2022 Edition

Family Foster Care and Kinship Care (CA-FKC) 11: Physical and Mental Healthcare

Children receive comprehensive healthcare services within appropriate timeframes to promote optimal physical, emotional, and developmental health.
NA The organization does not provide case management services for children.




Children in Family Foster Care and Kinship Care live in safe, stable, nurturing, and often temporary family settings that best provide the continuity of care to preserve relationships, promote well-being, and ensure permanency.
Examples: Providing children with a medical or health home, where care is provided by professionals with expertise on the issues of children in out-of-home care, can help to ensure that they receive comprehensive services that meet their needs.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Initial health screening procedures
  • Procedures for the coordination and provision of physical and mental health care assessments and services
  • List of health and mental care providers, with credentials
  • Informational health and wellness materials provided to children and youth

  • Interviews may include:
    • Program director
    • Relevant personnel
    • Resource parents
    • Parents served
    • Children and youth
  • Review case records

Fundamental Practice

CA-FKC 11.01

Prior to or within 72 hours of initial entry into the child welfare system children receive an initial health screening from a qualified medical practitioner to:
  1. identify health conditions that require immediate or prompt medical attention; 
  2. identify health conditions that should be considered in making placement decisions; and
  3. determine the need for developmental assessment for children under six.


The initial health screening for children entering the foster care system should only be conducted by a qualified medical practitioner. When possible, the screening should be performed by the child’s primary care physician who has knowledge of the child’s medical history, or a physician that can serve as the child’s medical home while in foster care. The screening may be completed by a nurse practitioner, registered nurse, or physician’s assistant if a physician is unavailable. 

For a rating of a 2, appropriately qualified and trained professional staff can administer a brief screening tool to determine if more immediate medical care is needed. The organization must demonstrate that:
  1. the screening tool was developed in collaboration with a qualified medical practitioner; 
  2. the tool and its administration are appropriately designed to be within the scope of the staff’s qualifications;
  3. staff are trained on administration of the tool and related procedures; and 
  4. procedures outline criteria for determining the need for and accessing medical care.


When the local child welfare authority is responsible for ensuring that the initial health screening occurs, the foster care organization must maintain documentation of the screening in order to ensure response to all conditions that affect placement decisions and conditions that require follow-up. The screening may be included in the assessment that occurs when a child is taken into custody following treatment at a hospital, clinic, or medical office.


Organizations should develop their own procedures, consistent with provincial, territorial, or local regulation, regarding whether it is appropriate for children in the temporary legal custody of kin to receive an initial health screening.
Examples: Conditions that require immediate or prompt medical attention include, but are not limited to: acute illnesses, chronic diseases requiring therapy, signs of abuse or neglect, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances. 


CA-FKC 11.02

Relevant information is shared with providers and resource parents as available and/or appropriate, concerning the child's:

  1. physical and mental health;
  2. family history;
  3. trauma history; and
  4. prescribed medications, including dosages, targeted symptoms, side effects, and monitoring processes for any psychotropic medications. 

Fundamental Practice

CA-FKC 11.03

Qualified professionals provide children with age-appropriate health services including: 
  1. comprehensive medical examinations within 30 days of entry into foster care and according to well child guidelines; 
  2. dental examinations for children over age three within 30 days of entry into foster care and every 6 months thereafter, or more frequently based on clinical need; 
  3. developmental screenings within 30 days of entry into foster care to identify the need for further assessment for children over age six; 
  4. ongoing developmental screenings according to well-child guidelines to identify the need for further assessment,
  5. alcohol and drug abuse screenings within 30 days of entry into care, and when indicated to identify the need for further diagnostic assessment; and 
  6. any services needed to address issues or conditions identified during health screenings, assessments, or examinations.


Medical assessments should include, as appropriate to children’s ages and circumstances: lead exposure, tuberculosis testing, and HIV/STD risk assessment screening. 


Regarding element (b), the organization can receive a rating of 2 if there is an annual preventive exam and evidence that recommendations from the dental care provider indicate children are not in need of more frequent care.

Fundamental Practice

CA-FKC 11.04

Children receive:
  1. mental health screenings within 30 days of entry into the child welfare system, and when indicated thereafter; and
  2. diagnostic mental health assessments, when indicated.


Initial screenings can be conducted by trained caseworkers, but follow-up mental health assessments should be provided by qualified mental health professionals. Screenings should include attention to trauma exposure and symptoms, and trauma-focused assessments should be provided when needed. When a child is in treatment foster care the diagnostic mental health assessment must occur within 30 days prior or subsequent to placement.

Fundamental Practice

CA-FKC 11.05

Qualified mental health professionals provide:

  1. any needed mental health services, including evidence-based psychosocial services and pharmacological treatments, as appropriate; and
  2. appropriate oversight of psychotropic medication use, including close supervision and monitoring of children receiving multiple medications or medications for off-label uses.


CA-FKC 11.06

Children receive age and developmentally appropriate support and education regarding: 
  1. proper nutrition and exercise;
  2. substance use and smoking;
  3. personal hygiene;
  4. safe and healthy relationships;
  5. sexual development;
  6. family planning and pregnancy options;
  7. pregnancy, prenatal care, and effective parenting; 
  8. prevention and treatment of sexually transmitted infections/diseases; and
  9. HIV/AIDS prevention.