O4307: Everyone Can Do It! Creating a Team to Improve Pediatric Care for foster Children in a Primary Care Setting

Purpose/Objectives: We set out to create a system for improving care for the pediatric patients of our health center who live in foster care settings. Our hypothesis was that creating a team dedicated to these children would improve adherence to the American Academy of Pediatrics foster care guidelines.

Design/Methods: We created a team to improve adherence with the AAP foster care guidelines. The team consisted of a Master's prepared Mental Health Counselor (MHC) , a Pediatric Nurse Practitioner and a medical assistant (MA). All were existing staff. The role of the MHC was to meet with each child and provide a mental health evaluation, providing short term therapy as needed. She also met with all foster parents to be of support and assess for goodness of fit. The role of the PNP was to see each child for primary care, following them until they were stable before referring back to the child’s PCP. The role of the MA was to be the liaison by telephone with child protective services (CPS) and foster parent, procuring all needed documents and scheduling and following up with missed appointments. We met weekly for case reviews.

Results: We found that, as expected, with our team approach we were able to improve adherence to the AAP guidelines, following the 8 guiding principles:

Interaction With Child Welfare Personnel: Improved with weekly meetings where we reached out to CPS. Met with CPS teams for individual care meetings, when needed.

Communication With Birth and Foster Parents: Improved due to more robust and frequent visits and by reaching out at the weekly meetings when families were not present at visit.

Health Education and Wellness Promotion: Improved with the enhanced communication with CPS and foster families. Also ensured that all specialty appointments were kept.

Intensity of Encounters. Improved by following AAP schedule and ensuring attendance through phone calls reminders and rescheduling no shows.

Medical History: Collection of old records improved with new system.

Child Abuse and Neglect Issues; Addressed with every case.

Special Training; All team members became educated in issues of child abuse and trauma.

Coordination of Multiple Health Care Needs: Done at every weekly case review meeting.

Conclusion/Discussion: Children and youth in foster care are a unique group, with significant morbidity in all areas of their lives. While the AAP recognizes the need for an enhanced level of care, it is very difficult to provide even basic pediatric care , let alone to follow these important guidelines. Our program, which does not require additional staff or money, was able to more closely follow these guidelines using a simple team approach.