594 - Creation of a medical home for youth involved with child welfare: Key stakeholder perspectives on optimal care

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 594
Publication Number: 594.103

Bird H. Gilmartin, University of Colorado School of Medicine, Denver, CO, United States; Antonia Chiesa, University of Colorado School of Medicine, Aurora, CO, United States; Maya Bunik, University of Colorado School of Medicine, Aurora, CO, United States; Ayelet Talmi, University of Colorado School of Medicine, Aurora, CO, United States; Jessica Kenny, University of Colorado School of Medicine, Aurora, CO, United States

Presenting Author(s)

Bird H. Gilmartin, MD (she/her/hers)

Assistant Professor, Assistant Clinical Medical Director of CHC, Medical Director of KICS
University of Colorado School of Medicine
Denver, Colorado, United States

Background: The AAP designates youth with child welfare involvement as having special health care needs (2021). This population faces high rates of trauma and adversity, lack of access to needed care, and poor and inequitable outcomes related to physical and mental/behavioral health, development, and education (NCSL, 2019). This population is highly mobile, which can further complicate their health care access and lead to reactive and delayed care. Youth of color are disproportionally over-represented in the child welfare system and more likely to experience negative outcomes in almost every area (NCSL, 2021). Best-practices for comprehensive and equitable care of this population is lacking. Given the multiple systems involved (e.g., medical, educational, legal, mental/behavioral health, multiple caregivers, child welfare) and lack of input solicited from this marginalized population, a multi-informant, preemptive approach to best serve these patients is needed.

Objective: The purpose of this process was to explore the perspectives and recommendations of key, diverse partners with lived experience related to child welfare to identify key factors needed to work towards increased access, more aligned systems, and more equitable outcomes in overall care for this population.

Design/Methods: Semi-structured interviews were conducted with four groups of key partners regarding optimal care for this population. Data were transcribed, coded, and analyzed independently by two separate reviewers to identify common key themes highlighted in the interviews.

Results:

17 Interviews were conducted with groups involved with child welfare (5 youth, 8 foster families, 2 biologic families and 2 county child welfare agencies). Five themes emerged: 1) improved communication across all involved systems, 2) coordination and integration of care within a single medical clinic, 3) trauma informed care and access to trauma specific resources and services, 4) mental/behavioral health services and resources, and 5) the need for patients and all family types to feel respected and not judged when receiving care.

Conclusion(s): Common partner themes were used to inform the development of an integrated, trauma-informed program that addresses health inequities for children in out of home placement. This model is in line with existing models of integrated medical homes (Talmi et al., 2016). Using critical partner input the Kids In Care Settings (KICS) Clinic, a medical home with integrated mental/behavioral health for youth involved with child welfare at Children’s Hospital Colorado, was developed.