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FOSTER CARE: The Foster Care System

In New York State, the Office of Child and Family Services (OCFS) manages the federal and state foster care regulations. In each county, a county agency and its commissioner manage the foster care system. In New York City, the New York City Administration for Children's Services (ACS) manages foster care. Most of the medical care and mental health care financing is through Medicaid.

Each county has the option to keep its children in "direct care," where county employees and foster parents provide services, or to place children in a "voluntary agency." In New York City, most children are placed in voluntary agencies (e.g. Catholic Charities). Most children in the rest of the state are in direct care. Some county agencies provide "therapeutic foster homes" that offer mental health services to children and extra training to foster parents. Regardless of the agency, all children remain in the legal custody of the commissioner of the local social services agency.

All children in foster care are assigned a caseworker by the local Department of Social Services (LDSS) and a law guardian. A family court judge appoints the law guardian who is generally involved with the process while the case is open with LDSS. This can include involvement in the reunification process (reuniting the child with biological parents and family), placement with an appropriate relative, or a final termination of parental rights.

Consent Issues
line spacer Children in foster care need permission to be evaluated by medical providers. In cases of emergency, medical providers are able to provide services without consent, as covered by the Good Samaritan laws. In general, permission is required for all routine care. Specific consents include:

  • Permission to provide medical care and release of medical information can be granted by the biological parent or the Commissioner of Social Services, but never by the foster care parent. The exception to this is for early intervention services, for which the foster parent can provide consent and the Commissioner cannot.

    • Within ten days of placement, the caseworker should get consent from the birth parent or previous legal guardian for all assessments and treatments that will be part of the initial evaluation. This includes routine medical and/or mental health assessments, immunization, and ongoing routine health care. Consent is also obtained for emergency medical or surgical care. If consent cannot be obtained, permission from the local Social Services Commissioner or designee is usually necessary.

    • If children are placed in foster care as a result of a court order or emergency protective removal from an unsafe home environment, consent from social services or the biological parent is necessary for medical treatment.

    • Children placed in foster care voluntarily, such as through PINS (Person in Need of Supervision) or JD (Juvenile Delinquent) court orders, need consent of the birth parent or guardian.

    • A teen parent in foster care may give consent for his or her own health care. A teen parent can give consent for his or her child whether or not the child is not in foster care. For more information about a minor's right to consent, see LEGAL ISSUES: Consent by Mature or Emancipated Minors .

  • Permission for HIV testing must be obtained, either from the biological parent, from the Commissioner of Social Services, or from the mature minor.

    • Request the Newborn HIV Screen results for children who enter foster care.

  • In many instances, adolescents may be able to obtain HIV testing and treatment services for themselves as well as for conditions related to sexuality, pregnancy, or sexually transmitted diseases. The New York Civil Liberties Union is a good source of information for consent issues. See and .

  • Minors may consent to alcohol abuse and substance abuse services if treatment is necessary and the parent/guardian has refused consent or if requiring consent of the parent could have a detrimental effect on the course of treatment.

  • Foster parents or biological parents can provide consent for early intervention services and foster parents can serve as surrogate parents if necessary to make decisions regarding the child's need for early intervention services.

The Medical Home Concept
line line The American Academy of Pediatrics recommends that every child have a primary health care provider who offers an ongoing relationship throughout the child's life until adulthood. It is often difficult for the same professional to provide routine preventive care, acute care, and chronic illness care prior to foster care placement, while in foster care, and at discharge. Communication between all medical providers should be a priority so that continuity of care is promoted.

Although each county is responsible for obtaining medical care for its children in foster care, reliance on Medicaid, the lack of access to providers with expertise, inexperienced caseworkers and foster parents, and difficulties in obtaining past medical records make coordination of medical care a challenge.

Keys to Effective Continuity of Care
  • Obtain all consents prior to the examination date when possible.

  • Maintain communication between medical providers prior to, during, and after foster care.

  • Schedule medical appointments so that the foster parent can be present. The use of a transporter is discouraged.

  • Maintain accurate documentation of all medical problems.

  • Obtain old records from prior examinations performed by other medical providers.

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Foster Care: Overview  Foster Care: Foster Care System  Foster Care: Health Concerns of Children in Foster Care  Foster Care: Foster Parents  Foster Care: The Caseworker  Foster Care: Biological Parents and Reunification  Foster Care: Additional Resources 

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Consent Issues
The Medical Home Concept