgia's medically fragile children."

11

Foster Care Unit Division of Family and Children Services

The 0

Foster Parent and Staff

Development Institutes: Partners for Children

How can we partner to bring children in foster care into a safe and happy future? Answering this question is the purpose of the 2000 Foster Parent and Staff Development Institutes.

As in past years, the

Catch up with the Institute

Institute offers foster parents and agency

April 14-15 ................. .Athens May 12-13 ........... . ... .Savannah

staff a selection of sessions with a practical focus. Friday's large-

June 9-10 ................... .Macon group session centers
on building relation-

ships, negotiating, and

coaching children about choices. The session also

examines social contracting to reach agreement

between foster parents and agency staff, as well as

between foster parents and children. Agency staff

and foster parents are invited to describe difficult

real-life challenges they have encountered, and

the presenter will suggest strategies and plans for effectively addressing such challenges.
Saturday's topics include working with alcohol and drug-exposed infants and children; understanding and managing challenging behaviors; parenting, coaching and enjoying teens; preparing teens for independent living; postadoption support services; the premature infant; and helping children with learning differences at school and in the home.
Foster parents can earn up to 12 continued parent development hours. Institute registration brochures will be mailed to foster parents. Foster parents are asked to coordinate their attendance with their local DFCS. If local DFCS agencies cannot answer a question about the Institutes, call 800.227.3410 for questions about attending the Institute; for all other questions, call 404.657.3454.