Abstract
Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.
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Acknowledgements
We thank Dr. Lynn K. Sheets for her thorough review of this manuscript. We gratefully acknowledge the staff of the Milwaukee Child Advocacy Center for their work in development and implementation of the Triage Tool.
Author Contributions
K.L.H.: designed and executed the study, assisted with data analysis, and wrote the paper. D.M.: performed data collection, assisted with data analysis, and collaborated in the writing of the study. M.L.N.: collaborated in study design and performed data analysis. P.M.S.: collaborated in study design and performed data analysis.
Compliance with Ethical Standards
This study was funded internally by the Medical College of Wisconsin Department of Pediatrics. In addition financial support for use of the project database was provided by CTSA NIH Grant 8UL1TR000055 from the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The authors declare that they have no competing interests.
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Hodges, K.L., Manda, D., Nugent, M.L. et al. A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care. J Child Fam Stud 27, 475–482 (2018). https://doi.org/10.1007/s10826-017-0909-z
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DOI: https://doi.org/10.1007/s10826-017-0909-z