O4306: Development of a Foster Care Clinic Within a Large Urban Academic Primary Care Practice

Purpose/Objectives: Children in foster care represent a population with considerable, often unmet, physical and mental health needs. At a large urban academic primary care practice, the ACTION (All Children Thrive in Our Neighborhood) Foster Care Clinic was established in September 2020. The program's mission is to provide holistic care to foster, kinship and biological families with the goal of creating a safe, stable, nurturing environment for children while they are in foster care and upon reunification. This is achieved by providing primary care as prescribed by the AAP Fostering Health standards of care, dedicated screening for signs of trauma and resilience factors, and anticipatory guidance specific to children in foster care. Electronic medical record (EMR) data was used to characterize the foster care population at the practice.

Design/Methods: Patients seen for office visits from October 2019-October 2022 age 21 and under were queried for any of the following criteria: a set of eight ICD-10 codes for foster care, encounters at the institution’s Fostering Health Program, patient relation listed as child welfare agency or foster parent, or address listed as headquarters for the local child welfare agency. A retrospective chart review was conducted one year after the initial ACTION clinic visit for 20 consecutive patients seen between March and June 2021.

Results: Of approximately 30,000 patients at the practice, 2,621 patients met any of the search parameters, accounting for 8.7% of the total practice population having experienced foster care. Only 37% (975/2621) of patients in foster care were up to date on routine well visits. Between September 2020 and March 2023, 104 patients were seen in ACTION Clinic. In the ACTION patient sample, 80% (16/20) of patients had mental health needs at their initial visit, but one year later only 38% (6/16) of those patients were receiving services. 60% (12/20) of ACTION patients had educational difficulties at their initial visit, but only 50% (6/12) of those patients were receiving services one year later.

Conclusion/Discussion: ACTION Clinic serves a small portion of a sizeable number of foster care patients at the practice. Substantial gaps in routine care were present. Additionally, lack of mental health and educational services were frequent despite ACTION Clinic involvement, which represents an opportunity for improvement. The ACTION sample may not be characteristic of all ACTION patients or of the larger foster care population at the practice. Data comparing the foster care population to the general population was outside the scope of the current work. Next steps for quality improvement include expanding ACTION Clinic capacity, training office staff on enhanced primary care for foster care, enlisting a dedicated care coordinator and building collaborative partnerships with community organizations that specialize in mental health for children who have experienced trauma.