Coordinating care for foster children
CMs collaborate with caseworkers
When children in foster care are covered by UPMC for You, a pediatric case manager collaborates with a designated caseworker from each county’s Department of Children, Youth and Families to ensure that the children have access to all the care, preventive, and behavioral health services they need.
In the first year of the program, the proportion of children in foster care receiving annual well-child visits in Allegheny County, PA, increased from 53% to 78.5%, and the percentage of children with annual dental check-ups grew from 60% to 75%.
"Our goal is to ensure that all of the children covered by UPMC for You have access to the Early Screening, Diagnosis and Treatment component of Medicaid designed to improve the health of low-income children. Foster children often have major unmet needs and are behind on immunizations and well-child visits and many times, their medical and dental records are scattered among several providers," says Laura Fennimore, RN, DNP, a clinical director who oversees pediatrics for UPMC Health Plan. UPMC for You is the Pittsburgh-based health plan’s Medicaid managed care plan.
The state of Pennsylvania sends UPMC for You a list of children placed in foster care or juvenile protection every two weeks. The health plan’s pediatric case managers access claims data to find out if the children on the list are up on their immunizations and have had a well-child visit or seen a dentist. "We use our electronic health record to identify children with gaps in care and focus on those we are most concerned about who have missed an important piece of all aspects of preventive care," she says.
The health plan’s pediatric case management team gets in touch with each child’s Department of Children, Youth, and Families caseworker and works with him or her to make sure the child has had preventive services. "We don’t work directly with foster parents, but collaborate with the caseworkers to ensure that the children covered by our health plan get the care they need," she says. In some instances, if the foster parents or the birth parents agree, the UMPC for You pediatric case managers work directly with them.
Using health plan claims data, UPMC for You case managers prepare an abbreviated medical record showing children’s hospitalizations and emergency department visits as well as where the gaps in preventive care are occurring. "We share it with the caseworker, who can use the information to encourage foster families to take the children for well-care visits with their pediatrician, to the dentist, and to keep them up on their immunizations," she says.
UMPC for You case managers provide monthly updates to the case workers on interventions foster children receive, including hospitalizations and emergency department visits for physical health and behavioral health issues. "This is another way to make sure the case worker is aware of any issues going on with the children," she says.
Children who are enrolled in Medicaid frequently have gaps in care, partially because of poverty and all the social issues that come with poverty, Fennimore says. Foster children are especially challenging because they may move from one family to another and often the caseworker is the one who has the most complete history and there still may be missing pieces, she adds. Often, foster families have trouble navigating the healthcare system or issues with transportation. "We can’t work with them directly, but we work through their caseworker to help overcome the barriers to care," she says.
"The pediatric case management team can help the caseworker obtain a complete medical history and can help them connect the child with providers," she says. For instance, if children are placed in foster homes that are across town from their previous homes, the case manager can help the caseworker find a pediatrician or a pediatric dentist who accepts members covered by the plan in a location that is convenient for the foster family.
The health plan has developed a Foster Pilot Work Group with Allegheny County’s foster care system to look at ways to improve the process. A pediatric social worker and a behavioral health case manager meet regularly with the staff from the Allegheny County Department of Human Services and discuss ways to work together to coordinate services and ensure that foster children have access to the healthcare they need.
"The work group members discuss ways to engage foster families in preventive care services and barriers they encounter, such as difficulty in scheduling appointments or transportation problems," she says. The pediatric case managers can help families access funding for transportation, or if the foster children are disabled, line up door-to-door transportation.
The circumstances that lead to children being in foster care often lead to serious behavioral health concerns, and many foster children have behavioral health issues as well as medical needs.
In Allegheny County, behavioral health benefits are provided by Community Care Behavioral Health, which is part of the UPMC organization. Case managers from the behavioral health organization also work with the case worker to make sure children are seen by a behavioral health professional within seven days of discharge after a stay in a psychiatric hospital.
The UPMC for You case managers coordinate physical health services with the behavioral health case managers and make sure that the Children, Youth and Families caseworkers have the full picture, she says.
Caseworkers have expressed their appreciation for the program, Fennimore says. "They welcome the health plan care managers as a valuable resource in helping them meet the children’s needs," she says.