O3003: Caring for Children in Foster Care in the Hospital: Implications for Provider Training, Preparedness and Practice

Background: Children in foster care have high rates of chronic medical, behavioral and developmental conditions. They are more likely to be hospitalized and have longer lengths of stay than their peers not in foster care. Although inpatient providers regularly care for children in foster care, little is known about providers’ experience and challenges encountered working with this population. The objective of our study was to explore inpatient providers’ training, preparedness and practice related to caring for children in foster care.

Methods: Inpatient pediatric providers with prior experience caring for children in foster care were recruited from Mid-Atlantic hospitals. Semi-structured interviews focused on providers’ training, preparedness and practice related to caring for children in foster care. Participants were also asked about suggestions to improve care for children in foster care. Conventional content analysis was applied to interview transcripts using Dedoose software.

Results: Interviews were conducted with 15 MDs/NPs, 11 RNs, 10 social workers and 2 case managers. Nearly all (90%) of participants reported at least monthly interactions with children in foster care. Yet, social workers were the only group that consistently received formal training about foster care and expressed feeling “very prepared” to address the unique needs of children in foster care. The majority of non-social worker participants reported receiving inadequate/no training and their feeling of preparedness was largely contingent on access to social work (Table 1). Table 2 includes themes and illustrative quotations related to training, preparedness and practice challenges, including identifying that a child is in foster care, obtaining consent, documenting relevant legal and foster-care related information, navigating interpersonal stress with caregivers and trauma history and communicating with multiple team members. Participants offered suggestions for improving their ability to care for this population, including expanded training, standardized use of electronic medical record (EMR) to support workflow, and improved communication across sites and systems of care.

Conclusion: There are unique medical, social and legal aspects of caring for hospitalized children in foster care; pediatric medical providers receive limited training on these topics and rely heavily on their social worker colleagues to navigate the practice challenges of caring for this population. Targeted educational and health system interventions are needed to help inpatient providers feel better prepared to efficiently and effectively meet the needs of children in foster care.