Stepping stones to stability
Children in foster care often face instability. Through a growing network of clinics, the School of Nursing is building something these kids can count on — a path to better health
By Jessica Binkley Lain
In just five years as a designated Foster Care Center of Excellence, the School of Nursing’s Wellness 360 pediatric practice at UT Health San Antonio has expanded to six locations across South Texas, with a seventh clinic in development, providing vital health care to children in foster care and their families.
“It’s a center, but a center spread out,” said Karen Schwab, PhD, APRN, CPNP-PC, clinical associate professor and director of Wellness 360 pediatric services for the School of Nursing. “It’s really an infrastructure we’re building in the region so these kids can have a stable medical home, even if their placement changes.”
Superior HealthPlan designated UT Health San Antonio as a Foster Care Center of Excellence in December 2019. The School of Nursing’s Wellness 360 is one of only 10 such centers in Texas and the only one in South Texas. It remains distinct as the only nurse-led and managed Foster Care Center of Excellence in the state.
An evolving collaboration
The School of Nursing’s Wellness 360 serves the Texas Department of Family and Protective Service’s Region 8, where there are about 3,300 children in foster care. Since its designation, the program has expanded significantly to meet the needs of this population.
When it first became a Foster Care Center of Excellence, the nursing practice served 55 foster children; today, that number has grown to over 880, accounting for nearly 25% of the foster care population in the region. In 2023–2024 alone, the clinic conducted 4,800 visits and prevented 396 urgent care visits.
The program initially operated from the School of Nursing’s on-campus clinic, offering primary care to foster families. Over time, community providers sought partnerships, leading to on-site clinics at foster care facilities. In 2022, the school secured a four-year federal grant from the Health Resources and Services Administration to fund access to community-based health care for foster care children and their families across Region 8, allowing for expansion to six locations, with a mobile unit further extending care.
“It’s so rewarding. And it’s unfolded very organically,” said Schwab. “It’s kind of like crossing a river by hopping from rock to rock. We just keep jumping to the next one, and we’re always amazed the next rock is bigger and more stable.”
Accessible health for all
A key priority has been making health care more accessible and convenient for foster families, who are often facing challenges that make traditional health care hours and processes difficult.
“We do everything we can to make it easy to reduce skipped appointments and gaps in health care,” Schwab said. “So, instead of requiring multiple appointments for different concerns like asthma or ADHD, we strive to address all issues in one visit to ease the burden of taking time off work or arranging transportation.”
By providing in-house labs, the need for off-site visits is eliminated. Collaboration with behavioral health professionals ensures families can access necessary services without extensive travel. Offering extended hours and the ability to see multiple siblings at once also help to reduce logistical challenges.
Addressing the unique needs of foster children
Foster children often experience a range of complex health challenges. Many enter the system with chronic or untreated physical conditions, while others face developmental delays or significant mental health concerns.
Schwab explained that 35% of foster youth have ongoing physical health needs, 60% experience developmental delays and 90% have mental health conditions, often stemming from trauma. Older children, in particular, are more likely to exhibit PTSD-related behaviors as a result of their experiences.
“Children in foster care often experience a higher number of adverse childhood events. Entering into foster care is unfortunately a process that is inevitably going to cause some level of trauma,” she said.
Frequent placement changes can further disrupt a child’s well-being. On average, each relocation results in a six-month setback in their education, compounding the challenges they already face. Many endure multiple placement transitions, failed foster home placements or even unsuccessful adoptions, making stability in health care even more critical.
With multiple clinic locations, the School of Nursing’s Wellness 360 provides continuity of care despite these disruptions. A child who receives treatment at one clinic may later visit another, where staff recognize them and maintain seamless medical records. Improved communication between locations ensures that children do not miss specialty appointments or critical follow-ups. In group home settings, on-site nurses and nurse practitioners provide immediate health support, and after-hours care allows continued access to medical guidance outside of standard clinic hours.
“It’s kind of like crossing a river by hopping from rock to rock. We just keep jumping to the next one, and we’re always amazed the next rock is bigger and more stable.”
— Karen Schwab, PhD, APRN, CPNP-PC
A model for the future
Schwab and her team envision their work becoming a model for foster care health programs beyond Texas. Too often, health care is overlooked in placement decisions, even though placement changes can significantly impact a child’s well-being.
“We hope to create a model that improves health care for foster youth, not just in Texas but beyond,” said Schwab. “We are finally in positions where we can bring the health care perspective to the table and ensure it is considered in decisions about a child’s well-being.”
