1. Foster Care and HIV Presentation for the NYC DOHMH HIV Planning Council April 8, 2009 Sally Serio, Program Director Pediatric AIDS Unit NYC Children’s Services

2. New York City Children’s Services Mission: to ensure the safety and well-being of New York City children.

3. Services Provided Child Care and Head Start Preventive care Foster care

4. Kids in Foster Care with HIV

5. Statistics: (as of 12/31/2007) Number Infected: 98 Source of Infection: Perinatal: 86% Consensual Sex: 10% Sexual Abuse: 4%

6. Statistics: (as of 12/31/2007) Gender: –Female:54% –Male: 46% Race/Ethnicity: –Black: 62% –Hispanic: 31% –White: 5% –Mixed: 1% –Unreported: 1%

7. Statistics: Age (as of 12/31/2007)

8. HIV Testing Current Policy – HIV testing recommended to all children and youth who have an identified risk factor –Risk assessment is done at the foster care agencies every six months –Newborn screening report for infants and young children –Policy is based upon old state regulations

9. HIV Testing New Policy (soon to be released) – Voluntary HIV testing recommended for all youth, regardless of risk assessment, during annual physical check-up, and on an as- needed basis if concern about exposure exists –Voluntary HIV testing offered at Children’s Center

10. HIV Prevention: ACS Initiatives Condom distribution HIV education for ACS and staff members at foster care agencies –Semi-annual Meetings –Quarterly Trainings of medical staff working in foster care agencies –Monitor agencies: staff and foster parent training

11. HIV Prevention: ACS Initiatives HIV Prevention Workgroup –Power Through Choices HIV Testing –Expanded voluntary testing of adolescents –Monitoring agencies Revised HIV Policy Bulletin

12. HIV Prevention: Agency Initiatives Medical Department Sexual Health: one-on-one by nurses

13. HIV Prevention: Agency Initiatives Independent Living Program (ILP) Workshops on issues such as budgeting, housing applications, how to start a bank account, as well as sexual health and substance abuse – things they need to know when adolescents age out of care Outside providers frequently utilized for sexual health component skits and weekend retreats Attendance voluntary, not mandatory

14. Discharge Planning General Rule: Children discharged on 21 st birthday, but can discharge themselves once they reach age 18 Vocational, educational, housing, medical component involved, as is linkage to neighborhood resources –Medical Component: physical check-up before final discharge, identifying medical provider to follow up after discharge, and insurance

15. Discharge Planning Procrastination by some youth complicates the process. Per ACS mandate: discharge does occur until a place is found. Trial Discharge: agency follow-up continues for 3 months. Preventive follow- up care lasts longer. Final Discharge: formal follow-up with agencies ends.

16. AWOL ACS mandates that children are not discharged from foster care until a place for them to go is found. The one exception to this is that sometimes youth go AWOL, and if they are AWOL for a very long time and agencies are unable to locate them, then the youth can be discharged from an agency.

17. AWOL Where do kids go? –Extended family, friends, girl and boyfriend’s place, sometimes unknown What do agencies do to find them? –Family court or missing person warrant –Follow-up with families and friends –Some agencies using face book to help locate AWOLed kids

18. AWOL When kids return to foster care… –Medical evaluation and clearance by nurse or physician. Evaluation may include HIV and syphilis testing. What do agencies do to prevent its reoccurrence? –When kids return, case workers talk with them to identify issues that caused AWOL and develop strategies to stabilize placement

19. AWOL How big of an issue is this? –It’s big according to most agencies… Not necessarily in numbers, One agency reported a small group of chronic AWOLers One agency noted that the kids that go AWOL were the ones that they were most concerned about because of mental health issues Several agencies noted AWOL particularly problematic in group residences

20. NY/NY III Housing New program that was started about 1-1/2 years ago and is still evolving Includes 9,000 beds total for families and individuals throughout the city Of these, 250-300 are set aside for children discharged from foster care

21. NY/NY III Housing Eligibility Kids aging out of foster care Those who have been in foster care within the previous 2 years Those who are in foster care for 1 year after their 16 th birthday Prior criminal record history is not a disqualifier –Exceptions: Sex offenders and fire starters are disqualified

22. NY/NY III Housing Application Requirements Psychosocial evaluation required Mental health and drug abuse applicants are directed into a more restrictive settings

23. NY/NY III Housing Availability At present, 143 beds are available; 114 of which are being utilized 117 additional beds will become available shortly

24. NY/NY III Housing Participating Agencies: Current: SCO Family of Services NY Foundling Lantern Group Neighborhood Coalition Chelsea Foyer Pending: St. Vincent’s The Door Lantern Group (more beds being added)

25. The Intersection: HIV & Foster Care Our statistics –Infection rate less than 1% of children placed in foster care and not absent from care –Percentage is surprisingly low for this population

26. The Intersection: HIV & Foster Care HEAT Program –Large portion of kids at clinic have or have had experience with child welfare system Questions: –Placed or tracked by ACS? –Infected before or after discharge from ACS? –Behaviorally vs. perinatally infected? –History of AWOL? –At what age were they discharged? –Where were they discharged to?

27. Thoughts About RFPs ACS –Pilot of Power through Choices (ACS or CDHS?) –Housing Unit Foster Care Agencies –Health educators that can work on behavioral issues as well as provide sex education (which kids are currently receiving) –Summer youth programs/year-round recreation programs –Funding to pay staff overtime to work evenings and on weekends

28. ACS’ RFP ( R equest f or P arents) We need foster and adoptive parents! If you are interested, or know anyone who would be interested, please let me know.

29. Thanks!