Sarah J Beal1, Constance A Mara2, Katie Nause3, Robert T Ammerman2, Rebecca Seltzer4, Melissa Jonson-Reid5, Mary V Greiner6. 1. Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center (SJ Beal, CA Mara, K Nause, and RT Ammerman), Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati (SJ Beal, CA Mara, RT Ammerman, and MV Greiner), Cincinnati, Ohio. Electronic address: Sarah.Beal@cchmc.org. 2. Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center (SJ Beal, CA Mara, K Nause, and RT Ammerman), Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati (SJ Beal, CA Mara, RT Ammerman, and MV Greiner), Cincinnati, Ohio. 3. Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center (SJ Beal, CA Mara, K Nause, and RT Ammerman), Cincinnati, Ohio. 4. Bernam Institute of Bioethics, Johns Hopkins School of Medicine (R Seltzer), Baltimore, Md. 5. Brown School of Social Work, Washington University (M Jonson-Reid), St. Louis, Mo. 6. Department of Pediatrics, College of Medicine, University of Cincinnati (SJ Beal, CA Mara, RT Ammerman, and MV Greiner), Cincinnati, Ohio; General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (MV Greiner), Cincinnati, Ohio.
Abstract
OBJECTIVE: To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups. METHODS: Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts. RESULTS: In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use. CONCLUSIONS: Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.
OBJECTIVE: To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups. METHODS: Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts. RESULTS: In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use. CONCLUSIONS: Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.
Authors: Mary V Greiner; Jennifer Ross; Courtney M Brown; Sarah J Beal; Susan N Sherman Journal: Clin Pediatr (Phila) Date: 2015-01-05 Impact factor: 1.168
Authors: Dennis Z Kuo; Maria Melguizo-Castro; Anthony Goudie; Todd G Nick; James M Robbins; Patrick H Casey Journal: Matern Child Health J Date: 2015-01
Authors: Jennifer E Lapin; Sarah J Beal; Ryan E Adams; Jennifer Ehrhardt; Ernest Pedapati; Tanya E Froehlich Journal: J Dev Behav Pediatr Date: 2022-04-22 Impact factor: 2.988