Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;22(3):387-395.
doi: 10.1016/j.acap.2021.05.016. Epub 2021 May 21.

Effects of Child Protective Custody Status and Health Risk Behaviors on Health Care Use Among Adolescents

Sarah J Beal  1 , Constance A Mara  2 , Katie Nause  3 , Robert T Ammerman  2 , Rebecca Seltzer  4 , Melissa Jonson-Reid  5 , Mary V Greiner  6
Affiliations

Effects of Child Protective Custody Status and Health Risk Behaviors on Health Care Use Among Adolescents

Sarah J Beal et al. Acad Pediatr. 2022 Apr.

Abstract

Objective: To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups.

Methods: Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts.

Results: In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use.

Conclusions: Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.

Keywords: child welfare; foster care; health care utilization; health risk.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Differences in healthcare utilization for youth in protective custody and comparison youth across ages 10–20, adjusting for duration of representation in the study data.
Figure 2.
Figure 2.
Differences in healthcare utilization for youth in protective custody and comparison youth across ages 10–20, adjusting for duration of representation in the study data, demographic characteristics, health characteristics, and health risk behaviors.
See this image and copyright information in PMC

References

    1. Greiner MV, Ross J, Brown CM, Beal SJ, Sherman SN. Foster caregivers’ perspectives on the medical challenges of children placed in their care: implications for pediatricians caring for children in foster care. Clinical pediatrics. 2015;54(9):853–861. - PubMed
    1. Woods SB, Farineau HM, McWey LM. Physical health, mental health, and behaviour problems among early adolescents in foster care. Child: Care, Health and Development. 2013;39(2):220–227. doi:10.1111/j.1365-2214.2011.01357.x - DOI - PubMed
    1. Landers G, Snyder A, Zhou M. Comparing Preventive Visits of Children in Foster Care with other Children in Medicaid. Journal of health care for the poor and underserved. 2013;24(2):802–812. - PubMed
    1. Takayama JI, Bergman AB, Connell FA. Children in Foster Care in the State of Washington: Health Care Utilization and Expenditures. JAMA. 1994;271(23):1850–1855. doi:10.1001/jama.1994.03510470054034 - DOI - PubMed
    1. Sanchez K, Gomez R, Davis K. Fostering connections and medical homes: Addressing health disparities among children in substitute care. Children and Youth Services Review. 2010;32(2):286–291.

Publication types

LinkOut - more resources