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More frequent placements of foster children increase their reliance on emergency departments for outpatient care

The nearly 550,000 children living in foster care are much more likely than children not in foster care to have mental health and chronic medical problems. However, addressing their health care needs can be problematic, since children in foster care are often moved between homes, disrupting links with primary care providers. As a result, Medicaid-insured foster children rely more on emergency departments (EDs) for outpatient care than their Medicaid-eligible peers not in foster care.

These findings suggest poor availability of nonemergency outpatient care settings for children entering foster care, according to researchers from the University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia. In a study supported in part by the Agency for Healthcare Research and Quality (K08 HS00002), they used Medicaid claims data linked to foster care administrative data for 1993 to 1996 to examine the rate of visits to an ED or other outpatient setting by foster children in a large urban area. They compared the children's health care use with a Medicaid-eligible group of children not in foster care during FY 1995.

Of those in foster care, 38 percent experienced two or more placement changes. Foster children of all ages showed increasing reliance on the ED for outpatient care services as the number of placements increased. For instance, the rate of ED visits among adolescents with more than four placements was twice that of adolescents not in foster care. Also, 75 percent of ED visits for foster children occurred within 3 weeks of a placement change. There was much less use of nonemergency outpatient care for all foster children, but particularly for toddlers and infants, compared with their Medicaid-eligible non-foster peers. These findings underscore the need for better health care management for foster children, particularly in the period after placement changes.

More details are in "Placement changes and emergency department visits in the first year of foster care," by David M. Rubin, M.D., M.S.C.E., Evaline A. Alessandrini, M.D., M.S.C.E., Chris Feudtner, M.D., Ph.D., and others, in the September 2004 Pediatrics 114(3), online at

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