How many times have I met someone new, or run into someone I haven’t seen for a while, where the conversation turns to, “You’re a nurse? Where do you work?” The idea of a nurse is easy. The quick assumption is that nurses work in hospitals, or doctor’s offices, or maybe in a school. They care for your families, or your children, or you. They take vital signs, assess body systems, give medications, change bandages, comfort in times of need. When I change the direction of their thoughts by saying, “I work at SaintA as a nurse in child welfare,” the expression goes blank. Then, “That must be hard,” followed immediately by “What do you do?” Here’s where it gets tricky. What do we do as nurses in child welfare? Where do I begin? How do I explain?
Nurses originated as part of a new design in child welfare in Milwaukee to help ensure the youngest and most vulnerable children are safe. In the beginning we went to the homes of all foster children under 3 years old to make sure they were getting their needs met: medically and developmentally. Were they getting to their well-child checks in a timely fashion? We made sure that was happening. If they needed a specialty doctor, we facilitated that connection.
If we saw that they weren’t meeting developmental milestones, we worked with the case managers to make sure a Birth to 3 developmental assessment referral was made in order for therapies to be brought in. Birth to 3 is a federally mandated program to support families of children under the age of 3 with delays or disabilities. We also became trained to look with a medical eye for the physical signs of child abuse. Did we ever find it? Unfortunately, yes. More often, however, I think we were able to alleviate the need for further examination with our knowledge and ensure children were being kept safe.
As we made our monthly or quarterly visits to families and saw these children, asking about their eating and sleeping habits, patterns started emerging: behaviors that appeared after visitation, eating problems with children who were neglected, sleeping issues in those who were abused. We saw many children who had developmental delays but did not make the 25% delay requirements of Birth to 3. Our visits started to include not only assurance that physical needs were being met, but providing information to enhance caregivers’ and case managers’ education about why our children were acting the way they were and how best to handle the issues, or giving reassurance that the right things were being done.
In January of last year, with the advent of Care4Kids, our roles began to change. Care4Kids is a Medicaid program that provides comprehensive and coordinated health care for children in out-of-home care. It uses primary care physicians who are trained in the needs of these children and creates a team of professionals who coordinate their care. No longer were we required to see all children under 3 on a regular basis, but we were expected to visit more often as needs arose. This has opened us up to a whole new world. Where there was some interdisciplinary collaboration before between nurses and case managers, now we work much closer with our case workers, as well as with mental health providers, educators, families and even legal parties. Now we go from zero through age 18 and into adulthood.
We read through medical records to clarify what the doctors are actually saying. We make medical recommendations based on those records. We navigate through psychotropic medications and the need for psychiatric care. We educate case managers, foster parents and biological parents on the needs of their children. We follow pregnant teens and make recommendations for care and resources. We team up with Care4Kids to ensure necessary follow-ups are happening. And we still assess for development in our younger children. And those behavioral patterns that we became aware of in our younger children when we first started visiting homes? We now have the ability to do social/emotional assessments to determine what children’s behaviors are, what they may be related to, and how we can best help them and the families they live with in alleviating these behaviors with recommendations to SaintA’s Caregiver Support and School Based Services staff, mental health and early education providers.
This does not encompass all that we do, but it’s a fair snapshot. We are a unique program, the only one like it in the country. We’re innovative and different, setting new standards for the care of children in child welfare. This is a small piece of what SaintA is all about.
When I answer the question of what I do, I usually don’t go into all these details. I may give them just a brief overview, or I may keep it simple and say I work with kids and their families. Above all else, when somebody asks me about my career, I say I love what I do. I can’t imagine doing anything else. Hard or not, I know I make a difference in the lives of many. I work with an amazing group of people, nurses and social workers alike, all of us dedicated to one of the most vulnerable populations identified.
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