Soros Advocacy Fellowship for Physicians

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Case Studies

Fellowship Partnering Organization: Children’s Alliance of Washington
Home Institution: University of Washington School of Medicine

Bergman was awarded a fellowship to assist Washington's Department of Social and Health Services (DSHS) make the systemic changes necessary to improve the access to and the quality of health care provided to children in foster care, and to insure that all 0–5 children in foster care have access to early learning/preschool programs. Specific goals were: a) improving access to quality health care by instituting a regionalized case management system; b) overcoming the “disconnect” between child welfare and medical care services by creating a coordinated foster care health unit; c) enabling physicians to gain access to medical information about foster children under their care; d) carrying out quality assurance audits; and e) increasing the statewide percentage of 0–5 foster children in Head Start from 3% to 20% in 3 years.

Fellowship Successes

All foster children were "emancipated" from Medicaid managed care in favor of Medicaid fee-for-service.

• Doubled the professional fee paid to physicians for health supervision visits (EPSDT).
• Provided temporary vouchers for medications and physician visits before a new foster child is entered in the official registry.
• Appointed part-time physicians in the six DSHS regions to serve as consultants to child welfare workers on vexing medical care issues.
• Piloted-tested a system whereby physicians could rapidly obtain summary medical information from automated Medicaid claims data.
• Conducted focus groups throughout the state to identify the barriers that deter enrollment of foster children in Head Start programs.
• Pilot-tested a system in a SE King County bringing together child welfare and Head Start staff to overcome the enrollment barriers. Prior to the intervention, only 1 foster child from the Kent DCFS office was enrolled in Head Start. None were enrolled in Early Head Start or ECEAP. Over the 5-month project duration, 30 referrals were made and 11 foster children were enrolled.

Post-Fellowship Successes

• The new Assistant Secretary of DSHS for Children’s Services upgraded the importance of health, education, and early learning of foster children within the child welfare bureaucracy by creating a unit alongside the traditional units of licensing and permanency planning.
• Assessment of early learning/preschool status is now an obligatory part of the foster care intake process.
• An expedited referral process of 0–5 foster children to Head Start is now being tested in two large districts, Seattle and Tacoma.
• A quality-assurance audit on prescribing psychotropic drugs has been completed, looking at the medical records of 136 children in one regions for whom psychotropic drugs were prescribed. This may be the first quality-assurance audit for foster children carried out in the county.
• Children removed from their homes and placed with relatives (kinship care) will now automatically be covered by Medicaid. Up to now, the relatives have had to go to the local welfare office and apply for the benefits.