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Spring 2009, Issue 10

Improving Children’s Healthcare by Connecting Everyone Involved

Laurel Kristin Leslie, MD, MPH, joined the clinical staff of Tufts Medical Center in 2007. She is associate director of the Center on Child and Family Outcomes in the Institute for Clinical Research and Health Policy Studies and is director of the Program for Aligning Researchers and Communities for Health in the Tufts Clinical and Translational Science Institute (CTSI). Leslie is also an associate professor in the departments of medicine and pediatrics at Tufts University School of Medicine and a member of the faculty of the Sackler School of Graduate Biomedical Sciences. Leslie works across the spectrum of healthcare, which includes basic research, clinical research, hospital care, community-based care, healthcare policies, and healthcare participants. A central theme of her many projects is improving healthcare by improving connections across this spectrum.

Leslie earned her MD from the University of North Carolina at Chapel Hill and her MPH in epidemiology and biostatistics from the San Diego State University Graduate School of Public Health. She did postdoctoral training in pediatrics and behavioral and developmental pediatrics at the University of California, San Francisco. She has held academic positions at San Diego State University and the University of California (San Diego), and continues as a research scientist at the Rady Children’s Hospital in San Diego.

Leslie is passionate about making systems work better for children and families. Her passion stems in large part from an experience during her training as a pediatrician in a San Francisco emergency room. Leslie recalled: “She was a three-year-old removed from her home. She was with a social worker, but not her assigned social worker. The social worker didn’t have any past history or medical information. The child didn’t answer a single question I asked. I didn’t know if she spoke another language or not; I tried English, French, and Spanish. My job was to provide a comprehensive physical examination assuring that the three-year-old was healthy, had no visible signs of abuse or neglect, and had no problems requiring additional services.” Leslie did her job, documenting possible reasons for the child’s muteness and suggesting further evaluation. But the experience and its potential impact on the child shook her to the core. She thought there had to be a way to better connect biological parents, foster parents, social workers, clinicians, and other professionals into a network that would provide quality care for children.

The overlap between children’s health and the child welfare system is foremost in Leslie’s work. She is trying to improve identification and treatment of the needs of children and adolescents by creating a network across the health, mental health, school, and family sectors. Nowhere is this network more needed than for children and adolescents in foster care, who are often caught between multiple caregivers, practitioners, and agencies. About 50% of children entering foster care have developmental and behavioral problems. Leslie currently holds a Distinguished Fellowship from the W.T. Grant Foundation to work directly with the Massachusetts Department of Children and Families (DCF) on policies to improve health outcomes for youth in foster care. She will be spending one or two days a week for the next two years working at DCF. Leslie and her research group are also conducting semi-structured interviews with early intervention providers, foster parents, and social service workers to see what barriers there are for implementing new federal policies related to the health of children in child welfare. “Because if you do this type of research without grounding it in the agencies that have to go on to implement it, it won’t be effective at all,” says Leslie.

Improving national child healthcare policies is also on Leslie’s agenda. She spoke to Congress in May 2008 about data that she and others had collected on the use of psychotropic medications for children in foster care. A federal law was passed in October 2008 requiring child welfare agencies to work with mental health, Medicaid, and pediatric providers on monitoring medications. Leslie’s research group is gathering policy data from child welfare agencies in all fifty states on psychotropic medication use in children in foster care, including questions about consent and quality-of-care markers. She will be going to Washington, DC, about four times a year to meet with policy makers on these and related policy issues as part of her W.T. Grant Foundation fellowship.

“The other thing about this type of data is that it’s got to be linked so much to the community or it will sit in a journal and do nothing,” says Leslie, who is promoting community links through her position as director of the Tufts CTSI Program on Aligning Researchers and Communities for Health and her membership on the steering committee of the Tufts Community Research Center. Leslie plans to work with all communities involved to improve dialogue and trust and to create roadmaps to better healthcare and health outcomes.

Leslie is also working to improve clinical care for youth with a number of mental health conditions, including attention-deficit hyperactivity disorder (ADHD). “One of the grants I have right now is looking at whether or not children should have an electrocardiogram before they go on medication for ADHD,” says Leslie. There is a theoretical concern that these medications could increase heart rate and trigger a sudden cardiac event in someone with a previously unidentified, underlying cardiac condition. The group is doing an evidence-based synthesis of available data and creating decision analysis models.

For more information on Leslie’s research, please go to http://160.109.101.132/icrhps/faculty/facultypages/LeslieLaurel.asp.

 

 

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