Predictors of mental health emergency department visits and psychiatric hospitalizations in children in foster care

Abstract

BackgroundDespite the promise of safe, nurturing environments, children in foster care are at significantly elevated risk of mental health disorders. ObjectiveTo identify factors associated with increased mental health emergency department (ED) visits and psychiatric hospitalizations for children in foster care. ParticipantsChildren aged 4–18 years in child welfare services custody who presented to a foster care clinic from December 2017 to January 2020 (N = 311). MethodsA descriptive cohort study was conducted to collect semi-structured data on a child’s foster care placement history, trauma history, reported behavioral concerns, academic delay, and demographics after new foster care placement. Mental health ED visits and psychiatric hospitalizations within one year of the foster clinic visit were identified using a health information exchange platform. Simple and multiple logistic regression was used to determine unadjusted and adjusted odds ratios for associations of independent variables with mental health ED visits and psychiatric hospitalizations. ResultsIn the study population, most children (78.5 %) were placed with foster families, followed by group homes (18.3 %) and kinship care (3.2 %). Within one year of the foster clinic visit, 24.1 % and 7.4 % of patients had ≥1 ED visit for mental health concerns or ≥1 psychiatric hospitalization, respectively. While children with increased prior placements and group home placement had increased odds of ≥1 ED visit in univariate analyses, no significant association was seen in multivariable analysis. More than half of the children placed in group homes had at least one mental health ED visit compared to 17.4 % of children placed with foster families. ConclusionsChildren placed into out-of-home care have high rates of mental health ED visits and psychiatric hospitalizations. Understanding predictors of poor mental health and associated service utilization can help guide the allocation of resources for better prevention.