Objectives:To comprehensively assess family services, health, and health care outcomes for US children in kinship care vs foster care.Design: A 3-year prospective cohort study.Setting: National Survey of Child and Adolescent Well-Being.
Participants:The sample consisted of 1308 US children entering out-of-home care following reported maltreatment.Main Exposure: Kinship care vs foster care.Main Outcome Measures: Baseline caregivers' support services and the children's behavioral, mental health, and health service use outcomes 3 years after placement.Results: Kinship caregivers were more likely than foster caregivers to have a low socioeconomic status but re-ported significantly fewer support services (caregiver subsidies, parent training, peer support, and respite care). Kinship care was associated with a lower risk ratio (RR) of continuing behavioral problems (RR=0.59; 95% confidence interval [CI], 0.41-0.80), low social skills (RR=0.61; 95% CI, 0.40-0.87), mental health therapy use (RR=0.45; 95% CI, 0.27-0.73), and psychotropic medication use (RR=0.46; 95% CI, 0.24-0.82) but higher risk of substance use (RR=1.88; 95% CI, 0.92-3.20) and pregnancy (RR=4.78; 95% CI, 1.07-17.11).Conclusions: Kinship caregivers received fewer support services than foster caregivers. Children in kinship care fared better with behavioral and social skills problems, mental health therapy use, and psychotropic medication use. Adolescents in kinship care may be at higher risk for substance use and pregnancy.
Objective: Minority families experience disparities in the diagnosis and management of autism spectrum disorder (hereafter "autism"). To date, the experiences of Chinese immigrant families in the United States have not been explored. Utilizing parent and provider perspectives, this research sought to identify barriers and facilitators to the diagnosis and management of autism among Chinese immigrant children.
Methods:We conducted semi-structured qualitative interviews with sixteen parents of Chinese children diagnosed with autism and sixteen providers who assist in the diagnosis and management of autism. Participant characteristics were analyzed utilizing descriptive statistics. Interviews were audio-recorded, transcribed, translated, and independently coded by two researchers until consensus was reached. Coded data were analyzed using a modified grounded therapy approach.Results: Parents and providers both identified cultural beliefs as an influence on the understanding and acceptance of autism as a diagnosis. There was a high degree of alignment in themes related to barriers to health care access and parent-provider communication. Recommendations to improve the system of care include: (1) supporting communication, (2) cultural sensitivity, and (3) care coordination programming.Conclusions: Findings reinforce that diagnosis and treatment of autism should take into account culturally specific beliefs about child developmental norms, and address systems-, provider-, and family-level barriers.
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