Integrating Child Welfare and Electronic Health Records to Improve Care Delivery for Youth in Protective Custody: Feasibility and Impact

Research has repeatedly demonstrated that children enter child welfare protective custody with significant health needs, including acute illnesses (e.g., infections, communicable diseases), chronic medical conditions (e.g., asthma), developmental delays (e.g., speech delay), and mental and behavioral health concerns. In response to this, most states mandate that children entering protective custody be examined by a medical care provider around the time children enter protective custody, and often also with changes in placement. However, health information is frequently not accessible to child welfare frontline workers, either at the time that children enter custody or when placement changes are occurring, resulting in a failure to communicate health histories to new caregivers or to ensure that children are placed in environments where their health needs can be met. This lack of integrated health information for children in protective custody likely contributes to increased healthcare costs, ineffective healthcare delivery, and placement instability.

More recently, advances in informatics and computer science as well as an openness to enhancing data-based tools for child welfare workers has created an opportunity for child welfare agencies to provide enhanced and integrated information to be used at the point of care. This has been applied more predominantly to decision-support tools at the time of screening, to identify where to stratify services for families involved with child welfare, or to understand patterns in healthcare utilization via Medicaid billing data. The focus of this roundtable will be to discuss strategies for leveraging similar strategies for cross-sector (in this case healthcare and child welfare) integration of information to be shared and used at the point-of-care, and evidence of the impact of this approach on the care received by children and families in protective custody.

This roundtable session will begin a dialogue about opportunities to integrate cross-sector data within the child welfare context, the impact of sharing that information, and the responsible use of such data. Our first presenter will provide background on the healthcare needs of children in protective custody, the impact of limited health information on service delivery in child welfare, and a model developed in Hamilton County Ohio to address this problem via the development of a data sharing platform. Two presenters will discuss the approach and strategy taken to integrate and disseminate real-time data access for caseworkers, with an emphasis on implications for social work policy and practice. Our fourth presenter will discuss the research strategies used to evaluate the impact of integrated health and child welfare information on child health outcomes. A fifth presenter will discuss the implications of data-sharing within the context of child welfare and juvenile court policy and practice, with a focus on broader implications of data sharing in the child welfare context. Our goal is to stimulate conversation that will promote understanding of the opportunities and challenges of integrating cross-sector data within child welfare, the importance of such initiatives for child health, and the potential impact of these approaches for policy and practice.