Differences in Health Problems and Health Care Use Between Maltreated Adolescents and a Comparison Population

Purpose: Children in foster care have serious, chronic health care problems and these problems are comparable for maltreated children who remain at home.  It is not known whether health problems and utilization of health care are similar for nonmaltreated youth living in the same low-income neighborhoods as maltreated youth. This study used data from the second assessment of a longitudinal study on child maltreatment to answer the following questions: 1) What are the differences between the health status, medications, and health care usage for maltreated versus comparison youth? 2) Do caregiver characteristics affect health status or usage?

 

Methods: The study sample was limited to adolescents who had lived with the current caretaker for at least12 months, resulting in a sample of 142 comparison and 207 maltreated adolescents (Mean age=12.08, SD=1.18; Age range=10-15). Maltreated adolescents lived with different types of caregivers: 127 with a biological parent, 58 with a relative, and 22 with an unrelated foster caregiver. Caregivers reported on the adolescent’s health care status, use of services, and perception of the adolescent’s physical and psychological health. Variables were created to examine the number of illnesses in the past 12 months and symptoms in the past 30 days, whether the adolescent had been to the doctor in the past 12 months, health insurance type, and medications.

Results: Comparison adolescents had more respiratory illnesses in the past year, and more colds and aches/pains in the past month. There was no difference in the number of medications taken by the maltreated versus comparison groups although maltreated youth were more likely be taking psychotropic medications (p<.05; 6.8% vs. 1.4%). Maltreated adolescents were more likely to have been to the doctor in the last 12 months (p<.05) than comparison adolescents. Within the maltreated group, there was a significant association between caregiver type and having a medical checkup in the past year (χ² =5.83, p=.05), with youth in unrelated foster care reporting 100%, biological caregiver 88.8%, and kinship caregiver 80.7%. Adolescents on Medicaid were 2.6 times more likely to have been to the doctor last year (CI=1.47-4.66, p<.01). Caregivers of maltreated adolescents rated them to have poorer psychological health (85%) than caregivers of comparison youth (61%; p<.01) and identified more difficulties with the child's psychological health from a parenting perspective.

Conclusions: Comparison adolescents were reported to have more physical health problems than maltreated adolescents, yet the comparison adolescents were not using pediatric health care services as frequently as maltreated youth.  Some of the maltreated youth were in foster care, and the higher level of health care utilization may have resulted from the receipt of child welfare case management services and/or receipt of Medicaid insurance.  In terms of psychological health, the maltreated youth, not surprisingly, were rated to have poorer health by their caregiver. With the implementation of the Affordable Care Act, and the assurance that all children will have health insurance, it is likely that health care utilization will increase for low-income adolescents, many of whom have high need for regular medical care.