About

Rebecca R. Seltzer, MD, MHS, is an Associate Professor of Pediatrics at the Johns Hopkins School of Medicine and a faculty member at the Johns Hopkins Berman Institute of Bioethics. Her research involves improving care for children with medical complexity, with a particular focus on those in the child welfare system. She explores the ethical and policy challenges that arise when caring for this vulnerable population, including issues related to medical decision-making, conducting research with children in foster care, and addressing gaps in community supports and placement options. Dr. Seltzer is also involved in developing clinics such as the Bridging to Wellness clinic for children evaluated for abuse and neglect, and she oversees pediatric residents and medical students at the Harriet Lane Primary Care clinic. Her background includes a BA from the University of Virginia, an MD from the Perelman School of Medicine at the University of Pennsylvania, pediatric residency at the Children's Hospital of Philadelphia, fellowship training in Academic General Pediatrics and ethics at Johns Hopkins, and an MHS from the Johns Hopkins Bloomberg School of Public Health.

Research topics

• Medicine
• Political Science
• Psychology
• Nursing
• Environmental health
• Family medicine
• Psychiatry
• Medical emergency
• Social psychology

Selected publications

• Characterizing the use of home-based behavioral health services among children in foster care

  Children and Youth Services Review · 2026-03-14

  articleOpen accessSenior author

  • Children in foster care were twice as likely to use home-based behavioral health services. • Home-based care use linked to fewer hospitalizations and emergency visits. • HBHS use associated with lower odds of new psychotropic prescriptions. • HBHS reached clinically complex and racially diverse populations in foster care. • Expanding HBHS access may reduce reliance on restrictive or pharmacologic care. Children in foster care (FC) experience disproportionately high rates of mental health (MH) needs and frequently use behavioral health services. They are overrepresented in restrictive MH settings and are more likely to be prescribed psychotropic medications. Home-based behavioral health services (HBHS) offer a less restrictive alternative for addressing the complex needs of children in FC, but their use and effectiveness remain understudied. Using Medicaid data from 28 states, we examined MH service utilization among children aged 3–18 with primary MH diagnoses across three eligibility groups: FC (n = 128,180), disability (n = 214,959), and low-income (n = 1,054,426). We summarized utilization patterns, estimated multivariable models of HBHS take-up, and assessed associations between HBHS and other MH-related care. About 60% of children in FC had a MH diagnosis, compared with 65% of children with disabilities and 19% of children with income-based eligibility. HBHS use was highest among children in FC (29%), exceeding use among children with disabilities (15%) and low-income children (10%). Among children in FC, HBHS use was associated with greater MH diagnostic complexity, Black and Hispanic race/ethnicity, and certain MH diagnoses. HBHS use (vs. no use) was associated with lower odds of hospitalization (aOR = 0.82), ED visits (aOR = 0.75), and new psychotropic prescriptions (antipsychotics aOR = 0.76; SSRIs aOR = 0.80; ADHD medications aOR = 0.77), and higher odds of school-based MH service use (aOR = 1.47). HBHS are widely used within FC and serve clinically complex populations. Their use was linked to reduced reliance on restrictive and pharmaceutical care, suggesting that expanding access may enhance MH services for children.

  PublisherDOI

• Services and supports for child-welfare involved children with medical complexity: Data from a national survey of child welfare agencies

  Child Abuse & Neglect · 2026-02-18

  article1st authorCorresponding
  PublisherDOI

• Children With Medical Complexity

  American Academy of PediatricsItasca, IL eBooks · 2025-10-16

  book-chapter1st authorCorresponding
  PublisherDOI

• Home Health Care Research for Children With Disability and Medical Complexity

  PEDIATRICS · 2025-01-14 · 19 citations

  reviewOpen access

  Pediatric home health care represents a vital system of care for children with disability and medical complexity, encompassing services provided by family caregivers and nonfamily home health care providers and the use of durable medical equipment and supplies. Home health care is medically necessary for the physiologic health of children with disability and medical complexity and for their participation and function within home, school, and community settings. While the study of pediatric home health care in the United States has increased in the last decade, its research remains primarily methodologically limited to observational studies. Dedicated funding and research efforts are needed to transform American home health care research to address multifaceted outcomes valued by families and providers as well as payers and government programs. In this paper, we review the recent literature in pediatric home health care and then propose an actional agenda that could address its missing evidence base. We posit that pediatricians should partner with family caregiving experts and patients to advance knowledge about child and family health outcomes, home health care use, new models of care, and optimal approaches to education and training while also considering meaningful approaches to address disparities. The creation of an American pediatric home health care data-sharing consortium, patient registry, and reproducible access and quality measures is also needed. Most importantly, efforts should center on patient- and family-centered health priorities, with the goal of ensuring equitable outcomes for every child and family.

  PublisherOA PDFDOI

• Safe Enough: Subjective Determinations in Hospital Discharge for Patients With Medical Complexity

  PEDIATRICS · 2025-05-12 · 4 citations

  articleOpen access

  Determining whether a discharge plan is safe relies on both objective and subjective evaluations. These safety determinations are often made with the goal of having children reintegrated into their community. In the case of pediatric mechanical ventilation via tracheostomy, the stakes for discharge home are high given potential morbidity and mortality risk if there are insufficient services in place. Clinical practice guidelines recommend that these children have continuous monitoring from a nurse or trained caregiver. However, this monitoring recommendation has led to unintended delays in discharges due to nursing shortages and limited caregiver availability. Conflicts can then arise about whether patients should remain hospitalized indefinitely until nursing is secured, be discharged home without adequate nursing support, or be placed in a long-term care facility until criteria are met. Important ethical considerations when addressing this conflict include the legal obligation to ensure children are properly integrated into their communities, the biases and racism that may impact which families are deemed as being unable to provide a safe environment, and the harm associated with the clinical team overriding a parent's decision about their child's care and recommending state intervention. To balance the medical goal of maximizing safety with the ethical standard of respecting autonomy and the civil rights that children with disabilities have to receive care at home, we must reconsider how safety is evaluated by seeking an integrated approach that provides a shared understanding of best practices and values between the clinical team and family in defining "safe."

  PublisherOA PDFDOI

• Expanding Access to Home-Based Behavioral Health Services for Children in Foster Care

  Administration and Policy in Mental Health and Mental Health Services Research · 2024-04-02

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Alterations in care for children with special healthcare needs during the early COVID-19 pandemic: ethical and policy considerations

  Bioethics News · 2024-12-11

  reviewSenior author
  PublisherDOI

• The Home-Built Environment of Children With Medical Complexity

  Clinical Pediatrics · 2024-12-22 · 2 citations

  articleSenior authorCorresponding

  This study aimed to describe the home-built environment of children with medical complexity (CMC) using novel photovoice methodology. Parents/guardians of CMC uploaded and discussed photographs of their home environment through semi-structured interviews. Conventional content analysis was applied to interview transcripts embedded with corresponding photographs. All participants modified their home environment to optimize the health, function, and well-being of the child and family; extent of modifications varied. Two main themes and subthemes characterized the home-built environment: (1) replicating hospital function and structure: ensuring accessibility, promoting safety, optimizing organization of supplies, and equipment and (2) maintaining a sense of home: self-expression, entertaining, family participation, and comfort. Elements of hospital structure and function and traditional home aesthetics and utility were equally important to families, the interplay between both facets informed modifications. By understanding the home-built environment, pediatric providers can more holistically support the health and well-being of CMC and their caregivers.

  PublisherDOI

• Correction to: Expanding Access to HomeBased Behavioral Health Services for Children in Foster Care

  Administration and Policy in Mental Health and Mental Health Services Research · 2024-05-25

  erratumOpen accessSenior author
  PublisherOA PDFDOI

• Considerations for Alternative Decision-Making When Transitioning to Adulthood for Youth With Intellectual and Developmental Disabilities: Policy Statement

  PEDIATRICS · 2024-05-28 · 15 citations

  article

  With advances in medical care, more youth with intellectual and/or developmental disabilities (IDD) are transitioning into adulthood. Patient- and family-centered, integrated care is warranted around this time of transition. Support teams (including the youth, caregivers, teachers, and pediatricians) should engage in transition planning, ideally starting between 12 and 14 years of age, to identify and develop resources to support the maturing youth's capacity for independent decision-making. Care teams should consider the varied levels of alternative decision-making support, which may include supported decision-making, medical proxy decision-making, power of attorney, and/or establishment of legal guardianship arrangements, to support the youth's health and well-being optimally. Ultimately, if independent decision-making is not appropriate, the goal for youth with IDD should be the least restrictive alternative, while preserving human rights and human dignity and promoting their autonomy. These considerations review alternative decision-making support, concepts, and legal requirements available for youth with IDD and their care teams. Pediatricians can support youth with IDD and their families in the transition process and decision-making autonomy by actively engaging the youth in care decisions, supporting needs for augmentative communication, fostering their expression of preferences and understanding of care decisions, and linking them to resources such as the medical-legal partnership model.

  PublisherDOI

Frequent coauthors

• Renee D. Boss

  Johns Hopkins Medicine

  69 shared

• Pamela Donohue

  Johns Hopkins University

  46 shared

• Jeff Jones

  Johns Hopkins Berman Institute of Bioethics

  20 shared

• Erin P. Williams

  Columbia University

  16 shared

• Andrea Gropman

  Children's National

  15 shared

• Emily Hahn

  13 shared

• Carrie M. Henderson

  Louisiana State University

  12 shared

• Brandon M. Smith

  Johns Hopkins Medicine

  12 shared

Awards & honors

• Hecht-Levi Fellow at the Berman Institute of Bioethics