{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T21:05:46Z","timestamp":1780520746190,"version":"3.54.1"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>The American Academy of Pediatrics (AAP) recommends children in foster care (FC) have an initial medical evaluation within 3 days of custody initiation; however, this vulnerable population often suffers from disjointed care. Our aim was to improve the mean time to initial foster care evaluation (TIE) from 32 to &amp;lt;7 days within 12 months for children in FC in Durham County, North Carolina.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>This study was a time series, quality improvement project used to target interventions within an academic clinic and a community agency. Interventions were tested through multiple plan-do-study-act cycles. Control charts of the primary outcome, the TIE, were constructed. Charts were annotated with the dates of interventions, including workshops, performance feedback, integration of state forms, identification of appointments, development of an urgent appointment pathway, and empowerment of the scheduler.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>The mean TIE improved from 32 to 9 days within 12 months. Significant improvement in the following 2 process measures contributed to this: the time from custody initiation to the referral date improved from an average of 10 to 3 days, and the time from referral date to the initial evaluation improved from an average of 22 to 6 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Improvement interventions and increased collaboration between medical and child welfare agencies can result in significant improvement of the TIE. However, despite improvement efforts, challenges remain in meeting the AAP 3-day TIE recommendation. We recommend further assessment of the AAP guideline as it relates to implementation feasibility and health outcomes of children in FC.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2018-0725","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T08:36:58Z","timestamp":1542357418000},"source":"Crossref","is-referenced-by-count":8,"title":["Improving Timeliness of Medical Evaluations for Children Entering Foster Care"],"prefix":"10.1542","volume":"142","author":[{"given":"Lindsay G.","family":"Terrell","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Duke Children\u2019s Primary Care, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asheley C.","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke Children\u2019s Primary Care, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditee P.","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke Children\u2019s Primary Care, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2018,12,1]]},"reference":[{"key":"2021121103355113500_B1","unstructured":"Administration for Children & Families; Children\u2019s Bureau. Trends in foster care and adoption. 2015. Available at: https:\/\/www.acf.hhs.gov\/cb\/resource\/trends-in-foster-care-and-adoption. Accessed June 11, 2017"},{"issue":"3","key":"2021121103355113500_B2","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1542\/peds.109.3.536","article-title":"Health care of young children in foster care.","volume":"109","author":"Committee on Early Childhood, Adoption, and Dependent Care","year":"2002","journal-title":"Pediatrics"},{"issue":"4","key":"2021121103355113500_B3","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1542\/peds.93.4.594","article-title":"Assessing the health status of children entering foster care.","volume":"93","author":"Chernoff","year":"1994","journal-title":"Pediatrics"},{"issue":"6, pt 2","key":"2021121103355113500_B4","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1542\/peds.89.6.1230","article-title":"Children in foster care in California: an examination of Medicaid reimbursed health services utilization.","volume":"89","author":"Halfon","year":"1992","journal-title":"Pediatrics"},{"issue":"1","key":"2021121103355113500_B5","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/0145-2134(87)90033-0","article-title":"The medical and psychosocial needs of children entering foster care.","volume":"11","author":"Hochstadt","year":"1987","journal-title":"Child Abuse Negl"},{"issue":"4","key":"2021121103355113500_B6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-2656","article-title":"Health care issues for children and adolescents in foster care and kinship care.","volume":"136","author":"Szilagyi","year":"2015","journal-title":"Pediatrics"},{"key":"2021121103355113500_B7","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.childyouth.2015.10.004","article-title":"Quality improvement learning collaborative to examine foster care guidelines.","volume":"59","author":"Jee","year":"2015","journal-title":"Child Youth Serv Rev"},{"key":"2021121103355113500_B8","unstructured":"Fostering Court Improvement\n          . Statistics for Durham County: Durham County children in foster care during October 2015 through September 2016. 2016. Available at: http:\/\/fosteringcourtimprovement.org\/nc\/County\/Durham\/. Accessed July 7, 2017"},{"key":"2021121103355113500_B9","unstructured":"North Carolina Division of Social Services\n          . Family services manual: 1201, v. out of home placement services. 2016. Available at: https:\/\/www2.ncdhhs.gov\/info\/olm\/manuals\/dss\/csm-10\/man\/1201sV.pdf. Accessed January 1, 2016"},{"key":"2021121103355113500_B10","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009","edition":"2nd ed."},{"key":"2021121103355113500_B11","unstructured":"Institute for Healthcare Improvement\n          . How to improve. 2016. Available at: www.ihi.org\/resources\/Pages\/HowtoImprove\/default.aspx. Accessed January 1, 2016"},{"key":"2021121103355113500_B12","unstructured":"North Carolina Pediatric Society\n          . About fostering health NC. 2016. Available at: www.ncpeds.org\/?page=FHNCLibrary. Accessed July 8, 2017"},{"key":"2021121103355113500_B13","unstructured":"Robert Lloyd\u2008P; Institute for Healthcare Improvement. On demand: using run and control charts to understand variation. 2016. Available at: www.ihi.org\/education\/WebTraining\/OnDemand\/Run_ControlCharts\/Pages\/default.aspx?__hstc=162322147.42ae74e2d101e9ef8ad707184b9f4edc.1384265654927.1413577595052.1413817337874.77&__hssc=162322147.20.1413817337874&__hsfp=2428894759. Accessed October 19, 2018"},{"key":"2021121103355113500_B14","volume-title":"Internal Monthly Management Report","author":"Durham County Department of Social Services","year":"2016"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-0725\/1075512\/peds_20180725.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-0725\/1075512\/peds_20180725.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T08:45:39Z","timestamp":1639212339000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/142\/6\/e20180725\/37515\/Improving-Timeliness-of-Medical-Evaluations-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,1]]},"references-count":14,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,12,1]]},"published-print":{"date-parts":[[2018,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2018-0725","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,1]]},"article-number":"e20180725"}}