Abstract
To observe pregnancy prevalence and service delivery among foster youth and examine impact on prenatal care utilization by a state policy insurance change. This cohort study utilizes linked, state administrative data to analyze child welfare and Medicaid claims of 4721 female foster youth in Michigan. 38.3% had pregnancy-related charges, and 17% experienced at least one birth. Only 64% received adequate prenatal care. Geography (Urban vs rural), and type of health insurance are significant predictors of prenatal care access for youth in foster care with youth in the largest urban county and those enrolled in managed care Medicaid plans receiving less care than youth living in smaller counties and those enrolled in fee for service Medicaid plans. Number of placements and type of placement were not associated with prenatal care access. Pregnancy prevalence in foster youth is much greater than in non-foster youth. Type of insurance model and geographic area a youth resides in significantly affect adequate prenatal care. Although not significant, age and racial disparities were also trending towards significance in terms of prenatal care access. Younger pregnant foster youth and Black youth received less care. Our findings may be indicative of access to adequate prenatal care by foster youth in other states.
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References
Alexander, G. R., Krogan, M. D., & Nabukera, S. (2002). Racial differences in prenatal care use in the United States: Are disparities decreasing? American Journal of Public Health, 92(12), 1970–1975. https://doi.org/10.2105/ajph.92.12.1970
Alexander, G. R., & Kotelchuck, M. (2001). Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Reports, 116(4), 306–316.
Allen, K. D., & Hendricks, T. (2013). Medicaid and children in foster care. Center for Health Care Strategies.
American Association of Pediatrics. (2021). Care of adolescent parents and their children. Pediatrics, 147(5), e2021050919. https://doi.org/10.1542/peds.2021-050919
Bipartisan Budget Act of 2018, TITLE VII—FAMILY FIRST PREVENTION SERVICES ACT Subtitle A—Investing in Prevention and Supporting Families, Senate 115th Congress 431–468 § 50701 (2018).
Boonstra, D. (2011). Teen pregnancy among young women in foster care: A primer. Guttmacher Policy Review, 14(2), 8–19.
Cederbaum, J. A., Putnam-Hornstein, E., King, B., Gilbert, K., & Needell, B. (2013). Infant birth weight and maltreatment of adolescent mothers. American Journal of Preventive Medicine, 45(2), 197–201.
Center for Medicare and Medicaid. (2020). Quality measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures
Child Trends. (2015). Late or no prenatal care. http://www.childtrends.org/?late-or-no-prenatal-care
Christiani, A., Hundson, A. L., Nyamathi, A., Mutere, M., & Sweat, J. (2008). Attitudes of homeless and drug-using youth regarding barriers and facilitators in delivery of quality and culturally sensitive health care. Journal of Child and Adolescent Psychiatric Nursing, 21(3), 154–163. https://doi.org/10.1111/j.1744-6171.2008.00139.x
Coleman-Cowger, V. H., Green, B. A., & Clark, T. T. (2011). The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement. Children and Youth Services Review, 33(11), 2207–2212. https://doi.org/10.1016/j.childyouth.2011.07.007
Congressional Research Service. (2018). Medicaid coverage for former foster youth up to age 26. https://sgp.fas.org/crs/misc/IF11010.pdf
Courtney, M. E., Dworsky, A., Lee, J. S, & Rapp, M. (2010). Midwest evaluation of adult functioning of former foster youth: Outcomes at ages 23 and 24. https://www.chapinhall.org/sites/default/files/Midwest_Study_Age_23_24.pdf
Courtney, M. E., Okpych, N. J., Charles, P., Mikell, D., Stevenson, B., Park, K., Kindle, B., Harty, J., Feng, H., & Mikell, D. (2016). Findings from the California youth transitions to adulthood study (CalYOUTH): Conditions of youth at age 19. Chapin Hall at the University of Chicago. 19–3125.
Day, A., & Preston, M. (2013). Reevaluating the government's role in parenting older foster care youth: An analysis of the Fostering Connections to Success and Increasing Adoptions Act of 2008 and its implementation in California and Michigan. UC Davis J. Juv. L. & Pol'y, 17, 1.
DiGiuseppe, D. L., & Christakis, D. A. (2003). Continuity of care for children in foster care. Pediatrics, 111(3), e208–e213.
Dudley, T. I. (2013). Bearing injustice: Foster care, pregnancy prevention, and the law. Berkley Journal of Gender Law and Justice, 28, 77–82.
Dworsky, A. (2015). child welfare service involvement among the children of young parents in foster care. Child Abuse and Neglect, 45, 68–79. https://doi.org/10.1016/j.chiabu.2015.04.005
Dworsky, A., & Courtney, M. E. (2010). The risk of teenage pregnancy among transitioning foster youth: Implications for extending state care beyond age 18. Children and Youth Services Review, 32(10), 1351–1356.
Dworskey, A., & DeCoursey, J. (2009). Pregnant and parenting foster youth: Their needs, their experiences. https://www.chapinhall.org/research/pregnant-and-parenting-youth-in-foster-care-their-needs-their-experiences/
Eastman, A. L., Palmer, L., & Ahn, E. (2019). Pregnant and parenting youth in care and their children: A literature review. Child and Adolecent Social Work Journal. https://doi.org/10.1007/s10560-019-00598-8
Federal Trade Commission. (2004). Improving health care: A dose of competition. https://www.ftc.gov/sites/default/files/documents/reports/improving-health-care-dose-competition-report-federal-trade-commission-and-department-justice/040723healthcarerpt.pdf
Fernandes-Alcantara, A. L. (2019). Youth transitioning from foster care: Background and federal programs. Congressional Research Service. https://sgp.fas.org/crs/misc/RL34499.pdf
Finigan-Carr, N. M., Murray, K. W., O’Connor, J. M., Rushovich, B. R., Dixon, D. A., & Barth, R. P. (2015). Preventing rapid repeat pregnancy and promoting positive parenting among young mothers in foster care. Social Work in Public Health, 30, 1–17. https://doi.org/10.1080/19371918.2014.938388
Fiscella, K. (1995). Does prenatal care improve birth outcomes? A critical review. Obstetrics & Gynecology, 85, 468–479.
Friedman, J. (n.d.). Assessing accessibility: Do teens in foster care have access to the full range of reproductive health care services under Medicaid? https://youthlaw.org/publication/assessing-accessibility-do-teens-in-foster-care-have-access-to-the-full-range-of-reproductive-health-care-services-under-medicaid/
Foster Care: State Practices for Assessing Health Needs Facilitating Service Delivery, and Monitoring Children's Care, House of Representatives. (2009). https://www.gao.gov/assets/a285999.html
Gesse, T., Golembeski, S., & Potter, J. (1999). Cost analysis of prenatal care using the activity-based costing model: A pilot study. Journal of Perinatal Education, 8(2), 20–27. https://doi.org/10.1624/105812499X87088
Guttmacher Institute. (2021). Minor's access to contraceptive services. https://www.guttmacher.org/state-policy/explore/minors-access-contraceptive-services
Harrison, M. E., Clarkin, C., Rohde, K., Worth, K., & Fleming, N. (2017). Treat me but don’t judge me: A qualitative examination of the health care experiences of pregnant and parenting youth. Journal of Pediatric Adolescent Gynecology, 30, 209–214. https://doi.org/10.1016/j.pag.2016.10.001
Hudson, A. L. (2012). Where do youth in foster care receive information about preventing unplanned pregnancy and sexually transmitted infections? Journal of Pediatric Nursing, 27(5), 443–450.
James, S., Montgomery, S. B., Leslie, L. K., & Zhang, J. (2009). Sexual risk behaviors among youth in the child welfare system. Children and Youth Services Review, 31, 990–1000. https://doi.org/10.1016/j.childyouth.2009.04014
King, B., Eastman, A. L., Grinnell-Davis, C., & Aparicio, E. (2019). Early childbirth among foster youth: A letent class analysis to determine subgroups at increased risk. Perspectives on Sexual & Reproductive Health, 51(4), 229–238. https://doi.org/10.1363/psrh.12124
King, B., Putnam-Hornstein, E., Cederbaum, J. A., & Needell, B. (2014). A cross-sectional examination of birth rates among adolescent girls in foster care. Children and Youth Services Review, 36, 179–186. https://doi.org/10.1016/j.childyouth.2013.11.007
Lee, H., Hirari, A. H., Lin, C. C. C., & Snyder, J. E. (2020). Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States. PLoS ONE, 15(12), e0240700. https://doi.org/10.1371/journal.pone.0240700
Medicaid prenatal care: States improve access and enhance services, but face new challenges, U.S. Senate. (1994). https://www.gao.gov/assets/hehs-94-152br.pdf
Michigan Department of Health and Human Services. (2018). Foster Care Manual. https://dhhs.michigan.gov/OLMWEB/EX/FO/Public/FOM/803.pdf
Michigan League for Public Policy. (2019). Kids Count in Michigan Databook. https://mlpp.org/wp-content/uploads/2019/04/2019-kcdb-master.pdf
Moore, K. (2012). Pregnant in foster care: Prenatal care, abortion, and the consequences for foster families. Columbia Journal of Gender and the Law, 23(1), 29–64.
National Council on Disability. (2013). Medicaid managed care for people with disabilities: Appendix D types of network based health plans. Washington, D.C.: https://www.ncd.gov/rawmedia_repository/20ca8222_42d6_45a5_9e85_6bd57788d726.pdf
Office of Women’s Health. (2012). Prenatal care factsheet. Washington, D.C. https://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html#a
Oshima, K. M. M., Narendorf, S. C., & McMillen, J. C. (2013). Pregnancy risk among older youth transitioning out of foster care. Children and Youth Services Review, 35, 1760–1765. https://doi.org/10.1016/j.childyouth.2013.08.001
Palmer, M., Marton, J., Yelowitz, A., & Talbert, J. (2017). Medicaid managed care and the health care utilization of foster children. Inquiry, 54, 1–9. https://doi.org/10.1177/0046958017698550
Pecora, P. J., Williams, J., Kessler, R. C., Downs, A. C., O’Brien, K., Hiripi, E., & Morello, S. (2003). Assessing the effects of foster care: Early results from the Casey National Alumni Study. Casey Family Programs.
Phillippi, J. C., & Roman, M. W. (2013). The motiviation-facilitation theory of prenatal care access. Journal of Midwifery & Women’s Health, 58, 509–515. https://doi.org/10.1111/jmwh.12041
Possibilities for Change. (2022). Creating a judgement free zone. https://possibilitiesforchange.org/creating-a-judgement-free-zone/
Putnam-Hornstein, E., Cederbaum, J. A., King, B., Cleveland, J., & Needell, B. (2013). A population-based examination of maltreatment history among adolescent mothers in California. Journal of Adolescent Health, 53, 794–797. https://doi.org/10.1016/j.adohealth.2013.08.004
Rice, S., Cotton, S., Moeller-Saxone, K., Mihalopoulos, C., Magnus, A., Harvey, C., Humphreys, C., Halperin, S., Scheppokat, A., McGorry, P., & Herrman, H. (2017). Placement instability among young people removed from their original family and likley mental health implications. Shanghai Archives of Psychiatry, 29(2), 85–94. https://doi.org/10.11919/j.issn.1002-0829.216090
Shpiegel, S., Cascardi, M., & Dineen, M. (2017). A social ecology analysis of childbirth among females emancipating from foster care. Journal of Adolescent Health, 60, 563–569. https://doi.org/10.1016/j.adohealth.2016.09.013
Shpiegel, S., Fleming, T., Mishraky, L., VanWert, S., Goetz, B., Aparicio, E. M., & King, B. (2021). Factors associated with first and repeat births among females emancipating from foster care. Children and Youth Services Review, 125, 105977. https://doi.org/10.1016/j.childyouth.2021.105977
Svoboda, D. V., Shaw, T. V., Barth, R. P., & Bright, C. L. (2012). Pregnancy and parenting among youth in foster care: A review. Children and Youth Services Review, 34(5), 867–875. https://doi.org/10.1016/j.childyouth.2012.01023
The National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). Counting It Up | The National Campaign. https://thenationalcampaign.org/why-it-matters/public-cost
Wendling, A., Taglione, V., Rezmer, R., Lwin, P., Frost, J., Terhune, T., & Kerver, J. (2021). Access to maternity and prenatal care services in rural Michigan. Birth Issues in Perinatal Care, 48(4), 566–573. https://doi.org/10.1111/birt.12563
Wynand, P. M. M. M., De Ven, V., & Ellis, R. P. (2000). Chapter 14- Risk adjustment in competitive health plan markets. In Handbook of health ecomomics (vol. 1, pp. 755–845). https://doi.org/10.1016/S1574-0064(00)80173-0
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This study was funded by a grant from the Blue Cross Blue Shield Foundation of Michigan.
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Day, A., Curtis, A., Paul, R. et al. Access to Adequate Prenatal Care and Delivery Services Among Female Youth in Foster Care: Michigan Medicaid Claim Analysis. Child Adolesc Soc Work J 39, 669–681 (2022). https://doi.org/10.1007/s10560-022-00853-5
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DOI: https://doi.org/10.1007/s10560-022-00853-5