111P
The Relationship Between Spells in Placement, Hotline Reports, and Age of First Report with Chronic Mental and Physical Health Diagnoses in a Foster Care Population
The United States has over 400,000 children in the foster care system, and prior research has shown that such children have high rates of chronic medical and mental health conditions. More information is needed, however, about how placement-related factors such as number of placements or length of time in care affect health outcomes. This study extends the current literature by investigating how placement-related variables and demographic factors are related to externalizing and internalizing behavior disorders, asthma, and diabetes in a large sample of urban children in foster care.
METHODS
Data were drawn from an administrative dataset investigating child maltreatment and included a sample of children age 1 day-11 years old entering foster care system in a Midwestern metropolitan area (N =1404) between 1984-2006. Multivariate logistic regression models were developed that included both demographic predictors (family size, maternal education attainment, race, receipt of AFDC benefits, county of residence and child gender) and placement-related variables (total number of hotline calls, total number of spells in foster care, and age of first placement in foster care). Dependent variables were externalizing behavior disorder, internalizing behavior disorder, and asthma diagnoses as recorded in medical records captured through a combination of emergency room visits, Medicaid data, and child mental health records.
RESULTS
When controlling for demographic variables, placement variables (age of first placement, total number of hotline calls, and total number of spells in foster care) were all predictive of a diagnosis of an externalizing behavior disorder [age of first placement (OR = 1.055, 95% CI 1.030, 1.080) total number of hotline calls (OR = 1.102, 95% CI 1.061, 1.145), and total number of spells in foster care (OR = 2.035, 95% CI 1.545, 2.680)] and were also predictive of a diagnosis of an internalizing behavior disorder [age of first placement (OR = 1.136, 95% CI 1.108, 1.165), total number of hotline calls (OR = 1.119, 95% CI 1.077, 1.162) and total number of spells in foster care (OR = 2.580, 95% CI 1.948, 3.415)]. When controlling for demographic variables, the placement variables of the total number of hotline calls (OR = 1.055, 95% CI 1.007, 1.106) and the total number of spells in foster care (OR = 1.439, 95% CI 1.072, 1.932) were predictive of an asthma diagnosis. African-American youth were found to have decreased odds of being diagnosed with an externalizing (OR = .744, 95% CI .557, .994) or internalizing (OR = .613, 95% CI .456, .824) behavioral disorder but increased odds of being diagnosed with asthma (OR = 1.6, 95% CI 1.048, 2.444). Placement and demographic variables were not predictive of a diagnosis of diabetes in the sample population.
IMPLICATIONS
Our results indicate that placement variables are predictive of mental health and chronic medical diagnoses. These results suggest that a coordinated care system, such as providing medical homes for children in foster care, may enable better treatment of chronic conditions in this high-risk population, especially among children that experience chronic maltreatment as evidenced through spells in foster care and hotline reports.