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Caring for Hospitalized Children in Foster Care: Provider Training, Preparedness, and Practice
Rosalie M Sleppy1, Breanna D Watson2, Pamela K Donohue1,2
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric providers caring for children and youth in foster care (CYFC) often lack training and rely on social workers. Improving care requires better education and health IT interventions for these vulnerable youth.
Area of Science:
- Pediatric Healthcare
- Health Services Research
Background:
- Children and youth in foster care (CYFC) exhibit high healthcare utilization, particularly inpatient services.
- Understanding the experiences of inpatient providers caring for CYFC is crucial for improving care delivery.
Purpose of the Study:
- To explore the inpatient provider experience when caring for children and youth in foster care.
- To identify challenges and effective strategies for optimizing care for CYFC in hospital settings.
Main Methods:
- Conducted semistructured interviews with 38 inpatient pediatric providers across 6 Mid-Atlantic hospitals.
- Included hospitalists, advanced practice providers, registered nurses, social workers, and case managers.
- Applied conventional content analysis to interview transcripts to identify key themes.
Main Results:
- Most providers (90%) interacted with CYFC monthly.
- Key challenges included lack of formal training, limited knowledge of foster care systems, difficulty identifying patients, obtaining consent, and documentation.
- Providers emphasized the critical role of social workers (SWs) and suggested increasing SW capacity, enhancing provider training, and standardizing electronic medical record (EMR) documentation.
Conclusions:
- Inpatient providers caring for CYFC face unique medical, social, and legal complexities with insufficient training.
- Reliance on social workers highlights a gap in provider preparedness.
- Targeted educational programs and health information technology solutions are essential to better equip inpatient providers for the needs of CYFC.
Background And Objectives:
Children and youth in foster care (CYFC) have high rates of health care utilization, including inpatient care. The objective of this study was to explore the inpatient provider experience caring for CYFC.
Methods:
Semistructured interviews were conducted with inpatient pediatric providers from Mid-Atlantic hospitals. Interview questions focused on 3 domains: provider training and preparedness, practice challenges, and strategies to improve care for CYFC. Conventional content analysis was applied to interview transcripts.
Results:
Thirty-eight interviews were completed with providers from 6 hospitals, including 14 hospitalists, 1 advanced practice provider, 11 registered nurses, 10 social workers (SWs), and 2 case managers. Nearly all (90%) reported at least monthly interactions with CYFC. Themes related to training and preparedness to care for CYFC included: medical providers' lack of formal training, limited foster care knowledge, and feeling of preparedness contingent on access to SWs. Themes related to unique practice challenges included: identifying CYFC, obtaining consent, documenting foster care status, complex team communication, and navigating interpersonal stress. Participants' suggestions for improving their ability to care for CYFC included increasing SW capacity, expanding provider training, standardizing electronic medical record documentation and order sets, and improving team communication and information sharing.
Conclusions:
There are unique medical, social, and legal aspects of caring for hospitalized CYFC; pediatric medical providers receive limited training on these topics and rely heavily on SWs to navigate associated practice challenges. Targeted educational and health information technology interventions are needed to help inpatient providers feel better prepared to effectively meet the needs of CYFC.
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