Designing Policy to Serve Children With Special Medical Needs in Child Welfare: Lessons From New York City

Abstract

Despite the heightened vulnerability of children with special medical needs (CSMN), few child welfare systems have explicit policies, training, or case management procedures designed to ensure their identification and monitor their safety. This study highlights an innovative approach in New York City that aims to enhance staff's ability to work more effectively with CSMN families. The results of these efforts are compelling, and include targeted training of child protective staff, the development of a comprehensive policy for working with CSMN families, and practice changes designed to ensure staff access to medical expertise. Drawing on interviews and focus groups with staff and experts in the field of CSMN, the study describes the challenges that all child welfare agencies face in their efforts to serve CSMN, and provides recommendations for how agencies can design viable policies to address those challenges.

KEYWORDS:

• policy issues
• organizations/systems
• child protection
• assessment
• child maltreatment

Notes

The study was made possible by New York City's Administration for Children's Services, Casey Family Programs, and The Fund for the City of New York. The authors would also like to thank Melinda Dutton, Kinda Serafi, and Morissa Sobelson for their collaboration on this study.

1. Sections 160.203, 164.502(g) (5), and 164.512 of HIPAA have regulations that pertain to child abuse and neglect investigations. For more information, see Davidson (2003).

2. In response to the child's death, ACS appointed a panel of experts to guide the agency's response to the tragedy, which comprised service providers, child welfare experts, agency staff, and advocates and leaders from the community of child healthcare providers. The panel, ACS, and the city's elected Public Advocate issued a joint report with recommendations for reforms (see New York City Administration for Children's Services, 2011).

3. The authors learned about these programs through their interviews with national experts and program directors using the model. Information about Utah's Fostering Healthy Children Program can be found at http://health.utah.gov/cshcn/FHCP/ and information about the Child Health Program in New Jersey can be found at http://www.fxbcenter.org/childwelfarenursing.html

4. This information was drawn from interviews with national experts and program directors. Information about Utah's Fostering Healthy Children Program can be found at http://health.utah.gov/cshcn/FHCP/