The FaCES Experience: A Collaborative System to Improve Medical Care for Children in Foster Care Linda Sagor, MD, MPH Director, FaCES Clinic UMass Memorial Children’s Medical Center Worcester, Massachusetts

2000: Identifying the Problem Internal audit revealed that many children in foster care in Massachusetts were not receiving screening and comprehensive medical visits after placement per Department of Children and Families (DCF) policy.

2001: Our Response Create a task force to enable cross-system collaboration to respond to this problem: Child Welfare Agency (DCF)MedicaidJuvenile JusticeUMass Dept of PediatricsOffice of District CongressmanDiocesan representative

: Learning and Teaching Met with all stakeholders, especially those on the front lines Reviewed models of medical care Developed the infrastructure for an evaluation model Found funding Got the message out about the needs and issues of children in foster care

Health Care Models for Children in Foster Care Medical HomeEvaluation Nurse CoordinatorPreferred providerHealth plan/managed care coordination

2003: Implementation Referral from Worcester DCF Screening and comprehensive visits All medical data entered into electronic database Follow-up appointments made with primary care provider; all info sent to PCP and DCF FaCES Clinic opens at UMass Memorial Medical Center November 2003

: FaCES Grew monthly meetings, training sessions with social workers, participation in MAPP training Constant collaboration with DCF: medical students/residents, advocacy groups, business leaders Continued community education: new issues requiring attention Internal discussions re:

: New Initiatives Obesity Trauma screening and treatment Website Expansion to other locations Fitchburg in North Central Massachusetts(2011) Salem in Northeastern Massachusetts (2013)

Challenges Difficulty of transformational change Complexity of systems interacting with each other Maintaining momentum given competing priorities Financial

Lessons Learned Importance of collaboration and frequent meetings with stakeholders Funding beyond Medicaid reimbursement is helpful Commitment to change by stakeholders is essential