Public Release: 

For foster children, unstable placements have higher healthcare costs

Children's Hospital of Philadelphia

For children in foster care, those with multiple placements are more likely to incur higher mental health costs than children in more stable placements. Those children in less-stable placements are also more likely to have higher medical costs in general.

Researchers from The Children's Hospital of Philadelphia reported on a sample of more than 1,600 Pennsylvania children in the foster care system in the May issue of the journal Pediatrics. The findings may help policy makers to better target scarce healthcare resources to subgroups of children most in need of services, such as those in their first year of placement.

"A child with medical problems, developmental problems, or mental health problems is more likely to drift from placement to placement and spend considerable time in the foster care system," said David Rubin, M.D., a general pediatrician at The Children's Hospital of Philadelphia and primary investigator of this study. "Because mental health and global health are interrelated for children in foster care, we need to consider the overall health needs of these children."

Using a sample of 1,635 children above two years of age, the researchers found that the top 10 percent of mental health service users accounted for 83 percent of the $2.4 million in mental health costs, and that higher physical health care costs also increased the probability of high mental health use. Of those children sampled, 41 percent had two or more foster care placements and five percent had episodic foster care placements during the year observed. The sample was identified from foster care data provided by the Pennsylvania Department of Public Welfare. Medicaid and child welfare data were successfully linked for all children in the sample population.

Multiple placements and episodic foster care both increased the predicted probability of high mental health service use. Higher physical health care costs also increased the probability of high mental health use for all children, but the increased probability was most dramatic among children with episodic foster care. Older children were at much greater risk of being high users of mental health services, as were children with higher physical health care costs.

"These results have important policy implications for the development of interventions in this population. They suggest that initiatives to improve the delivery of mental health services that fail to consider the global health of children in foster care may fall short in addressing the needs of children in foster care," said Dr. Rubin. "Such results support the American Academy of Pediatrics' recommendation for specialized health programs to provide the global case management that is imperative for improving the overall health of children in the foster care system."


Dr. Rubin's coauthors were Evaline A. Alessandrini, M.D, M.S.C.E.; Chris Feudtner, M.D., Ph.D., M.P.H.; David S. Mandell, Sc.D. all of The Children's Hospital of Philadelphia, and A. Russell Localio, J.D., M.S.; and Trevor Hadley, Ph.D., both of the University of Pennsylvania School of Medicine.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked in 2003 as the best pediatric hospital in the nation by U.S.News & World Report and Child magazines. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding among children's hospitals. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. Children's Hospital operates the largest pediatric healthcare system in the U.S. with more than 40 locations in Pennsylvania, New Jersey and Delaware.

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