Chronic Health Conditions More Common Among Children in Child Welfare System

By Lily Conover

Youth investigated by child welfare agencies in the United States suffer from chronic health conditions at a rate much higher than that of the general population, according to research published in the journal Pediatrics in March 2013.

The disproportionate rate of chronic health conditions, which the study’s results indicate is 1.5 times greater for children involved in the child welfare system, highlights the need for additional healthcare monitoring and resources for the youth with whom welfare agencies interact. Los Angeles County’s Blue Ribbon Commission on Child Protection acknowledged this need in 2013 when it called for an expansion in county health services for foster youth.

Dr. Michael Hurlburt, assistant professor at the USC School of Social Work and co-author of the Pediatrics study, said health disparities among youth in the foster care system are often a reflection of the neglect that leads to child welfare investigations in the first place.

“A lot of the kids who’ve been investigated have been investigated due to neglect.” Hurlburt said. “This might mean parents have been less attentive to [children’s] needs, that includes health needs. You end up finding that kids have issues that have not been addressed.”

The Pediatrics study analyzed data collected in the second National Survey of Child and Adolescent Well-Being, which included 5,872 children ages 0 to 17.5 years. According to the study’s authors, this research was the first to observe — from birth through adolescence, and on a national level — rates of chronic conditions among youth investigated by child welfare agencies.

Chronic health conditions included asthma, autism, AIDS, Down’s syndrome, diabetes, ADHD, heart problems, hypertension, depression, anxiety, and migraines, among others. Depending on the measurement researchers used, 30.6 to 49 percent of children investigated were found to have a chronic condition.

On all measures, male children aged six or older were more likely to have a condition.

Some experts say the health disparities in this population can be attributed to psychological trauma and stress associated with living in an unstable or unsafe environment.

The 1998 Adverse Childhood Experiences study presented evidence that experiencing abuse or dysfunctional household environments during childhood was strongly correlated with later exhibiting multiple risk factors for leading causes of death among adults.

Because this research is retrospective — it asks subjects to recall information from the past — it does not necessarily provide strong evidence of the predictive nature of such experiences.

Hurlburt explained that socioeconomic factors also influence health outcomes.

“If you look at the data on characteristics of families whose children become involved in foster care, if you look at the income breakdown, it’s one of the strongest predictors,” Hurlburt said. “Most of the children coming into foster care are coming from families at the very lowest of the socioeconomic spectrum … [This could mean] growing up in areas where resources and community risks are much higher, including risks around pollution and lack of access to services.”

In 2006, Los Angeles County Department of Health Services, Department of Children and Family Services (DCFS), and Department of Mental Health developed a countywide Medical Hub Program to provide children in the system with medical and mental health services. The program currently has six hubs; however, the Hub at LAC+USC Medical Center is the only to provide comprehensive, 24/7 services for children.

Los Angeles County’s Blue Ribbon Commission, recognizing that “medical or developmental issues may be symptoms of child abuse or neglect,” recommended an expansion of the hub system in its December 2013 Interim Report.

The commission recommended that “all children entering placement and children under age one whose cases are investigated by DCFS should be screened at a Medical Hub” and that “children placed in out-of-home care or served by DCFS in their homes should have ongoing health care provided by physicians at the [hubs].”

Lily Conover is a student of public policy at USC’s Sol Price School of Public Policy. She wrote this story while taking as part of her coursework for the class called Media for Social Change. 

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