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Continuity of care for youth in foster care with serious emotional disturbances

Author

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  • Fontanella, Cynthia A.
  • Gupta, Lipi
  • Hiance-Steelesmith, Danielle L.
  • Valentine, Sedona

Abstract

Continuity of mental health care has long been considered an essential component to the delivery of a high-quality mental health services, particularly for children with special needs. Unfortunately, discontinuities in care are common for children in foster care due in part to placement instability, disruptions in health coverage, and the fragmented health system. This retrospective cohort study examined factors associated with continuity of care for youth (aged 5–17years) in foster care diagnosed with schizophrenia and bipolar disorder. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Continuity of care was defined as regularity of care—utilization of at least one outpatient mental health visit per month during the year. Multilevel modeling was used to assess the association between individual and contextual-level variables and continuity of care. Of the 952 youth in the study sample, 439 (46.1%) received regular monthly outpatient visits over the 1year follow-up period. The odds of receipt of regular outpatient treatment were associated with prior outpatient care (odds ratio (OR): 7.43, 95% confidence interval (CI): 2.60–21.20), the presence of a chronic medical illness (OR: 1.45, 95% CI: 0.98–2.16), comorbid anxiety (Or: 1.76, 95% CI 1.22–2.53), or conduct disorder (OR: 1.57, 95% CI: 1.13–2.18), and the use of multiple psychotropic medications as compared to no medications (OR: 1.55, 95% CI: 1.08–2.23). The odds of receiving regular outpatient treatment were higher for youths who resided in suburban areas as compared to metropolitan areas (OR: 1.97, 95% CI: 1.04–3.73) and for those who resided in areas with greater supply of psychiatrists per capita (OR: 1.22, 95% CI: 1.02–1.45). Study findings underscore the need for quality improvement initiatives that improve access to care, care coordination, and continuity of care.

Suggested Citation

  • Fontanella, Cynthia A. & Gupta, Lipi & Hiance-Steelesmith, Danielle L. & Valentine, Sedona, 2015. "Continuity of care for youth in foster care with serious emotional disturbances," Children and Youth Services Review, Elsevier, vol. 50(C), pages 38-43.
    • Handle: RePEc:eee:cysrev:v:50:y:2015:i:c:p:38-43
    DOI: 10.1016/j.childyouth.2015.01.004
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    References listed on IDEAS

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    1. Landsverk, John & Davis, Inger & Ganger, William & Newton, Rae & Johnson, Ivory, 1996. "Impact of child psychosocial functioning on reunification from out-of-home placement," Children and Youth Services Review, Elsevier, vol. 18(4-5), pages 447-462.
    2. Eberhardt, M.S. & Pamuk, E.R., 2004. "The importance of place of residence: Examining health in rural and nonrural areas," American Journal of Public Health, American Public Health Association, vol. 94(10), pages 1682-1686.
    3. DosReis, S. & Zito, J.M. & Safer, D.J. & Soeken, K.L., 2001. "Mental health services for youths in foster care and disabled youths," American Journal of Public Health, American Public Health Association, vol. 91(7), pages 1094-1099.
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    1. Cross, Theodore P. & Tran, Steve P. & Betteridge, Eliza & Hjertquist, Robert & Spinelli, Tawny & Prior, Jennifer & Jordan, Neil, 2021. "The relationship of needs assessed at entry into out-of-home care to children and youth’s later emotional and behavioral problems in care," Children and Youth Services Review, Elsevier, vol. 122(C).
    2. Naert, Jan & Roose, Rudi & Rapp, Richard C. & Vanderplasschen, Wouter, 2017. "Continuity of care in youth services: A systematic review," Children and Youth Services Review, Elsevier, vol. 75(C), pages 116-126.

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