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Comprehensive assessments for children entering foster care: a national perspective
Laurel K Leslie1, Michael S Hurlburt, John Landsverk
1University of California San Diego, San Diego, California, USA. lleslie@casrc.org
Insights
Many children in out-of-home care lack comprehensive health assessments. Policies for mental and developmental health screenings are less common, highlighting a need for improved practices and provider education.
Area of Science:
- Child Health
- Public Health Policy
- Healthcare Assessment
Background:
- Children entering out-of-home care often have complex health needs.
- Existing national guidelines recommend comprehensive health assessments for these children.
- The status of policy implementation for these assessments varies across regions.
Purpose of the Study:
- To investigate the current policies for comprehensive health assessments of children entering out-of-home care.
- To profile primary sampling units (PSUs) based on assessment policy comprehensiveness (physical, mental, developmental).
- To examine relationships between policy inclusivity, assessment rates, location, and provider type.
Main Methods:
- A national probability sample of 92 PSUs was surveyed.
- Telephone surveys with child welfare key informants collected data on assessment policies.
- Weighted descriptive statistics were used to analyze policy data.
Main Results:
- Over 94% of PSUs assessed all children for physical health.
- Fewer PSUs had inclusive policies for mental health (47.8%) and developmental (57.8%) assessments.
- Only 42.6% of PSUs provided comprehensive physical, mental, and developmental assessments for all children.
Conclusions:
- Many PSUs lack comprehensive policies and practices for assessing children in out-of-home care, despite national guidelines.
- Primary care providers are frequently used for assessments and require education on the needs of this population.
- Improving assessment comprehensiveness is crucial for the well-being of children in out-of-home care.
Objectives:
To 1) investigate the status of policies for comprehensive health assessments of children entering out-of-home care, 2) develop a profile for each primary sampling unit (PSU) regarding the comprehensiveness of its assessment policies with respect to physical, mental, and developmental health, and 3) examine the relationship between inclusiveness and the estimated percentage of children assessed, primary assessment location, and principal assessment provider type.
Method:
In collaboration with the National Survey of Child and Adolescent Well-Being, a national probability sample of 92 PSUs was identified. Detailed telephone survey data, addressing policies for the assessment of physical, mental, and developmental needs of children on entry into out-of-home care, were collected from child welfare key informants. Descriptive statistics were used for analyses, and were weighted to account for the sampling strategy.
Results:
Over 94% of PSUs surveyed assessed all children for physical health problems. The percentage of PSUs with inclusive policies regarding mental health and developmental assessment was much lower (47.8% and 57.8%, respectively). Only 42.6% of PSUs provided comprehensive physical, mental health, and developmental examinations inclusive of all children entering out-of-home care. Community locations and primary care providers were most often used to conduct assessments for physical and developmental problems.
Conclusions:
Despite the publication of national guidelines regarding assessment, many PSUs do not have comprehensive policies or routine practices that address all children entering out-of-home care. Given the high use of primary care providers, these providers must be educated regarding the prevalence and types of problems experienced by children entering foster care.