The FaCES Experience: A Collaborative System to Improve Medical Care for Children in Foster Care

Linda Sagor, MD, MPH

Director, FaCES Clinic

UMass Memorial Children’s Medical Center

Worcester, Massachusetts

2000: Identifying the Problem

Internal audit revealed that many children in foster care in Massachusetts were not receiving screening and comprehensive medical visits after placement per Department of Children and Families (DCF) policy.

2001: Our Response

Create a task force to enable cross-system collaboration to respond to this problem:

Child Welfare Agency (DCF)

Medicaid

Juvenile Justice

UMass Dept of Pediatrics

Office of District Congressman

Diocesan representative

2001-2003: Learning and Teaching

Met with all stakeholders,

especially those on the

front lines

Reviewed models of medical

care

Developed the

infrastructure for an

evaluation model

Found funding

Got the message out

about the needs and issues of

children in foster care

Health Care Models for Children in Foster Care

Medical Home

Evaluation

Nurse Coordinator

Preferred provider

Health plan/managed care coordination

2003: Implementation

•Referral from Worcester DCF•Screening and comprehensive visits•All medical data entered into electronic database•Follow-up appointments made with primary care provider; all info sent to PCP and DCF

FaCES Clinic opens at UMass

Memorial Medical Center

November 2003

2003-2007: FaCES Grew

•monthly meetings, training sessions with social workers, participation in MAPP training

Constant collaboration with DCF:

•medical students/residents, advocacy groups, business leaders

Continued community education:

•new issues requiring attention

Internal discussions

re:

2007-2012: New Initiatives

ObesityTrauma

screening and treatment

Website

Expansion to other locations• Fitchburg in North

Central Massachusetts(2011)

• Salem in Northeastern Massachusetts (2013)

Challenges

Difficulty of transformation

al change

Complexity of systems

interacting with each other

Maintaining momentum

given competing priorities

Financial

Lessons Learned

Importance of collaboration and frequent meetings with stakeholders

Funding beyond Medicaid

reimbursement is helpful

Commitment to change by

stakeholders is essential