Toward providing equal access to health care for foster youth

This article examines the history of health care policy for older foster youth, and suggests new directions for continued progress. A review of previous research indicates that the high health needs of this group, coupled with their poor outcomes, are well established in the literature. Next, empirical evidence is presented, which demonstrates that over the past 10 years the proportion of older foster youth has increased steadily, even while the overall foster population has started to decline. These trends form an important impetus to developing programs and services that are tailored to older and aged out youth. More than two decades of federal legislation have brought some improvements, but fallen short of providing access to reliable health care. Today, most young adults continue leave the foster care system uncovered and at risk. However, foster youth are not the only group that has been historically denied health care coverage. In fact, new health care legislation addresses the issue of the uninsured, thereby providing a promising template for achieving equal access to health care for older foster youth. The paper concludes with broad policy and legal considerations aimed at developing foster youth health care parity in relation to the new standards contained within the recent health care reforms. This article describes the unique health care needs of older and aged foster youth and documents the proportional increase of this group within the child welfare system over the last decade. In addition, a review of relevant legislative and data trends are TOWARDS PROVIDING EQUAL ACCESS Michigan Journal of Social Work and Social Welfare, Volume II, Issue I | 39 presented, citing Michigan as a case study and using data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth. Finally, policy and legal approaches are considered in relation to health care reform. Health Needs of Older Foster Youth Large scale, generalizable studies regarding outcomes for older youth involved in the child welfare system are difficult to conduct due to the instability of this population and the lack of a comprehensive national approach to child welfare. However, many smaller studies have consistently found that foster children have serious health care needs. The high health needs of this group, coupled with their poor outcomes as adults, are well established in the literature and have been reported for decades. There is significant evidence that, for most foster youth, the onset of both physical and mental health problems begin before they enter the child welfare system (Halfon, Berkowitz, & Klee, 1992; Leslie et al., 2000; Simms, Dubowitz, & Szilagyi, 2000). In fact, children with disabilities and high health needs are more likely to enter the child welfare system, and those with serious problems remain in care longer (Horwitz, Simms, & Farrington, 1994; Orme & Buehler, 2001). Once in foster care, preexisting issues are often exacerbated, while new concerns arise. For many children, the foster care system itself becomes a source of abuse, neglect, and trauma (Fox & Berrick, 2007; Hochman, Hochman, & Miller, 2004; Pecora et al., 2005). One early study found that 47 percent of teens in foster care had a disability (Cook, 1990). In a California study, foster care youth constituted 41 percent of clients of mental health services, despite that fact that they make up only 4 percent of the eligible population (Halfon, Berkowitz, & Klee, 1992). Another California study found that 80 percent of children in their sample had one or more diagnosable mental disorder (Leslie et al, 2000). A study regarding psychiatric disorders among foster youth in Missouri found that youth were three times more likely to suffer from depression and two times more likely to suffer from PTSD than their peers (McMillen, et al., 2005). Psychotropic medication is a typical method of treatment for a wide range of such problems in foster care youth, although the validity of this approach is not well evidenced