Physical and Behavioral Health Care Use of Former Foster Youth at Age 21

Purpose: Many youth in foster care exit the system due to age rather than because they found a forever home. These young adults are a vulnerable population who have experienced a wide range of adverse experiences, and who are at high risk for negative health outcomes. Therefore, continuity of physical and behavioral health care is particularly important in this population. This study aimed to describe the use of physical and behavioral health care among young adults, age 21, who were in foster care at the age of 17.

Methods: The National Youth in Transition Database (NYTD) is a federally funded national longitudinal survey of youth who age out of foster care. NYTD collects three waves of data (ages 17, 19, 21). Each state surveys participants on federally-required questions and has the option to also add state-specific questions. Data reported in this study were collected in 2017-2018 and are from 21 year olds in one southeastern state in which questions addressing physical and behavioral health care were added as state-specific questions. Participants (n=93) were majority female (57%), 74% reported having a high school degree/GED/Vocational certificate, and racially/ethnically diverse (48.4% African American, 47.3% Caucasian, 1.2% American Indian, 1.2% Asian, 1.2% multiracial). Descriptive statistics were calculated using SAS 9.4.

Results: Participants indicated a range of medical care with 20% of 21-year-old respondents not having seen a doctor since exiting foster care and 34% not having seen a dentist. A concerning proportion of the sample were not receiving annual medical (57%) or dental visits (70%) since exiting foster care. One-third of participants (34%) indicated they were on prescription medications when exiting foster care. Within that group, 47% continued to renew and take prescriptions after leaving foster care. Reasons for continuing prescription use included physical and behavioral health needs and observed improvements from use. For those who stopped taking prescriptions, 75% made this choice without consulting their doctor. Reasons included choice (medication not helping, not needed any more) and barriers (too expensive, inadequate insurance, lack of access to provider). Approximately one-quarter (27%) of participants reported seeing a mental health counselor/therapist regularly when exiting foster care. Within that group, 48% had discontinued therapy after leaving foster care. Both voluntary (i.e., no longer needed) and involuntary reasons (i.e., too expensive, lack of insurance, lack of access) were described for stopping therapy. Of the 39 respondents with full-time employment, seven (17.9%) had private health insurance, 21 (53.8%) had Medicaid, and 11 (28.2%) did not report any health insurance.

Conclusions/Implications: In this sample, many young adults who stopped renewing prescriptions or attending therapy did so to due to barriers to access. A large portion of the sample were not receiving recommended annual medical or dental care. Young adults exiting the foster care system are in need of continuous medical and behavioral health care but many do not access available resources. This research supports the need for outreach and education for this vulnerable population with high behavioral health care needs.