Medical complexity and placement outcomes for children in foster care |
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| Institution: | 1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States;2. Berman Institute of Bioethics, Baltimore, MD, United States;3. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States;1. School of Social Welfare, University of Kansas, 1545 Lilac Lane, Lawrence, KS 66045, United States;2. School of Social Work, Colorado State University, United States;1. University of California, San Francisco, Department of Psychiatry, Weill Institute for Neurosciences, United States;2. Zuckerberg San Francisco General Hospital, Division of Infant, Child, and Adolescent Psychiatry, United States;3. Rhode Island Hospital, Department of Psychiatry, United States;4. Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States;5. Northeastern University, Department of Applied Psychology, United States;6. Roger Williams University, Department of Psychology, United States;1. Forensic Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018, WS, Amsterdam, The Netherlands;2. Child and Adolescent Studies, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands |
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| Abstract: | ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ2 tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes. |
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