Decreasing Health Risks for Adolescents in Protective Custody By Optimizing Health and Child Welfare Systems

Introduction. Children in child welfare protective custody (e.g., foster care) are known to have increased health concerns compared to children not in protective custody (Woods et al., 2013). The poor health documented for children in protective custody persists well into adulthood; young adults who emancipate from protective custody report poorer health, lower quality of life, and increased health risk behaviors compared to young adults in the general population (Courtney et al., 2011). This includes increased mental health concerns, substance use, sexually transmitted infections, unintended pregnancy, and HIV diagnosis. Identifying foster youth with mental health concerns, chronic medical conditions, and increased health risk behaviors while they remain in protective custody would provide the opportunity to target prevention and intervention efforts to curtail poor health outcomes. Better integration of health and child welfare systems could enhance service delivery and promote prevention.

Methods. This study leveraged linked electronic health records and child welfare administrative records for 351 foster youth ages 16 and older (M age = 17.63, SD = 1.40) to identify young people experiencing mental health concerns, chronic medical conditions, and health risk behaviors (e.g., substance use, sexual risk). The majority of the sample were African American (70%) or White (23%); 54% of those in the study were young women. Bivariate and multiple regression analyses were conducted in SAS 9.4.

Results. Almost half (45.3%) of foster youth have a mental health diagnosis, with depression and behavior disorders most common. Additionally, 16.5% of foster youth experience chronic medical conditions, primarily chronic migraines or obesity. Finally, 35.6% of foster youth use substances and 29.9% engage in risky sexual behaviors. Predictors of health risks were examined. Those findings indicate that women and those in independent living are at greatest risk. Specifically, young women experienced earlier onset of sexually transmitted infections than young men (p = 0.04) and were also more likely to receive a mental health or chronic condition diagnosis (ps < .05). Young men and youth in Independent Living were more likely to use substances (ps < .05).

Conclusions. Results suggest a need to ensure that foster youth remain connected to health and mental health safety nets, with particular attention needed for adolescents in care for longer and/or those placed in independent living. Identifying youth most at risk requires better integration of child welfare and medical records; this is a critical first step for developing interventions and policies to target youth who are most vulnerable for increased health concerns.