ABSTRACT
OBJECTIVE: We compared the prevalence rates of mental health and physical health problems between adults with histories of childhood foster care and those without. METHODS: We used 2003-2005 California Health Interview Survey data (n = 70,456) to test our hypothesis that adults with childhood histories of foster care will report higher rates of mental and physical health concerns, including those that affect the ability to work, than will those without. RESULTS: Adults with a history of childhood foster care had more than twice the odds of receiving Social Security Disability Insurance because they were unable to work owing to mental or physical health problems for the past year, even after stratifying by age and adjusting for demographic and socioeconomic characteristics. CONCLUSIONS: Childhood foster care may be a sentinel event, signaling the increased risk of adulthood mental and physical health problems. A mental and physical health care delivery program that includes screening and treatment and ensures follow-up for children and youths who have had contact with the foster care system may decrease these individuals' disproportionately high prevalence of poor outcomes throughout their adulthood.
Subject(s)
Foster Home Care , Health Status , Life Change Events , Mental Disorders/epidemiology , Adolescent , Adult , Aged , California/epidemiology , Female , Health Surveys , Humans , Logistic Models , Male , Middle Aged , Young AdultABSTRACT
The Deficit Reduction Act of 2005 makes changes in the Medicaid program that may have a significant effect on children's health. Nurses and other health care professionals should be aware of these changes in order to monitor the impact of the legislation, guide families in the process of accessing needed services, and advocating on behalf of children and families.
Subject(s)
Child Health Services/economics , Health Services Accessibility/economics , Medicaid/economics , Benchmarking , Case Management/organization & administration , Child , Cost Control , Cost Sharing , Documentation , Eligibility Determination , Humans , Medical Indigency/economics , Organizational Innovation , Pediatric Nursing/organization & administration , Poverty/economics , Residence Characteristics , United StatesABSTRACT
Children living in poverty not only have disproportionately more health problems, but also have disproportionately lower health care service utilization. Change, whether in health care delivery system or in family living situation, may interfere with or jeopardize insurance status and thereby influence access to health care services. We hypothesized that children who have maintained Medicaid insurance compared to those who have not will be more likely to have preventive care visits and less likely to have emergency room visits. We further hypothesized that transient situations such as homeless episodes, foster care placement, and living in more than one location in the same 1-year period will contribute to loss in Medicaid coverage. This retrospective cohort study was conducted at an urban children's hospital outpatient clinic at which 210 family respondents were recruited over a 1-year period. An in-person interview containing several standardized instruments was administered to the caregiver. In addition, children's medical records were retrospectively abstracted from point of study entry to first contact. Findings indicated that children who lost Medicaid coverage, compared to others, had significantly fewer preventive care health visits. There were no differences in emergency room visits. Transient situations did not appear to influence preventive or emergency room care. In addition, the change into a managed-care delivery system also increased loss of coverage. Loss of coverage may be a barrier to preventive care services. To ensure optimal preventive care services, the onus is on the providers and plans to facilitate continued insurance coverage.
