This article analyzes whether a validated screening instrument in a pediatric medical home setting can improve detection of developmental delay for children in foster care. Children in foster care have high risk for developmental delay, but to date there have been few systematic efforts to screen foster care children for developmental delay in pediatric practices. Recent efforts promote the pediatric medical home as a model for comprehensive care for children in foster care.

The authors conducted a pre-post study at a pediatrics practice in Rochester, New York to evaluate a screening instrument that systematically assesses the developmental health of children in foster care. Beginning in 2007, the pediatrics practice mandated that foster parents complete the screening instrument prior to the first well-child visit for any child new to foster care. In total, 251 questionnaires were completed for children ranging in age from four to 61 months.

Key Findings:

• Detection of developmental delays was much higher among children whose caregivers completed the screening instrument than among the entire population of children new to foster care. The screening instrument identified developmental delay among 37 percent of infants, 89 percent of toddlers, and 82 percent of pre-schoolers.
• The screening instrument was an effective way to reach out to foster children. Of 261 well-child visits with a child new to foster care, 251 (96%) resulted in a successful completion of the screening instrument.

Using the screening instrument prior to well-child visits resulted in a doubling of the detection rate for developmental delay among children new to foster care. This system may be a viable model for using pediatric medical homes to assess the development of high-risk children.