Along with the hurt, confusion, and sadness that come when a child is removed from their home by social services, a host of medical needs are often present as well.
That’s why, in 2023, the University of Colorado School of Medicine’s sections of general academic pediatrics and psychiatry, in partnership with Kempe and Children’s Hospital Colorado, created the Kids in Care Settings (KICS) Clinic, exclusively serving children in out-of-home placement. Founded on the principles of trauma-informed, culturally responsive care, the clinic — located in the Child Health Clinic at Children’s Colorado — serves children along with their biological and foster or kinship families. KICS focuses on mental and behavioral health, physical health, and coordination and navigation of care among families, courts, and child welfare agencies. The clinic employs a multidisciplinary team that includes pediatricians, a psychologist, a nurse care coordinator, a social worker, a community health navigator, a child life specialist, a nurse and medical assistants, and Spanish-language interpreters.
“Children in foster care have higher rates of chronic medical conditions and unmet medical conditions, higher rates of dental needs, higher rates of substance exposure,” says Amanda Bird Gilmartin, MD, founder and director of the KICS Clinic. “They have higher rates of child maltreatment, higher behavioral health needs, higher rates of suicidality, higher rates of developmental delays, higher rates of education attainment problems, and higher rates of incarceration, housing insecurity, and homelessness. Our hope is that KICS can help address some of these adversities.”
Amanda Bird Gilmartin, MD, director of the KICS Clinic.
Not only that, but the children’s health concerns are often exacerbated by the conditions that led to their removal in the first place, Gilmartin says.
“It's the dovetailing of a lot of factors,” she says. “It's the trauma and chaos of their lives. There is intergenerational trauma. There is a fracturing of information known about them. This population is exclusively insured by Medicaid, so there are a limited number of providers who can serve this population. There are delays in their care because of consent problems. There are large systems involved in their lives — the courts, child welfare, and health care — and none of those systems talk well to each other. Put all that together, and you see some really stark outcome concerns.”
Longitudinal relationships
KICS currently works exclusively with children in Arapahoe County, though it hopes to eventually expand to work with other counties as well. Utilizing a medical home model, KICS sees children for their initial assessments once they are placed in foster or kinship care, but it also works to create a longer-term relationship that includes well child checks, follow-up care, referrals to specialists, and even continued care once the child has been reunified with their biological family.
“The kids and families are really special,” says Gilmartin, who also is an associate professor of clinical pediatrics. “They're amazing, resilient, beautiful people. It can take time for them to warm up, but when they do, it is one of the gifts of our clinic. We get to see them over time and build that relationship with them. Some of them are hard nuts to crack, and for good reason. They don't have a lot of reason to trust people, so they get to be skeptical until we earn that trust.”
IHQSE assistance
For help with the regulatory and logistical challenges that go along with creating a new center, KICS staffers in 2023 turned to the Institute for Healthcare Quality, Safety and Efficiency (IHQSE) in the CU School of Medicine. The institute’s mission is to improve the care provided to patients by developing people, improving care processes, and building higher-achieving organizations.
“IHQSE was a huge support to get the clinic up and running and make it more successful,” says Rachel Chantala, DNP, MPH, associate clinical manager at KICS. “They set you up to think through the problems, the outcomes you want, and how you’re going to get there. Along the way, they provide you with skills for leadership and process improvement. They connected us with resources and networking that we probably eventually would have gotten to, but not as quickly.”
Social determinants
Part of KICS’ mission is taking into account all the factors that led to a child being removed from their home — which can include everything from poverty to addiction to housing insecurity.
Rachel Chantala, DNP, MPH, associate clinical manager at KICS.
“We do extensive screening every visit for the child and their family, looking at development, behavioral health — substance use, depression, anxiety — and traumatic stress,” Chantala says. “We look at things from a psychosocial perspective with the foster family as well as the biological family, if they’re present for the visit. Do they have housing concerns, financial concerns, food insecurity? Do they need a primary care doctor? Are there mental health needs? Those social determinants of health, access to basic needs, have very large impacts on overall health and well-being.”
An additional concern, Gilmartin says, is creating an environment where children and their families feel comfortable and are able to be honest about their circumstances and concerns.
“Health care isn’t always a particularly welcoming place in general,” she says. “It's a hard system to navigate. Different people have different medical literacies. For families who experience child welfare involvement, it can feel like a judgmental, harsh, punitive place. One of our goals with KICS is to say, ‘You are welcome, you are wanted here, and we are here to support you in whatever way we can.’ We hope we can be a place of healing or an olive branch for the future. We do not intend to judge or ‘fix,’ but to listen to, partner with, and be in service of the patients and families we care for.”
KICS is currently open two days a week, though Gilmartin hopes the clinic’s hours can expand along with the population it serves. The work can be hard, she says, but its rewards are many and deep.
“I am humbled by our patients and our families every day — what they do, how strong they are,” Gilmartin says. “They show up; they keep going. It's humbling. They're really amazing, and it’s a privilege to get to take care of them and be a part of their lives.”
Featured image: The KICS Clinic staff
