Prevalence of Special Health Care Needs Among Foster Youth: Evidence from a Nationally Representative Survey

Background and Purpose:  Children in foster care have the highest rates of chronic conditions of any studied child population (Leslie et al., 2005; Stein et al., 2013). To date the gold-standard source of rates of special health care needs among children in foster care has come from the National Survey of Child and Adolescent Well-Being (NSCAW) I and II; however, these surveys do not allow for comparisons between children living in foster care and those living in other types of parental and non-parental care.  The purpose of this study is to address this gap and describe current rates of special health care needs and specific mental health and developmental conditions by caregiver type.

 

Methods:  The study uses survey data from the 2016 National Survey of Children’s Health (NSCH).  Weighted estimates are representative of all non-institutionalized children ages 0 to 17 in the U.S. The unweighted sample include 50,212 children.  For the first time, the NSCH provided a public use variable that allows researchers to distinguish different types of caregivers.  We focused on four types:  foster parents, relative caregivers, other non-relative caregivers, and biological or adoptive parents.  To assess child health, caregivers were asked whether a doctor, health care professional, or educator ever told them that their child had a specific condition and if so whether the condition was current.  We examined rates of nine specific mental health and developmental conditions as well as the rate of overall special health care needs (SHCN).  Predictive margins from logistic regressions adjusted by child demographic and socioeconomic characteristics are presented, and average marginal effects are estimated. 

Results:  Average adjusted predictions revealed that children living with foster parents were more likely to have SHCN (51%) compared with children living with relatives (27%, p<0,01), with non-foster, non-relative caregivers (20%, p<0.01), and with biological or adoptive parents (18%, p<0.01).  Similarly, children living with foster parents were more likely to have behavior and conduct problems (25%) than children living with relatives (10%, p<0.05), with other non-relatives 8%, p<0.05), or with biological or adoptive parents (6%, p<0.01).  Children living with foster parents were also more likely to have current developmental delays (18%) compared with children living with relatives (5%, p<0.05), with other non-relatives (4%, p<0.05) and with biological or adoptive parents (4%, p<0.05).  There were no differences in rates of learning disability, attention deficit hyperactivity disorder, depression, anxiety, autism spectrum disorder, speech language disorders, or intellectual disability by caregiver type. 

Implications:  Children living with foster parents had significantly higher rates of SHCN, behavioral or conduct problems, and developmental delay than children in other caregiver types.  Overall rates of special health care needs are substantially higher than those measured in NSCAW I (35%, (Ringeisen, et al., 2008). Little is known about the effects of SHCN on caregivers particularly among foster parents. A better understanding of these effects may help to inform strategies to better support caregivers and reduce stress.