Integrating Primary and Mental Health Care for Children in Foster Care

Grantee Name

University of Rochester and Starlight Pediatrics

Funding Area

Special Projects Fund

Publication Date

May 2014

Grant Amount

$296,850

Grant Date:

November 2009 – April 2013

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Mental health problems are a significant health concern for children in foster care.

On any given day, approximately 510,000 children are in foster care, with total foster care placement estimated at 795,000 annually in the United States. Seventy percent of children have been admitted to foster care because of child abuse and neglect, which are strong predictors of poor long-term outcomes. These children suffer from high rates of chronic medical, developmental, and mental health problems. Starlight Pediatrics is a model pediatric medical home in Rochester, serving all 700 children in family-based foster care in Monroe County through 3,400 visits per year. Operating for nearly two decades, Starlight Pediatrics is the oldest existing centralized medical home model for children in foster care in the country. In addition to providing comprehensive primary care services, Starlight Pediatrics provides all health care management services for children in foster family care. To address both the primary care and mental health needs of children in foster care, Starlight Pediatrics implemented the Fostering Connections program, which integrated on-site mental health services and parent training in the same location where medical care is provided. In 2009, NYHealth awarded University of Rochester and Starlight Pediatrics a grant to support Fostering Connections.

Outcomes and Lessons Learned

Adapted an evidence-based parenting program—The Incredible Years—that was trauma-informed and specific for foster and kinship care parents and pediatric staff;
Conducted three 14-week training sessions in effective and therapeutic parenting of traumatized children for foster or kinship care parents with preschool-age children;
Formed the Foster Care Learning Collaborative (FCLC), a consortium of 17 participating programs, to share ideas on best practice models of foster care and attempt to improve medical coordination of foster care at 10 locations within a 2-year period; and
Gathered quantitative and qualitative data through surveys and focus groups to improve the training of foster care parenting groups, The Incredible Years curriculum, and the best practice health care delivery model of the FCLC.

Work from this NYHealth-funded project laid the groundwork for a spectrum of new initiatives providing direct services to youth in foster and kinship care in Rochester. Specifically, the University of Rochester is conducting a pilot program to provide support groups for youth (14–21 years old) in foster and kinship care. Team members also are conducting secondary data analyses of the National Survey of Child and Adolescent Well-Being II. This effort is yielding useful data—based on a nationally representative sample—to demonstrate the benefit of group-based interventions for youth in foster care. Finally, Dr. Moira Szilagyi, Medical Director of Starlight Pediatrics, was awarded a five-year grant from New York State Department of Health for the Successfully Transitioning Youth to Adolescence initiative, which establishes adult-supervised groups to promote healthy development of high-risk children between the ages of 9 and 12 years old, residing in certain zip codes. The American Academy of Pediatrics also is disseminating nationally the project’s group-based work with foster parents and models of health care delivery.

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