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Putting the Care in Foster Care

When Sara Goscha was 8, her mother took her and her sister away from the home she knew. In the time that followed, she experienced poverty and food insecurity on top of emotional and physical abuse.

“She used to leave me on the side of the road a lot because she didn’t really want me,” Sara said. “I didn’t think anyone would love me. When your own mother doesn’t love you, you begin to wonder if anyone can.”


Despite her struggles, Sara calls herself one of the “lucky” ones. At 15, she was finally able to disclose to her father the abuse that took place. He took her back into his home – Sara calls it a rescue – to give her unconditional love and support. Now, as the director of foster care for UnitedHealthcare Community & State, she’s taking that experience and advocating for foster care children to help them find their way.

Though she wasn’t in foster care herself, Sara shares her story to demonstrate how kids in tough situations show resiliency every day, particularly in a complicated system like foster care, where people from many types of organizations come together to support kids who need it.

“(That includes) being part of that larger ecosystem and eco-map of people that wrap around the child,” Sara said. “We have to get to the right person to help coordinate the care. We have to use all the data and things we know about the child to make good decisions.”

This eco-map includes the biological family, court system, UnitedHealthcare, education, other human service agencies, medical providers, behavioral health providers, child welfare system and the foster family. 

UnitedHealthcare serves more than 65,000 foster care children in 13 states. This includes children who were adopted but still receive services until the age of 18 from whole teams of case managers, nurses and care coordinators. These teams serve and advocate for children with extremely complex needs. According to Sara, kids in foster care nationally account for 4% of the Medicaid population, but make up 15% of the cost.

“We’re really focused on quality outcomes for these kids, and not just changing how we care for them, but improving their lives every day,” she said.

For UnitedHealthcare, it’s first a clinical model that puts the foster kids at the center. By anchoring the child’s experience in a dedicated and integrated model of trauma-informed care, one assumes that all children in the foster care system have experienced trauma at some level.

Trauma creates barriers to care, and it requires sensitivity to help prevent re-traumatization.

“We have to be able to say that our systems and our system partners understand that trauma and know where those kids are coming from,” Sara said. “When they actually give treatment, they know it might not be appropriate to put a stethoscope on a child’s back because they were hit there. And they might have to find other ways to talk to the child because a voice may remind them of something that happened in their childhood.”

Besides this emphasis on trauma, UnitedHealthcare’s model also puts a priority on:

  • Making sure transitions in care are as seamless as possible for the child.
  • Identifying risk factors for children so they receive the right care with a dedicated team.
  • Keeping kids safe from being overprescribed mood-altering drugs without oversight.

No one organization can do it alone, and that’s why partnerships can be so transformative. UnitedHealthcare’s partnership with the National Foster Parent Association has led to training programs for foster parents so they feel supported as well, which means better outcomes for the children.

“You can’t provide well-being if you don’t have well-being,” said Irene Clements, executive director of the National Foster Parent Association. “And that’s what we’re supposed to be doing for these children who join our families.”

As for Sara, the opportunity to give back has been powerful.

“We survive it, we thrive in it, and then we find places where we can help others. Foster kids are the ones who are going to grow up and be the adults that take on the world,” she said. “So we have to make sure they have the care they need.”

Visit UnitedHealthcare Community & State to learn more about UnitedHealthcare’s partnership and trainings with the National Foster Parent Association.