Creating A Medical Home For Children and Youth In Foster Care

Due to the severe and oftentimes traumatic experiences of many children who end up in the foster care systems, the have a special set of medical and health needs that deserve to be addressed in a comprehensive and routine manner. The aim of this program is to improve the use of social emotional screening rates, referral patterns, and follow-up in the delivery of care for patients in foster care in pediatric and family practices.

This activity, approved by both the American Board of Family Medicine (ABFM) and the American Board of Pediatrics (ABP) for 20 MOC IV credits, is designed for family physicians and pediatricians (other kinds of providers are also welcome), and is also approved by the AAFP for 20 Prescribed CME credits (AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 Credit™).

Anyone is invited and encouraged to participate, including physicians, nurses, front desk staff, professionals in in-patient and out-patient settings, and child welfare service staff.

Participants should contact the Activity Director (Marietta Ellis at mellis@ncafp.com) to register to complete this activity. The suggested time frame for completion of this activity is 4-6 months.


Activity Aim

The aim of this project is to improve the use of social emotional screening rates, referral patterns, and follow up in the delivery of care for patients in foster care in pediatric and family practices. This activity will assess the various practices and protocols in place for integrating patients in foster care into a medical home using a strategic population based management approach. Additionally, participants will receive education on a variety of topics essential to addressing and improving quality of care for children, youth and famillies in the foster care system, as well as coordination and communication at the practice level.

Activity Overview

Studies consistently demonstrate that many health care needs for children in the foster care system go unmet. Many children and adolescents are coming from abusive situations and may have acute needs that must be addressed efficiently. Many of these patients will have chronic health issues, such as asthma, that have been neglected due to sporadic health care and the lack of a continuous medical home. These are some of the common physical health needs of this special population, that are compounded by overwhelming mental and emotional health needs, and oral health needs.

This activity proposes to integrate patients in the foster care system into a medical home in order to address these numerous issues in a routine and comprehensive way.

Unfortunately, like the numerous special health care needs that exist, there are also many complicated barriers that prevent the successful integration of this patient population into a medical home. Some of these barriers will be incorporated as proposed areas to improve quality of care, coordination and communication:

  1. Standardized communication between primary care and child welfare
  2. Patient access to initiial visits & assessment of needs upon entry into the medical system;
  3. Provider awareness about the standards for patients in foster care;
  4. Patient access to specialized care and services for patients in foster care;
  5. The importance of follow through among providers who identify special issues and needs.

Suggested Resources

Due to the severe and often traumatic experiences of many children who end up in the foster care system, they have a special set of medical and health needs that deserve to addressed in a comprehensive and routine manner. As a result, the American Academy of Pediatrics created an initiative called "Healthy Foster Care America." Many of the guidelines proposed in this activity follow the AAP recommendations.

Please see more about their "Healthy Foster Care America" initiative at: http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/heal...

Learning Objectives & Activity Guide

The quality improvement activity learning objectives and activity steps are as follows:

STEP A: Activity Pre-Work: Complete the Pre-Assessment

STEP B: View Learning Session 1: This session includes an activity orientation and key educational content.

STEP C: Complete the First Set of 10 Patient Chart Extractions, and enter each chart into the website tool, by clicking “Add Patient Chart,” and please select “Baseline” Chart Extraction and click “Save” for each chart.


Learning Objectives

  • Deepen the provider's understanding of children and adolescents in foster care as children and youth with special health care needs and their exposure to toxic stress and trauma to 100% by the end of Learning Session I and the end of the 6 month activity period.
  • Enhance the provider and practice's understanding of and implementation of a population management approach and processes within their practice for foster care patients by the end of Learning Session II and the end of the activity period.
  • Increase the provider and practice's adoption of a standardized communication system with the child welfare agency, including having a practice contact, to 100% by the end of the activity period.
  • Increase the provider and practice's incorporation of the AAP guidelines for scheduling, office processes, and the enhanced periodicity schedule for follow-up, billing and coding for foster care patients to 100% by the end of the activity period, including having open access to initial visits and preparation for a comprehensive visit.
  • STEP D: Complete A PDSA Cycle: Document a workflow system that allows for open access to initial visits and preparation for a comprehensive visit.
  • STEP E: Complete the Second Set of 10 (new or recent) Patient Chart Extractions, and enter each chart into the website tool, by clicking “Add Patient Chart,” and please select “Midline” for this round of Chart Extractions and click “Save” for each chart.
  • Increase the provider's routine implementation of social emotional development screenings for children in foster care to 75% by the end of the activity period.
  • For patients with positive screens, increase the provider's referral rate to 100% and increase the follow up rate to 25% by the end of the 6 month activity period.
  • Enhance the provider's knowledge of the importance of promoting a dental home and dental varnish (for patients 6 months-42 months of age) for patients in foster care by the end of Learning Session II.
  • Increase the provider's knowledge of the availability of data and identification of patients in foster care within the CCNC Informatics Center to 100% by the end of Learning Session III.
  • Increase the provider's understanding of the importance of a transition plan for their adolescent foster care patients by the end of Learning Session IV.
  • STEP F: Complete the third set of 10 (new or recent) Patient Chart Extractions, and enter each chart into the website tool, by clicking “Add Patient Chart,” and please select “Final” for this round of Chart Extractions and click “Save” for each chart.
  • Augment the provider's understanding of the policies around Consent and Confidentiality at the end of Learning Session V and by the end of the activity period.
  • STEP G: Activity Wrap-Up Work: Complete the Post Assessment and Activity Evaluation

Presenting Faculty

Marian F. Earls, MD, FAAP

Dr. Earls is the Lead Pediatric Consultant for Community Care of North Carolina, and is the current lead on the state CHIPRA Quality Demonstration Grant for the state. From 1994 to July 2012 she was the Medical Director of Guilford Child Health., a large, non-profit, private Pediatric practice that is the pediatric division of Triad Adult and Pediatric Medicine in Greensboro, North Carolina. She is also a Developmental and Behavioral Pediatrician. Guilford Child Health is a public-private partnership between two community health systems and the department of public health, and serves families at or below 200% of the Federal Poverty Level. She is a Clinical Professor of Pediatrics for the University of North Carolina Medical School. Dr. Earls also is Medical Director of the Neonatal Follow-up Clinic (multidisciplinary) for the Level III NICU at Women's Hospital in Greensboro. Dr. Earls is Immediate Past President of the North Carolina Pediatric Society (President 2008-2010). She is chair of the Mental Health/School Health Committee for NCPS. She has been a member of the Committee on the Psychosocial Aspects of Child and Family Health of the AAP, and was the lead author on the committees Clinical Report "Incorporating Recognition and Management of perinatal and postpartum Depression into Pediatric Practice," (PEDIATRICS, November 2010). She is a liaison from the AAP to AACAP (American Academy of Child and Adolescent Psychiatry). She has been elected to the Executive Committee of the AAP's Section on Early Education and Child Care. She is a member of the Mental Health Leadership Work Group of the AAP that is charged with national dissemination of mental health integration in primary care pediatrics.

María Esther Díaz-González de Ferris, MD, MPH, PhD

Dr. Ferris is an Associate Professor in the Division of Nephrology & Hypertension at the University of North Carolina – Chapel Hill. She is the Medical Director, since 2000 to present of the UNC Pediatric Dialysis Unit, Renal Research Institute. She is the founder and co-director 2009 to present of The International Health Care Transition Research Consortium https://sites.google.com/site/healthcaretransition/. Dr. Ferris is also the founder and Medical Director of the UNC Health Care Transition Program http://www.unckidneycenter.org/hcprofessionals/transition.html.

Kevin Kelley, MSW (NC DSS | Child Welfare)

Mr. Kelley is the Section Chief for the NC Division of Social Services (NCDSS). Mr. Kelley has spent much of his career in DSS addressing the needs of automation and data collection at the local case worker level. Mr. Kelley began his career as a child welfare social worker working in a private provider agency. For the past several years, the focus for North Carolina has been on developing a system that addresses child well-being, rather than program process measures. These efforts are also currently underway using a collaborative approach with leadership from various divisions within the North Carolina Department of Health and Human Services as well as related Departments for Juvenile Justice and the courts. As a county administered state, the role of the NC DSS is to provide training and technical assistance to county agencies in a consistent and effective manner. In this regard, the Division is committed to a high level of commitment to transforming the child welfare system in North Carolina by enhancing the application of evidenced based and evidenced informed practices.

Aditee Narayan, MD, MPH

Dr. Narayan is Associate Professor of Pediatrics at Duke University Medical Center in the Department of Pediatrics. She is the Associate Medical Director for the Duke Child Abuse and Neglect Medical Evaluation Team, as well as the Program Director for the Duke Child Abuse Fellowship. Dr. Narayan performs medical evaluations of pediatric patients who may have been abused or neglected.

Leigh Poole, MA

Leigh Poole is a native North Carolinian and a graduate of The University of North Carolina at Wilmington where she earned her undergraduate degree, and The University of North Carolina at Chapel Hill where she earned her Master's degree in Educational Psychology, Measurement and Evaluation. Leigh has worked with universities, non-profits, and statewide organizations providing expertise in program evaluation, technical assistance, project management, and systems level data management. Currently, Leigh works with the NC Pediatric Society on Fostering Health NC, an initiative focused on building and strengthening medical homes for children in foster care. In this role, Leigh manages implementation of the program, provides technical assistance to the field, and works with the state advisory team to develop and promote best practices.

Esther Smith, MD, FAAP

Dr. Smith graduated with a Bachelor of Science from Indiana University and attended medical school at University of St. Eustatius where her first two years in the classroom were spent on an island in the Caribbean, then she finished her 2 years of clinical rotations in Washington, DC. Her residency was through East Carolina University in Greenville, NC, where she met her husband, who is also now a Pediatrician. She has been practicing outpatient Pediatrics for 5 years in Greensboro, NC. She is a participant of the Community Practitioner Program through the NC Medical Society Foundation, and her areas of interest have included Pediatric Obesity, Foster Care, and Pediatric Palliative Care.

Jean Smith, MD

Dr. Jean Smith is a Developmental- Behavioral Pediatrician, recently retired from Wake County Human Services in Raleigh, NC. Dr. Smith served for over 10 years with the Children's Health and Development Programs that provide comprehensive and holistic assessments for children entering foster care in Wake County. Currently, she is a consultant for Fostering Health NC, a recent initiative under the NC Pediatric Society.

Leslie Starsoneck, MSW

Leslie Starsoneck holds a Master's degree in Social Work and has worked for many years in the area of public policy and nonprofit programming for children and families. For the last decade, she has worked as a private consultant, assisting nonprofits and state government agencies in capacity building activities, research, and program development. She has worked with the NC Pediatric Society since November, 2011 assisting with organizational development initiatives and leading efforts related to connecting children in foster care to medical homes.

Adam Svolto, MPA

Mr. Svolto completed his undergraduate studies at the U.S. Air Force Academy in Colorado. He then attended flight training and served as a navigator with assignments to bases in North Carolina and abroad. After completing his military service, Adam entered the private sector and gained experience in operations management and consulting. Adam joined the NC Pediatric Society in March, 2014 and currently serves as Program Director for the Fostering Health NC initiative. He holds a Master's degree in Public Administration from North Carolina State University.

Lindsay Terrell, MD

Dr. Terrell is a Child Abuse and Neglect Fellow at Duke University Medical Center. She completed her residency at Duke University in 2014. Dr. Terrell performs medical evaluations of pediatric patients who may have been abused or neglected and has a special interest in children in foster care

Activity Completion

Upon activity completion, the Activity Director, Marietta Ellis will complete a Physician Attestation form on your behalf regarding your completion of the activity in order to receive full MOC IV credit. Participants will need to utilize standard self-report procedure to attain CME credits and will receive a CME certificate. Please contact her with any questions about this MOC IV Activity by email at mellis@ncafp.com

Timeframe

The NC Pediatric Society and the NC Academy of Family Physicians received funding from Community Care of North Carolina’s (CCNC) federal CHIPRA grant to develop and pilot test this activity. This opportunity has been extended until June 2017. To get credit, participants must have completed the MOC by that time.