There's a special clinic that could hold the key to helping Iowa's troubled foster kids

Walk around this third-floor clinic at Blank Children’s Hospital and you can't help but think: What if?

What if the social workers or police who first connected with Natalie Finn or Sabrina Ray or Malayia Knapp and their siblings in foster care insisted they come here: A clinic designed to treat the special medical and mental health needs of children in Iowa’s child-welfare system?

If you are a social worker, a lawyer, a prosecutor, a judge, a teacher or a parent who works with foster children in central Iowa, you should know about Blank's Foster Care Clinic.

Now a year old, the clinic is housed in the hospital’s STAR Center, which provides child advocacy, forensic interviews, services for drug-endangered children, and health and nutrition counseling for children failing to thrive.

Formerly called the Regional Child Protective Center, the STAR Center long has been a place where child-protective workers could refer abused children for physical exams after they are removed

from homes, or examine them after allegations of sexual abuse or assaults.

But the STAR Center's mission is now boarder than that. And the foster-care clinic provides primary care, mental health assessments, therapy, educational support and more coordinated care with the families’ regular providers.

It’s an incredible but still little-known resource in a state where many parents — birth, foster and adoptive — often lack help to deal with the real and varied needs of traumatized children.

Only about 80 children have been seen at the clinic in the past year, even as central Iowa has thousands of children in foster care and post-adoptive homes.

"We noticed in doing exams of these children that they would have unmet dental health needs, medical needs, mental health needs, and we used to just send them out in the community," said Dr. Ken McCann, the pediatrician who began the clinic. “We found this is a population of children that really needed more than maybe what was available in your general pediatric or general family practice clinic."

Children brought to the STAR Center are examined and, if necessary, interviewed. But the staff at the foster clinic provides ongoing medical care and works with parents and foster parents until after the child is placed back home or is adopted. 

Families aren’t rushed through visits. Sometimes, they will stay hours, as the clinic’s staff assess a child’s medical and mental health needs.

And because the center is supported by private donations from partners such as the Community Foundation of Greater Des Moines and the children are covered by Medicaid, ongoing services such as therapy are free.

Children in foster care are classified by the American Academy of Pediatrics as a population with special health care needs. The clinic follows the academy’s recommendations to see the children twice as often as others their age to better address their care.

Some 80 percent of children entering foster care having at least one unmet medical or mental health need.

Maybe the child has never seen a dentist. Maybe she hasn’t had regular medication to treat asthma or eczema.

Or maybe, as often is the case, she can’t seem to regulate her emotions or differentiate between wants and needs.

"They may have behavior issues in school and social problems, so they don’t have a lot of friends. Things may snowball from there," said Renae Jones, the clinic's mental health therapist. "We try to teach that it's the trauma, not the child."

Talk to people like Sue Renfrow, whose West Des Moines agency is one of the primary providers of parenting classes in the metro, and you learn parents accused of abuse and neglect love their children, but they have almost always suffered multiple traumas, too.

"In a dangerous situation, kids have to be removed. But it's really traumatic for them, and I don't think we look at that enough," said Renfrow, who runs Parenting Way Inc. "When the children don't get to go back home, there's trauma that we see years later."

The behavior and outbursts that come with that trauma can cause parents, relatives and educators to give up on a foster child.

But staff at the Foster Care Clinic can work with those who live and work with the child to help build skills to be more successful. Jones said she is often playing a part in family team meetings with social service providers and educators to help the children adjust.

“When there’s a punitive approach, they develop negative beliefs about themselves and that, ‘I’m just not a good kid.’ And that can be self-fulfilling,” Jones said. “So we really work on being nurturing, identifying feelings, developing calm-down plans.”

The goal is to learn how to keep foster children in a “window of tolerance” so they are not escalating situations or “go flat” and become disassociated, failing to absorb what’s going on around them.

Colin Witt, a juvenile judge in Polk County, said Blank's decision to give the STAR Center a broader mission was a good thing.

But the new foster center is not being used as a resource as much as it should be — in part because the old regional child abuse center was used primarily after emergencies involving child removal.

"There is probably need for greater coordination and collaboration," he said. "(Polk's juvenile judges) are trying to have a meeting with them in two months. So many of our kids are involved there. … This is going to help us focus on all of them for longer periods of time."

Other options, other results?

So, imagine if Natalie Finn and her siblings had been brought to such a clinic years ago — after their birth parents were first accused of child abuse.

Or what if Nicole Finn, convicted of Natalie's murder, would have relied on the clinic's staff for guidance on how to better cope with the unique and sometimes difficult children she and her ex-husband chose to adopt.

Imagine what might be different if a social worker, prosecutor or juvenile judge insisted Natalie be examined at the clinic when a high school nurse and principal reported last year that she was begging for food and appeared underweight.

Who would be likely to be better able to get to the bottom of things if Nicole Finn claimed her 16-year-old adoptive daughter was eating too much, hoarding food or had an eating disorder?

If the Finn teens needed to be interviewed about the child abuse perpetrated against them, wouldn't that be better to do it in a place where they could be recorded and observed by a police officer and social worker listening from behind a double mirror?

And most importantly, what if more of those responding to foster kids' needs saw them more often, had specialized training and worked from the same page?

What if.

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Contact her at lrood@dmreg.com, 515-284-8549 on Twitter @leerood or at Facebook.com/readerswatchdog.