Improving Timeliness of Medical Evaluations for Children Entering Foster Care

Abstract

BACKGROUND AND OBJECTIVES:The American Academy of Pediatrics (AAP) recommends children in foster care (FC) have an initial medical evaluation within 3 days of custody initiation; however, this vulnerable population often suffers from disjointed care. Our aim was to improve the mean time to initial foster care evaluation (TIE) from 32 to <7 days within 12 months for children in FC in Durham County, North Carolina. METHODS:This study was a time series, quality improvement project used to target interventions within an academic clinic and a community agency. Interventions were tested through multiple plan-do-study-act cycles. Control charts of the primary outcome, the TIE, were constructed. Charts were annotated with the dates of interventions, including workshops, performance feedback, integration of state forms, identification of appointments, development of an urgent appointment pathway, and empowerment of the scheduler. RESULTS:The mean TIE improved from 32 to 9 days within 12 months. Significant improvement in the following 2 process measures contributed to this: the time from custody initiation to the referral date improved from an average of 10 to 3 days, and the time from referral date to the initial evaluation improved from an average of 22 to 6 days. CONCLUSIONS: Improvement interventions and increased collaboration between medical and child welfare agencies can result in significant improvement of the TIE. However, despite improvement efforts, challenges remain in meeting the AAP 3-day TIE recommendation. We recommend further assessment of the AAP guideline as it relates to implementation feasibility and health outcomes of children in FC.

Learning Collaborative Events With Child Welfare and Health Care Providers Improve Systems Knowledge and Intent to Change

“…The physician interview data indicated that physicians passed the knowledge they gained from the events to colleagues, thus expanding the reach of practice change beyond those who attended the events. These results are consistent with the findings by Terrell et al 12 which showed that a learning collaborative involving child welfare personnel and a single pediatric practice helped to identify communication gaps and improve the time to initial examination for children new to foster care.…”

“…The physician interview data indicated that physicians passed the knowledge they gained from the events to colleagues, thus expanding the reach of practice change beyond those who attended the events. These results are consistent with the findings by Terrell et al 12 which showed that a learning collaborative involving child welfare personnel and a single pediatric practice helped to identify communication gaps and improve the time to initial examination for children new to foster care. The results from this project highlight the capacity for even a brief (2 session) learning collaborative process to improve knowledge about the health care needs of children in foster care, understanding of the challenges developing a coordinated system to serve these children and to begin the process of practice change.…”

“…Despite such efforts, evidence shows persisting gaps in achieving health care benchmarks for children in foster care. 10 - 12 National trends are reflected in some of the challenges faced by states, including ensuring seamless insurance coverage during the transition into foster care, maximizing the access pathways to health care providers, supporting foster caregivers in making and keeping appointments and ensuring effective health information transfer. 2 , 10 The Michigan Department of Health and Human Services (MDHHS) engages its internal departments and divisions and external community partners to address these barriers to timely, comprehensive, and quality health care for children.…”

Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports

“…Case reviews of child deaths highlight that early recognition of needs and safeguarding intervention can dramatically improve outcomes for vulnerable children by removing them from harmful and violent home environments and providing extra support in the home 30. Terrell et al highlight similar challenges with the provision of timely health assessments for looked-after children in the USA, as a result of issues coordinating care, incomplete and delayed referrals for assessment, documentation issues and appointment availability 31…”

Identifying Children in Foster Care and Improving Foster Care Documentation in Primary Care

“…[2][3][4][5][6][7][8][9][10][11][12] Recognizing that this population has more intensive healthcare needs, the American Academy of patient in FC, as they are a FC-specific clinic. 21 Delivering high-quality care that follows the standards is simplified in counties or states with systems to identify CYFC and consolidate care to specialized FC-specific clinics. In contrast, it is challenging to identify patients in FC where care is dispersed across numerous primary care clinics and where providers may not be routinely notified when patients enter or exit FC.…”