Innovative Pediatric Nursing Role: Public Health Nurses in Child Welfare

Janet U. Schneiderman


Pediatr Nurs. 2006;32(4):317-321. 

In This Article

Theoretical Framework for Health Case Management Role

The difficulties meeting the health care needs of foster care children and the proposed solutions call for a more comprehensive way of looking at health and health care. Viewing health issues from a Social Ecological Model accounts for both the causes of illness and proposes new ways to promote holistic health, prevent illness, and treat patients. The emphasis is caring for individuals, families, and communities prior to their descent into illness (called upstream thinking) (Butterfield, 1990). This model takes into account age, gender, race, ethnicity, and socioeconomic differences that affect how individuals function and grow, and therefore directly and indirectly influence heath risks and resources (Institute of Medicine, 2000). The environment (social, political, and economic) is an important part of the equation in determining health in the Social Ecological Model (Lomas, 1998). These demographic and societal issues are some of the same causes of the burgeoning population of foster care children.

The Public Health Interventions Model described by the Minnesota Department of Health (2000) operationalizes the Social Ecology Model for public health nurses, including foster care nurses. This intervention model focuses on the broad determinants of health such as income, social status, housing, food security, social support networks, education, neighborhood safety, cultural customs, and community capacity of support family, as well as on prevention. The social, political, and economic environments of the Social Ecological Health Model are the same as the broad determinants of health in the Minnesota Model. The practice arena of the nursing interventions includes individual and family, community, and system-wide. The Minnesota Model is incorporated into the public health nursing practice model adopted by Los Angeles County Public Health Nursing Department (Smith & Bazini-Barakat, 2003).

The Public Health Intervention Model, often called the Wheel because of its shape, specifies 17 interventions that are independent functions of the public health nurse (see Table 2 ). The model focuses on populations, identification of the at-risk groups, and assessment of health status to determine health needs. The Wheel has five related categories. Case finding is part of the interventions of surveillance, disease investigation, outreach, and screening. Case management is related to referral and follow-up, counseling, and consultation. Community focuses interventions include collaboration, coalition building, and community organization. The fifth category of system-focused interventions includes advocacy, social marketing, and policy development and enforcement (Minnesota Department of Health, 2000).

The new foster care nurses have the opportunity to address some of the concerns raised in reports criticizing the existing system of health care delivery to foster care children within California (Department of Health Services: Little Hoover Commission Report, 1999; Institute for Research on Women and Families, 1998). The nurses' ability to meet the health care needs of this vulnerable population will depend on their ability to function in their case management role and chose applicable interventions. The Minnesota Public Health Intervention Model provides a powerful framework for nurses to deliver care to foster children.


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