Children with Chronic Health Conditions in Foster Care: Differences in Health Care Service Utilization by Placement

Background:  Children entering foster care are at high risk for chronic physical, developmental, and psychological conditions requiring intensive health and rehabilitative services.  Even though Medicaid covers all children in foster care, research shows that many children with chronic health conditions (CCHC) do not receive the necessary specialized or primary care services they require.  CCHC with kin caregivers may be at a particular disadvantage, according to previous studies.  This study assesses health care utilization for CCHC and those without in a large sample of children entering either kinship or traditional placements.

Methods:  We used data from the 2008 National Survey of Child and Adolescent Well-being, which interviewed foster caregivers about children’s health and health services at baseline (four months after the maltreatment investigation that led to placement) and at an 18 month follow-up. Regarding CCHC, caregivers were asked if their children had any of an array of specific chronic conditions (e.g., asthma, Down syndrome, diabetes, cerebral palsy etc.) or a medical or behavioral condition expected to go on for at least one year that reduced the amount of time that he/she can exert in any activity.       

Results:  Overall, 32% of children entering foster care were CCHC; specific conditions included asthma (58%), a medical or behavioral condition reducing effort (17%), life-threatening allergic reaction (6%), and autism (5%).  More CCHC, compared to children without any condition, had seen a dentist (72% v. 53%), had been to a well-child visit (67% v. 46%), and had been to the ER or urgent care (29% v. 15%) at the time of interview.  The use of a dentist, well-child services, hospitalization, and ER or urgent care for CHCC in kin and traditional foster care were comparable.  Slightly fewer CCHC in traditional foster care were up-to-date on their immunizations compared to kin (92% v. 99%), although almost all CCHC at 18 month follow-up were up-to-date regardless of placement (99%).  More CCHC in traditional foster care had been hospitalized by time of interview compared to CCHC in kinship care (7% v. 2%), and this difference remained at 18 month follow-up (12% v. 6%).  Traditional foster caregivers of CHCC reported being unable to obtain needed health or mental health related services in 18% of cases, which was over four times more common than kin caregivers (4%).  Controlling for child age, gender, and race in a logistic regression model, CCHC in traditional foster care placements had 4.9 greater odds of being unable to obtain needed services (p<.01).

Conclusion:  A greater number of CCHC than non-CCHC children accessed primary care services following foster care placement, regardless of placement type.  CCHC in traditional foster care were more likely to be hospitalized than CCHC in kinship care and less likely to receive needed physical and mental health care services than their peers in kinship care, according to caregivers.  Possible explanations for the differences in results between traditional and kin caregivers are differences in the severity of medical conditions for children placed with each group and differences in caregivers’ perception of need for services.