Mental Health and Developmental Disorder Diagnoses of Foster and Nonfoster Children Enrolled in Medicaid

Abstract

Objective: This study used Medicaid claims to compare the prevalence of mental health disorders (MHDs) and developmental disorders (DDs) between foster and nonfoster youth. Methods: Medicaid claims data were used to identify MHDs and DDs. Diagnosis codes were categorized into 16 MHD and 8 DD groups.Children were enrolled in their respective Medicaid plan for at least 30 days and had at least 1 health care encounter generating a claim. Prevalence was compared between children in foster care and children not in foster care overall and by age group. Logistic regression was used to compare the odds of having an MHD or DD diagnosis. Results: Of the 8706 children in foster care, 20.1% had an MHD compared with 9.7% of the 392,815 nonfoster children. Overall, the 5 most prevalent MHD and DD conditions among foster youth were attention-deficit/hyperactivity disorder (ADHD) (11.0%), miscellaneous (9.3%), bipolar disorders (5.6%), communication disorders (5.4%), and depressive disorders (5.1%). The 5 most prevalent conditions among children not in foster care were ADHD (6.1%); communication disorders (3.0%); disruptive, impulse control, and conduct disorders (2.7%); specific learning disorders (2.5%); and trauma and stressor-related disorders (2.4%). Anxiety was significantly higher among nonfoster children. The prevalence of the most common conditions by age group is reported. Overall, children in foster care had 2.5 and 2.3 times higher odds of having an MHD or DD diagnosis, respectively. Conclusion: Children in foster care had significantly higher rates of mental health and DD diagnoses compared with children not in foster care.

Description of Audiologic, Developmental, Ophthalmologic, and Neurologic Diagnoses at a Primary Care Clinic for Children in Foster Care

“…They found a prevalence of hearing impairment (3.8%), epilepsy (1.2%), visual impairments (11.2%), and ADHD (6.2%), but they did not describe the prevalence of more specific impairments, and they had a much smaller sample size. Keefe et al (2022) 17 reviewed Medicaid claims data across many pediatric practices in the Houston area and found that 21.0% of children in foster care had a developmental disorder diagnosis. This prevalence is lower than in our clinic, which could be due to our clinic exclusively serving children in foster care or due to more rigorous surveillance and screening in our clinic.…”

“…7,8 Reported health conditions that may be more common in children in foster care compared with the general population include hearing problems (4% vs ,1%), 4,9,10 vision problems (3.4%-11% vs 1.5%-5.7%), 4,[11][12][13] neurologic and developmental problems or delays (25%-33.8% vs 6%-17%), 3,[13][14][15][16] and speech delays (11% vs 5%). 4 Previous research often relied on national surveys based primarily on caregiver reports, 4 Medicaid claims records, 17,18 and data from referral and assessment centers for children initially entering foster care, 3 but there are few data about medically diagnosed audiologic, developmental, neurologic, and ophthalmologic conditions in children in foster care in a primary care setting. Data from a primary care setting that follow the medical home model may be particularly useful because of the model's emphasis on continuity of care and comprehensive medical care for children in foster care.…”

“Vulnerability” and Its Unintended Consequences

“…Children in foster care are a uniquely vulnerable population with increased mental health needs due to very high rates of complex trauma that arises from adverse childhood experiences both prior to and during foster care. (Keefe et al 2022) From previous research we know that this youth are vulnerable in many ways, and at extra risk of continued or later marginalization. (Bakketeig and Backe-Hansen 2008, p. 18…”

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study

“…The most commonly diagnosed conditions among foster youth are attention deficit/hyperactivity disorder (ADHD), bipolar disorder, communication disorder, and depressive disorders ( 5 ). Treatments for these commonly encountered disorders may include psychotropic medication in conjunction with other therapies, and indications for psychotropic medication use vary by diagnosis and severity of illness.…”

“…Nationally, there is a growing number of children requiring mental health services (1). Within the pediatric population, several state-based studies found that children in the foster care system are more likely to have a mental health diagnosis, higher mental health needs, and higher rates of psychotropic use (2)(3)(4)(5). Furthermore, psychotropic medication use in pediatric populations has significantly increased over the past decade, especially off-label use of atypical antipsychotic medications (6,7).…”