As visitors poured in from around the world, Cook Children’s Health Care System provided top-notch medical care not just for residents, but for traveling fans with children who may have needed unexpected care. Cook Children’s treated more than 200 visiting families in its Urgent Care centers over the course of the event.

Between the heat and the fandom, the summer games would bring the health system launched the "World Cup Wednesday" public health series. For nine weeks leading up to the tournament, this series provided families with essential resources on injury prevention, heat and water safety tips, and more.

While soccer matches in North Texas have come to an end, the impact of keeping global and local visitors safe will live long after the fans have gone home.

The Cook Children's Fostering Health Program serves more than 2,000 children from across North Texas and as far west as Stephenville. In March, the Clinic helped more than 200 children, a record number for the program.

“Our clinic functions as a primary care medical home and offers complete health care for children in foster care through age 21,” said Brittany Schoonover, pediatric nurse practitioner for the Fostering Health Program.

It begins with trauma-informed care.

“We recognize when a child is removed from a home that in itself is trauma,” explained Keirsten Velez, LMSW, a social worker for the Fostering Health Program. “Sometimes we see the child the day after it happens, so our goal is to empower the child.”

That empowerment includes involving children in their own health journey while helping caregivers navigate the foster care system.

“There are a lot of nuances that come with providing medical care for a kiddo in foster care,” said Velez. “For example, most agencies require the foster parent to have a nine-page form completely filled out and signed at the end of every medical visit.”

Even before the first exam, the team works to fill the gaps in a child’s medical history by tracking down records from schools, hospitals and previous pediatricians.

“Often times we find fragmented care where the child had initial medical exams but often not follow up care,” explained Schoonover. “Our clinic is helpful to connect the dots and put the puzzle pieces together to be able to provide the best care for the child.”

Velez noted often placements occur with limited time or funds for foster parents to prepare for the child’s arrival. The team strives to address immediate needs, providing patients with essentials such as clothes, toys, and diapers, while also serving as a bridge to long-term support through Cook Children’s and community support.

“We try to make navigating the system easier for the caregivers,” said Velez, “We're kind of advocating alongside of them for what they may need.”

The support does not end when a child’s case closes. Schoonover and the team ensure continuity of care by providing families with information about new pediatricians and specialists.

“We’ll send over whatever they need to the new doctor, we want to keep the continuity of care that they have had here in their medical home,” said Velez.

That sense of urgency for these kids moved the state of Texas to pass a law in 2017 that made it mandatory for all children entering into conservatorship to have a medical exam within three business days after the child was removed from their home.

While the law is an important one to the well-being of the child, the reality of providing timely and thorough medical exams within three days proved to be a difficult task for many parents.

The exam is a medical screening that is intended to provide a baseline of a child’s physical health upon entering foster care. It is also an opportunity for the caregiver to obtain necessary treatment and medications for a child that may not have been obtained at the time of removal, such as an asthma inhaler or eczema cream.

The child abuse experts at Cook Children’s understood the need for foster parents in the community to meet the requirements of the state.

Jamye Coffman, M.D., medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect and the CARE team​, said it was clear there was an issue and Cook Children’s wanted to aide in the solution.

The result? The Cook Children’s Fostering Health clinic that launched in 2018. The clinic provides comprehensive services for all kids living with foster parents from foster infants to young adults, as well as foster children who have become parents.

Dr. Coffman says one of the goals of the clinic is to help foster parents better understand trauma behavior in children and to take more time with the families than just a quick appointment in a primary care office.

“We knew there was going to be a problem getting children into a clinic within three days, because they would be new patients with insurance and billing issues to figure out,” Dr. Coffman explained.

Cory and Maddie Churchman are foster parents who’ve brought four children through the clinic. The couple express their gratitude for the resource they say “has never failed them.”

“We know several families who’ve had to take their child to the emergency room or urgent care, just to have them seen within three days,” Maddie said.

The Churchman family says many offices won’t accept Medicaid insurance, or the office is full and not accepting new patients, so having the foster care clinic at Cook Children’s alleviates that stress.

The clinic allows an hour per visit for every patient they see. Dr. Coffman says this is important because evaluations usually take time because many children enter their new homes and the foster parents know little or nothing about the child.

“Before they even come in our door, we’ve already gathered medical records, immunization records and trauma history, and spoken with Child Protective Services (CPS) to help those parents transition,” Dr. Coffman explains.

The Churchmans say they are prime examples of not having any information on their children when they enter the home. The family adopted the first child they fostered, a one-year-old girl, and said they had doctors ask them for information they weren’t always able to provide.

“There are many doctors who don’t specialize in foster care who ask us as foster parents things we don’t know the answer to. We don’t know if they’re vaccinated or anything,” Maddie said. “We show up at the (Cook Children’s) clinic, and they’ve already looked into everything, which is a huge help.”

The Churchman family says they tell other foster parents to allow people to help you who are in place to do so.

“They saw a need and they are standing in the gap,” Maddie said. “I just want everyone to know they are there, they get it, and they really want to help you.”

The Churchman family is always eager to take their daughter back to see the staff when they have other appointments for their new foster placements.

“We are very grateful that they’re there for us and continue to do their jobs every single day,” Maddie said.

When Patti Wilson was pregnant with her daughter Melanie in 1980, health care and technology looked a whole lot different than it does today.

Routine sonograms did not exist and there was no way for expectant mothers to know whether anything was wrong with their baby until the child was born. Up until labor, Patti’s pregnancy had been text book and no one had any reason to suspect anything was wrong with Melanie.

However, on June 3, 1980, when Patti went into labor, everything changed.

Doctors began noticing Melanie’s heart would stop every time Patti had a contraction. They originally thought the umbilical cord was wrapped around Melanie’s neck, but after an emergency C-section was performed, Patti and her husband learned their newborn baby girl was facing a life-threatening diagnosis.

The day after Melanie was born; she was transferred to Cook Children’s, which was called Fort Worth Children’s at the time. The prognosis Melanie’s parents received was bleak.

At 5 days old, Melanie had her first heart catheterization. This first procedure allowed doctors to diagnose Melanie with a combination of congenital heart defects that included transposition of the great arteries, ventricular septal defect and pulmonary stenosis. She would need multiple procedures to fix the structural abnormalities in her heart but the catheterization temporarily fixed the problem to postpone surgery as long as possible.

Melanie was a year old when she had her first open heart surgery at Cook Children’s. The procedure was called the Rastelli procedure and the surgeon performing the surgery had practiced under Giancarlo Rastelli himself before coming to Cook Children’s. Throughout her life, Melanie had additional surgeries at 3, 10, 16 and 27 years old. She also underwent multiple heart catheterizations and procedures.

Over the years, Cook Children’s has become a home away from home and Cook Children’s cardiologist Richard Readinger,, M.D, , who has followed Melanie since she was 8 years old, feels more like a family member a doctor.

When asked about how her diagnosis affected her life as a child, Melanie said it was all she ever knew. She learned about her diagnosis as a child learns most things – by experiencing it as time goes on. At age 11, James “Hud” Allender, M.D., another Cook Children’s cardiologist, sat her down to explain that her mom may not always be with her if there is an emergency and she must know and understand her own diagnosis. It was at this point that Melanie remembers truly understanding what she had been coping with up until then.

Since her last procedure at age 27, Melanie has had no complications. Even though she’s an adult, she continues to be followed by cardiologists at Cook Children’s who are skilled in treating patients of all ages with congenital heart defects. With the continued advancements in pediatric cardiology, children with congenital heart defects are not only surviving, but growing up to become adults who lead rich, full lives. Cook Children’s Adult Congenital Heart Disease program is one of only a few formal programs nationwide to offer inpatient and outpatient care for patients from the moment they are born all the way into adulthood.

But the story doesn’t end there.

Due to Melanie’s diagnosis, she was told that pregnancy would likely be too risky. Her doctors were unsure if her heart would be strong enough to carry a baby to term.

But, some things are left to fate and Melanie began to have vivid dreams that she was feeding twin girls that she knew had to be her own. She would wake up absolutely bewildered because she knew it wasn’t a possibility. Fast forward a few weeks and Melanie and her husband found out the shocking news that she was pregnant.

Melanie immediately made an appointment with Dr. Readinger where he performed an EKG, echocardiogram and an exam and said, “It’s the strangest thing. Your heart appears to be in the best shape it’s ever been in. If you’re going to have a baby, now is the time.” The sonogram revealed that Melanie was actually pregnant with twins as her dreams suggested. Unfortunately the one baby’s heart never fully formed and at 8 weeks another sonogram revealed that the baby had been absorbed.

Having wanted to create a girl name from two men’s names, Melanie and her husband already had a plan when they found out 15 weeks into the pregnancy that they would have a baby girl. Rossleigh is named after her great grandfather, Ross, and her grandfather, David Lee.

Melanie’s pregnancy went smoothly physically, but it was incredibly draining emotionally. At the beginning, Melanie and her husband felt as if they were only receiving disheartening news. At week 18, the couple was informed that there was an issue with Rossleigh’s heart and the perinatologist could only see one kidney. Luckily, her second kidney would be detected on a later sonogram.

At week 22, a fetal echo was performed at Cook Children’s where cardiologists could diagnose Rossleigh’s heart defect while she was still inside Melanie. Fetal echocardiography didn’t exist when Melanie was born. A fetal echo allows doctors to see a baby’s heart while it’s still in the womb. Doctors can make the diagnosis and work with the surgical team to come up with a treatment plan even before birth. This technology gives the gift of time, both for the surgical team and for the family.

When the fetal echo was performed, Rossleigh was originally diagnosed with Truncus Arteriosus with a ventricular septal defect but at birth, that diagnosis would change.

Rossleigh Claire Dewey was born on Sept. 26, 2012 and was immediately transferred to the Neonatal Intensive Care Unit at Cook Children’s. An echocardiogram would show that her diagnosis was actually Tetralogy of Fallot and pulmonary atresia. Only five days after birth, Vincent Tam, M.D., Cook Children’s medical director of Cardiothoracic Surgery, operated on Rossleigh’s heart. She stayed in the hospital for 29 days, ironically, in the exact same surgery recovery room that Melanie had stayed in after her most recent surgery, and has had no procedures since. She could end up needing another procedure in her teenage years but right now, she is living life like any other 5 year old.

The bond between a mother and daughter is always special and unique, but Melanie and Rossleigh’s bond is even more unique because of their shared experiences.

These days, because both Melanie and Rossleigh are still being followed by Dr. Readinger, they have annual mother-daughter cardiology appointments. Melanie said that while one is getting their echo, the other will hang out in the waiting room and vice versa. A unique mother-daughter experience that most don’t have to share but they make the best out of a tough situation.

The Dewey family is forever grateful to Dr. Readinger and the care and compassion that he has shown both Melanie and Rossleigh throughout their medical journey. Melanie bragged on his ability to appropriately explain and literally sketch out the most complicated situations to both generations of heart patients.

Even though nearing retirement age, Dr. Readinger wanted to be the one to treat Rossleigh so that he could be involved in both of their care. He has made a great impact on their lives and the family is forever thankful.

As Melanie reflected back on everything she’s been through, she explained, “I have such a unique viewpoint going into this situation. I’ve been on both sides, as a patient who was scared to go into their own heart surgery, as well as the mom of a child with heart issues. Both are frightening in their own ways but I was able to gain the courage to push through these circumstances because of my faith and an amazing team of skilled doctors in nurses.”

As we look back over Cook Children’s 100 year history, Melanie’s story is proof of not only how many medical advancements have been made but how things are literally changing each and every day. If Melanie was born 10 years earlier, the Rastelli procedure wouldn’t have existed and she would have died as an infant. However, if she was born 10 years later, she would have been able to undergo a newer procedure, at the time, called the Nikaidoh procedure where they could easily switch the two sides of the heart. It’s likely she would have needed just the one surgery rather than five. Plus, she would have had the added benefit of the experience of Dr. Tam and Hisashi Nikaidoh, M.D, who created the procedure, and have the largest combined experience of aortic translocations in North America.

These advancements are even more apparent with Rossleigh’s journey thus far.

All of these medical advancements are not taken for granted at Cook Children’s and we know that we could not have made these strides without your help. Our generous donors and supportive community allow us to help Melanie and Rossleigh to live their lives to the fullest, despite their complications. As you join in our celebration of 100 years, remember who we are really celebrating – patients like Melanie and Rossleigh, and also, you. Thank you for being the 1 in our 100.

Celebrating Cook Children's Centennial

Cook Children's is turning 100 and will be celebrating all year! Don't miss out on the fun throughout 2018. Enjoy unique stories, parades, special guests, and community events across Fort Worth. We hope that you can share in some our celebrations because you're the 1 in our 100!

Celebrate with us

Sometimes you have to lay out the risks of not innovating to affect change. What are they?

1. Becoming obsolete. Someone will pass you up. It could be a digital health company, another health system or a small mom-and-pop clinic. If it’s a small, irrelevant business line it may not matter but what if you miss out on the next big thing.

2. Accepting status quo. A health system that isn’t looking to innovate or improve will miss out on delivering the best care possible. A culture of innovation and improvement helps to protect you from providing average or below average care.

3. Losing great personnel. Innovative and creative people need freedom to innovate. They need a structure to help them execute. If you don’t have freedom or structure, frustration sets in. When frustration sets in, those personnel with great ideas will get picked off.

Health care systems can innovate and they must in order to maintain relevancy in a rapidly changing and challenging landscape

I’d be hard pressed to compare waiting for a doctor’s appointment including an appointment with me to the anticipation of waiting in line for any Disney ride or show.

It happens that the question about Disney and healthcare actually crossed my mind in March. While checking in on Twitter, I came across an intriguing book mentioned by one of the folks whom I follow: @JohnNosta.

The skeptic in me wondered how the entertainment industry could have any relevance to health care. Fortunately, the curious skeptic in me decided to buy the book and learn more.

The author approaches healthcare from a business, non-physician perspective focused on serving patients and those who care for patients. I found some fresh perspectives that I think will help me going forward.

Here are three pearls that I got out of the book.

Pearl 1: A focus on loyalty and not satisfaction

Loyalty and trust are different from satisfaction. Loyalty is built on a consistent caring and engaged compassion. Loyalty is built in large part by creating a memorable event in a patient care experience.

Pearl 2: Courtesy is more important than efficiency

A commitment to courtesy both improves experience and can lead to opportunities for efficiency improvement.

A focus on the satisfaction and service for others in your institutional may improve responsiveness and lead to better sharing of resources.

Pearl 3: Create a climate of dissatisfaction

Dissatisfaction with the status quo combined with the dream for what can be are key ingredients in growth and improvement. Even when all measures are near the top, there will always be room for improvement.Final Thoughts

I don’t believe it’s completely valid to compare the work done by me and others at Cook Children’s to work done in other service fields. Stakes and expectations are much higher - solving a problem, managing chronic illness, fixing a hurt - than getting a Starbucks order right or the thrill of a roller coaster ride.

Still we are all compared to real life experiences. Waiting in line is seldom fun. And the ride is sometimes not a ride the child or family would choose. We can still strive to make the experience as pleasant as possible.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.

Hepatitis A is an infection of the liver. It can be passed easily from contaminated food, water or close contact with an infected person.

"Hepatitis A can cause outbreaks in day care which infect many children and last for several months,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “Good hand washing techniques can prevent outbreaks and decrease the spread of the disease, but the best protection for your child is to have them vaccinated.”

Hepatitis A usually goes away on its own within two months. There are no lasting effects in most once the infection passes. Symptoms include:

• Tiredness
• Loss of appetite
• Fever
• Nausea and vomiting
• Abdominal pain or discomfort
• Yellowing of the eyes and skin—jaundice
• Darker colored urine
• Light or chalky colored stools
• Rash

Medical treatments that may help prevent infection include:

• Immune (Gamma) Globulin—temporary protection from hepatitis A. It can last about 3-6 months. It must be given before exposure to the virus or within 2 weeks after exposure.
• Hepatitis A vaccine—highly effective in preventing infection. It provides full protection 4 weeks after the first injection. A second injection provides long-term protection. The vaccine should be considered for:

• All children aged 12-23 months.
• Children aged 24 months or older who are at high risk and have not been previously vaccinated.
• People traveling to areas where hepatitis A is prevalent (The Centers for Disease Control and Prevention's http://wwwnc.cdc.gov/travel/ shows which areas have a high prevalence of hepatitis A).
• People with chronic liver disease.
• People with blood-clotting disorders, such as hemophilia. 
• People who desire immunity to hepatitis A.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.