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Meeting the Health Care Needs of Children in Foster Care
National Association of State Foster Care Managers
Washington, DC – 10/24/05
Jan McCarthy
National TA Center for Children’s Mental Health
Georgetown University
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The Health and Mental Health Discussion – Why It’s Important
Health Care Needs of
Children in Foster Care
Needs similar among all children: Well-child care Immunizations Treatment for acute illnesses Treatment for chronic medical problems
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Unique Needs of Children in Foster Care:
High prevalence of medical, dental, developmental, mental health, and behavior problems, conditions and disabilities
Substance use disorders Need for ongoing treatment for these
conditions
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Unique Experiences of Children in Foster Care
Children’s vulnerability and risk Prior life experiences Often previous lack of attention to
health care Trauma of separation from family Ongoing issues of loss while in foster
care – multiple placements Impact on child health and well being
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Link to Safety, Permanency and Well-Being
Appropriate health, developmental and mental health care: Enhances child’s chance for healthy development Reduces stress on caregivers Helps families care for their children Stabilizes families and placements Provides information needed to make
permanency/placement decisions Improves child’s school performance Increases chance of achieving permanency
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A Comprehensive Framework Specific components for creating a
comprehensive community-based health care system for children in FC
Rarely are all components implemented in one site
Framework provides issues to consider in assessing current system and prioritizing
Implementation of components also requires strong child welfare and cross-system policies
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“CRITICAL COMPONENTS” OF A COMPREHENSIVE FRAMEWORK Initial Health Screening and Comprehensive Assessment Access to Health Care Services and Treatment Management of Health Care Data Coordination of Care Collaboration Among Systems Family Participation Attention to Cultural Issues Monitoring & Evaluation Training & Education Funding Strategies Managed Care Strategies
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Initial Health Screening and Comprehensive Assessment
Initial Screening – for all children as they enter care
Comprehensive Assessment – within 30 days, at regular intervals and transitions
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Access to Health Care Services and Treatment
Access Issues – immediate eligibility for Medicaid, transportation, location of care, adequate providers, medical necessity criteria, waiting lists
Services – comprehensive array, prevention to intensive intervention, primary care and specialty care, mental health,dental, developmental, family support services
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Management of Health Care Data and Information
Multiple strategies – both paper and electronic
Tasks are to: Gather Organize Retain Share Update regularly Aggregate data of individual children
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Coordination of Care
Coordination assigned to specific person (e.g., health care coordinator) or unit (e.g., health care management unit)
Health plan for every child
Health plan addressed at all court and review hearings
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Collaboration Among Systems
Cross-system responsibility to meet health care needs of children in foster care
Families and community-based organizations involved in planning and implementing
Some strategies – co-location, blending funds, cross-system training, interagency structures and agreements
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Family Participation All families (BPs, FPs, APs, Kin) partners in
assuring health care for child Roles – sources of information/history,
obtaining on-going care, ensuring continuity of care when child moves
Child’s health care viewed in context of family strengths, needs, culture, environment
BPs included in ongoing health care of child Families receive services to enhance their
capacity to provide health care for child Families provide system level input
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Attention to Cultural Issues
Knowledge of child/family culture influences health care design and delivery, creation of provider network, training
Knowledge of how culture and beliefs shape child/family view of health and illness incorporated in approach
Traditional and non-traditional approaches used
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Monitoring and Evaluation
Ensure that established health care procedures are followed
Track health outcomes (individual and aggregate)
Assess family, child and provider satisfaction and cost effectiveness
Make improvements based on data and outcomes
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Training and Education Training for parents, caregivers, providers,
social workers, other systems, and youth
May address multiple issues such as – general health and development special, individualized health care needs navigating health care system how child welfare system works…
Parents/caregivers as co-trainers
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Funding Strategies Policy makers know how to target different
funding sources for different aspects of health care, e.g., treatment/services, care coordination, data management, administration, training
Flexibility in funding strategies encouraged Medicaid waivers requested and Medicaid
options pursued when needed Interagency agreements about the transfer of
funds among child-serving agencies (to maximize funding sources)
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Designing Managed Care to Fit the Needs of Children in Child Welfare Address special needs of children in custody
when designing managed care system, e.g., Developing contracts Setting capitation and case rates Defining makeup of provider networks
Ensure that there are mechanisms to: Solve problems (e.g., clinical liaisons) Ensure continuity of care when child changes
placements Provide services for family members (in addition to
identified child)
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Managed Care (cont’d) Examples of special provisions for children in
custody: Eligibility Enrollment process Authorization of services Priority for receiving services Medical necessity criteria Service array Provider rates Collecting specific data Tracking outcomes
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A Health Care Delivery Model- Center for Healthier Children,
Families and Communities, UCLA (Halfon, et al)
Child’s health needs
Entry into custody
Health Services Delivery
Initial health exam
Comprehensive assessment
Ongoing health care
Transition assessments
Child welfare
Child health
Mental health
Medicaid
Performancemonitoring
Child’s well-being
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Intermediate outcomes
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Foster Care Health Delivery System Model
Child Welfare System
• Organization
• Procedures
• Financing
Health Outcomes• health status• child developmental• functional• clinical
Child’s Needs• Safety• Medical• Mental Health• Dental• Nutritional• Developmental• Relationships
Antecedent Factors• prenatal substance exposure• abuse and neglect history
Intermediate Outcomes
• % of children receiving appraisal
• % of children receiving appropriate care
Child Health System
• Organization
• Procedures
• Financing
Performance Monitoring
Performance Measurers (IOM)
•Effectiveness
•Access
•Appropriate quality
•Acceptability
•Continuity
Quality Critical Management Processes
Continuous Quality Improvement
Pre-placement Health Exam
Comprehensive Health Assessment
Continuing Health Care Referrals & Specialty Services
Transition Assessments at Placement Change
Health Service DeliveryS
ervice In
tegration
Coo
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ated
Clin
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M
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Family Factors• Enabling• Predisposing
Entry into the system
From: Neal Halfon, MD, MPH, Victor Perez, MD, MPH, Neal Kaufman, MD, MPH, Providing Health Services to Children in Foster Care
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New Health Care Delivery Model – Milwaukee, WI
Name - Allied Services for Healthy Foster Children Program
Goal – improve access, coordination, quality and efficiency of health care services for foster children in Milwaukee
Operated by Abri Health Plan, Inc. - managed care organization
Anticipated date to implement – February 2006 (3,000 children)
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Allied Services for Healthy Foster Children (cont’d)
Managed care model (1915 B Medicaid Waiver)
Health plan at full risk (capitation rate/child)
Abri subcontracts with partners to be providers (e.g., Wraparound Milwaukee for BH care)
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Allied Services for Healthy Foster Children (cont’d)
Features: Coordinated system of health care to meet
physical, behavioral, developmental and mental health needs of children in out-of-home care
Integrated physical and mental health care Health care managers for each child Medical home for each child Health plan and health passport for each
child
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Allied Services for Healthy Foster Children (cont’d)
Features (cont’d) Screening, assessment and enhanced services
Promotion of preventive care and early intervention
Transition planning
Quality assurance and utilization management to guarantee access to services
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Allied Services for Healthy Foster Children (cont’d)
Contact Persons: Burnie Bridge, Administrator, Division of Children
and Family Services, 608/267-3905
Mike Fox, Division of Health Care Financing (Medicaid), 608/266-7559
Jane Wick, President, Abri Health, 262/834-1120
Bruce Kamradt, Wraparound Milwaukee (behavioral health), 414/257-7531
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Community Example – Screening and Assessment
FaCES
(Foster Care Evaluation Services)
Worcester, MA
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Contact Information
Jan McCarthyDirector of Child Welfare Policy
National TA Center for Children’s Mental HealthGeorgetown University Center for Child and
Human Development
202/687-5062 voice202/687-1954 fax