Effects of Child Protective Custody Status and Health Risk Behaviors on Healthcare Use among Adolescents

Abstract Objective To determine whether current protective custody status (i.e., youth currently in the temporary or permanent custody of child protective services, e.g., foster and kinship care) contributes to increased healthcare utilization compared to youth never in protective custody. Health characteristics (e.g., mental health diagnoses) and behaviors (e.g., substance use) were expected to account for differences in healthcare 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 healthcare from the same children's hospital. Healthcare use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts. Results In baseline models, healthcare 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 healthcare 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 healthcare systems interested in altering healthcare use and/or cost for this population.