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Poor health care access after foster care
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CHICAGO—Youth who have been homeless for any period of time after leaving the foster care system appear to have more problems accessing health care than those with stable housing situations, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

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About 20,000 of the 550,000 children in the U.S. foster care system are emancipated or released from the system due to age each year, according to background information in the article. "These youth are at high risk of homelessness and have poor health outcomes, including high rates of drug and alcohol use, unplanned pregnancies and poor mental health outcomes," the authors write. "Approximately 40 percent of homeless adults aged 18 to 20 years were in the foster care system as youth."

Margot B. Kushel, M.D., of the University of California, San Francisco, and San Francisco General Hospital, and colleagues in 2002 to 2003 interviewed 749 foster youth age 17 or 18 in Illinois, Wisconsin or Iowa. One year later, 643 youth completed a follow-up interview. On both occasions, participants were asked about their sociodemographics, access to health care, housing situation and physical and mental health status.

At the second interview, about half (45.7 percent) of the participants were still in the foster care system and the rest were emancipated. Among those who had left the system, 14.2 percent had experienced homelessness and 39.4 percent had unstable housing situations, meaning that since emancipation they had moved three or more times or that they spent more than 50 percent of their income on rent.

"We found high rates of poor access to health care among all emancipated youth, with an experience of homelessness being associated with significantly higher odds of being uninsured and of having unmet need for health care," the authors write.

"While approximately 30 percent of young adults in the general population report an episode of being uninsured over the course of the past year, we found that more than half of emancipated participants were uninsured, with rates ranging from 46.5 percent of the stably housed to 76.6 percent of the participants with an experience of homelessness. More than one-fifth (22 percent) of emancipated participants reported unmet need for medical care (14.5 percent of stably housed youth, up to 40.8 percent of those with homelessness) compared with approximately 12 percent of young adults in the general population."

Overall, 12.1 percent of the participants had fair or poor (rather than good or excellent) health status, with no significant differences based on housing status. This compares with less than 4 percent of all adults of a similar age.

"Recently emancipated foster youth are at high risk for poor housing and poor health care access, which are associated with one another," the authors conclude. "Strategies to improve health outcomes among emancipated youth should address both their lack of health insurance and their risk of housing instability and homelessness."
(Arch Pediatr Adolesc Med. 2007;161(10):986-993.

Editor's Note: Dr. Kushel was supported by the Stuart Foundation, the Agency for Healthcare Research and Quality, and by the Hellman Family Award for early career development. Co-author Dr. Yen was supported by the Stuart Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


"The available research indicates that youth transitioning from foster care are likely to experience a number of negative outcomes in addition to homelessness," write Peter J. Pecora, Ph.D., and Tiffany Washington, M.S., of Casey Family Programs, Seattle, in an accompanying editorial.

"To make a difference in these young people's lives, programs must provide them with age-appropriate life skills, more stable environments with ties to the local community, and contact with as many birth-family or clan members as possible," they conclude. "It makes no sense to spend tens of thousands of dollars to care for young people during childhood, only to ignore their developmental needs and abandon them as young adults."
(Arch Pediatr Adolesc Med. 2007;161(10):1006-1008.

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .

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