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Hospitalization of Children in Foster Homes: A Canadian Cohort Study
Ashley Quinn1, Nicole Racine2,3, Nico Trocmé4
1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Insights
Children in foster care have higher hospitalization rates, particularly Indigenous First Nations youth. These health needs persist into adulthood, highlighting the need for accessible mental and reproductive health services.
Area of Science:
- Pediatric Health
- Public Health
- Health Services Research
Background:
- Approximately 4-7% of Canadian children experience foster care.
- Foster care is a significant part of childhood for many youth.
- Understanding health outcomes for this population is crucial.
Purpose of the Study:
- To investigate hospitalization rates in children with foster care experience.
- To compare hospitalization rates between children in foster care and the general child population.
- To identify key health needs and disparities within this demographic.
Main Methods:
- Utilized linked Canadian Census and health administrative data (2011-2017).
- Included children under 18 across all Canadian provinces and territories (excluding Quebec).
- Defined 'foster child' status via Census Day 2011 and analyzed hospitalization data.
Main Results:
- Children with foster care experience had nearly double the hospitalization rate (283/1000 vs. 140/1000).
- Indigenous First Nations children were in foster care at a significantly higher rate (50.49/1000) compared to white children (3.28/1000).
- Top hospitalization causes included mental health, substance use, and reproductive health complications.
Conclusions:
- Children and young adults with foster care experience exhibit acute health needs extending into adulthood.
- Early and accessible mental health and reproductive health services are vital for this population.
- Addressing these health disparities requires targeted interventions and support systems.
Background And Objectives:
In Canada, approximately 4% to 7% of children live in a foster home during their childhood. This study reports on hospitalizations of children in foster homes, with the hypothesis that rates of hospitalization are higher for children with foster home experience compared to all other children.
Methods:
We used linked Canadian Census records and health administrative databases. All children <18 years old were included in all provinces and territories except for Quebec. Our exposure was being identified as a "foster child" on Census Day 2011. Our primary outcome was hospitalizations between 2011 and 2017. Survey weights were applied to obtain a sample size representative of the Canadian population.
Results:
Our study represented weighted N = 31 595 (unweighted N = 5796) children in foster homes compared to weighted N = 5 317 346 (unweighted N = 1 062 694) children not in a foster home. Indigenous First Nations children were in foster homes at a rate of 50.49 per 1000, compared to 3.28 per 1000 white children (ratio 15.4, 95% CI, 9.27-25.43). Children with foster home experience were more likely to be hospitalized compared to those without (283 per 1000 vs 140 per 1000, relative rate 1.94, 95% CI, 1.69-2.22). The top causes of hospitalization for young adults with foster home experience were mental health, substance use, and complications of reproductive health.
Conclusion:
Children and young adults with foster home experience have acute health needs that last into their adult years and would benefit from early and accessible mental health and reproductive health services.
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