Foster Care for At-Risk Babies: One Nurse's Story


Foster Care for At-Risk Babies: One Nurse's Story

By Christine Contillo, RN, BSN
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Although she is the proud mother of three and lives in an upscale suburb of New York City, Elizabeth Kuehne, RN, APN-C, is all too familiar with families that can, at their best, be described as dysfunctional. Betsy, as she is known, is a pediatric advance practice nurse, and the nurse consultant for Children’s Aid and Family services in Paramus, New Jersey. In conjunction with the New Jersey State Division of Youth and Family Services, Children’s Aid offers a comprehensive “boarder baby” program. These are babies born to substance abusing mothers and are thus subject to withdrawal symptoms and developmental delays. Without a program like hers they would languish in hospital nurseries, unable to be discharged with the mothers who cannot properly care for them.

Foster care, however, allows the infant to enjoy more appropriate family-centered care than that found in a hospital setting. The mother can then obtain the services she needs to address her own problems. Statistics show that many of these babies eventually join their birth mothers, while others are placed with family members. Some are eventually released for adoption and foster care.

The American Academy of Pediatrics recommends that a healthcare provider be included on the team for foster care planning. The medical staff must be responsible for making sure that well care and immunization visits are maintained and that all therapeutic care is coordinated. Most of the infants in this program receive physical, occupational and/or speech therapy.

Babies Caught in the "Crack Epidemic"

Betsy came to the agency with extensive experience working with infants who had prenatal drug and alcohol exposure. During the 1990s she had worked as a nurse practitioner for The Floating Hospital, Inc., in New York City, and also for the Children’s Aid Society. Both agencies operated clinics for children and infants whose families were caught in the explosion of crack cocaine use in inner-city neighborhoods. Her expertise led her to give presentations at national conferences and to author articles on both foster care and substance abuse in professional journals like The Journal of Pediatric Health Care and textbooks like Primary Care of the Child with a Chronic Condition.

In her role as a nurse consultant for Children’s Aid and Family Services, Betsy provides the 18 hours of foster care training now required for parents being prescreened for service. While she works with some mothers who have already fostered 200-300 children, others are first-time parents. The training includes not just the effects of prenatal drugs and alcohol but also how to soothe an irritable infant, injury prevention and common medical problems. She teaches normal growth and development expectations and delves into other issues, like interacting with the birth mother — dealing with visitations and providing her with photos and a calendar of the child’s milestones and progress.

Betsy reviews each infant’s medical record — some are quite lengthy while others are skimpy and lack crucial information. She then prepares a summary that can be provided to the new physician or clinic while the child is with the foster family. She tries to make a home visit with the social worker, writes an assessment and plan, and makes herself available for subsequent staff meetings when each case is discussed and progress evaluated.

National Foster Care Coalition

In April of 2005, the American Academy of Pediatrics sponsored the Healthy Foster Care America Summit in Washington, D.C. The first national meeting of this kind, it brought together multidisciplinary representatives from a variety of fields, all having impact on some aspect of foster care — nurses, pediatric practitioners, social workers, lawyers, judges, mental health workers, state legislators, foster care representatives and members of education and advocacy programs.

Their goal was to create a vision for care in the foster system where common concerns could be addressed and prioritized. Over the next three years they set themselves eight ambitious goals that begin with developing a national foster care coalition. They will research existing programs to develop best practices and make those the standard of care. Betsy represented pediatric nurse practitioners, with the hope that nursing will be directly involved and continue to have vital input in the foster care system at the local, state and national level.

She claims that it’s just a part-time job, but it’s easy to see that her commitment to the program is full time. While some might find it difficult to work within a system already acknowledged to be riddled with flaws, Betsy is able to take satisfaction in knowing that she’s had a positive effect on the children she works with.

Christine Contillo, RN, BSN, has worked as a nurse since 1979. Christine has written extensively for various nursing publications, as well as
The New York Times.

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