Research That Matters (January 17 - 20, 2008)

Background and Purpose: Children in the child welfare system have more chronic health problems than Medicaid-eligible children and often do not receive adequate and timely health care. Caregivers are being recognized as “gatekeepers” to accessing and utilizing pediatric health services for their children. The goal of this study was to examine access barriers to pediatric health services as perceived by caregivers (including birth, kinship foster, and unrelated foster) using an adaptation of Flores Pediatric Access Survey tool (Flores, Abreu, Olivar & Kastner, 1998).

Methods: Caregivers were interviewed at a child welfare pediatric clinic in Los Angeles California about their prior experiences accessing health services. A 92 question survey was used which included multiple-choice and open-ended questions assessing the family's sociodemographic characteristics, child's health insurance, 10 previously defined common access barriers, health status, and use of health services. A convenience sample (n=237) of primary caregivers included 28% birth parents with children in family maintenance (mean age: 33.7 years), 25% related foster care caregivers (mean age: 45.2 years), and 46% unrelated foster care caregivers (mean age: 46.6 years). Descriptive statistics were calculated on demographic background of the children and caregivers and co-variates of children's age, caregivers' characteristics, and number of children under care were controlled in all General Linear Models and Logistic Regression Models.

Results: The results indicate that the access barriers most often identified by all caregivers (both English and Spanish speaking) was 1) difficulty understanding physicians and, in order of frequency, 2) wait too long to see a doctor, 3) clinic hours inconvenient and 4) too difficult to make an appointment. Birth parents were younger in age, had less education and income and were more likely to rate transportation as an access barrier (p=.00) and less likely to have used pediatric services (p=.05) than related or unrelated foster caregivers. Insurance coverage (94%) and perceived health status of children (86% rating good to excellent) did not differ by type of caregiver. Subjects with income greater than $30,000 are predicted to have a 1.77 times more chance to have “good or better” general health rating than those with incomes less than or equal to $30,000.

Conclusions and Implications: Caregivers may have an unrealistic view of their child's health status since almost 87% rate their child's health as excellent or good when research has shown that children in the child welfare system have serious chronic health problems. These findings suggest that even with health insurance, access barriers are problematic for foster caregivers, but even more important for birth parents of children in family maintenance since birth parents identified similar access barriers but reported less use of health services than foster caregivers. Social workers in child welfare need to make health care a priority and help caregivers understand medical instructions to increase adherence to health care recommendations and especially target birth parents and caregivers with lower income to encourage health service use.