State Child Welfare Policy Guide: Part of the Policy Matters Series

7.5 Medical and education records (passports)

Safeguarding the medical and educational records of children in foster care and ensuring that their records follow them throughout their time in care can help improve child well-being.  One study found that more than 30 percent of youth in foster care had eight or more placements with foster families or group homes. Sixty-five percent experienced seven or more school changes from elementary through high school.[i]  As a result of changes in schools and health care providers tied to placement moves, available educational and health information about these children is often incomplete. [ii]   Misplaced, delayed, inaccessible, or incomplete educational records contribute to negative school experiences -- including inappropriate programming, missed days, and delayed high school graduation. [iii]   Inadequate medical records can result in life-threatening health care crises for children in foster care.  A federal study of Medicaid services for children in foster care in New Jersey found that caseworkers for half the children in the sample and the majority of caregivers did not receive the child’s medical records or received only partial records. [iv]   

To enhance continuity of health care, several states have developed an abbreviated health record often called a medical passport.  Held by the child welfare agency and the foster parent, the medical passport has the potential to facilitate the transfer of essential information among physical and mental health professionals.  It provides a brief listing of the child’s medical problems, allergies, chronic medications, and immunization data as well as basic social service and family history.  Foster parents are instructed to keep this document for the child, bring it to all health visits, and ensure that health care providers update the information on the form.  When the child changes foster care placements, reunifies with his or her family, or achieves another permanent placement, the medical passport is transferred to the child’s new caregiver.  Computerized health information systems are also being developed in several states to make specific health information about children in foster care more readily accessible to practitioners and child welfare agencies, to safeguard the data despite changes in caseworkers and caregivers, and to ensure confidentiality of the information. [v]

Educational passports can help promote seamless educational transitions for children and youth when educational placement changes occur.  In the Child and Family Services Reviews, the federal government rates availability of school records as one factor for judging how well a state is meeting the Child Well-Being Outcome for education.  In 18 of the first 37 states reviewed, education records were missing from case files or had not been made available to foster parents. [vi]   The Fostering Connections legislation responds to this concern by requiring states to ensure that educational records are provided to a new school when children can not stay in the school in which they were enrolled when they were placed in foster care. [vii]

Several states have enacted legislation aimed at improving records sharing and avoiding both delays in enrollment and uninformed educational programming.  For example, Texas legislation (2005 Tex. Gen. Laws, SB 6, Chap. 268) r equires the State Health and Human Services Commission to develop an educational passport for each foster child to include educational records, the child’s grade-level performance, and any other relevant information.  The child welfare agency is required to make the passport available to the person authorized to consent to medical care and to a health care provider if the information is necessary to the provision of medical care.

The courts have an important role to ensure that children in foster care receive needed and appropriate services and that health and education records follow a child.  The National Council of Juvenile and Family Court Judges has developed a judicial checklist that court officials can use to monitor children’s education needs and treatment.  Checklists have been developed for use by judges in Alaska, California, District of Columbia, Idaho, New Mexico, New York, and Washington. [viii]  

Policy Options:    States can promote record sharing by adopting 1, 2, 3, or 4 of the following policies:

·         Medical passports are required for all children in foster care.

·         Educational passports are required for all children in foster care.

·         Computerized health information systems safeguard medical information about children in foster care.  

·         Courts monitor children’s medical and educational needs and services.