Homelessness and health care access after emancipation: results from the Midwest Evaluation of Adult Functioning of Former Foster Youth

Abstract

Objective: To estimate the association between housing status and health care access and outcomes among young adults aging out of the child welfare system.

Design: Prospective cohort study

Setting: Illinois, Iowa, and Wisconsin. Baseline interviews were conducted between May 2002 and March 2003 and follow-up interviews, between March and December 2004.

Participants: Participants were foster youth aged 17 or 18 years in Illinois, Wisconsin, or Iowa. We invited a random sample of 67% of eligible Illinois youth and all eligible youth from Wisconsin and Iowa to participate. Researchers interviewed 749 at baseline (94.7% response) and 643 at follow-up (85.8%); we excluded 8 participants without housing data (n=635). We included only the 345 emancipated participants in analyses of health care access. MAIN EXPOSURE Housing status after emancipation: stable housing; unstable housing; or homeless.

Main outcome measures: Multivariate adjusted odds ratio (AOR) of association between main exposure variables with 3 measures of access to care and 2 health outcomes.

Results: Among the 345 emancipated participants, 14.2% experienced homelessness and 39.4% were unstably housed. In multivariate analysis of emancipated participants, homelessness was associated with being uninsured (AOR, 3.41; 95% confidence interval, 1.52-7.63) and having unmet need for health care (AOR, 3.26; 95% confidence interval, 1.40-7.56); it was not associated with not having had ambulatory care. In multivariate analysis of all participants, housing status was not associated with reporting fair or poor health at follow-up or, among women, with having had a pregnancy.

Conclusion: Having had an episode of homelessness after emancipation is associated with worse health access, but not worse outcomes, among youth emancipated from foster care.