P3.072: Access to Developmental-Behavioral Pediatrics in an Integrated Care Clinic for Children in Foster Care

Background: Given that >80% of children in foster care experience developmental or behavioral (DB) conditions, the American Academy of Pediatrics (AAP) recommends that children have DB assessments within 30 days of foster care placement. However, national wait times for DB specialty appointments average > 130 days. Integrated care models are effective for improving access to behavioral health specialists, but such models have not been widely used to enhance access to DB specialists for children in foster care. Through a partnership between an academic health center and a federally qualified health center, a team-based integrated care clinic was implemented to enable close collaboration between primary care pediatricians, mental health specialists, care coordinators, family navigators and developmental-behavioral pediatricians for children at risk of or in foster care placement. This evaluation assessed access to developmental-behavioral pediatric (DBP) specialty appointments in this integrated care clinic.

Methods: A retrospective chart review of children seen between November 2020 - August 2024. Figure 1 illustrates the clinic model. We descriptively summarized the patient population and measured two primary outcome domains: 1) the proportion of DBP referrals resulting in scheduled and completed appointments, and 2) time to appointment completion (for the first and follow-up DBP appointments).

Results: Of 305 children seen in the clinic, 85 were referred to DBP. All referred children had public insurance, 60% were male, with a median age of 4 years. Among referred children, 28 (33%) were non-Hispanic Black, 26 (31%) were non-Hispanic White, 17 (20%) were Hispanic, and 12 (14%) had unknown race and ethnicity. Of referred children, 84 (99%) had a scheduled and 78 (92%) had a completed DBP appointment. The median time to first DBP appointment was 35 days [interquartile range (IQR) 10 – 91]. Of the 78 with a completed DBP appointment, 36 (46%) had at least 1 follow-up DBP appointment that occurred 130 days [IQR 75 – 252] after the first appointment. The most common referral concerns were developmental delay (51%), suspected autism (26%), suspected ADHD (8%), and behavioral assessment (8%).

Conclusion: Integrating DB specialists in safety-net primary care clinics may enable more timely access to DBP assessments and better alignment with AAP standards of care for children in foster care. We postulate that the high DBP appointment completion rates in this clinic stem from offering patients specialty services within their primary medical home (thereby eliminating the need to navigate and fulfill requirements of tertiary care clinics). Our next steps will compare DBP appointment completion rates in this integrated clinic to the local tertiary care DBP clinic. Future mixed-methods work will also assess barriers and facilitators for spreading this innovative primary care model and examine healthcare quality outcomes beyond access.