P3.G130: Foster Parent Insights on the Development of a Group Well Child Care Model for Children in Substitute Care: A Qualitative Analysis

Background: Foster and kinship caregivers face unique challenges when caring for children in substitute care. Studies show that children in substitute care have better health outcomes when their caregivers are provided with continued support and education. The Group Well Child Care (GWCC) model is a promising new approach to primary care that could help meet the needs of this population. Unique strengths of GWCC include increased retention of anticipatory guidance, increased attendance at scheduled well-child visits, and promotion of resilience and a sense of community. Little is known regarding the feasibility of the GWCC model for children in substitute care.

Methods: Through a CATCH grant from the AAP, foster parents’ insights into the GWCC model were explored. This study qualified for a non-regulated research exemption through institutional IRB. Participants were recruited through community partners. One focus group and five individual interviews were conducted. Questions were developed in consultation with child welfare experts. They centered around perceived benefits, challenges, and considerations in the development of the GWCC model for children in substitute care. Consensus coding was achieved through an iterative process involving independent reviewers. Qualitative analysis via thematic coding identified essential themes to inform the design of the GWCC model in a primary care medical home for children in substitute care.

Results: Major themes that emerged were perceived benefits, perceived challenges, logistical considerations for development, and desired educational topics. Foster parents identified peer-to-peer teaching, resource sharing, and emotional support as the main benefits of GWCC. The largest challenges they foresaw were time management, medical and physical privacy. Multiple parents were concerned their children would be overstimulated in a large group. Families agreed that visits should occur Tuesday through Thursday. While it was found that there were pros and cons of having groups with both kinship and foster caregivers, there was no agreement on whether it would be better to have groups together or separate. Another important consideration is the transient nature of children in the welfare system and what should be done when children go to different homes. Foster parents asked for teaching in development and behavioral health, most commonly from therapists and nutritionists.

Conclusion: There are perceived benefits to implementing a GWCC model for children in foster care and their caregivers; however, the logistics and unique experiences of children in foster care (e.g. history of trauma, complex symptoms, placement changes) must be considered the design of a GWCC model within a medical home that serves children and families involved with the child welfare system. Next steps include focus groups and interviews with kinship caregivers and designing a pilot to assess the feasibility and efficacy of a GWCC model in a pediatric primary care medical home dedicated to children in the child welfare system.