Continuity of Care for Children in Foster Care

Abstract

ABSTRACT. Objective. To compare the continuity of care experienced by children who are in foster care with that of children who are not in foster care and are covered under Medicaid managed care and Medicaid fee-for-service (FFS).Methods. This retrospective cohort study used Medicaid claims/encounter data from Washington state. A total of 903 children who were in foster care and continuously enrolled in Medicaid for 24 months (1998 -1999) were matched by age, gender, and rural/urban residence to 903 Medicaid managed care enrollees and 903 FFS beneficiaries who were not in foster care. Indices of the continuity of primary care experienced were calculated for each patient, and differences in continuity among the cohorts were assessed by running 3 multiple linear regression models for all possible pairings of cohorts, controlling for age, gender, rural/urban residence, and total number of primary care visits.Results. Foster care status was associated with decreased continuity of care relative to nonfoster managed care status (␤ ‫؍‬ ؊0.12; 95% confidence interval [CI]: ؊0.15 to ؊0.09). Nonfoster FFS status was associated with lower continuity than managed care (␤ ‫؍‬ ؊0.09; 95% CI: ؊0.12 to ؊0.06) and slightly higher continuity than foster care status (␤ ‫؍‬ 0.03; 95% CI: 0.01-0.06). Conclusion.Although not dramatically different, continuity seems somewhat lacking for children in foster care. It is unclear to what degree the observed difference is confounded by the managed care/FFS distinction. As the enrollment of children in foster care into managed care plans has been controversial, efforts to promote the consistency of contact with providers while maintaining the flexibility afforded by FFS coverage seem warranted. Pediatrics 2003;111:e208 -e213. URL: http: //www.pediatrics.org/cgi/content/full/111/3/e208; foster home care, continuity of patient care, child, Medicaid.ABBREVIATIONS. COC, continuity of care; FFS, fee-for-service.T he estimated number of children in relative and nonrelative foster family homes in the United States as of March 31, 2000, was roughly 430 000. 1 The plight of these children as medically vulnerable, disproportionately high users of mental and health care services has been repeatedly described in the literature. 2-23 Previous authors have characterized children in foster care as having been abused and neglected by biological parents, 2,15,16,18 having lived in poverty, 11,16,17,22 having a high prevalence of chronic conditions, 5,6,11,14 -16,18,21 and receiving inadequate health care services once in the foster care system. 3,4,6,8,11,13,15,17,18,21,22 The medical and social needs of children in foster care have prompted the American Academy of Pediatrics to issue multiple calls for continuity of care (COC) for these children. [23][24][25] There is a growing body of evidence that COC is associated with desirable outcomes in pediatric populations, including increased immunization rates, decreased emergency department and inpatient utilization, increased patient perceptions of quality,...

Continuity of care for youth in foster care with serious emotional disturbances

“…Because this study is among the first evaluating continuity conformance rates for children in foster care with SED, there are few points of comparison. However, our findings support concerns raised that this high-needs population is at risk for receiving inadequate outpatient health care (Bellamy, Gopalan, & Traube, 2010;DiGiuseppe & Christakis, 2003;Kerker & Dore, 2006;United States Government Accountability Office, 2012) and illuminate the overlooked fact that their care is often sporadic and prematurely terminated.…”

“…The few existing studies that have examined continuity of care have focused exclusively on examination of visit continuity for physical health conditions (Christakis, Mell, Koepsell, Zimmerman, & Connell, 2001;DiGiuseppe & Christakis, 2003). The current study addresses this gap in knowledge by combining several data sources to examine a wide range of factors associated with continuity of care in a large population-based sample of foster children with SED.…”

Health Care Issues for Children and Adolescents in Foster Care and Kinship Care

“…Ideally, a child or teenager in foster care retains a relationship with his or her former health care provider, but it is common for children and teenagers entering foster care to have had limited health access before placement or to have sought care from multiple providers. 1 A medical home for a child or teenager in foster care ideally offers high-quality, comprehensive, coordinated health care that is continuous over time, compassionate, culturally competent, trauma informed, family centered, and child focused 104,105 (Table 2). This requires a special commitment on the part of the pediatrician because of the more intensive needs of this population, as well as the mandates and innate complexities of the child welfare system.…”

Health Outcomes in Young Adults From Foster Care and Economically Diverse Backgrounds

“…Medical care for foster youth is often discontinuous, making it difficult for trusting patient-provider relationships to form and evidencebased treatments to be delivered. 28,29 Although little research has evaluated continuity and quality of care among emancipated foster youth, there is little reason to believe these problems improve as foster youth become young adults facing homelessness, unemployment, and other issues known to affect quality of health care. [17][18][19][20][21][22]30,31 Future exploration is merited to determine care-related contributors to this group' s disproportionate disease burden.…”