Underrstanding the Interconnectedness of Health and Children's Experience in Foster Care

Background/Purpose

Child well-being is a multifaceted concept inclusive of health related to the physical and mental health of children. Researchers have examined the child well-being within a variety of contexts; however, the physical and mental health characteristics regarding children within foster care is understudied.  The primary aim of this study is to investigate and identify indicators of child well-being for children in foster care, to gain insight into the interconnectedness between health and a child’s experience in-care.  Specifically, this study seeks to answer the following questions: 1) What are the sociodemographic characteristics of youth entering foster care with physical and mental health diagnoses?  2) Do these youth differ from the general foster care population? 3) Is presence of a physical and/or mental health diagnosis when entering foster care associated with differential permanency outcomes in comparison to youth with no health diagnoses?

Methods

A cohort of foster youth in 2012 was identified (n=249,006) using the Adoption and Foster Care Reporting System (AFCARS) dataset.  Bivariate and multivariate analyses were conducted, examining the associations between race/ethnicity and health variables. AFCARS health variables (e.g. DSM diagnosis, medical diagnosis, clinical disability, vision/hearing impairment) were collapsed to yield an overall health variable with four levels: 1) no physical or mental health diagnosis (80%, n=200,595) 2) physical diagnosis only (9.7%, n=24,332), 3) mental health diagnosis only (<1%, n=89) and 4) both a physical and mental health diagnosis (9.6%, n=23,990). 

Results

Bivariate analysis revealed that youth with any diagnosis are more likely to be male (53% physical health only, 57.4% both diagnoses group) in comparison to the total population of youth in foster care (51.8% male).  There was no statistical difference between groups on race, except children with physical health diagnoses were less likely to be white (55%) in comparison to the other groups (64.6% both diagnoses group, 64.6% no diagnosis group). Differences were observed regarding reason for removal: youth with health concerns were more likely to be removed for drug use of the child, child’s disability, child behavior problems (both diagnoses group), parent’s inability to cope, sexual abuse (both diagnoses group), and neglect (physical health only group).  Youth with health concerns were less likely to be removed for inadequate housing or a parent’s incarceration. 

A multinomial logistic regression found when compared to youth with no health issues, youth with physical health issues alone were: 2.6 times likely to be placed in a pre-adoptive (OR=2.6; 2.19,3.09) and 1.4 times likely to have a case goal of long-term foster care (OR=1.4; 1.24,1.62). In comparison to youth with no health issues, youth with both physical and mental health issues were: 1.4 times more likely to have a case goal of emancipation (OR=1.4; 1.19,1.68) and 3.5 times more likely to die while in care (OR=3.49; 2.54,4.79).

Conclusions/Implications

The foster care system has a primary purpose to ensure the safety and well-being of the children in its care. When considering interventions and efforts to address child well-being with this population, the health characteristics of the children the system must be addressed and identified.