Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems.

OBJECTIVE: Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. METHODS: This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. RESULTS: Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%). CONCLUSIONS: Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.

Beyond "Disconnected Youth": Characterizing Developmental Heterogeneity in School or Work Connections During Emerging Adulthood.

Prior research on disconnected youth has defined connectedness to school or work during emerging adulthood as an either/or outcome, conflicting with research on emerging adulthood, which suggests varied, individualized pathways. This study used a growth mixture model method with data from the Panel Study of Income Dynamics Transition into Adulthood Supplement to elucidate developmental heterogeneity in connectedness to school or work during emerging adulthood (n = 1,977). Results indicated distinct subgroups of connectedness to school or work with additional variation within groups. Racialized group and parenting status differentiated between being fully connected or not but did not explain differences among those with less consistent connectedness. Policy implications include that the timing and duration of policies targeting disconnected youth may be missing a substantial minority of young people. Re-thinking supports for disconnected youth can be further informed by future research focused on examining factors related to individual differences in the timing and nature of connectedness to school or work.

The impacts of COVID-19 on LGBTQ+ foster youth alumni.

BACKGROUND: LGBTQ+ youth frequently experience disparities in outcomes related to permanency and overall well-being while in out-of-home care. These negative outcomes often persist after youth have transitioned out of care, particularly in the domains of housing, education, employment, and mental health. Initial research has found that the ongoing COVID-19 pandemic has exacerbated negative physical and mental health outcomes, as well as decreased economic stability among transition age youth. OBJECTIVE: This study seeks to determine if COVID-19 has resulted in unique impacts on foster care alumni, and if these impacts are the same for LGBTQ+ and non-LGBTQ+ transition age youth. PARTICIPANTS AND SETTING: This study used data from the 2020 Jim Casey Youth Opportunities Initiative Opportunity Passport Survey to explore these questions. METHODS: This survey was administered electronically to a national sample of 1223 youth ages 18-26 with lived experience in foster care. RESULTS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, black, indigenous and other people of color (BIPOC) youth and LGBTQ+ youth being most frequently impacted. CONCLUSIONS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, BIPOC youth and LGBTQ+ youth being most frequently impacted. Implications for practice and policy are explored.

Screening for trauma and behavioral health needs in child welfare: Practice implications for promoting placement stability.

BACKGROUND: Although the child welfare field has initiated efforts to use standardized screening for trauma and behavioral health needs, research has rarely examined whether these screenings have influenced permanency outcomes. OBJECTIVE: Using data from three states' federal demonstration projects, we examined whether receipt of trauma and behavioral health screening and results of screening were associated with placement stability (i.e., fewer placements). Our inquiry focused on whether similar patterns of statistical associations would be observed in three distinct state settings. PARTICIPANTS AND SETTING: Samples comprised children in out-of-home care in three states newly implementing trauma and behavioral health screening. The states included a South Central state, New England state, and a Central Midwestern state. RESULTS: In all three states, findings showed children who received screening had a higher number of placements (i.e., placement instability). Likewise, all three states found that children whose screening results indicated greater need, such as higher number of trauma symptoms or lower behavioral health functioning, were more likely to experience a higher number of placements (i.e., placement instability). CONCLUSION: Despite differences in screening tools and state-specific approaches, findings suggest that early screenings may provide important information that could be used to identify children's needs, make appropriate service referrals, establish well-matched placements, and support resource parents and birth parents toward better permanency outcomes. Regardless of potential benefits of early screening, it may be underutilized in the field. Future research is needed to replicate these findings and continue to build an evidence base for trauma and behavioral health screening.

COVID-19 and disconnected youth: Lessons and opportunities from OECD countries.

AIMS: This paper highlights how the novel coronavirus pandemic (COVID-19) has amplified economic instability and health risks for disconnected youth and young adults (YYA). We offer a brief review of governmental policy responses in four OECD countries and how they may impact the disconnect YYA within those countries. METHODS: Literature was reviewed utilizing Cochrane Library, ERIC, PsychINFO, PubMed/MEDLINE and Web of Science to outline existing inequities among disconnected YYA and COVID-19 economic and health impacts. Government responses to COVID-19 from four OECD countries were reviewed. Using the social protection model, we highlighted significant policy changes and developments that influence the protection of vulnerable populations and evaluated the potential effect of long-term economic dislocations prompted by the COVID-19 pandemic. RESULTS: Disconnected YYA suffered significant financial and health burdens with no social protection floor in place. Lessons learned prior to and during the pandemic indicate that initiatives aimed at improving health and well-being among vulnerable YYA and their communities must be adequately funded, flexible, and comprehensive. Attempts to connect or reconnect YYA who were disconnected prior to the COVID-19 pandemic will require a re-envisioning of policy. CONCLUSIONS: Globally, governments must invest in social safety net programs that focus on supporting those most at-risk. A concentrated focus on job creation, education and training, and paid work experience, investments in early childhood care and education, housing, health and mental health care is necessary to not only offset the pandemic's effects but also support thriving in the future for YYA.

Characteristics of Emergency Department Visits by Homeless Young Adults in the U.S.

PURPOSE: Homeless young adults often seek health care at emergency departments (EDs) after they are no longer able to ignore a pressing health problem. However, a dearth of literature examines homeless young adults' ED visits. This study aimed to increase understanding of ED visits among homeless young adults within the U.S. METHODS: Data for this study were obtained from the 2011-2015 National Hospital Ambulatory Medical Care Survey. The sample for this study included all ED visits made by homeless and housed young adults aged 18-29 years (unweighted N = 25,068). RESULTS: ED visits by homeless young adults were distinguished in terms of gender, region, payment sources, and triage level. Furthermore, ED visits made by homeless young adults were more likely related to mental health and suicide. Homeless young adults' ED visits were characterized by a longer average length of stay and were less likely to be referred to a physician or clinic for follow-up, given medication, or have a procedure performed in the ED. CONCLUSIONS: This study highlighted differences in ED utilization for homeless young adults. The findings of this study suggest a need to further examine the characteristics of ED services received by homeless young adults to better understand differences in ED service receipt related to housing status. This knowledge can inform efforts to reduce costs through improving access to housing and outpatient mental health care and reducing stigma among health care professionals to ensure continuity of care.

Investigating the Relationship between Trauma Symptoms and Placement Instability.

BACKGROUND: Placement stability while in foster care has important implications for children's permanency and well-being. Though a majority of youth have adequate placement stability while in foster care, a substantial minority experience multiple moves during their time in care. Research on correlates of placement instability has demonstrated a relationship between externalizing behaviors and placement instability. Likewise, evidence suggests higher levels of trauma are associated with increased externalizing behaviors. However, few studies have examined the relationship between trauma symptoms and placement instability. OBJECTIVE: The purpose of this study was to investigate whether children with clinically significant trauma symptoms had higher odds of placement instability. PARTICIPANTS AND SETTING: Administrative data collected as a part of a summative evaluation for a federally-funded trauma III grant project were used. The sample included 1,668 children ages 5 and older who entered foster care during a 30-month period in a Midwestern state and completed a self-reported trauma screen within 120 days of entering care. METHODS: Hierarchical logistic regression was conducted to examine the contributions of trauma symptoms scores to placement instability, above and beyond demographic characteristics and case characteristics. RESULTS: Results from the final analytic model, which controlled for demographic and case characteristics, showed that children with clinically significant trauma symptoms (i.e., scores ≥19) had 46% higher odds of experiencing placement instability (OR = 1.46, 95% CIs [1.16, 1.82], p = .001). Findings support the need to screen for and treat trauma symptomology among youth in foster care.

The predictors of perceived social support among former foster youth.

Based on a 5-wave panel survey of 732 foster youth, the current study examined the respective relationships between foster youths' individual characteristics, youths' social connections with individuals and formal institutions, and the development of perceived social support across the transition to adulthood. Several youth characteristics - including self-reported delinquency and attachment insecurity - were found to be statistically significantly associated with perceived social support. Attachment insecurity also appeared to mediate the relationships between social support and several other youth-level characteristics, including prior placement disruptions and placement with relatives. Social connections with different types of individuals - including caregivers, relatives, natural mentors, and romantic partners - were found to be associated with additive increases in perceived social support. However, some types of connections (e.g., romantic partners, natural mentors) appeared to be associated with much larger increases in social support than other connections (e.g., school or employment). Collectively, the findings help inform agencies' efforts to bolster foster youths' social connections as they transition to adulthood.