Medical foster care for children with chronic critical illness: Identifying strengths and challenges

Objectives: A growing population of children has chronic critical illness (CCI), defined as children with complex and chronic medical conditions who require repeated and prolonged ICU hospitalizations. Some of these children are unable to be cared for by their parents and are placed in medical foster care (MFC). We sought to better understand the potential strengths and challenges of MFC as a placement setting for children with CCI. Methods: As part of a larger study exploring barriers to care for children with CCI, we conducted semi-structured interviews with healthcare professionals (inpatient; outpatient; home care; foster care) with extensive CCI experience. The subset of questions related to MFC was included in this analysis. Participants were recruited from 5 metropolitan areas across the US. Results: Content analysis of 44 participant transcripts revealed the following themes: 1) why CCI children enter MFC; 2) transition from hospital into MFC; 3) potential strengths and 4) potential challenges of MFC for CCI children. Complicated hospitalizations commonly precede entrance into MFC for children with CCI, a transition complicated by delays in identifying need for MFC, limited MFC availability, and discharge training of foster parents. MFC strengths included quality MFC caregivers, MFC system supports, and a home environment. Challenges included separation from biological family, fragmented medical care, decision-making, variable quality, and transitioning out of MFC. Conclusion: The advantages of MFC for CCI children can be potentially improved through intentional child welfare and health care system collaboration, protocols for hospital-to-MFC transitions, consistent medical homes, alternative medical decision-making policies, greater MFC availability, and broader biological family supports.