Dental Healthcare Among Children in out-of-Home Placements: Social Work Exploring Child Protection Practices to Provide Adequate Dental Health Care

Background and Purpose: Federal laws require that children in child protective services have regular health and dental care. Little is known about the quality of dental healthcare for children in the custody of State Social Services. Federal and state law requires adequate and regular health assessment for all children in foster care, residential treatment programs, and group homes. Physical and mental stressors or abnormalities in special needs children can affect one’s self care (Horwitz, Kerker, Owens, Zigler, 2000). Further, foster children may receive minimum dental care because they rely on other people to have their health issues taken care of (Kopelman & Mouradian, 2001).

The objectives of the investigation:  Through Medicaid and the Children’s Health Insurance Program (CHIP), the federal government mandates health coverage to millions of children. This coverage includes oral healthcare policies for indigent youth and applies to children in protective custody.  Social workers are often hired in positions in child protective services. The objectives of this study were as follows: 1) To examine dental care provided to foster children, and 2) To assess the knowledge in child dental care among workers.

Method used: This exploratory research utilized an on-line survey to gain information from CPS workers.  Forty-one (41) CPS workers responded, a 40% response rate. Thirty-nine (39) survey questions inquired if the workers had children in their caseload that needed dental care and if dental related habit history was routinely gathered. Respondents were asked to address accessibility of dentists or lack thereof. This study probed if workers had acquired special education to equip them for dental assessment of children.

Results: Data revealed that 93% of workers had children that needed dental care. Less than 15% of respondents consistently inquired on eating and smoking habits that are significant for oral and dental health. Less than 5% of workers were able to get dental care appointments within one week of a request; 30% could get appointments only after 2-6 months. Reasons given for lack of regular dental care included: a) unavailability of the dentists, b) dentists not taking Medicaid, c) lack of state funding available for DFS children, and d) caseworkers not being aware of a child’s dental needs. Significantly, 95% of respondents had no training in child dental case management. 

Conclusions and Implications: Many states require MSW and/or BSW graduates in child protection positions, thus our social work curriculum must help students examine policies and practice as is demonstrated in this study. Social workers must meet mandated health care policies, particularly impacting vulnerable populations such as those children in foster care. Additionally, social workers should work collaboratively with dental specialists to better respond to the dental needs of these children.

References

Horwitz S.M., Kerker B.D., Owens P.L., & Zigler E. (2000). The health status and needs of individuals with mental retardation. Yale University School of Medicine; Department of Psychology, Yale University, New Haven, CT.

Kopelman, L.M., Mouradian, W.E. (2001). Do children get their fair share of health and dental care? Journal of Medicine and Philosophy, 26(2):127-136.