Medical and Mental Health of Children Entering the Utah Foster Care System

University of Utah School of Medicine, Department of Pediatrics, 50 N Medical Dr, Salt Lake City, UT 84132, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2008; 122(3):e703-9. DOI: 10.1542/peds.2008-0360
Source: PubMed


Investigators from several states have reported that children entering foster care are at risk for medical and mental health conditions. Additional information based on data from a larger statewide population of children in foster care would assist in the development of appropriate strategies of care for these children.
The purpose of this work was to describe the prevalence of medical and mental health conditions, the number of referrals for specialty care, the use of medications and to compare the prevalence of these conditions across age groups of children entering foster care in Utah.
We conducted an analysis of a statewide database containing abstracted medical and mental health information from the initial medical and mental health assessments of all children entering foster care between January 1, 2001, and December 16, 2004.
Of the 6177 children who entered foster care during the study period, 83% were white and 24% were Hispanic. One or more acute or chronic medical conditions were present in 54%, and 44% had >/=1 mental health condition. The most prevalent medical conditions in all of the children were overweight or obesity (35%), 30% had a referral for specialty care. The most prevalent mental health conditions were oppositional defiant disorder or conduct disorder (18%), reactive attachment and adjustment disorders (17%), and mood disorders (15%). The frequency of psychotropic medication use increased with age. Of the 2747 children of all ages with a diagnosed mental health condition, 35% were receiving psychotropic medications.
This study of a statewide cohort of children entering foster care supports and strengthens previous evidence that children in foster care are more likely to have more health care needs compared with the general pediatric population. Focused strategies are needed that address prevalent conditions, the need for continuity of care, ongoing mental health services, and medication management.

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    • "Individual differences in emotionality have been largely attributed to cognitive regulation processes (Ochsner & Gross, 2008). Cognitive regulatory skills (which can include related processes such as inhibitory control, effortful control, cognitive control, and other executive functions) are often impaired following caregiving adversity in childhood (Garland et al., 2001; Lewis et al., 2007; Linares et al., 2010; Loman et al., 2013; Merz, McCall, Wright, & Luna, 2013; Pollak et al., 2010; Rogosch, Dackis, & Cicchetti, 2011; Simmel, Brooks, Barth, & Hinshaw, 2001; Steele & Buchi, 2008; Tottenham et al., 2010), in adolescence, and in adulthood (Bos, Fox, Zeanah, & Nelson Iii, 2009; Colvert et al., 2008; Mueller et al., 2010; Navalta, Polcari, Webster, Boghossian, & Teicher, 2006), as documented by both parent/self reports as well as laboratory-based performance (e.g., go/nogo tasks). Despite being highly modifiable by caregiving factors, cognitive regulatory skills are also influenced by factors other than caregiving (e.g., genetic polymorphisms, Smith, Kryski, Sheikh, Singh, & Hayden, 2013; reviewed in Barnes, Dean, Nandam, O'Connell, & Bellgrove, 2011). "
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    ABSTRACT: Individuals with a history of foster care (FC) are at elevated risk for emotion regulation-related mental illness. The purpose of the current study was to characterize regulatory function in a group of adults with a history of FC (N = 26) relative to those without a history of FC (N = 27) and how regulatory function moderates adverse caregiving-related outcomes (daily cortisol production and trait anxiety). Self-report items (anxiety, emotion regulation strategies, inhibitory control, caregiving history) were collected along with more objective measures (computerized task and salivary cortisol). Inhibitory control was assessed via self-report and a computerized task (emotional face go/nogo). Results showed that for adults with a history of FC, higher levels of inhibitory control were associated with higher accuracy on the emotional face go/nogo task and greater reported use of the emotion regulation strategy cognitive reappraisal. Greater use of cognitive reappraisal in turn was associated with healthier stress-related outcomes (decreased trait anxiety and steeper sloped cortisol production throughout the day). Dose-response associations were observed between self-reported regulatory skills and FC experiences (i.e., number of placements and age when exited foster care). These findings suggest that adverse caregiving can have long-term influences on mental health that extend into adulthood; however, individual differences in regulatory skills moderate these outcomes and may be an important target for intervention following caregiving adversity. © 2014 The Authors. Developmental Psychobiology published by Wiley Periodicals, Inc. Dev Psychobiol
    Developmental Psychobiology 01/2015; 57(1). DOI:10.1002/dev.21227 · 3.31 Impact Factor
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    • "More children in foster care suffer from untreated acute illnesses, chronic conditions, and developmental and mental health problems than those in the general population (Jaudes, Bilaver, Goerge, Masterson, & Catania, 2004; Kortenkamp & Ehrle, 2002). Common medical problems include upper respiratory and skin infections, asthma, severe allergies, and more recently, obesity (Halfon et al., 1995; Hansen, Mawjee, Barton, Metcalf, & Joye, 2004; Schneiderman, Leslie, Arnold-Clark, McDaniel, & Xie, 2011; Steele & Buchi, 2008). These overall health problems are also common in adolescents in foster care (Kools, Paul, Jones, Monasterio, & Norbeck, 2013; Rubin, O'Reilly, Luan, & Localio, 2007). "
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    ABSTRACT: Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care. © 2014 Wiley Periodicals, Inc.
    Research in Nursing & Health 12/2014; 38(1). DOI:10.1002/nur.21634 · 1.27 Impact Factor
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    • "Although research has been limited, more recent findings suggest a growing prevalence of obesity and associated health risks for young people in OOHC (Skouteris et al., 2011). Our systematic review (Skouteris et al., 2011) examined the literature on nutrition and weight-related issues for children in OOHC over the last decade and revealed that, worldwide, only six studies have examined these concerns: three Australian studies (Nathanson & Tzioumi, 2007; Tarren-Sweeney, 2006; Osborn, 2006), and three international studies (Hadfield & Preece, 2008; Schneider et al., 2009; Steele & Buchi, 2008). International studies provide a clear indication that rates of overweight and obesity increase significantly whilst children and young people are in care (Skouteris et al., 2011). "
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    ABSTRACT: Rates of overweight and obesity increase significantly whilst children and young people are in out-of-home care. This paper provides the protocol for a study, funded by the Australian Research Council (2012–2014), being conducted to evaluate the effectiveness of a Healthy Eating and Active Living intervention programme for adolescents who live in out-of-home residential care. This randomised trial will be conducted with 118 adolescents aged 13–17 years of age in out-of-home residential care and the residential staff who look after them. Adolescents' eating habits, physical activity levels, psychological well-being, body dissatisfaction and weight status will be assessed at baseline, immediately post the programme (which runs for 6 months), and again 12 months post baseline. Similar measures will be obtained from residential carers (across the same time points). If effective, this programme could be implemented as usual care to modify levels of obesity amongst these vulnerable young people.
    International journal of adolescence and youth 08/2013; 19(4). DOI:10.1080/02673843.2012.762407
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