The Medically Fragile Foster Child

Developing a needs assessment to improve the health and wellbeing of children with special health care needs in foster care in Milwaukee County

Full Project Name:The Medically Fragile Foster Child ‐ Improving Health Status Through Education and Community LinkagesPrimary Community Organization:University of Wisconsin-MilwaukeePrimary Academic Partner:Elizabeth Moberg-Wolff, MD, Physical Medicine and RehabilitationAward Amount:45,848
Award Date
July2008
Project Duration:12 months

Project Description Narrative:


Children with special health care needs typically have complex medical and/or social needs that result in an increased risk of chronic disease, maltreatment, or neglect. A disproportionate number of these children are in foster care. Despite this, a 2006 national survey showed that the majority of states, Wisconsin included, had no defined "special needs" health care curriculum to assist child welfare workers and foster families with the complex medical and system issues that these children encounter. In addition, children's court personnel receive no special training to help them understand medical issues that can impact placement decisions.

In Milwaukee, the metro area reports a 24% prevalence of children with special health care needs - a rate that is double that of the state and nation. In Milwaukee county , more than 2,600 children are in foster placements, of which nearly 800 are children with special health care needs.

Through this funding award, project partners aim to develop a needs summary that will identify gaps in knowledge, communication, and system navigation among medical providers, families, and child welfare workers who provide care to children in foster care with special health care needs, with a goal of identifying opportunities to improve skills and cross system collaboration and improve the health and well-being of children in Milwaukee County.

Community partners:
Bureau of Milwaukee Child Welfare (BMCW), UW-Milwaukee Helen Bader School of Social Welfare

Additional MCW academic partners:
Maria Ocasio-Silva, MD, Physical Medicine and Rehabilitation; Lisa Zetley, MD, Pediatrics; Dawn Bragg, PhD, Academic Affairs

Outcomes & Lessons Learned:


• Established an advisory board comprised of key community leaders from four priority target groups — foster parents, child welfare, physicians, and legal system professionals — to guide the development and collection of data, review of data, and next steps

• Conducted literature reviews, electronic surveys, focus groups, key informant interviews, and in-house consultations to gather data regarding communication challenges and educational needs. Survey data identified common themes, including difficulty with both intra- and inter-system navigation and coordination, difficulty finding key contact information and making key contacts, difficulty learning information about other systems, and difficulty sharing and understanding information obtained

• Disseminated results of the project at two community forums and several national meetings, including the American Academy of Pediatrics annual meeting, as well as with leadership of Children's Hospital of Wisconsin and the Bureau of Milwaukee Child Welfare

• Secured commitments from each target group to pursue ongoing strategies responsive to the needs and issues raised by the project

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