Health care utilization by children entering foster care: Factors associated with provider-initiated health referral and referral completion

Abstract

Because of the events that precipitate entry into foster care, of social characteristics, and of the trauma associated with placement, foster children represent one of America's most vulnerable groups in terms of their health needs. Unfortunately, prior research has demonstrated that the probability of the health needs of these children being met is poor. Additionally, the Maryland Department of Human Resources has been sued for, among other things, failure to provide adequate health care to foster children. The resulting consent decree requires that children entering foster care receive a health assessment within five days of entry and a more comprehensive assessment after 30 days. The primary purpose of this study was to determine the ability of selected factors to explain (1) provider-initiated health referrals, and (2) the completion of those referrals for a cohort of children entering foster care in Baltimore. Multivariate analyses techniques were used with data from nonprobability samples of 1910 children entering care (#1) and 262 children in care for at least 30 days (#2). Consistent with previous studies, this study found that the sample children had multiple health problems. More than 70% of the children had 2 or more problems and 98.4% had at least one referral for additional services. Moreover, the children continue to have unmet health needs with only 45% of non-routine referrals completed during the study period. Age, race, sexual abuse, number of mental health problems, number of physical health problems and sexual activity explained 39% of the variance in number of referrals while age and completion time explained 9% of the variance in referral completion. Age was the best predictor of both number of referrals and referral completion. Age and number of mental health problems predicted type of referral (dental, medical or mental health). This study demonstrates that despite a lawsuit and new health project, foster children are still not getting their health needs met. It is critical that child welfare personnel recognize the need for comprehensive health care for foster children. More research in health care utilization by foster children is needed; this study demonstrates the applicability of the Aday/Andersen model of health utilization and multivariate analysis techniques to that study.