205846 Medical Home INITIATIVE for CHILDREN IN Foster CARE: A PILOT to Improve Show Rate to Dental Visits

Sunday, November 8, 2009

Rhonique Shields-Harris, MD, MHA , Director of Mobil Health Programs, Children's National Medical Center, Washington, DC

The AAP defines a medical home as “providing care that is accessible and family centered and provides high quality care that is comprehensive, coordinated, compassionate, and continuous over time.” The pilot was to attempt to improve dental care coordination for foster children via use of their medical home care coordination team.


Children in out of home foster care in the District of Columbia.

Program/Project Description

The Medical Home Initiative model has been operating since May 2007 producing positive changes. In this pilot, the team attempted to improve the show rate to dental providers.


Data was collected for a 5-month pre-pilot period to create a baseline. After choosing optimal provider to assess in 2-month pilot, the team employed many strategies to improve 60% show rate.


Some barriers to making dental appointments were largely beyond the control of the team. For example, there was persistent turnover among social workers, lack of coordinated communication among care givers, systemic transportation issues and lack of prioritizing the need for kept appointments. Thus, no improvement occurred.

Conclusions/Lessons Learned

This pilot reinforces the need for more accountability and collaboration. Improved communication among stakeholders, a commitment to not only scheduling but ensuring transport to appointments are all vital. Beyond making appointments, it's clear that other barriers prevent health care access for foster care children. Investment in health prevention and promotion starts with addressing systematic and programmatic hurdles to following through with care.

Learning Objectives:
1. Assess some of the challenges faced by children in foster care. 2. Explain the process employed in the pilot to improve the show rate to dental appointments. 3. Discuss the issues foster care children face as it relates to making their dental appointments. 4. Identify the lessons learned from this pilot.

Keywords: Oral Health, Special Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Rhonique Shields-Harris, MD, MHA, FAAP, is a board certified pediatrician who currently serves as the Medical Director of Mobile Health Programs and the Children's Health Project of DC at the Children's National Medical Center in Washington, DC. She has presented at numerous regional and national conferences and written multiple health-related articles. The focus of her medical practice is serving underserved, uninsured and special needs populations without regard to their ability to pay for care. Mr. Franklyn Baker, MBA has 16 years of cross-functional health care management experience in the areas of public health, government and external affairs, healthcare operations, program design and management, fiscal and clinical oversight and strategic planning. The lion's share of his experience has focused on the special needs populations (i.e., Medicaid, foster care, etc.)
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.