Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care

Objective

To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access.

Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging out of Foster Care

ObjectiveTo examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.MethodsFocus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the “threat of mental health problems,” treatment benefits versus barriers to accessing mental health services, self-efficacy, and “cues to action.” Data were analyzed using a modified grounded-theory approach.ResultsYouth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports “cueing action” during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation.ConclusionsYouths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care.     

Adverse Childhood Experiences and Young Adult Health Outcomes Among Youth Aging Out of Foster Care

Objective

Former youth in foster care (YFC) are at greater risk of chronic health conditions than their peers. Although research in general population samples has shown a dose–response relationship between adverse childhood experiences (ACEs) and adult health outcomes, few studies have conducted similar analyses in highly stress-exposed populations such as YFC. In this study we used person-centered latent class analysis methods to examine the relationship between different profiles of ACE exposures and divergent health trajectories among this high-risk population.

Childhood emotional and behavioural problems: A comparison of children's reports with reports from parents and teachers

Abstract Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.     

A Comparative Study of Greek Children in Long-term Residential Group Care and in Two-parent Families: I. Social, Emotional, and Behavioural Differences

The social, behavioural, and school adjustment of 41 9-year-old children in long-term residential group care in Greece was compared with that of children of the same sex and age brought up in two-parent families. Observational, interview, and questionnaire measures were employed. Observations in school classrooms showed that compared with their classmates, the group care children were more inattentive, participated less often in the classroom activities, were more likely to be passive, and tended to be involved in alternative and nonproductive activities. In the playground, they rarely interacted with non-institutional children. On both parent and teacher scales the group care children showed significantly more overall disturbance. The boys showed poor task involvement in the classroom and more emotional difficulties, conduct problems, and hyperactivity, whereas the between-group differences for girls were statistically significant only for emotional disturbance and poor task involvement in the classroom. Both boys and girls in long-term residential care showed less harmonious, confiding relationships with peers than those reared in families, and were more affection-seeking with teachers.     

A Comparative Study of Greek Children in Long-term Residential Group Care and in Two-parent Families: II. Possible Mediating Mechanisms

Forty-one children reared in group care were compared with 41 age- and sex-matched family care children according to interview, questionnaire, and observation measures of behavioural and scholastic functioning. Individual differences in outcome within the group care sample were examined in relation to a range of possible risk/protective indicators. The strongest predictor of outcome proved to be the reason for admission into residential care, with the implication that the outcome was best for children who had experienced stable, harmonious family relationships in their early years. The risk and protective effects applied to both the children's behaviour and scholastic attainments but, although the two were intercorrelated, neither accounted for the other. All subgroups of children in institutional care failed to show a lack of confiding peer relationships, with the pattern of findings suggesting that this stemmed from some aspect of experiences (possibly involving peer relationships) during residential care, as well as from discontinuity in caregiving during the early years.     

Quality of Care for Children With Medical Complexity: An Analysis of Continuity of Care as a Potential Quality Indicator

Objective

To examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination.

Use of Medical Care and Antibiotics among Preschool Children in Different Day Care Settings

ABSTRACT. The use of medical care among 880 1-5 year olds in different day care settings was studied using register information on physician visits, purchases of antibiotics and municipal day care in 1984. The unit of analysis was months in the different day care settings and not children. The rates of physician visits were 1.4 to 1.8 times higher for acute upper respiratory tract infections and all acute infections and 2 to 3 times higher for secretory otitis media during day care centre months and family day care months as compared to home care months. The rate of visits for bronchial asthma was 5 times higher during day care centre months than during home care months. No differences were found between day care centre months and family day care months with respect to the rates of physician visits for acute upper respiratory tract infections, acute otitis media and all acute infections. Among children in family day care, the daily number of hours in day care, and size, average age and age homogeneity of the groups were not significantly associated with rates of visits for all acute infections or purchases of antibiotics.     

The development of adopted children after institutional care: a follow-up study

BACKGROUND: Research suggests that institutional care has long-lasting effects on children. However, no study has longitudinally studied infants in an institution and their subsequent development at age four. METHODS: Sixty-one adopted children aged four years who had spent their first two years of life in an institution were compared to 39 children reared in their own two-parent families. Cognitive development, security of attachment, shyness, children's emotional understanding and behavioural problems were examined in both groups. Parental health and stress were also assessed. RESULTS: At four years adopted children still had lower scores on cognitive development, were less secure, and less able to understand emotions than family-reared children. Children with a secure attachment type in infancy were found to be less secure at age four, compared with those who were classified in infancy as having an insecure attachment type. Their physical development had recovered, they were less shy, had no behavioural problems and no problems in the relationship with their teacher. CONCLUSIONS: Early residential group care has long-lasting effects on important socio-emotional and cognitive aspects of preschool children's development.