disease burden, unemployment and untreated mental health.
RESIDENTS & NEW PHYSICIANS
Older Children in Foster Care — An Opportunity for Family Medicine By A. Bradley Thompson, MD, MS PGY-2 Cone Health Family Medicine Residency Program
Did you know that foster children have an opportunity for insurance coverage beyond the age of 18? Many children in the North Carolina foster care (FC) system face neglect or abuse that negatively impacts both their physical and mental health. For these patients, their primary care provider, usually a pediatrician or family physician, is first in line to handle the litany of health problems that often accompanies youth in foster care. Fortunately, Medicaid covers medical expenses for foster youth until age 18, at which point participants may enroll in expanded coverage available to age 26. Poor mechanisms exist to ensure robust re-enrollment into Medicaid when foster youth reach 18, and no standardized model exists to help the transfer of medical care from a pediatrician to an adult primary care medical home (PCMH). As a result, many former foster youths (FFYs) are lost to the healthcare system as they enter adulthood. Youth who have been in foster care experience higher rates of homelessness, chronic
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As family physicians, it positions us to assist this vulnerable patient population at this critical junction in their lives. Since we see patients from “womb to tomb,” our broad scope of practice gives us unparalleled exposure and experience to aid patients through this point of transition in their lives as they pass from adolescents to adulthood. As part of a project sponsored by the American Academy of Family Physicians Foundation’s Family Medicine Leads/Emerging Leaders Institute, we developed a system that prepares Guilford County transitioned-aged foster youth (16-17 years old) for the next step in their medical lives as they transfer care from their pediatrician to an adult PCMH. As a secondary goal, we are offering them the choice to set up care at the Cone Family Medicine Center Residency Clinic.
In 2019, Dr. Thompson was selected by the AAFP Foundation to participate in the Emerging Leaders Institute. His experiences with fostercare led to his project for that year-long program and he was scheduled to present his work at the STFM Annual Spring Conference, now re-scheduled for August. Dr. Thompson hails from North Carolina and has been educated in three of the state’s universities along the way. He completed his undergraduate degree at NC State, his master’s degree at Wake Forest and completed his medical school education at the University of North Carolina School of Medicine. He is currently a second-year resident at Cone Health Family Medicine Residency Program in Greensboro.
Using materials from Got Transitions, we developed a transition of care model that assesses a client’s “transition readiness” and then provides educational materials for areas of weakness. Referrals are placed to social workers who offer a link to social services and to a Medicaid-eligibility specialist to make sure re-enrollment into Medicaid occurs. During this project, I conducted a gap analysis reviewing published literature and attending multiple meetings with the AAFP, NCAFP, American Academy of Pediatrics, Fostering Health NC (a branch of the NC Pediatric Society), SAYSO (a foster youth advocacy group), and Youth Villages (a non-profit dedicated to helping foster youth and former foster youth). Several barriers were identified including Medicaid re-enrollment policy issues, transience of the population, general mistrust from within the foster care community toward
The North Carolina Family Physician
