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.

Despite a recognized need, the majority of families at Cook Children’s are unable to access legal services. Social workers at the medical center are often contacted by patient families who have been unsuccessful in qualifying for public benefits, obtaining a guardianship for their incapacitated adult child or communicating with their landlord to remediate unsafe housing issues. These social, economic and environmental factors have a direct impact on a child’s health.

“The health and wellbeing of our patients is impacted by so many factors beyond the scope of traditional medical care,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “Having an accessible, dedicated resource for our families to turn to for assistance in navigating their legal challenges will be an invaluable addition to the family-centered care we strive to provide every day.”

The medical-legal partnership allows law students the opportunity to develop and apply their skills on behalf of clients who cannot afford legal representation.

“We are giving these children and their families a chance of success by increasing their quality of life by decreasing their unresolved legal needs,” said Robert B. Ahdieh, dean of Texas A&M School of Law.

The collaboration, which officially launched in March 2020, has already assisted dozens of patient families. Felicia Carey is one of the program’s first clients. She was referred to the TAMU Law after her sister passed away, leaving her to care for three teenagers, including a niece diagnosed with spina bifida.

“At first it was very difficult because I lost the paperwork that allowed me guardianship so I could take the children to the doctor,” said Carey. “A social worker at Cook Children’s referred me to the program and it’s been phenomenal. They made a process, which was unbearable, extremely easy.”

Since finalizing her guardianship issues, Carey is now working with TAMU Law on an adult adoption, veterans benefits and developing her will. The program also provides patients and families with access to legal services in family law, housing and public benefits.

“Our job is to prepare compassionate lawyers who will advocate tirelessly for their clients. That’s what sets Texas A&M Law a part from other law schools. We embody our core values, especially selfless service,” said Ahdieh.

The Texas Department of Public Safety will be responsible for the licensing of at least three dispensing organizations by Sept. 1, 2017 before CBD will be available for patients.

CBD is the non-euphoric component of marijuana and contains no psychoactive properties, so it doesn’t produce a “high.” CBD is not administered by children smoking. It is typically formulated into an oil-based liquid so it can be given by mouth.

Texas agencies will regulate the distribution of the oils to patients whose symptoms have not responded to available treatments and the risks of treatment are outweighed by the potential benefits, according to their epileptologist. The treatment has to be agreed upon by two epileptologists before CBD can be administered.

M. Scott Perry, M.D., medical director of the Epilepsy Monitoring Unit and Tuberous Sclerosis Complex Clinic at Cook Children’s, estimates he discusses with parents and patients the pros and cons of marijuana use for epilepsy three or four times a day at minimum.

Dr. Perry said families are looking for any therapy that works for their child’s uncontrolled seizures once other options have failed, and some have either left the state or had plans on leaving Texas if the bill didn’t become law.

“I think we have seen enough in the other states that have already made CBD available to understand there is potential benefit to CBD use,” Dr. Perry said. “From what we’ve seen in the medical community so far, it’s very encouraging, but more research still needs to be done before CBD is a treatment of choice for most patients with epilepsy. For now, CBD may provide benefit for a small population with intractable (unmanageable) epilepsy, in which other treatments have been unhelpful. I’m glad that this bill will now afford me the same opportunity as other physicians in my field to prescribe CBD to this population of patients in Texas.”