Aging out-quality improvement in transitions of care foradolescents leaving the foster care system

ABSTRACT

Background: Adolescents placed in the foster care system are a vulnerable population where socialdeterminants lead to health disparities that greatly impact their health and wellbeing into adulthood. Betweenthe ages of 18 and 21, these young adults age out of the foster care system and must also transition frompediatric to adult models of care. Unstructured transitions lead to poor health outcomes, however only 14-17% of youth meet health care transition performance measures. Objective: To assess transition readinessamong adolescents in foster care and use that data to incorporate a structured transition using the Six CoreElements into our Children in Foster and Kinship Care Clinic. Methods: We are currently performing a needsassessment among adolescents in foster care, aged 12 - 18, who receive care at a medical home for youth infoster care in a large, western US city from 3/1/2020 - 4/30/2020. To date, 12 adolescents have completed theTransition Readiness Assessment (TRA)-part of the Six Core Elements that have been validated using QImethodologies in a variety of care settings. Initially, participants completed the TRA in person;however,responses were collected by phone after COVID-19 physical distancing measures became mandatory. Results:The Mean age of patients that completed the TRA was 15.3 years (SD 2.0). Importance in preparing andconfidence in ability to change to an adult doctor were moderate overall. However, adolescents age16-18 hadsimilar importance (mean 5.8, SD 1.6, 95% CI 4.0 - 7.4), but much lower confidence measures (mean 2.5, SD2.7, 95% CI -0.4 - 5.4). The majority of our patients indicated they knew their personal health information,however their understanding of health care privacy and decision-making were much lower. Similarly, ourpatients have a perceived inability to manage the logistics of accessing health care. Alarmingly, a very smallportion of our patients have a plan to keep health insurance after age 18 despite the ACA's expansion ofMedicaid to this population until age 26. Conclusions: Our results suggest that our adolescent patients haveinsufficient education regarding changes in health care privacy and decision-making and perceived inability tomanage their own health care. Together, these indicate a strong need for a structured transition to adultmodels of care for adolescents in out of home care. Going forward, we plan to incorporate transitions into theworkflow of our clinic using a tool within the EMR, therefore consistently addressing transitions for all ouradolescent patients. For patients greater than 18 years, we have developed a Transition of Care clinicspecifically for young adults leaving foster care led by an internal medicine-pediatrics trained physician, thusimproving continuity for young adults who have aged out of foster care.