In 2021, CHOP’s pediatric residency program received CHOP Cares Community Grant funding through the Office of Community Impact to support their project, FosteRx: Empowering Foster Families with Comprehensive Health Information. The overarching goal of FosteRx is to improve coordination and continuity of medical care for children in foster or kinship care. These children have a high prevalence of chronic medical and behavioral health conditions, but their healthcare needs often go unmet due to frequent transitions between caregivers that leave their medical records scattered across multiple offices and hospitals. This barrier to care and source of health disparity is defined in the 2019 CHOP PolicyLab article, “Information Sharing to Improve Health for Children in Foster Care”.
FosteRx addresses care fragmentation by providing new foster caregivers with a durable binder that contains comprehensive medical information about their child, such as their immunization record, medication list, and contact information for prior medical providers. Each child receives a book as well as a care package of age-appropriate comfort items. As part of the project, tools were created within the EPIC electronic medical record for clinicians to update the chart with a child’s current caregivers, caseworkers, and key contacts that medical providers need to ensure follow-up communication.
After gathering feedback and input from families and other key stakeholders throughout early 2021, FosteRx began distributing binders in late summer 2021 on the inpatient floors at CHOP and at the ACTION (All Children Thrive In Our Neighborhood) clinic at the Karabots Pediatric Care Center. They have received overwhelmingly positive feedback from families. One foster parent, who is also a Philadelphia DHS employee, felt that the binder was a great idea from the perspective of both a caregiver and a caseworker. Another parent whose children were seen in the ACTION clinic explained how when her daughter was first placed with her, she was not given much background information about her medical history and was not provided with accurate contact information for her daughter’s prior primary care pediatrician. When given her FosteRx care binder, she shared,
“Something like this would have been so helpful when my foster daughter came to me.”
As pediatric residents, the FosteRx founders knew that incorporating a new workflow to prepare the binder at discharge and update the medical record would be a challenge, given the many demands on clinicians on the inpatient floors. To mitigate this, they partnered with the Care Team Associate (CTA) program. The CTAs help with care coordination and discharge planning on CHOP’s inpatient services, and now assist clinicians with many aspects of the FosteRx program, including identifying eligible patients and printing materials for the care binders.
In addition to the binders, children receive care packages. There are currently two standard packages with a few items each, one for infants/toddlers and one for children/teens. In the future, once the pilot is complete and with availability of more resources, the FosteRx program would love to be able to offer more personalized or comprehensive care packages for kids entering foster care. To date, patients have been excited about receiving the items, even if they do not ultimately plan to keep them -- one young boy seen in the ACTION clinic told his pediatrician that he planned to give his stuffed animal keychain to a friend as a present!
The FosteRx program has been distributing binders as a pilot in both the inpatient and outpatient settings this academic year, and a major ramp-up is currently underway. Over the coming months, distribution of FosteRx binders and care packages will roll out in three of CHOP’s primary care clinics in Philadelphia: Karabots, Cobbs Creek, and South Philly. The team will also provide binders and care packages in partnership with the Fostering Health Program at CHOP. These expansions will allow FosteRx to reach even more patients and families and continue to evolve as it receives feedback from families to best meet the needs of children in foster care.