Post-Traumatic Stress Symptomatology and Service Use Among Youth in Foster Care

Background and Purpose: Among youth in foster care, trauma exposure can vary substantially. For example, it has been suggested that 19-51% of youth experience clinically significant levels of post-traumatic stress symptoms (PTTS) (Jaramillo et al., 2022; Kolko et al., 2010). Although PTSS may result in diminished physical and mental health (MH) care and increased need for MH services (Pecora et al., 2009), research has not carefully examined the relationship between PTSS and MH service use among youth in care. Nor has research explored if PTSS informs the use of other critical services (e.g., ER visits, vision/dental care). The current study examined whether PTSS informs the use of MH and healthcare services.

Methods: Secondary quantitative data reflected the Supporting Siblings in Foster Care study, in particular examining the association of PTSS with various types of service use. Youth reported using the following services in the past 60 days: MH, emergency, hospitalization, general medical, vision, and dental services. Two measures of PTSS included Child Report of Post-traumatic Symptoms (CROPS) (m=20.58) and Parent Report of Post-traumatic Symptoms (PROPS) (m=15.37), with a CROPS score of 19 or higher and a PROPS score of 16 or higher indicating clinical concern (r(CROPS, PROPS)=.27) (Greenwald & Rubin, 1999). We controlled for youth gender, age, whether youth were older or younger siblings, race/ethnicity, days in home prior to enrollment, and youth-reported integration in the foster home. Descriptive analysis of the number of services used was followed by multivariate logistic regressions examining whether each PTSS measure predicted odds of service use, accounting for aforementioned controls.

Results: Youth received the following services: hospitalization (5%), crisis (7%), emergency (18%), vision (40%), dental (62%), MH (62%), and general medical services (68%). Multivariate analyses identified the following associations at p<.05. PROPS scores predicted MH service receipt and emergency department utilization (OR=1.04, p=.008 and OR=1.04, p=.03, respectively); and CROPS scores predicted crisis experiences (OR=1.06, p=.03). Other covariates were significantly associated with the use of different types of services. For example, days in the current foster home predicted use of MH and general medical services (OR=1.00, p=<.001 and OR=1.00, p=.01 respectively). Having a better relationship with one’s foster parent, and being male, predicted hospitalization (OR=.63, p=.02 and OR=7.79, p=.01 respectively). Gender predicted vision services (OR=.45, p=.005). No significant predictors of dental services emerged.

Conclusions and Implications: The current study explored contemporaneous youth and foster parent reports of PTSS, and examined their associations with the use of diverse essential services. Both measures of PTSS were associated with service receipt among the pre-adolescents and adolescents in foster care. Notably, the foster parent-reported measure of PTSS predicted ER use and MH service receipt, whereas the youth-reported measure of PTSS predicted crisis service use. We therefore suggest that different reporting agents (specifically, foster parents and youth) provide complementary perspectives concerning youths’ service needs and service receipt.