program-models

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Program/Project Name CHECK Foster Care Clinic
Affiliation Name Cincinnati Children's Hospital Medical Center
Website URL http://www.cincinnatichildrens.org/service/c/foster-care/default/
Model Type Evaluation
City Hamilton, Butler
State OH
State specific location Hospital-based Clinic
How is program/project funded? County Funding, Health Insurance
Describe how it's funded

Medical evaluations are billed to Medicaid.  A stipend is provided by county children's services to cover services not covered by Medicaid, i.e. program coordinator.

What services does it provide Entry to care health assessment
Where does it provide services County-based
Description of program/project

​Cincinnati Children Hospital Medical Center’s Comprehensive Health Evaluations for Cincinnati’s Kids (CHECK) Foster Care Clinic provides state-required exams for almost 900 children placed into foster care in Hamilton County and Butler County, Ohio each year. We provide a centralized location for medical records of evaluated children that includes physical exams, laboratory work, vaccines, dental care, vision care and developmental, behavioral and mental health screenings.  The initial visit at the CHECK Clinic is performed by staff trained in detecting abuse, neglect and foster care issues.  A record review is completed to identify children with known medical problems and known specialist involvement to notify families and providers to ensure continuity of care while placed. The child’s medication list is reviewed and prescriptions are provided as needed. Screening labs are conducted to check for infectious disease (HIV, syphilis, tuberculosis, Hepatitis B and C) as well as anemia and lead levels. An immunization record is obtained and vaccines are given if needed.  A social worker is available to meet with the family to identify needs and provide emergency supplies such as clothing, shoes, formula, and diapers, as well as comfort items for the child, such as a blanket and stuffed animal. Urgent anticipatory guidance is provided on caring for the child, such as back-to-sleep strategies and car seat safety. The family is given a folder with age-appropriate information, scrapbook with photo of the child, and 30-day follow-up information, as well as CHECK Clinic contact information for problems/concerns.  By the 30-day visit, the child’s medical records have been obtained.  The child gets a physical exam by a pediatrician focused on the care of children in foster care.  Any outstanding vaccinations are given. For all children, a formal developmental screening is performed. Children 6 months to 3 years may receive direct developmental assessment by a developmental pediatrician that is accepted by Help Me Grow (Hamilton County’s Early Intervention Services).  All children receive formal behavior screening (Child Behavior Checklist) and mental health screening (Trauma Symptom Checklist). The foster parent receives stress screening (Parenting Stress Index) to look for warning signs of family dysfunction. A social worker meets with each family to discuss testing results and recommendations and identify any family needs. Age-appropriate anticipatory guidance is provided, including a growth and nutritional evaluation and counseling. Vision and hearing screenings are performed. All necessary referrals are made, including specialists and community services. A primary care doctor is identified. All records are provided to Jobs and Family Services, the foster care agency, and the new primary care pediatrician. The family leaves with an updated scrapbook with a new photo and resources to meet newly identified needs. Perhaps most importantly, the family knows they have someone to call if things are not working.  The entire process is repeated with every change of placement to ensure maximum continuity of care and continued CHECK presence in the lives of the child and foster families.  After reunification or permanent placement, the biological or adoptive family is encouraged to come to the CHECK Clinic to learn about their child’s time in foster care and learn how to care for their medical/mental health/and behavioral needs.

How are patients tracked? Commercial electronic medical record, Specialized database for your program
Provide special focus Developmental delay/issues, Mental health, Children in family foster care, Youth in group home/residential care, Young Children, Adolescents
Program/Project strengths

​A key component of the CHECK Clinic is changing the focus from the child to the child AND the family – not only to make sure the child is healthy and getting all medical needs met, including developmental and mental health needs - but also to evaluate the family as a unit and identify risks for placement failures and plans to support and stabilize the placements.  The biggest strength for the CHECK Foster Care Clinic is the collaboration with our children's services agency, our private foster care networks, and our many community partners, including GALs, CASAs, mentors, Juvenile Court Magistrates, Early Intervention Services, Head Start, and many others.  The clinic serves to function in concert with these other community resources maximizing the communication and ultimately benefit for the children in foster care.  Intra-hospital collaboration has also allowed for new programs targeted at children and youth in foster care with Developmental and Behavioral Pediatrics as well as Adolescent and Transitional Health.  A dedicated mental health collaboration program is in the works to expand on the current screening and referral process.  Finally, CHECK is dedicated to identifying medical homes for children in foster care and has plans for expansion into providing medical home services for children without stable medical homes.

Program/Project challenges

​Funding continues to be a challenge.  Despite billing Medicaid and securing contracts with the counties for stipends to cover services not billable to Medicaid, the clinic still struggles with the quest to become revenue neutral.

Contact Name Mary Greiner, M.D., M.S.
Email Address mary.greiner@cchmc.org
Phone Number 513-636-0057