Health Care Services for Children Placed in Foster or Kinship Care
This project evaluated physical and mental health services among children in out-of-home placement. The data were from the National Survey of America’s Families. There are several distinct forms of out-of-home placement that include: Traditional foster care in which a child welfare system removes a child from their home and places him/her with a non-relative foster parent; Formal kinship care which is similar to the latter except that the child is placed with a relative; and Informal Kinship care, in which a child goes to live with a relative but no child welfare agency is ever involved in that change of living situation. It is important to identify these placement types as distinct groups. Changes in the child welfare system now preferentially channel children into formal kinship care. Children in informal kinship care often have no help or monitoring from a social work agency. It is estimated that approximately 2.2 million children live in some form of kinship care, the majority of whom are in informal arrangements. There is very little known about the health care utilization of this population. The analyses focused on three primary comparisons: informal kinship care versus the control group of children living with a biological parent; formal kinship care versus foster care, and informal and formal kinship care versus foster care specifically on the use of mental health services. The findings are summarized below: -Informal kinship care versus the control group: In comparison to the control group, children in informal kinship care were more likely to be older, African American, living in poverty and to experience household food insecurity (food running out) in univariate analyses. Children in informal kinship care were more likely to be uninsured and to either lack well-child care, or have a caregiver who is unaware of what well-child care has been received in both univariate and multivariate analyses. Children in informal kinship care were more likely to lack a regular source of care and to be in poor health in univariate analyses but not in multivariate analyses. However, lacking health insurance was the most significant predictor for lacking a regular source of care and likely contributes substantially in the informal kinship population. Caregivers in informal kinship care were more likely to be older, unmarried, less educated, in poor health, and to have a disability univariate analyses. -Formal kinship care versus foster care: In comparison foster care group, children in formal kinship care were more likely to be older, African American, living in poverty and to experience household food insecurity in univariate analyses. In multivariate analyses children in formal kinship care are at twice the odds of living in poverty and of experiencing household food insecurity. Children in formal kinship care are equally likely in univariate and multivariate analyses to experience poor health status and a limitation in their activity. Children in formal kinship care are more likely to lack health insurance, and have a five-fold increase in the odds of lacking health insurance in multivariate analyses. Power limitations prevent multivariate analysis of this variable. Caregivers in formal kinship care are more likely in univariate analyses to be older, unmarried, less educated, in poor health and to have a disability. -Informal and formal kinship care versus foster care on mental health need: In comparing all three out-of-home placements to each other, children in both kinship groups were more likely than foster group to be African American and to be living in poverty in univariate analyses. Mental health need was lowest in the informal kinship group in univariate analyses. Mental health service use was significantly lower in both kinship groups, even among children with mental health need. In multivariate analyses, children in informal kinship care were almost five times more likely, and children in formal kinship care were more than twice as likely to lack mental health services when compared to the foster care group. These findings are relevant to several different areas of public policy. First, it is clear that obtaining health insurance is a problem for both formal and informal kinship groups. Most of these children would likely be eligible for Medicaid based on household income. Outreach and enrollment policies for public insurance programs need to recognize children living in kinship arrangements as a unique and high risk population. Secondly, child welfare agencies and policymakers may need to re-evaluate the current practice of preferentially placing children in kinship homes. These placements may require a substantially greater amount of financial and social services support to address the fact that formal kinship children have high rates of health problems, while their caregivers are often elderly, poor and in ill health. Lastly, while children in formal kinship care received fewer mental health services than those in foster care, almost one quarter of children in foster care with mental health need did not receive services. Policies for obtaining mental health evaluations for these high risk groups of children urgently need to address this unmet need.