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Youth “aging out” of foster care (YAO) face significant challenges accessing healthcare due to frequent placement changes, fluctuating health insurance eligibility, and inconsistent/diminishing adult guidance during the transition into adulthood. Prevalence of behavioral and physical disability diagnoses intensify concerns over health access. Additionally, racial disproportionality within the child welfare system is well-documented—black youth experience foster care at twice the rate of white youth. Studies exploring specific psychosocial (e.g., stigma) and structural (e.g., systemic bias/racism) barriers to healthcare access within racially diverse, urban, and rural communities across Alabama are crucial to improving health equity.
Set against a backdrop of long-standing concerns over health access and equity in Alabama, this study seeks to provide a foundational understanding of existing facilitators of and barriers to healthcare access for YAOwD across Alabama’s urban and rural service settings. Recognizing the importance of stakeholder engagement in developing a community-engaged research program, this presentation aims to describe the findings of our study and detail the process of engaging multiple stakeholders within the research process to better inform future health promotion strategies for YAOwD in Alabama.
METHODS:
To understand the multi-faceted determinants of healthcare access among YAOwD in AL, this exploratory study leverages a partnership with direct service providers to YAOwD to collaboratively recruit participants, interpret findings, and implement change. Accordingly, 9 in-depth semi-structured focus groups were conducted across three locations in Alabama with distinct stakeholder populations: (a) YAO (18+) with diagnosed disabilities (n=12); (b) caregivers of YAOwD (n=29); and (c) child welfare professionals serving YAOwD (n=30). Themes were collaboratively developed and independently coded by two researchers to enhance rigor.
RESULTS:
Findings illustrate several factors challenging healthcare access for YAOwD, including: (1) misconceptions about Medicaid eligibility after leaving care; (2) insufficient opportunities for youth to gain knowledge/comfort with independently managing healthcare needs prior to leaving care; and (3) desires to be “normal” and free of mental and behavioral health medications associated with foster care. While different concerns were noted across stakeholders by urbanicity, youth ability and gender, race was not identified as a concern among participants.
Findings from this research-to-action partnership were communicated through accessible and tailored modes of dissemination to multiple stakeholders within the community, including executive summary, flyers and social media graphics, and CEU presentations.
CONCLUSIONS & IMPLICATIONS:
Policy and practice recommendations include consistent integration of healthcare access into independent living skills prior to aging out. Similarly, YAOwD would benefit from access to health liaisons who can discreetly advise on sensitive health matters and promote continuity of care across care placements and transitions to adulthood.
Engaging with multiple stakeholders (including YAOwD) toward improving outcomes among YAOwD in AL advances a community-engaged research program that centers equity for diverse and intersectional populations. To better understanding personal, physical, social, and structural facilitators and barriers to urban and rural healthcare access in AL, future research and interventions can—and must—be informed by the needs and values of those who stand to benefit most from improved access: YAOwD and their adult allies.