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Patterns of healthcare utilization with placement changes for youth in foster care
Sarah J Beal1, Robert T Ammerman1, Constance A Mara1
1Department of Pediatrics, University of Cincinnati College of Medicine, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
Insights
Placement changes disrupt healthcare for children in foster care, increasing planned visits. Delays in mandated care correlate with lower overall healthcare use, highlighting the need for consistent access to primary and specialty care.
Area of Science:
- Pediatric Health Services Research
- Child Welfare Policy
- Healthcare Access and Utilization
Background:
- Children in foster care exhibit poorer health outcomes and higher healthcare utilization.
- Frequent placement changes disrupt continuity of care for these children.
- Existing studies on healthcare use have not adequately addressed the impact of placement instability.
Purpose of the Study:
- To analyze healthcare utilization patterns among children in foster care.
- To investigate the influence of placement changes on healthcare access.
- To account for mandated healthcare visits upon entry into foster care and during placement transitions.
Main Methods:
- Utilized linked administrative data from a child welfare agency and a pediatric healthcare system.
- Included children aged 4 and older in foster care between 2012 and 2017.
- Employed negative binomial models to predict planned, unplanned, and missed healthcare days per month.
Main Results:
- Planned healthcare visits significantly increased with placement changes (IRR=1.69) and decreased with placement stability (IRR=0.92).
- Later timing of mandated visits was associated with fewer planned (IRR=0.81) and unplanned (IRR=0.82) healthcare days.
- Placement instability directly correlates with increased healthcare utilization, particularly planned visits.
Conclusions:
- Healthcare patterns indicate a need for improved continuity of primary and specialty care during foster care placements and transitions.
- Delayed mandated visits may be indicative of overall reduced healthcare engagement.
- Ensuring consistent clinical care, irrespective of placement disruptions, is crucial for the well-being of children in foster care.
Background:
Children in foster care experience poor health and high healthcare use. Child welfare agencies frequently require healthcare visits when children enter foster care; subsequent placement changes also disrupt healthcare. Studies of healthcare use have not accounted for placement changes.
Objective:
To understand patterns of healthcare use throughout the time a child enters foster care and with placement changes, accounting for mandated visits when children enter foster care or experience a placement change.
Participants And Setting:
Children 4 and older in foster care between 2012 and 2017 (N = 2787) with linked child welfare administrative data from one county child welfare agency and one Midwest pediatric healthcare system.
Methods:
Negative binomial models predicted healthcare days per month that were planned (e.g., scheduled primary/specialty care), unplanned (e.g., emergency care), or missed.
Results:
Planned healthcare days increased as a function of placement changes (Incident Rate Ratio [IRR] =1.69, p < .05) and decreased with placement stability (IRR = 0.92, p < .01). Mandated visits that occurred later in a placement were associated with fewer planned (IRR = 0.81, p < .01) and unplanned (IRR = 0.82, p < .01) healthcare days during that placement.
Conclusions:
Patterns of planned healthcare over the time children are in one placement and move between placements suggest more can be done to ensure youth remain connected to primary and specialty care throughout placements and placement transitions, s that children are seen as clinically appropriate rather than a function of placement disruption. Findings regarding the timing of mandated visits suggest that delays in mandated care may also reflect lower healthcare use overall.
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