Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
Divisions of General and Community Pediatrics.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2019-0580.
There are ∼443 000 children in child protective custody (ie, foster care) in the United States. Children in protective custody have more medical, behavioral, and developmental problems that require health care services than the general population. These health problems are compounded by poor information exchange impeding care coordination. Health care providers often do not know which of their patients are in protective custody and are not privy to the critical social history collected by child protective services, including placement history and maltreatment history. Meanwhile, the custodial child protection agency and designated caregivers (ie, foster caregivers and kinship providers) often lack vital elements of the health history of children in their care, which can result in poor health care delivery such as medication lapses, immunization delay, and poor chronic disease management. In this case study, we address this critical component of health care delivery for a vulnerable population by describing a process of developing an information sharing system between health care and child welfare organizations in collaboration with child protection community partners. Lessons learned include recommended steps for improved information sharing: (1) develop shared community vision, (2) determine shareable information components, (3) implement and analyze information sharing approaches, and (4) evaluate information sharing efforts. A successful example of advocating for improvement of information sharing for youth in protective custody is explored to highlight these steps. In collaboration with child protective services, pediatricians can improve information sharing to impact both health care delivery and child protection outcomes.
在美国，约有 443000 名儿童受到儿童保护监护（即寄养）。受监护的儿童比一般人群有更多的医疗、行为和发育问题，需要医疗保健服务。这些健康问题因信息交流不畅阻碍了护理协调而更加复杂。医疗保健提供者通常不知道他们的哪些患者受到保护监护，也无法了解儿童保护服务机构收集的关键社会历史，包括安置历史和虐待历史。与此同时，监护儿童保护机构和指定照顾者（即寄养照顾者和亲属提供者）通常缺乏他们所照顾的儿童的重要健康史信息，这可能导致医疗服务提供不佳，如药物漏服、免疫接种延迟和慢性疾病管理不善。在本案例研究中，我们通过描述与儿童保护社区合作伙伴合作，在医疗保健和儿童福利组织之间开发信息共享系统的过程，解决了弱势人群医疗服务提供的这一关键环节。所学到的经验包括改进信息共享的推荐步骤：（1）发展共享的社区愿景，（2）确定可共享的信息组成部分，（3）实施和分析信息共享方法，以及（4）评估信息共享工作。通过倡导改善受保护儿童的信息共享，探讨了一个成功的例子，以突出这些步骤。儿科学家可以与儿童保护服务机构合作，改善信息共享，从而影响医疗服务提供和儿童保护结果。
