Exploring Medical Foster Care

Exploring medical foster care as a placement option for children with medical complexity

A subset of children with medical complexity have biological parents that lack the resources or abilities to provide for their child’s intensive daily care needs and require out-of-home placement. Medical foster care is a placement setting within the child welfare system that provides specialized care for children with complex medical needs. Yet, very little is known about the medical foster care experience for children and families.

Objective

  • To describe the medical foster care experience, with a focus on: medical and social characteristics of the child, care team composition and roles, continuity of care, medical decision-making, quality of life, and areas for improvement.

Methodology & Progress

We conducted a mixed methods study, including surveys and semi-structured interviews, with the care team members of 15 children in medical foster care. We completed a total of 58 interviews with foster parents, biological parents, child welfare staff, primary care physicians, and medical foster care agency nurses and case workers.

Presentations
Medical Decision-Making for Children in Medical Foster Care
  • Seltzer, R.R., Raisanen, J.C., Williams, E.P., Donohue, P.K., Boss, R.D. (2018). Academic Pediatric Association (APA) Region IV Conference, Charlottesville, VA. (Speaker: R.R. Seltzer; received the fellow abstract award).
  • Seltzer, R.R., Raisanen, J.C., Williams, E.P., Donohue, P.K., Boss, R.D. (2018). Pediatric Academic Societies (PAS), Toronto, CA. (Presenter: R.R. Seltzer)
  • 2016 ASBH conference “Who knows the best interests of a parentless child? The challenges of medical decision-making for children in foster care”
  • 2017 AAP NCE conference “Decision-making for Medically Complex Children in Foster Care: Exploring the Ethical Challenges.”
Publications
Exploring Medical Foster Care as a Placement Option for Children with Medical Complexity
  • Seltzer, R.R., Raisanen, J.C., Williams, E.P., Da Silva, T., Donohue, P.K., Boss, R.D. (2019). Hospital Pediatrics. 
Medical Decision-making for Children with Medical Complexity in Foster Care: Data from medical and child welfare teams
  • Seltzer, R.R., Raisanen, J.C., Da Silva, T., Donohue, P.K., Williams, E.P., Shepard, J., Boss, R.D. (2019). Academic Pediatrics. 
Williams EP, Seltzer RR, Boss RD. Language Matters: Finding Medically Complex Children in Foster Care. Pediatrics. 2017 Oct;140(4).
Seltzer RR, Singleton MK, Williams EP, Boss RD “Medically Complex Children in Foster Care: Do Research “Protections” Make this “Vulnerable Population” More Vulnerable? J Clin Ethics. 2018 Summer;28(2):145-149

Seltzer RR, Dodge R, Boss RD. “Medical Decision Making for Medically Complex Children in Foster Care: Who Knows the Child’s Best Interests?” J Clin Ethics. 2018 Summer;28(2):139-144

Team Lead

Rebecca Seltzer, MD, MHS

Johns Hopkins School of Medicine, Johns Hopkins Berman Institute of Bioethics

Core Team

Renee D. Boss, MD, MHS

Johns Hopkins School of Medicine, Johns Hopkins Berman Institute of Bioethics

Pamela K. Donohue, ScD, MS

Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health

Jessica C. Raisanen, MSPH

Johns Hopkins Berman Institute of Bioethics

Jennifer Shepard, CRNP

Johns Hopkins Children’s Center

Erin P. Williams, MBE

Johns Hopkins Berman Institute of Bioethics, Columbia University Vagelos College of Physicians and Surgeons