April 19, 2019—When a child leaves their parents’ home and enters the foster care system, it’s often a challenge to maintain a sense of routine or normalcy, especially when it comes to health. It’s a reality that drives pediatrician Jessica Simkins, M.D. ’14, to work her hardest to provide regular, organized medical care for her patients at The Children’s Village, a foster care agency with medical clinics in New York City’s Harlem and The Bronx.

Simkins says The Children’s Village, which was founded in 1851, contains a full service medical home for newborns through 25-year-olds in foster care. Simkins provides vaccinations, chronic disease management, long-term health care and contraceptive care to a patient population with a higher than average risk of developmental delays and poor health outcomes due to trauma experienced early in life.

“If a child is in an environment where life isn’t stable—if they’re seeing violence at home or in the community or they’re being physically harmed—they don’t feel safe. If they don’t feel safe, they may be in fight or flight mode, focused on how to survive,” she says. “When you’re always in survival mode, it’s difficult to pay attention to what’s around you, to learn language, to connect words to objects, to use motor skills. They have difficulty forming healthy relationships and maintaining healthy boundaries. Often in their later years, they are labeled the bad kids in school. Their nervous system may be pre-wired to argue, fight, shut down or run out of the room when they feel threatened, and it affects every aspect of their lives. Once they reach the teenage years, it takes a long time and a lot of work to unlearn those behaviors. For some, that may never happen.”

However, Simkins says, children possess a resilience to overcome the effects of trauma, an outcome she hopes her work at The Children’s Village will produce.

“It’s not all doom and gloom,” she says. “If the child is taken out of the unsafe environment, they can recover those milestones and catch up. They can start to learn again. There may be long term health outcomes, but their brains can adapt very quickly. A positive, nurturing environment changes their trajectory significantly.”

In order to change the trajectories of her patients’ lives, Simkins aims to sift through the chaos to create a sense of safety through regular, compassionate care.

“These kids are often jumping from home to home. In between homes, they lose all their medications. We often see a child for an intake appointment, and we don’t have any family or personal history. We don’t know if they were on medications or had vaccinations, though we try to find that information,” she says. “It’s a lot of chaos that we try to organize to make sure we do the best possible job.”

She’s often asked if learning the backgrounds and past struggles of her patients forms the hardest part of her work at The Children’s Village, but for Simkins, knowing that she’s doing work that directly impacts a patient population who needs help most keeps her motivated on the toughest days.

“For me, as difficult as the children’s stories are to hear, I know that what we’re doing is so good for them,” Simkins says. “Having a place they and their parents can go to safely talk about whatever is going on with them helps me sleep at night. I know, even though they’ve gone through so much, we’re doing anything we can to get them back to their version of the most normal life they can have.”