Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S., Szilagyi, M. A., Harmon, D., Jaudes, P., Jones, V. F., Lee, P., Nalven, L., Prock, L., Sagor, L., Schulte, E., Springer, S., Tonniges, T., Braverman, P. K., Adelman, W. P., Alderman, E. M., Breuner, C. C., . . . Williams, P. G. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142–e1166. https://doi.org/10.1542/peds.2015-2656
This report elaborates the challenges that face youth in foster care with regard to the treatment and care of various complex health conditions that they have. Szilagyi and colleagues provide a comprehensive background, highlighting the goals of foster care, trends in foster care, and reasons for placement, and the various types of placement of young people in foster care. Observation and empirical research methods are used to obtain data from creditable sources, such as the Department of Health and Human Services. The references range from current to dated sources, which enhances the credibility of the report.
The analysis of data in this report is extensive, which results to clear outcomes. Risk factors for young people in foster care are highlighted, which include likely trauma experienced prior to placement and the transient nature of life in foster care. Effects of foster care on the emotional state of young people are also discussed, which in most cases exacerbate their already fragile health status. The report highlights the lack of health information, lack of care coordination, and financing as some of the barriers to quality healthcare for adolescents in foster care. Pediatricians are cited to have a critical role to improve medical care for youth with special health needs in foster care. The thoroughness of this report make it a good source of information for future researchers.
Sepulveda, K.A., Rosenberg, R., Sun, S., & Wilkins, A. (2020). Children and Youth with Special Health Care Needs in Foster Care. Child Trends.
This brief by Child Trends analyzes the occurrence and trends of young people with special health needs within the foster care system. The experiences recorded touch on the lack of adequate medical insurance, inequality and discrepancies in healthcare systems, and social isolation. The brief also brings to light the fact that more youth with special healthcare needs are placed in foster care compared to those without one. In the methodology, case files from the foster care reporting system are used to compare youth with special needs and those without, while considering demographics like gender and age. The brief contains a thorough discussion on the findings, which highlight most existing challenges. Limitations highlighted for the study include policy issues in different jurisdictions and the quality of data due to sampling issues.
Beal, S. J., Ammerman, R. T., Mara, C. A., Nause, K., & Greiner, M. V. (2022). Patterns of healthcare utilization with placement changes for youth in foster care. Child Abuse & Neglect, 128, 105592. https://doi.org/10.1016/j.chiabu.2022.105592
This journal article seeks to understand healthcare management throughout a youth’s life in foster care, especially subsequent to changes in placement. The study uses experimental methods to obtain data on the ground. Statistical methods, such as binomial models, are used to analyze data. The authors conclude that there is inadequate consideration for healthcare use in cases of changes in placement, such as transition from pediatric to adult care, which results to a likelihood of deteriorating health status. Concepts covered and methods used in this study are complex, making this study only beneficial to technical experts and professionals in healthcare.
Lohr, W. D., & Jones, V. F. (2016). Mental health issues in foster care. Pediatric Annals, 45(10). https://doi.org/10.3928/19382359-20160919-01
Lohr and Jones aim to highlight the mental health conditions that young people in foster care are suffer from. The authors establish that most young people in foster care end up having mental health issues due to negative circumstances prior to their placement in foster care. Data is obtained from agencies and government bodies, such as the Department of Health and Human Services. In their analysis, youth with mental health issues in foster care are compared to those out of foster care. The study also takes a look at the role of professions, such as pediatricians, in taking care of the special health needs of young people in foster care. Recommendations in improving medical care include understanding the individual needs of youth while focusing on trauma-based approaches.
Greiner, M. V., & Beal, S. J. (2017). Developing a health care system for children in foster care. Health Promotion Practice, 19(4), 621–628. https://doi.org/10.1177/1524839917730045
This journal article elaborates the design of effective strategies and systems within the foster care system that banks on ensuring inclusivity on all players involved including healthcare giver, organizations, and community partners like volunteers. One such system of care is the Comprehensive Health Evaluations for Cincinnati’s Kids Center, which is taken as a case study. The article outlines the aims of such systems to be the customization of healthcare models with considerations for available resources and specific needs of the parties involved. The methods used include study of health records of youth in foster care and follow up records for when they transit to adult healthcare. Outcomes indicate that inclusive healthcare systems result to an improvement of the health status of young people with special health needs even after they transition to adult healthcare systems. The concepts are clearly explained in this article. The up-to-date references used also increase the credibility of this article.
Chu, P. Y., Maslow, G., Von Isenburg, M., & Chung, R. (2015). Systematic review of the impact of transition interventions for adolescents with chronic illness on transfer from pediatric to adult healthcare. Journal of Pediatric Nursing, 30(5), e19–e27. https://doi.org/10.1016/j.pedn.2015.05.022
Chu et al. (2015) analyze interventions within the healthcare system, specifically with regard to the transfer of institutionalized young people in with various long-term health conditions from pediatric care to adult healthcare systems. This study heavily utilizes empirical research on already existing research documents that point to outcomes of interventions in the transfer process for young people with various chronic illnesses. This study uses research documents found in Medline, PsycINFO, and CINAHL databases. Search terms include healthcare transition, chronic illness, and adolescents. Chu and colleagues independently scrutinize the references used in the published studies. The authors establish that the methodological differences appear to be a hindrance to the evaluation of the transition process. The study concludes that there is need for consistent and clear metrics for the evaluation of the transfer process from pediatric care to adult healthcare systems.
Jegede, O. E., & Van Wyk, B. (2022). Transition Interventions for Adolescents on Antiretroviral Therapy on Transfer from Pediatric to Adult Healthcare: A Systematic Review. International Journal of Environmental Research and Public Health, 19(22), 14911. https://doi.org/10.3390/ijerph192214911
Jegede and Van Wyk (2022) review studies previously focusing on the care given to young people or adolescents living with HIV with search terms including transition intervention, retention in care, and adolescents. A number of young people in foster care are living with HIV. Jegede and Van Wyk highlight that the major challenge faced by this group is a low level of retention within the healthcare system as they transition to adult healthcare systems. The authors also cite failure to adhere to antiretroviral therapy as another challenge facing young people living with HIV. The study aims to identify interventions that have been designed to address these challenges within the healthcare system as young people transition from pediatric care to adult healthcare systems. The studies that were considered were carefully picked and even assessed using assessment tools from the National Institutes of Health. According to this study, interventions such as individualized care, psychological support, and communication have a positive impact on the transition process. There is evidence of improved outcomes, such as an improved retention rate after the transition process.
Engler, A. D., Sarpong, K. O., Van Horne, B. S., Greeley, C. S., & Keefe, R. J. (2020). A Systematic review of mental health disorders of children in foster care. Trauma, Violence, & Abuse, 23(1), 255–264. https://doi.org/10.1177/1524838020941197
This journal article aims to establish the prevalence of mental health conditions for youth in foster care. The authors highlight the types of conditions that they suffer from and how various factors impact on their mental condition. Databases, such as EMBASE Elsevier are used to obtain materials about foster youth of up to 18 years old in the United States and Canada. Analysis of the data indicate a higher prevalence of mental health conditions in foster youth compared to those at home. The authors highlight differences in assessment methods as one of the limitations during the study. However, the article is clearly and precisely presented.
Gray, W. N., Dorriz, P., Kim, H., Partain, L., Benekos, E., Carpinelli, A., Zupanc, M. L., Grant, K. J., & Weiss, M. (2021). Adult Provider Perspectives on Transition and Transfer to Adult Care: a multi-specialty, multi-institutional exploration. Journal of Pediatric Nursing, 59, 173–180. https://doi.org/10.1016/j.pedn.2021.04.017
Gray et al. (2021) conducted interviews with several healthcare providers and professionals in the adult healthcare system. The authors aim to get an understanding of the challenges they face as they onboard young patients from pediatric care. Professionals interviewed specialize in several medical fields, such as family medicine, neurology, and gastroenterology. Data obtained from the interviews were analyzed according to socioecological models of readiness for transition. Healthcare givers interviewed cited a lack of access to adequate resources and financial constraints as major barriers to a smooth transitioning process. Among the recommendations given are an improvement in communication among healthcare providers and more effort to educate affected families on how to navigate the healthcare system.
Reich, J., Cantrell, M. A., & Smeltzer, S. C. (2022). An Integrative Review: The Evolution of Provider Knowledge, Attitudes, Perceptions and Perceived Barriers to Caring for Patients with Sickle Cell Disease 1970–Now. Journal of Hematology/Oncology Nursing, 40(1), 43–64. https://doi.org/10.1177/27527530221090179
In their review, Reich et al. (2022) attempt to determine existing attitudes and perceived barriers that may result in challenges that young patients with sickle cell disease face within the healthcare system as they transition to adult care. Since sickle cell disease predominantly affects people of African descent, the authors try to identify the barriers that they may face within the healthcare system owing to their race. The authors acknowledge the existence of racial and ethnic disparities within the healthcare system. This predisposes adolescents with sickle cell disease to a higher risk of deteriorating health status when transitioning to adult care. The review determines that the existing gaps provide an opportunity for improved interventions, especially with regard to adolescents with sickle cell disease when transferring to adult healthcare systems.
Hambrick, E. P., Oppenheim-Weller, S., N’zi, A. M., & Taussig, H. N. (2016). Mental health interventions for children in foster care: A systematic review. Children and Youth Services Review, 70, 65–77. https://doi.org/10.1016/j.childyouth.2016.09.002
In their review, Hambrick et al. (2016) acknowledge that children in foster care are at a higher risk of developing mental health problems due to unfavorable conditions and their environment. The authors cite challenges that face young people in foster care relate to the complexity of their condition, especially during the transition process to adult care. The study highlights interventions for young people in foster care with mental health conditions. Effectiveness in the measures to address these challenges begins in the design of the programs that are meant to help young people cope with their condition. Another intervention includes the involvement of caregivers of the affected children to deal with problems of stigma associated with seeking the services of mental health professionals. Additionally, more efforts in training more professional caregivers to address the shortage of caregivers.
Bilaver, L. A., Havlicek, J., & Davis, M. M. (2020). Prevalence of special health care needs among foster youth in a nationally representative survey. JAMA Pediatrics, 174(7), 727. https://doi.org/10.1001/jamapediatrics.2020.0298
In this journal, the authors acknowledge that young people in foster care have a higher rate of chronic health conditions. Caregivers and professionals like pediatrics play an important role in providing much-needed care in the absence of permanent caregivers. Data in this study shows higher rates for young people up to the age of 17 suffering from mental conditions such as anxiety compared to young people living with biological parents or adoptive parents. Apart from mental health conditions, most young people in foster care show signs of developmental conditions like learning disabilities.
Turney, K., & Wildeman, C. (2016). Mental and physical health of children in foster care. Pediatrics, 138(5). https://doi.org/10.1542/peds.2016-1118
Turney and Wildeman (2016) heavily rely on data from the National Survey of Children’s Health to compare the outcomes of the health status of young people placed under foster care and those of young people who were not under the care of any institution. The authors attempt to determine if the placement of young people under foster care impacts negatively on their already existing health conditions. In their study, Turney and Wildeman conclude that there is evidence that placement in institutions, such as foster care, has a negative impact on the health status of young people. Pre-existing mental health conditions, such as anxiety, are reported to have gotten worse, or at least not improved, for children in foster care. The authors also conclude that the circumstances of the early lives of juveniles, which lead to them ending up in foster care, is a major predisposing factor to the mental condition and wellbeing of the youth.
Deutsch, S. A., & Fortin, K. (2015). Physical health problems and barriers to optimal health care among children in foster care. Current Problems in Pediatric and Adolescent Health Care, 45(10), 286–291. https://doi.org/10.1016/j.cppeds.2015.08.002
Deutsch and Fortin (2015) highlight the problems that adolescents in foster care face with regard to healthcare. Most adolescents usually have gone through multiple placements in different foster homes or institutions. Some young people are reported to experience prolonged stays within the foster system. A majority of young people within the foster care system do not have access to quality medical care for their health conditions. According to the study conducted by the author, most young people in foster care are unable to receive optimal medical care for their health conditions due to inadequate resources and a lack of effective policies within the foster care system. Rather than well-trained professionals, guardians, and caregivers are often relied upon to determine the amount of care and attention given to young people within the foster care system. The youth in foster care need specialized care and attention from professionals to help them cope with their health conditions.
Toulany, A., Stukel, T. A., Kurdyak, P., Fu, L., & Guttmann, A. (2019). Association of Primary Care Continuity With Outcomes Following Transition to Adult Care for Adolescents With Severe Mental Illness. JAMA Network Open, 2(8), e198415. https://doi.org/10.1001/jamanetworkopen.2019.8415
In their study, Toulany et al. (2019) determine whether the care given to adolescents in foster care with acute mental health conditions is given the same level of attention during and after they transition to adult care. A concern for young people transferring from pediatric care is the lack of enough knowledge on how to navigate the transition process. In their study, the authors focus on young people between the age of 12 and 16 years old with special mental health needs with conditions like schizophrenia. The outcomes of the study were visits to the health institutions for young adults who had already transitioned to adult care, compared to data from the period before the transition period. The results of the study show that slightly more than half of the case study had continuous care after transitioning. A smaller percentage of about 6% of the participants had a discontinuation of primary care after the transition. The study shows that those with continued primary care showed an improvement in their health conditions.
Schilling, S., Fortin, K., & Forkey, H. (2015). Medical management and trauma-informed care for children in foster care. Current Problems in Pediatric and Adolescent Health Care, 45(10), 298–305. https://doi.org/10.1016/j.cppeds.2015.08.004
According to the publication by Schilling et al. (2015), young people in foster care have a higher risk of developing mental and developmental conditions due to their earlier experiences. Young people in foster care are most likely predisposed to trauma and insufficient care from caregivers at an early age, which ends up having an impact on their health as youths. The study determines the need for approaches that focus on addressing trauma. Appropriate interventions to help in improving the health status of young people in foster care include the correct transfer of medical records during the transition period. The authors also cite the collaboration of organizations and professionals in as an effective intervention to improve the medical care of young people as they transition from foster care to adult care.
Baldwin, H. A., Biehal, N., Cusworth, L., Wade, J., Allgar, V., & Vostanis, P. (2019). Disentangling the effect of out-of-home care on child mental health. Child Abuse & Neglect, 88, 189–200. https://doi.org/10.1016/j.chiabu.2018.11.011
Baldwin et al. (2019) aim to determine whether the health status of young people is linked to the fact that they are placed in foster care. According to the study, a majority of young people in foster care are at risk of developing mental health issues compared to young people at home. Data indicate low success in separating the effects of foster care or out-of-home care for young people with the resulting mental health conditions. In their study, participants include adolescents in foster care placed in groups that are formed according to information obtained from caregivers. Results indicate higher chances of young people in foster care having conditions like reactive attachment disorder compared to young people living in the general population. The study helps to inform on whether placement in foster care has an impact on the health conditions of young people.
Naylor, M. W., Wakefield, S., Morgan, W., & Aneja, A. (2019). Depression in children and adolescents involved in the child welfare system. Child and Adolescent Psychiatric Clinics of North America, 28(3), 303–314. https://doi.org/10.1016/j.chc.2019.02.001
Naylor et al. (2019) observe that improper handling of adolescents is strongly linked to the development of depression. They also acknowledge that not all young people under foster care are mistreated but state that most of them at least have a history of undergoing mistreatment at some point early in life. The study identifies low self-esteem and fear due to improper handling of young people as the leading factors in the development of depression and other mental health conditions. The authors suggest collaboration between professionals and stakeholders as an intervention to improve the wellbeing of young people in foster care.
Saxone, K., McCutcheon, L., Halperin, S., & Herman, H. (2016). Meeting the primary care needs of young people in residential care. Australian Family Physician, 45(10): 706–711.
Saxone and colleagues aim to identify factors that lead to the health needs of young people in institutions and other types of care other than home care. Young people in the adolescent age often have a high likelihood of having gone through multiple placements. This is a predisposing factor that leads to higher chances of them developing various complex health conditions, including mental illnesses. The study points to the lack of proper policy and poor communication between involved organizations and institutions to have contributed to the lack of permanent placement of young people under foster care. To meet the health needs of young people in foster care, Saxone and colleagues suggest early detection by professionals in healthcare. The study also suggests an improvement in communication between involved institutions for better outcomes regarding the health of young people in foster care.
Sarvas, E. W., Eckerle, J. K., Gustafson, K. L., Freese, R., & Shlafer, R. J. (2021). Oral health needs among youth with a history of foster care. Journal of the American Dental Association, 152(8), 589–595. https://doi.org/10.1016/j.adaj.2021.03.008
Sarvas et al. (2021) compare the health needs, specifically oral health needs, of young people under foster care to those who live in the general population or at home. In their study, Sarvas and colleagues utilized data from the Minnesota Student Survey, where young people of adolescent age or in 5th up to the 11th grades are observed for indicators of oral health needs. Among the participants, young people with a history of having gone through the foster care system comprise 3% of the total population of the participants. The study reveals that young people with a history of foster care are found to have oral health problems. A major contributor to this condition is a lack of adequate access to oral healthcare within the foster care system. The study suggests an effective intervention of oral healthcare professionals recognizing the needs of young people in the foster care system and providing the required care for this group of people.
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