Foster care youth have higher behavioral health needs and more ER visits leading up to entry, research finds

A key step in improving the well-being of children and youth in foster care is understanding the complex health care needs they face, which is why a team of experts from the University of Colorado School of Medicine worked with Colorado agencies to analyze health data to identify trends among people in foster care through Colorado’s Medicaid program.

Dr. Mark Gritz, chair of the University of Colorado Health Policy Research Department and operating director of the Center for Adult and Pediatric Outcomes Research and Delivery Science, is leading the analysis project, which is part of a larger collaboration between the University of Colorado School of Medicine and the Colorado Department of Health Care Policy and Financing (HCPF).

In 2017, the two companies Inter-agency agreements Under the agreement, the CU School of Medicine agreed to provide data synthesis and analysis on projects identified by HCPF aimed at improving access to, outcomes and value of health care.

One of the initial projects focused on children and youth involved in the foster care system. Since 2019, the data work has been led by the CU Eugene S. Farley Jr. Center for Health Policy, with Gritz serving as the center’s director of operations.

“The last five years have been some of the most rewarding in my nearly 40-year career because we’ve been able to truly partner with state agencies,” Gritz said.

“These agencies have sought to improve conditions for children, adolescents and young adults who have experienced foster care, but these efforts need to be strengthened by better understanding their well-being and experiences in care.”

Documenting the complexities of health over time

According to the Colorado Department of Human Services, as of May 2024, there were 3,448 children and youth living in 2,471 licensed kinship and foster care homes in Colorado. These children and youth are covered by the state’s Medicaid program, Health First Colorado.

Once they become independent or “age out” of the foster care system, if they were already enrolled in Health First Colorado, they would be covered until they turn 26. This is similar to the policy that allows young people under the age of 26 to remain on their parents’ health insurance.

When Gritz and his team began analyzing health data on children and young people living in foster care, their primary goal was to document the health complexities facing these individuals.

“People in foster care are very different than the average child or youth covered by Medicaid,” Gritz said. “They have complex health issues, both physical and especially behavioral.”

The team’s first report looked at children and young people entering foster care for the first time and compared them to others who are eligible for Medicaid but not in the foster care system.

The survey results are as follows: Published in 2023 In the journal Academic PediatricsThe overall presence of behavioral health conditions such as anxiety/stress-related disorders, attention-deficit hyperactivity disorder, and major depressive disorder was approximately 3 times higher Children and young people who live in foster care are better off than those who do not.

Children in foster care also had higher rates of nearly every body system-specific physical and chronic condition, including pulmonary, respiratory, neurological and progressive diseases, than their non-foster care peers.

The research team also looked at how the physical and behavioral health of these children and young people changed after they entered foster care. Behavioral health status was high At 6 months after admission, they were compared with a comparison group matched on the basis of the presence or absence of medical complications.

Pulmonary, respiratory and neurological disorders, which were the most common at the time of entering the foster care system, also increased after six months.

The findings suggest that these health issues may not have been diagnosed before entering foster care, and they may have been exacerbated by the trauma of the transition to foster care.

Primary care and emergency department utilization

Following these findings, Gritz and his team shifted their focus to how often children and youth in the foster care system received health services.

in Published articles for 2022 In International Journal of Child AbuseGritz and his co-authors described a seven-year retrospective study that looked at primary care and behavioral health care utilization patterns from 2014 to 2021.

Data show that compared with a matched comparison group, people in the foster care cohort before entering foster care had lower rates of primary care use but higher rates of behavioral health use, but both primary care and behavioral health use increased while in foster care and 12 months after entering.

“The data shows that when children and young people are in foster care, they have equal access to primary care services,” Gritz said.

Further investigation revealed that before entering the foster care system, children and young people in the foster care system were more likely to visit the emergency room than a comparison group. Increased approximately 4 months before entry The proportion of children in foster care was particularly high among children aged 7 and above.

“If state child welfare agencies had access to information about children’s emergency department visits, it could lead to earlier identification of children at risk of being placed in foster care,” Gritz said.

As part of their study, Gritz and her colleagues also evaluated assertions from previous literature suggesting that children and young people growing up in foster care use emergency departments for primary care.

Data shows that emergency department visits for these children and young people dropped significantly one month after entering the foster care system, and over time, the rates nearly matched those of their peers not in the foster care system.

“Given the complexities of the physical and behavioral health conditions of children and young people in foster care, we do not find that they are more likely to use the emergency department than non-foster care children and young people,” Gritz said.

Further investigation Children and young people in foster care were found to have higher rates of emergency department visits related to suicide, deliberate self-harm, and fractures compared to their matched peers before entering foster care.

Rates of emergency department visits related to suicide and self-harm were particularly high before entering foster care among older children and adolescents, and rates continued to rise one year after entering foster care among 7- to 12-year-olds.

What happens after liberation?

After conducting several analyses of people entering the foster care system, the research team The focus shifted to the individual who liberatedChildren leaving the foster care system or reaching age to leave are compared with a matched comparison group.

“People who have been released from the foster care system Declining healthcare utilization “As we age, we change more dramatically than people our age,” Gritz says. “This is especially true for Regarding psychotropic drugs“It’s incredible how quickly patients stop using primary care and taking psychotropic medications once they become independent.”

Their study also found slightly increased rates of emergency department visits among people released from foster care compared to a control group. Medical costs have increased dramatically Changes in health among youth who have become independent from the foster care system in the 12 months following independence compared to the 12 months prior, particularly among youth with physical and behavioral health problems.

“This increase appears to be primarily due to the use of ancillary services such as therapy,” he said. “This indicates that these are people with many needs that were likely being met by the child welfare system while they were in foster care, but once they left foster care, they had to find alternative sources for that support.”

Looking back on years of work

Gritz said one of the most rewarding moments in her five years of work was when the Department of Health Policy and Financing emphasized that children, youth and young adults who have experienced foster care were a priority target as part of the state’s health policy. Accountable Care Collaborative program.

Gritz feels prioritization is necessary, given the complexity of behavioral health issues for children and youth in foster care that increases over time.

“The fact that there has been such an increase in behavioral health complications underscores the fact that these young people are experiencing very traumatic experiences that are really impacting their behavioral health,” he says.

He explains that many of these people may struggle to achieve certain outcomes in life because of the challenges they experienced as children growing up in foster care.

“This is not something they choose to do. It’s something that happens to them,” he said.

“To me, these are the populations we really need to focus on as a society. I would point out that strengthening our state’s behavioral health system to better serve this population, and young people with behavioral health issues in general, is a top priority in addressing the needs of not only these kids, but most people who have been historically underrepresented.”