Objective

To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups.

Methods

Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts.

Results

In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use.

Conclusions

Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.

中文翻译：

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儿童保护监护状况和健康风险行为对青少年医疗保健使用的影响

客观的

确定当前的保护性监护状态（即，与从未处于保护性监护中的青少年相比，目前处于儿童保护服务（例如寄养和亲属护理）临时或永久监护中的青少年是否有助于提高医疗保健利用率。健康特征（例如，心理健康诊断）和行为（例如，物质使用）预计会解释两组之间医疗保健使用的差异。

方法

2012 年至 2017 年间，从一个县的儿童福利系统和附属的独立儿童医院收集了回顾性儿童福利管理数据和关联的电子健康记录数据。确定了目前处于保护性监护下的青少年 (n = 2787)，并在人口统计学上与从未被监护过的同龄人进行了匹配（ n = 2787) 从同一家儿童医院接受医疗保健。提取并比较两个队列的医疗保健使用、健康风险行为以及社会、人口和诊断数据。

结果

在基线模型中，与同龄人相比，受到保护性监护的青少年的医疗保健使用率更高。在包括健康风险行为和患者特征的调整模型中，保护性监护状态与初级护理和错过护理的减少相关，并且不再是其他类型医疗保健使用的重要预测因素。

结论

与人口结构相似的同龄人相比，年轻人在保护性拘留期间的利用率明显更高；然而，健康风险行为似乎是大多数群体差异的原因。确定儿科环境中当前的监护状态并解决该人群的健康风险行为对于有兴趣改变该人群的医疗保健使用和/或成本的医疗保健系统可能很重要。