4 The Need: Health of children in foster care Children tend to enter foster care in a poor state of health: exposure to poverty poor prenatal care/ prenatal maternal substance abuse prenatal infection inadequate preventative health interventions family and neighborhood violence parental mental illness. Children coming into foster care have multiple physical problems: failure to thrive (10% to 50% of these children suffer from growth retardation) up to 80% have at least one chronic medical condition nearly one-quarter have 3 or more chronic conditions increased likelihood of delays in cognitive, language, and fine and gross motor skills development Recent studies found that children with multiple chronic problems at entry into care were more likely to remain in foster care.
5 DSS Health Screening Recommendations 7 Day Initial Screen 30 Day Comprehensive 2001 Study on Screening Compliance Overall rates for 7 and 30 day visits were approximately 10% and 25% respectively. Worcester Office rates: 9.5% (7 day) and 22.2% (30 day).
6 7 day components History taking Brief physical exam Evaluate for communicable diseases Evaluate for signs of physical/sexual abuse Evaluate for life threatening illness Discuss findings with caseworker and/or foster parents
7 30 day components Medical record review History taking with all parents if possible Immunization assessment Nutritional assessment Oral health screening Physical exam Developmental assessment Assess need for behavioral and other services/referrals Lab testing and lead screening Discuss findings with relevant stakeholders
9 FaCES Clinic Overview and Clinic started as model program based on prior research and program findings and 2001 data analysis November 2003: FaCES opens in Pediatric Department of UMass Medical School Began with children ages 0-5, expanded to now see children up to age 9 Only for foster care children referred by the Worcester DSS office.
10 FaCES Clinic Project Goal Goal: To provide medical assessments for all children from birth to five years of age who have been placed in foster homes under the auspices of Worcester DSS. Objectives: Improve compliance with recommended screenings Improve exchange of medical information during assessment period Assure uniformity of assessment Provide medical case management and facilitate finding a medical home Assess caseworker perception of benefit/effectiveness
11 FaCES Clinic: Unique Features Administrative Case Management Medical Case Management Data Management Collaboration between DSS & referral locations, collaboration between FaCES and medical homes/referrals
12 FaCES Clinic: Programmatic Information, Year 1 First year: 94 children seen (11/2003-12/2004) 0-5 years of age Generated 149 Referrals Wide range of diagnoses Wide range of medication gaps
14 Evaluation Plan Research Questions: Did project increase the rate of achievement of the 7 and 30 day screenings as compared to 2001 data? Did the project increase the rate of achievement of the 7 and 30 day screenings as compared to comparison group/Medicaid claims?
15 Additional Evaluation Questions: Did the project achieve its goals? Improve exchange of medical information during assessment period Assure uniformity of assessment Provide medical case management – immunizations, laboratory tests, referrals Assess case worker perception of benefit/effectiveness
16 Evaluation Plan Data Sources: FaCES database Comparison group: Statewide foster care population Medicaid claims, excluding Worcester DSS kids
18 Most Common Diagnosis Seen at FaCES Clinic Asthma Speech dysfluency Eczema Dermatitis Note: The most frequent diagnosis noted is well-child
19 Separate Study on Medication and Information Gaps Identified the frequency with which foster care children were placed in homes without access to necessary chronic medications for pre-diagnosed problems (75 patients) Chronic conditions/medications most frequently identified: Preventive health (fluoride) Eczema (topical steroid and immunomodulators) Asthma (beta agonists and inhaled steroids)
20 Results of Medication Gap Study 75% of children required at least one chronic medication 82% of those requiring the medication did not have the medication in the home of the foster parent 90% did not have medication for eczema 79% did not have medication for asthma
21 FaCES Database: Programmatic Number and Types of Referrals 31 11 76 25 33 0 10 20 30 40 50 60 70 80 Dental Audiology Early Intervention MD Specialist Mental Health Services Other Type of Referral Number of Referrals
22 FaCES Database: Programmatic Diagnosis Found at FaCES Clinic Hepatitis C (two cases) Object blocking nasal passages Genetic conditions (2): Branchio-oto-renal syndrome & Fragile X Atypical febrile seizures requiring diagnostic work up Abuse
23 FaCES Database: Programmatic Types of Medical Records Received
25 Caseworker Survey June and July 2005 Worcester DSS Area Office 45 respondents (out of approximately 75) Working on a comparison group survey right now in Northeast region of Massachusetts
26 Caseworker Survey Results 61% of those surveyed reported they had been caseworkers five or more years 80% of those surveyed knew the required time frame of 7 days for a foster child to get their initial health care screening following placement. 72 % of those surveyed thought that 30 days subsequent to placement was the required time frame for a foster care child to receive their comprehensive health care evaluation
27 Caseworker Survey, cont 82% of those surveyed felt the clinic made their job easier. Of those, 26 % of those surveyed found that the FaCES clinic makes it easier to find a child a doctor. 59% found it easier in terms of getting children health access 7% found that it makes their job more difficult
29 Discussions / Questions Evaluation of programs is key Difficulty around cost/benefit analysis Funding is an ongoing issue Programmatically Evaluation
30 Cui bono? Good for whom? a maxim which suggests that considering who will benefit is likely to reveal who is responsible for an unwelcome happening…$$$. Who is responsible for the health outcomes of these children? Pay now or pay later?