This article provides recommendations for adapting the pediatric medical home (PMH) model for health care needs of youth in foster care. Recommendations are based on key informant interviews regarding experiences at an established PMH for youth in foster care. Major clinic recommendations include expanding the PMH framework to include proficiency in Medicaid billing, promoting true interdisciplinary care teams, improving care accessibility via phone consultation, providing a stable place for medical records to be housed, delivering services throughout stages of the child welfare case, incorporating all family members, and implementing trauma-informed practice. Preliminary evidence suggests that the PMH model of care may be ideal for addressing the complex and often underserved needs of youth in foster care and their families. The present recommendations provide a logistical framework for establishing a clinic that thoughtfully considers the unique needs of this population. Future research is needed to examine best practices for implementation.
Medical Home Initiatives for Children With Special Needs Project Advisory Committee; American Academy of Pediatrics. The medical home. Pediatrics. 2002;110(1pt 1):184-186.
2.
ZiringPRBrazdziunasDCooleyWC, et al. American Academy of Pediatrics. Committee on Children with Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs. Pediatrics. 1999;104(4pt 1):978-981.
3.
Culturally effective pediatric care: education and training issues. American Academy of Pediatrics Committee on Pediatric Workforce. Pediatrics. 1999;103:167-170.
4.
SiaCTonnigesTFOsterhusETabaS.History of the medical home concept. Pediatrics. 2004;113(5 suppl):1473-1478.
5.
BrewerEJJrMcPhersonMMagrabPRHutchinsVL.Family-centered, community-based, coordinated care for children with special health care needs. Pediatrics. 1989;83:1055-1060.
6.
RosenthalTC.The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21:427-440.
7.
StarfieldBShiL.The medical home, access to care, and insurance: a review of evidence. Pediatrics. 2004;113(5 suppl):1493-1498.
8.
ReidRJFishmanPAYuO, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15:e71-e87.
9.
PalfreyJSSofisLADavidsonEJLiuJFreemanLGanzML; Pediatric Alliance for Coordinated Care. The Pediatric Alliance for Coordinated Care: evaluation of a medical home model. Pediatrics. 2004;113(5 suppl):1507-1516.
10.
CooleyWCMcAllisterJWSherriebKKuhlthauK.Improved outcomes associated with medical home implementation in pediatric primary care. Pediatrics. 2009;124:358-364.
11.
StricklandBBJonesJRGhandourRMKoganMDNewacheckPW.The medical home: health care access and impact for children and youth in the United States. Pediatrics. 2011;127:604-611.
12.
SalazarAMKellerTEGowenLKCourtneyME. Trauma exposure and PTSD among older adolescents in foster care. Soc Psychiatry Psychiatr Epidemiol. 2013;48:545-551.
13.
HansenRLMawjeeFLBartonKMetcalfMBJoyeNR.Comparing the health status of low-income children in and out of foster care. Child Welfare. 2004;83:367-380.
14.
KoolsSKennedyC.Foster child health and development: implications for primary care. Pediatr Nurs. 2003;29:39-41, 44-46.
15.
AltshulerSJPoertnerJ.Assessing child well-being in non-relative foster care with a new outcome measurement tool. J Fam Soc Work. 2003;7:73-85.
16.
HalfonNMendoncaABerkowitzG.Health status of children in foster care. The experience of the Center for the Vulnerable Child. Arch Pediatr Adolesc Med. 1995;149:386-392.
17.
Committee on Early Childhood, Adoption, and Dependent Care; American Academy of Pediatrics. Health care of young children in foster care. Pediatrics. 2002;109:536-541.
18.
BowenS.Language Barriers in Access to Health Care. Ottawa, Canada: Health Canada; 2001.
19.
FloresGVegaLR.Barriers to health care access for Latino children: a review. Fam Med. 1998;30:196-205.
20.
ScheppersEvan DongenEDekkerJGeertzenJDekkerJ.Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006;23:325-348.
21.
MarroneS.Understanding barriers to health care: a review of disparities in health care services among indigenous populations. Int J Circumpolar Health. 2007;66:188-198.
22.
GarlandAFLandsverkJALauAS.Racial/ethnic disparities in mental health service use among children in foster care. Child Youth Serv Rev. 2003;25:491-507.
23.
JaudesPKChampagneVHardenAMastersonJBilaverLA.Expanded medical home model works for children in foster care. Child Welfare. 2012;91:9-33.
24.
JeeSHConnAMSzilagyiPGBlumkinABaldwinCDSzilagyiMA.Identification of social-emotional problems among young children in foster care. J Child Psychol Psychiatry. 2010;51:1351-1358.
25.
AlcalaHEMitchellEKeim-MalpassJ.Adverse childhood experiences and cervical cancer screening. J Womens Health (Larchmt). 2017;26:58-63.
26.
AlcaláHEValdez-DadiaAvon EhrensteinOS.Adverse childhood experiences and access and utilization of health care. J Public Health (Oxf). 2018;40:684-692.
27.
RubinDMAlessandriniEAFeudtnerCMandellDSLocalioARHadleyT.Placement stability and mental health costs for children in foster care. Pediatrics. 2004;113:1336-1341.
28.
RubinDMAlessandriniEAFeudtnerCLocalioARHadleyT.Placement changes and emergency department visits in the first year of foster care. Pediatrics. 2004;114:e354-e360.
29.
DiGiuseppeDLChristakisDA.Continuity of care for children in foster care. Pediatrics. 2003;111:e208-e213.
30.
LandsverkJABurnsBJStambaughLFReutzJ.Psychosocial interventions for children and adolescents in foster care: review of research literature. Child Welfare. 2009;88:49-69.
31.
GreesonJKBriggsECKisielCL, et al. Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network. Child Welfare. 2011;90:91-108.
32.
OswaldSHHeilKGoldbeckL.History of maltreatment and mental health problems in foster children: a review of the literature. J Pediatr Psychol. 2009;35:462-472.
33.
McMillenJCRaghavanR.Pediatric to adult mental health service use of young people leaving the foster care system. J Adolesc Health. 2009;44:7-13.
34.
McMillenJCZimaBTScottLDJr, et al. Prevalence of psychiatric disorders among older youths in the foster care system. J Am Acad Child Adolesc Psychiatry. 2005;44:88-95.
35.
dosReisSZitoJMSaferDJSoekenKL.Mental health services for youths in foster care and disabled youths. Am J Public Health. 2001;91:1094-1099.
36.
AnsseauMDierickMBuntinkxF, et al. High prevalence of mental disorders in primary care. J Affect Disord. 2004;78:49-55.
37.
HemmingsA.Counselling in primary care: a review of the practice evidence. Br J Guidance Couns. 2000;28:233-252.
38.
JeeSHAntonucciTCAidaMSzilagyiMASzilagyiPG.Emergency department utilization by children in foster care. Ambul Pediatr. 2005;5:102-106.
39.
AndersenSLTomadaAVincowESValenteEPolcariATeicherMH.Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci. 2008;20:292-301.
40.
TottenhamNSheridanMA.A review of adversity, the amygdala and the hippocampus: a consideration of developmental timing. Front Hum Neurosci. 2010;3:68.
41.
FelittiVJAndaRFNordenbergD, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14:245-258.
42.
ChartierMJWalkerJRNaimarkB.Childhood abuse, adult health, and health care utilization: results from a representative community sample. Am J Epidemiol. 2007;165:1031-1038.
43.
ChartierMJWalkerJRNaimarkB.Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl. 2010;34:454-464.
44.
AuslanderWFMcMillenJCElzeDThompsonRJonson-ReidMStiffmanA.Mental health problems and sexual abuse among adolescents in foster care: relationship to HIV risk behaviors and intentions. AIDS Behav. 2002;6:351-359.
45.
BanyardVLWilliamsLMSiegelJA.The long-term mental health consequences of child sexual abuse: an exploratory study of the impact of multiple traumas in a sample of women. J Trauma Stress. 2001;14:697-715.
46.
RomanoEBabchishinLMarquisRFréchetteS.Childhood maltreatment and educational outcomes. Trauma Violence Abuse. 2015;16:418-437.
47.
DiLilloDLewisTLoreto-ColganAD.Child maltreatment history and subsequent romantic relationships: exploring a psychological route to dyadic difficulties. J Aggress Maltreatment Trauma. 2007;15:19-36.
