Electronic Medical Passports for Foster Children: First Step Towards Improving Health Outcomes

On April 16, 2009, seven year old Gabriel Myers committed suicide in a Broward County foster home. Gabriel had been in foster care since the previous June after his mother was slumped in her car, surrounded by narcotics. The media reported that Gabriel had been prescribed several psychiatric drugs linked to potentially dangerous side effects, including suicide. Children being prescribed various psychiatric drugs is not uncommon. In fact, Department of Children and Families’ records show that among children aged 6-12 in state of Florida care, more than 22 percent are prescribed psychiatric drugs. In a recent report by the Government Accountability Office (GAO), it was found that in 2008 foster children covered under Medicaid were prescribed psychotropic drugs at higher rates than non-foster children. According to the GAO report, experts’ opinions, and certain federal and state officials, this higher prescribing rate could be due in part to foster children's greater mental health needs and exposure to traumatic experiences as well as the challenges of coordinating their medical care. However, psychiatric drug prescriptions to foster children were also found to be more likely to have potential health risks.

 

Children in foster care enter the welfare system with serious health problems due to various factors, such as parental neglect and abuse, family substance use, and health problems associated with poverty (i.e., low birth weight, increased risk of lead poisoning, malnutrition, etc.). Additionally, a significant percentage of North America’s foster children are younger than 1 year of age. Unfortunately, young children who have been removed from their biological families and placed in foster care are at significant risk for poor developmental outcomes.

 

Tracking the medical history of foster children has been a challenge. These children move frequently either due to changing foster parents or cycling in/out of the child welfare system as attempts are made to unify them with their families. As a result, the children use different health providers and facilities and therefore maintaining complete medical records is difficult, at best. In addition to the health implications for this vulnerable population, there is also a tremendous burden on Medicaid spending. Medical costs for foster children are nearly four times that of other children covered under Medicaid. Yet the vast majority of foster children do not receive minimally adequate medical care or screening.

 

In 1988, the lack of quality medical care and incomplete documentation of services provided was addressed by the Child Welfare League of America in collaboration with the American Academy of Pediatrics (AAP). The group developed a comprehensive health care policy for children in ‘out of home’ care. One of the key aspects of this important policy paper is its advocacy for the use of a “medical passport” to document the health care problems and services delivered to children in ‘out of home’ care.

 

Our Kids of Miami Dade and Monroe, the lead agency for Community-Based Care (1) in South Florida directly confronted this problem by creating a strategic vision to develop an electronic Medical Passport. In January 2010, this vision was presented to the Florida Governor's Task Force on Child Welfare and key legislative staff. Our Kids joined with the Casey Family Programs and national experts on medical passports to learn from their efforts. Our Kids conducted additional research (i.e., focus groups with doctors, nurses, foster parents, case managers, etc.) with the goal of developing a prototype electronic Medical Passport. This prototype was patterned after a project called “Follow My Heart,” an interactive electronic Personal Health Record system for patients and their families suffering from congenital heart failure.

 

The prototyped electronic Medical Passport will be tested with 100 foster families, their doctors and case managers to determine its effectiveness on foster children’s health outcomes. This pilot test was made possible with a recent $65,000 award by the South Florida Health Foundation. Our Kids will engage a nurse case manager and independent evaluator to:

 

1) Measure changes in the foster children’s clinical outcomes as identified in the AAP’s Recommendations for Preventive Pediatric Health Care in comparison to a matched control group,

 

2) Measure changes in health literacy of foster parents and older foster children, and

 

3) Review Health IT utilization.

 

While Our Kids understands that the use of an electronic Medical Passport may not be able to save a child like Gabriel Meyers, they believe that with better coordinated care, our community’s children may have a better chance of having (1) their medical needs met, (2) appropriate interventions identified, and (3) improved health outcomes as compared than their peers across the United States.