NUR 402 Module 3 Group Paper 1: Health Disparities of a Vulnerable Population Example

Children Without a Constant: Health Disparities Among Youth in Foster Care

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 402: Concept Integration Across the Lifespan: Accomplished

Instructor Name

Month Day, Year

Children Without a Constant: Health Disparities Among Youth in Foster Care

Introduction

A child removed from home arrives in foster care carrying more than a bag of clothes. Many bring the effects of abuse, neglect, poverty or a parent's addiction, and they enter a system in which placements, schools and doctors may change several times a year. This paper analyzes the health disparities of youth in foster care, a population pediatric experts describe as children with special health care needs (Szilagyi et al., 2015).

Who the Population Is

Youth in foster care are children and adolescents placed outside their homes by a child welfare agency, living with licensed foster families, relatives or in group settings. They are vulnerable for three reasons: the adversity that led to removal, the instability of care after removal and their dependence on adults and systems that change often. Kinship placements with relatives are common and bring their own needs, since relatives may receive less support than licensed foster parents.

Disparity 1: Mental Health

Children in foster care have markedly higher rates of mental health problems than children in the general population, including depression, anxiety, behavioral problems and attention difficulties (Turney & Wildeman, 2016). These problems often trace to childhood adversity. In a landmark study, adults who reported more types of abuse and household dysfunction in childhood had higher risks of depression, substance use, suicide attempts and several chronic diseases later in life (Felitti et al., 1998). Foster youth, almost by definition, have high exposure to such experiences.

Disparity 2: Physical Health

The same national study found poorer physical health among children in foster care, including higher rates of conditions such as asthma, obesity, hearing and vision problems and developmental delay, compared with children in other family types (Turney & Wildeman, 2016). Notably, most of the difference was explained once the authors accounted for children's demographic characteristics and current home environment, which suggests that the conditions surrounding care, not foster care itself, drive much of the gap.

Disparity 3: Psychotropic Medication Use

Youth in foster care receive psychotropic medications at high rates. In one large state Medicaid sample, 41% of foster youth who were dispensed psychotropic drugs received three or more classes at the same time, and 16% received four or more (Zito et al., 2008). Some of these children have serious needs, but multiple medications raise concerns about side effects and monitoring, especially when prescribers and records change with each placement.

Disparity 4: Preventive and Dental Care

Frequent moves interrupt immunizations, screenings and dental visits. Pediatric guidance recommends a health screening soon after placement, a comprehensive assessment within the first month and more frequent well visits than for other children, because needs are high and records are often incomplete (Szilagyi et al., 2015). When records do not follow the child, care may be repeated, delayed or missed.

Disparity 5: Education

School changes that come with placement changes disrupt learning and can separate a child from a school nurse or counselor who knows them. Educational setbacks matter for health, because school connection is protective and educational attainment shapes adult health.

Why These Disparities Exist

Gaps in the Data

Much of the research is national or from other states. Arizona-specific data on health outcomes for youth in foster care are limited in the public literature, so the team relies on national findings and will be careful in applying them locally.

Conclusion and Next Step

Youth in foster care face disparities in mental and physical health, medication use, preventive care and education, driven largely by adversity and instability rather than by placement itself. In Paper 2, the team will prioritize mental health care continuity across placement changes, the disparity that connects most of the others.

References

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S., Council on Foster Care, Adoption, and Kinship Care, Committee on Adolescence, & Council on Early Childhood. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142-e1166. https://doi.org/10.1542/peds.2015-2656

Turney, K., & Wildeman, C. (2016). Mental and physical health of children in foster care. Pediatrics, 138(5), e20161118. https://doi.org/10.1542/peds.2016-1118

Zito, J. M., Safer, D. J., Sai, D., Gardner, J. F., Thomas, D., Coombes, P., Dubowski, M., & Mendez-Lewis, M. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics, 121(1), e157-e163. https://doi.org/10.1542/peds.2007-0212