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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