Page 15 - Delaware Medical Journal - February 2016

SCIENTIFIC ARTICLE
TABLE 1: Children in Delaware Foster Care by Age Cohort, FY13-FY14
AGE COHORT*
NUMBER
PERCENTAGE
Less than 1 year old 1-5 years old
6-12 years old 13-19 years old**
Total
203
333
405
517
1,458
14% 23% 28% 35%
100%
* Age was calculated at the beginning of FY13, or if the child did not start until FY14, at the beginning of FY14.
** Only 16 children in this age cohort were 18 and over. None of the children was over the age of 19 at the beginning of the FY13.
IntroductionAccording to the American Academy of Pediatrics (AAP),
children in foster care comprise a uniquely disadvantaged group

developmental, dental, and behavioral health problems, compared with other children.1 Children in foster care are disadvantaged due to the myriad reasons for which they enter care, including abuse, neglect, and mental illness and/or substance abuse among family members. Further, many children in foster care were exposed to drugs and alcohol prenatally, and many come from impoverished neighborhoods and toxic environments.1 Chronic early stress and adversity are thought to contribute to biological differences that can result in higher rates of physical and mental illness observed among children in foster care.2 Children often enter the foster care system with undiagnosed health problems and unmet health needs and, once in foster care, they can experience ongoing instability and other threats to their health and wellbeing.1
Children in foster care are categorically eligible for Medicaid, which means that they do not need to meet income thresholds in order to participate. All children in Medicaid, including those in foster care, are entitled to a comprehensive set of covered health care services referred to as Early, Periodic Screening, Diagnosis, and Treatment (EPSDT). Children in foster care comprise approximately 1-3 percent of children in Medicaid, but account for a disproportionate (4-8 percent) share of expenditures due to their greater health care needs.3 The difference in cost is largely attributable to greater needs for behavioral health services and psychotropic drug utilization.4
Due to the special needs of children in foster care, the AAP recommends a more rigorous schedule of preventive health visits for this population compared with other children. The recommendations include a screening visit within 72 hours of placement into
foster care, a comprehensive examination within 30 days, and
ongoing visits at least every six months.5 Despite recognition that preventive health care provides an opportunity for critical health problems leading to better disease management and better overall health and quality of life, many children in foster care do not receive the Inspector General of the U.S. Department of Health and Human Services examined the receipt of preventive health screenings among children in foster care across four states with large foster care populations: California, Illinois, New York, and Texas.6 Twenty-nine percent of children in foster care who were enrolled in Medicaid in these states did not receive at least one required health screening. Furthermore, a similar percentage (28 percent) received at least one required screening late.6
Given the state’s role in ensuring access to health care services for all children in foster care and concerns regarding the health needs
of this vulnerable population, the Delaware General Assembly established a Task Force on the Health of Children in Foster Care in June 2014. The Task Force was charged with examining the health and receipt of health services of children in the custody of the State. This work builds on an initial chart review and joint report by the Child Protection and Accountability Commission and Child Death, Near Death, and Stillbirth Commission.7 This study, conducted by the Center for Community Research and Services at the University of Delaware, supported the work of the Task Force by providing an analysis of the health care services provided to children in foster care through the State’s Medicaid program between July 1, 2012 and June 30, 2014. By comparing health care utilization patterns of children in foster care with other children in Medicaid, we were able to provide a snapshot of the needs of this particularly vulnerable population
in Delaware. The results highlight areas of ongoing need and opportunities for health system improvements, as well as a baseline for monitoring changes over time.
Del Med J | February 2016 | Vol. 88 | No. 2
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