Research

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  Prenatal Substance Exposure and Positive Developmental Delay Screening Among Patients in Foster Care

  Jill McLeigh, Lauren Malthaner, Gregory Knell, Katelyn Jetelina, Folefac Atem, and Sarah Messiah

  Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

  Children in foster care with PSE are at risk for positive developmental delay screening compared with those without; however, those with both PSE and prematurity are at extra risk. This interaction should be considered when making inferences regarding developmental delay screening in this population.

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  Perspective: Restoring rest-the critical role of sleep in foster care well-being

  Jill McLeigh, Likhita Shaik, and Ann Wani

  In 2023, approximately 400,000 children were in foster care in the United States, a population disproportionately affected by trauma, instability, and systemic inequities.1 These children face chronic disruptions in sleep—an essential physiological process that underpins physical development, learning, emotional regulation, and overall health.2–4 Adverse childhood experiences, including abuse, neglect, and household dysfunction, are prevalent in this group and contribute to significant sleep disturbances through pathways of hyperarousal, stress dysregulation, and recurrent nightmares.3,4 Understanding the interplay among foster care, social determinants of health (SDOH), and sleep health disparities highlights opportunities for targeted interventions to improve outcomes.

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  Placement, duration and re-entry outcomes for children in foster care with disabilities

  Jill McLeigh, PhD; Gunjan Singh; Rong Huang; and Alan Huang

  National, longitudinal studies exploring characteristics and outcomes of children in foster care (CFC) with disabilities are lacking. This study explores the prevalence, characteristics and relative risk of experiencing placement instability, staying in care for longer than 2 years, and returning to care within 3 years for CFC with a disability and by disability type.

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  Preventable Emergency Department Utilization Among Patients with Foster Care History Compared to Patients Without Foster Care History

  Lauren Malthaner, Jill McLeigh, Gregory Knell, Katelyn K. Jetelina, Folefac Atem, and Sarah Messiah

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  Child maltreatment and behavioral health outcomes in child welfare: Exploring the roles of severity and polyvictimization

  Jill McLeigh, Lauren Malthaner, Gregory Knell, Katelyn Jetelina, Folefac Atem, and Sarah Messiah

  Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

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  Barriers and facilitators to kinship care in Texas: A multi-stakeholder, mixed methods perspective

  Jill McLeigh, PhD; Mike Henson-Garcia; Hilda Loria, MD; Erinne Conner, LMSW; and Lauren Malthaner

  Kinship caregivers face numerous barriers to providing care for children placed with them and limited facilitators to help ensure successful placements. Although the needs of kinship caregivers are being examined and prioritized in the legislature, operational and policy-level interventions are needed. Results from this study allow for interventions tailored to the needs of kinship caregivers in the State of Texas as identified by a multitude of stakeholder groups.

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  The Impact of Health Status on Health Care Utilization of Children in Foster Care

  Jill McLeigh, PhD; Gunjan Singh; and Rong Huang

  This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

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  Caregivers of youth in foster care in Texas and their role in contraception decision-making for adolescents in care

  Shelby Edmondson, Ana B. Conrado, Hilda Loria, Jill McLeigh, Jasmin Tiro, Simon Lee, and Jenny K.R. Francis

  This study describes the perspectives of caregivers of youth in foster care in Texas about the caregiver’s role in adolescent contraception decision-making for adolescents in their care, particularly for long-acting reversible contraception. The study also explores how providers and foster care agencies can better support pregnancy prevention for youth in care.

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  Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care

  Jill McLeigh, Lauren Malthaner, Madeline Tovar, and Mohsin Khan

  This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables.

  chidlrens.com/fostercare

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  Examining the Feasibility of Telehealth Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with Young People in Foster Care

  JIll McLeigh, Adrianna N. Martin, and Laura Lamminen

  Despite the high rate of trauma exposure among young people with child welfare involvement, various systematic and patient barriers exist that inhibit utilization of evidence-based trauma treatments. One strategy for alleviating barriers to such treatments is using telehealth. A few studies have found that the clinical outcomes of telehealth TF-CBT are comparable to those found from clinic-based, in-person treatment administration. Studies have yet to examine the feasibility of telehealth TF-CBT with young people in care. The current study sought to address this gap by examining outcomes for patients who received telehealth TF-CBT, along with factors that may have impacted successful completion, at an integrated primary care clinic exclusively serving young people in care.

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  Trauma-Informed Care Training for Medical Students

  Tanisha Clark, Jill McLeigh, Hilda Loria, and Laura Lamminen

  Trauma-informed care (TIC) is an approach that is designed to address the needs of individuals who have experienced trauma; however, TIC training is not consistently integrated into the curriculum of medical and allied health students. This article reports the results of an evaluation of a brief, online TIC training adapted for medical and allied health care students.

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  Healthcare utilization among children with a history of neonatal opioid withdrawal syndrome: A matched cohort study

  Lauren Malthaner, Katelyn Jetelina, Hilda Loria, and Jill McLeigh

  Compare longitudinal healthcare utilization patterns in children with and without a history of neonatal opioid withdrawal syndrome (NOWS).A retrospective matched cohort study was conducted using billing data extracted from between 2003 and 2016 in North Texas hospitals. The sample included 595 pediatric patients diagnosed with NOWS (i.e. exposed). The unexposed were patients not diagnosed with NOWS and matched 4:1 on sex, age at first encounter, and ethnicity to the exposed who received care during the same period. Multi-level regression models (accounting for clustered data structure of multiple visits per patient) compared number of hospitalizations, number of outpatient visits, number of emergency department (ED) visits, average length of stay, and healthcare expenditures across patients with and without NOWS.

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  Paediatric integrated care in the primary care setting: A scoping review of populations served, models used and outcomes measured

  Jill McLeigh, Lauren Malthaner, Caitlin Winebrenner, and Kimberly Stone

  Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours. Models of and contexts in which PIC has been applied vary, as do the outcomes and measures used to determine its value. Thus, this study seeks to better understand (1) what paediatric subpopulations are receiving integrated care, (2) which models of PIC are being studied, (3) what PIC outcomes are being explored and what measures and strategies are being used to assess those outcomes, and (4) whether the various models are resulting in positive outcomes. These questions have significant policy and clinical implications, given current national- and state-level efforts aimed at promoting integrated health care.

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  Description of Audiologic, Developmental, Ophthalmologic, and Neurologic Diagnoses at a Primary Care Clinic for Children in Foster Care

  Melissa Reynoso, Jill McLeigh, Lauren Malthaner, and Kimberly Stone

  This study aimed to describe the prevalence of medically diagnosed audiologic, developmental, ophthalmologic, and neurologic conditions in a foster care primary care clinic and to identify any associations among these diagnoses and patient characteristics, placement type, and maltreatment type.

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  Research Participation of Minor Adolescents in Foster Care

  Jenny Francis, Jane Andresen, Alexic Guzman, Jill McLeigh, Heidi Kloster, and Susan Rosenthal

  In this study we evaluated published studies about foster care to: (1) determine the types of data used; (2) describe the degree to which a sexual/reproductive health topic was addressed; and (3) describe the consent process.

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  Trauma-informed, integrated primary care: A medical home model for children with prenatal drug exposure who enter foster care

  Hilda Loria, Jill McLeigh, Kelsey Craker, and Susanna Bird

  The rise in prenatal or childhood substance exposure diagnoses resulting from parental substance use has led to an increase in the number of children placed in foster care. Meeting the multifaceted health care needs of children with prenatal drug exposure (PDE) who enter foster care requires significant time, resources, and coordination. In addition to conditions resulting from their experiences of trauma, children in foster care often have unmet health care needs and experience disproportionate rates of adverse physical, mental and developmental health outcomes. This article outlines the barriers to providing comprehensive and high-quality care to this pediatric population and describes a trauma-informed, integrated primary care medical home model as a promising strategy to address these barriers. It concludes with a description of the limitations of the model and considerations in the implementation of trauma-informed, integrated primary care as a healthcare delivery model for children with PDE who enter foster care.

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  Caring for children in foster and kinship care during a pandemic: lessons learned and recommendations

  Hilda Loria, Jill McLeigh, Kristin Wolfe, Erinne Conner, Valerie Smith, and Christopher Greeley

  Through qualitative feedback from professionals in healthcare, mental health, and child welfare, this study explored the impact of the COVID-19 pandemic on the health and well-being of children in the child welfare system. Positive outcomes and challenges related to the care of children in foster or kinship care in Texas during the COVID-19 pandemic are described. Themes identified included disparities in the child welfare system; utilization of telehealth; cross-sector communication and collaboration; safety considerations; and placement stability and support. The article concludes with recommendations in each of these areas for ensuring the health and well-being of children in foster and kinship care during a pandemic.

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  Infectious disease screening in a dedicated primary care clinic for children in foster care

  Jill McLeigh, Kimberly Stone, Sarah Lairmore, and Ron Huang

  Children in foster care are considered at high risk for infectious diseases, and guidelines recommend screening for tuberculosis, hepatitis B and C, syphilis, gonorrhea and chlamydia. Little is known about the prevalence of infectious disease in children in foster care. Few positive infectious disease screenings were identified in children evaluated in a dedicated foster care primary care clinic despite presence of risk factors. Multiple visits to a primary care foster care clinic may increase the likelihood of completed screenings. Targeted infectious disease screening based on age and local epidemiology may be less traumatizing but still clinically appropriate.

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  Developmental Status of Young Children in Foster Care

  Jill McLeigh, Karlyn Tunnell, and Cecilia Lazcano

  Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains.

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  Development of an Integrated Medical and Behavioral Health Care Model for Children in Foster Care

  Kimberly Stone, Sara Pollard, and Sara Moore

  Children in foster care are classified as a population with special health care needs. They face multiple adverse childhood experiences and disrupted relationships, yet face barriers accessing consistent, high-quality health care. The American Academy of Pediatrics recommends integrated physical and behavioral health care for children in foster care, but little is known about the implementation of integrated care for this population. As a pediatrician, doctor of nursing practice, and psychologist in an academic medical setting, we describe the development and implementation of the Rees-Jones Center for Foster Care Excellence, emphasizing the role of medical and behavioral health providers in promoting the overall well being of children in foster care. We discuss the evolution of the integrated care model, as well as current initiatives for quality improvement, research, and advocacy; and future goals for evaluation, education, policy, and collaboration to improve the lives of children in foster care.

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  Caring for children in child welfare systems: A trauma-informed model of integrated primary care.

  Jill McLeigh, Laura Lamminen, and Heidi Roman

  Children involved with the child welfare system have high rates of behavioral health concerns, chronic health conditions, and developmental disabilities. Further, as a result of the complicated relationships among the court system, child protective services, and caregivers (i.e., biological, kinship, and/or foster caregivers) and the high volume of health-, behavior-, and development-related services children in care need, the services they receive tend to be fragmented and problem driven. On top of these challenges, children involved with the child welfare system have been exposed to trauma, and often more than one form of trauma. Taken together, these factors point to the need for care that is trauma-informed and integrated whereby health care is provided by a multidisciplinary team working collaboratively. This article describes such a model, including information about its development, structure and organization, and programs. It concludes with a discussion of lessons learned and remaining challenges. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

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  Foster Parent Perceptions of Feeding Infants Prenatally Exposed to Substance Use

  Sara Moore

  The Foster Parent Perceptions project framework utilized Ajzen’s Theory of Planned Behavior. This project aimed to investigate changes in Foster Parent Perceptions concerning feeding the infant prenatally exposed to substances. The project outcomes reinforced that foster parent perceptions change with topic-specific education. Focusing on foster parent education—before placing an infant who was vulnerable into the home—increased the foster parent’s toolbox of skills and promoted the potential that the infant would thrive in their environment.