Beal Sarah J, Nause Katie, Crosby Imani, Greiner Mary V
Department of Pediatrics, University of Cincinnati College of Medicine.
Cincinnati Children's Hospital Medical Center.
J Appl Res Child. 2018;9(1).
Children in child welfare protective custody (e.g., foster care) are known to have increased health concerns compared to children not in protective custody. The poor health documented for children in protective custody persists well into adulthood; young adults who emancipate from protective custody report poorer health, lower quality of life, and increased health risk behaviors compared to young adults in the general population. This includes increased mental health concerns, substance use, sexually transmitted infections, unintended pregnancy, and HIV diagnosis. Identifying youth in protective custody with mental health concerns, chronic medical conditions, and increased health risk behaviors while they remain in custody would provide the opportunity to target prevention and intervention efforts to curtail poor health outcomes while youth are still connected to health and social services. This study leveraged linked electronic health records and child welfare administrative records for 351 youth ages 15 and older to identify young people in custody who were experiencing mental health conditions, chronic medical conditions, and health risk behaviors (e.g., substance use, sexual risk). Results indicate that 41.6% of youth have a mental health diagnosis, with depression and behavior disorders most common. Additionally, 41.3% of youth experience chronic medical conditions, primarily allergies, obesity, and vision and hearing concerns. Finally, 39.6% of youth use substances and 37.0% engage in risky sexual behaviors. Predictors of health risks were examined. Those findings indicate that women, those with longer lengths of stay and more times in custody, and those in independent living and congregate care settings are at greatest risk for mental health conditions, chronic medical conditions, and health risk behaviors. Results suggest a need to ensure that youth remain connected to health and mental health safety nets, with particular attention needed for adolescents in care for longer and/or those placed in non-family style settings. Understanding who is at risk is critical for developing interventions and policies to target youth who are most vulnerable for increased health concerns that can be implemented while they are in custody and are available to receive services.
与未处于保护性监护的儿童相比，处于儿童福利保护性监护（如寄养）中的儿童有更多的健康问题。有记录表明，处于保护性监护中的儿童健康状况不佳的情况会一直持续到成年；从保护性监护中脱离出来的年轻人报告称，与普通人群中的年轻人相比，他们的健康状况较差、生活质量较低且健康风险行为增加。这包括心理健康问题增加、药物使用、性传播感染、意外怀孕和艾滋病毒诊断。识别处于保护性监护中且有心理健康问题、慢性疾病和健康风险行为增加的年轻人，将为在他们仍与健康和社会服务有联系时，针对预防和干预措施以减少不良健康后果提供机会。本研究利用了351名15岁及以上青少年的关联电子健康记录和儿童福利行政记录，以识别处于监护中的有心理健康状况、慢性疾病和健康风险行为（如药物使用、性风险）的年轻人。结果表明，41.6%的青少年有心理健康诊断，其中抑郁症和行为障碍最为常见。此外，41.3%的青少年患有慢性疾病，主要是过敏、肥胖以及视力和听力问题。最后，39.6%的青少年使用药物，37.0%的青少年有危险的性行为。研究了健康风险的预测因素。这些发现表明，女性、监护时间较长且次数较多的人以及处于独立生活和集体照料环境中的人，患心理健康状况、慢性疾病和健康风险行为的风险最大。结果表明，有必要确保青少年仍与健康和心理健康安全网保持联系，尤其需要关注监护时间较长和/或处于非家庭式环境中的青少年。了解哪些人有风险对于制定干预措施和政策至关重要，这些措施和政策针对的是最易出现健康问题增加的青少年，且可以在他们被监护期间实施并能获得服务。
