Foster Care Clinical Pathway — Outpatient Specialty Care
Foster Care Clinical Pathway — Outpatient Specialty Care
Laboratory Recommendations and Screening Tools by Age
Infants
Laboratory Testing
- Newborn screen
- Check the results of the newborn screen for infants < 12 months
- Access PA Department of Health Resources for the “How to Obtain Pennsylvania Newborn Screen” under lab information
- Complete if not yet done
- Check the results of the newborn screen for infants < 12 months
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
- Consider HIV and RPR if unable to verify that maternal prenatal testing was negative
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Survey of Well-being of Young Children (SWYC) Family Questions |
Psychosocial risk factors | Respond to positive responses |
|
Laboratory Testing
- Newborn Screen
- Check the results of the newborn screen for infants < 12 months
- Access PA Department of Health Resources for the “How to Obtain Pennsylvania Newborn Screen” under lab information
- Complete if not yet done
- Check the results of the newborn screen for infants < 12 months
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Baby Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones |
Development |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
Laboratory Testing
- Newborn Screen
- Check the results of the newborn screen for infants < 12 months
- Access PA Department of Health Resources for the “How to Obtain Pennsylvania Newborn Screen” under lab information
- Complete if not yet done
- Check the results of the newborn screen for infants < 12 months
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
- Risk assessment for anemia; HGB/HCT IF positive risk assessment
- Risk assessment: Prematurity, low birth weight, use of low-iron formula or infants not receiving iron-fortified formula, early introduction of cow’s milk
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Baby Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones |
Development |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
Laboratory Testing
- Newborn Screen
- Check the results of the newborn screen for infants < 12 months
- Access PA Department of Health Resources for the “How to Obtain Pennsylvania Newborn Screen” under lab information
- Complete if not yet done
- Check the results of the newborn screen for infants < 12 months
- HGB/HCT without differential at age 9-12 months if no documentation of test completed at 9 months or clinical concern
- Lead, if no documentation of test completed at 9 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Baby Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones |
Development |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
Toddlers
Laboratory Testing
- HGB/HCT without differential if no documentation of test completed between 8-12 months or clinical concern
- Lead, if no documentation of test completed at 9 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Baby Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
Laboratory Testing
- HGB/HCT without differential if no documentation of test completed at 9-12 months or clinical concern
- Lead, if no documentation of test completed at 8-12 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Baby pediatric symptom checklist | Social/emotional | 3 or greater |
|
| M-CHAT™ | Autism spectrum disorder |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
Laboratory Testing
- HGB/HCT without differential if no documentation of test completed at 9-12 months or clinical concern
- Lead, if no documentation of test completed at 8-12 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| M-CHAT | Autism spectrum disorder |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions |
Psychosocial risk factors | Respond to positive responses |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
| Preschool Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
Laboratory Testing
- Consider HGB/HCT without differential if no documentation of test completed at 24 months or clinical concern
- Lead, if no documentation of test completed at 24 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Consider hepatitis B serology if not immunized
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| M-CHAT | Autism spectrum disorder |
|
|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
| Preschool Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
Laboratory Testing
- Consider HGB/HCT without differential if no documentation of prior testing or positive risk assessment (at risk due to special health care needs, low-iron diet, environmental factors such as limited access to food)
- Lead, if no documentation of test completed at 24 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Consider hepatitis B serology if not immunized
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
| Preschool Pediatric Symptom Checklist | Social/emotional | 3 or greater |
|
Laboratory Testing
- Consider HGB/HCT without differential if no documentation of prior testing or positive risk assessment (at risk due to special health care needs, low-iron diet, environmental factors such as limited access to food)
- Lead, if no documentation of test completed at 24 months
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider PPD based on assessment
- Consider hepatitis B serology if not immunized
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| Survey of Well-being of Young Children (SWYC) Developmental Milestones | Development |
|
|
| Preschool Pediatric Symptom Checklist | Social/emotional | 3 or greater | Preschool Early Intervention: Elwyn SEEDS 215-222-8054 |
School Age
Laboratory Testing
- Consider HGB/HCT if no documentation of prior test completed, positive risk assessment (low iron diet, environmental factors such as limited access to food).
- Information About the City of Philadelphia Lead and Healthy Homes Program
- American Academy of Pediatrics Policy Statement Prevention of Childhood Lead Toxicity
- TB Risk Assessment: consider TB Test with IGRA based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| Pediatric Symptom Checklist (PSC-17) | Emotional/behavioral health |
|
Community Behavioral Health: 215-413-3100 |
| Medical History | Learning/developmental concerns | Concerns identified |
|
Laboratory Testing
- Consider HGB/HCT if no documentation of prior test completed, positive risk assessment (low iron diet, environmental factors such as limited access to food).
- TB Risk Assessment: consider TB Test with IGRA based on assessment
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Food Insecurity | Psychosocial risk factors | Respond to positive responses |
|
| Pediatric Symptom Checklist (PSC-17) | Emotional/behavioral health |
|
Community Behavioral Health: 215-413-3100 |
| Pediatric Traumatic Stress Screening Tool | PTSD | > 15 on first 17 questions | For a list of providers of trauma-focused and trauma-informed care in Philadelphia: PACTS (Philadelphia Alliance for Child Trauma Services) |
| Medical History | Learning/developmental concerns | Concerns identified |
|
Laboratory Testing
- Consider HGB/HCT if no documentation of prior test completed, positive risk assessment (low iron diet, environmental factors such as limited access to food).
- TB Risk Assessment: consider TB Test with IGRA based on assessment
- Consider STI testing if history of sexual abuse
- Consider non-fasting lipids (non-HDL = TC-HDL) – recommended at least once between the ages of 9 and 11. Acceptable borderline high, high, low and borderline low plasma lipid and lipoprotein concentrations (mg/dl) for children and adolescents
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Food Insecurity | Psychosocial risk factors | Respond to positive responses |
|
| Pediatric Symptom Checklist (PSC-17) | Emotional/behavioral Health |
|
Community Behavioral Health: 215-413-3100 |
| Pediatric Traumatic Stress Screening Tool | PTSD | > 15 on first 17 questions | For a list of providers of trauma-focused and trauma-informed care in Philadelphia: PACTS (Philadelphia Alliance for Child Trauma Services) |
| Medical History | Learning/developmental concerns | Concerns identified |
|
Adolescent
Laboratory Testing
- Consider Hb/ht if:
- Diet poor in iron
- History of iron deficiency anemia
- Excessive menstrual bleeding, periods lasting > 5 days
- TB Risk Assessment: consider TB test with IGRA based on assessment
- Consider lipid panel:
- At least once between ages 9-11
- Ages 17-21, obtain if not done, repeat if risk factors
- Consider lipid panel:
- Screening once between ages 9-11
- Screening once between the ages 17-21
- Acceptable borderline high, high, low and borderline low plasma lipid and lipoprotein concentrations (mg/dl) for children and adolescents
- If ≥ 15 years and consent obtained, screen for HIV
- If sexually active, consider:
- HIV, RPR
- Consider hepatitis B and C serology based on immunization history, risk
- Urine pregnancy (no contraception, amenorrhea, irregular menses)
- GC, chlamydia, trichomonas
- Targeted infection screening (hepatitis C, hepatitis B, syphilis, HIV, gonorrhea, chlamydia, and trichomonas) based on clinical evaluation. Factors to consider: history of perinatal or postnatal exposures, history of concern for sexual abuse, immunization status
Developmental and Psychosocial Screening
| Tool | Domain Measured | Score Needed for Referral |
Referral to: |
|---|---|---|---|
| Survey of Well-being of Young Children (SWYC) Family Questions | Psychosocial risk factors | Respond to positive responses |
|
| CRAFFT | Behavioral health, alcohol and drug use | ≥ 2 |
|
| Patient Health Questionnaire for Depression (PHQ-9) | Depression |
|
For a list of providers of trauma-focused and trauma-informed care in Philadelphia: PACTS (Philadelphia Alliance for Child Trauma Services) |
| Pediatric Symptom Checklist (PSC-17) | Emotional/behavioral health |
|
|
| Child PTSD Symptom Scale (CPSS) | PTSD | > 15 on first 17 questions | For a list of providers of trauma-focused and trauma-informed care in Philadelphia: PACTS (Philadelphia Alliance for Child Trauma Services) |
| Medical History | Learning/developmental concerns | Concerns identified |
|