Teaching Doctors Patient Care

By Dr. Alexándrea Evans Oneal

The American Academy of Pediatrics classifies youth in foster care as “children with special health care needs” due to the high prevalence of mental health, chronic illness and developmental concerns compared to children in the general population.

When caring for adults who grew up in foster care or were adopted, medical providers must consider the impact of adverse childhood experiences such as abuse, neglect, household challenges, separation from family, mental illness, physical neglect, domestic violence as well as housing insecurity, before making medical or emotional healthcare decisions.

Traditional medical and graduate school curricula do not typically include coursework about caring for systems-involved children.

In 2020, I developed and conducted a series of training seminars for medical and healthcare professionals after observing the absence of information on the foster and adoptive communities in their training catalogs.

The purpose of the seminars is to educate the medical community on how to interact in an affirming manner to create an environment where patients feel safe to discuss their biological history. The seminars also cover navigating the concerns, behaviors and worries which often present within patient-doctor interactions.

In my own training to become a psychologist, the coursework included considerations for diverse communities, but failed to provide guidance (or even mention) on the needs of those who have experienced adoption or foster care.

Without knowledge of the special concerns of these two populations, doctors are ill-prepared to fully address their needs. This lack of knowledge could have severe or even deadly consequences. For many, continuity of medical, psychological or even dental care is rare as children move through the child welfare system.

The lack of paperwork or a fragmented medical history often leads to a fabricated narrative weaved together from bits and pieces of their caretakers’ health histories.

They frequently tell this story to themselves and to others in order to feel “normal,” when responding to medical questions. The result is children often feel ashamed of their circumstances during routine exams.

Resource parents, who often receive limited details of a child’s medical history and even less about the biological family, are the first line of defense when it comes to accessing these missing or misplaced records, and incomplete or inaccurate information.

Without that information, it’s difficult for caregivers to address or get ahead of any medical or mental health risks.

It’s why I’ve advocated for a confidential national database accessible only by child welfare workers or agencies.

In the absence of such a tracking system, it’s nearly impossible to monitor or detect potential new medical issues. In this case, knowledge is a privilege the general population takes for granted.

The issue of inadequate care for youth is further compounded by how little medical professionals know about foster care and adoption in general. It’s become common after the presentations for participants to confess their medical training never covered the topic, although a few admit to having a family member in the system or a distant relative adopted into the family.

One doctor bravely confessed saying, “The only thing I know about this population is having a family member who was adopted or in the system. They talk about challenges, and even as the only doctor in my family, I realize now I don’t even know what to say or how to guide them.”

Without fail, I’m frequently asked to explain the difference between foster care and adoption.

Attendees who regularly work with systems-involved youth reported they received the greatest amount of training. However, as the child transitioned into adulthood, the connection between the patient and doctor was lost, along with much of the child’s medical history.

When 6% of all children in the United States find themselves in the foster care system before they turn 18 and one out of every 25 U.S. families with children have an adopted child, it’s incomprehensible why the professionals at these highly competitive and world-renowned medical facilities refer to these seminars as the first of its kind. The medical system must, and can, do better.

Talking with a New Provider

Of the hundreds of adoptees and youth in care I’ve interviewed, each reports they felt “anxious” before and during medical appointments. The reason: when handed a stack of papers or an electronic tablet to provide medical history information, there’s rarely a place to indicate one’s adoption or foster care status or history.  This crucial information could help the medical provider know how to approach care and apprise them of prior healthcare treatments and providers.

Resource parents are advocates for their child’s healthcare needs. If a  provider doesn’t ask standard questions such as “Are there any major illnesses, conditions or diagnoses that run in your family,?” be prepared to speak up. Prepare follow-up questions for the provider as well, such as, “How will this medication interfere with the medication my child is already taking?”

If your child’s provider fails to ask follow-up or open-ended questions of your child, your child may interpret this as a lack of interest in one of the major aspects that make up their entire life and identity.

Healthcare providers must also recognize and acknowledge the wide range of emotions and feelings that may present when asking a young adult about their family history. Tears should be expected, while other young patients may come across as timid or impersonal as they struggle with internal fear, anxiety, shame and guilt because of their inability to report any medical history.

What You Should Know & Do

  • Ensure the child’s caseworker is up to date on changes in medical treatments, medications, vaccinations, care providers and recurring symptoms.
  • If age appropriate, have a conversation with your child about disclosing their living situation with health care providers. Be patient and explain why this is important. For example, note if there is an unsafe environment, abuse, or lack of basic needs, including food and hygiene products.
  • Whenever possible, share updated information with the child’s first family, especially if reunification is the goal.
  • As the child gets older and prepares to transition to a new family or out of care, make time to discuss their medical history, and make them aware the providers they had in foster care may not be the same providers as they prepare for independence. You can help young adults succeed by providing a complete copy of their medical history and discussing the importance of self-advocacy.

What Medical Professionals Can Do

  • Request your institution include information on these populations in the curriculum. Educational curriculums are often out-of-date and do not meet the needs of the community unless requested.
  • Seek out opportunities during your training to work with both children in foster care and adult adoptees. Regardless of your specialization, children in foster care and adoptees all begin as children and may eventually step into your clinical room as adults.
  • Enroll in training courses to enhance your understanding of the lived experiences of the adoption and foster care community.
  • Seek out clinicians who specialize in the care of these communities and consult as needed to ensure competent and thorough care of your patients.
  • Be willing to ask each patient about their family system growing up to allow space for the patient to feel comfortable with bringing up potentially difficult topics and history. Be prepared to take extra time to discuss symptoms and support establishing a medical history from current reports of physical and mental health concerns. •


Alexándrea Evans Oneal, Psy.D. is a multi-racial adoptee, whose clinical practice expertly serves families, couples and individuals. Dr. A, as she is known affectionately by her patients and clients, is a family support specialist in the areas of foster, kinship and adoptive family systems, family dynamics, life transitions, academic concerns, work stress, trauma and grief, and loss. Dr. A is also a certified life, health and wellness coach whose practice has expanded to treat her patients holistically. Her approach addresses an individual’s physical, emotional, social, spiritual and mental well-being.