Takeaways:
- Black youths and females with intellectual and developmental disabilities (I/DD) have a higher risk of being involved in foster care compared to White youth and males, according to a cross-sectional study published in JAMA Pediatrics.
- Foster care associations increased with age, with those aged 13 to 17 years being more than twice as likely to have foster care involvement in all groups compared to the youngest age group.
- The study included individuals aged 21 years and younger enrolled in Medicaid in 2016, examining differing rates of foster care involvement based on race, ethnicity, age, and sex.
- Females were at an increased risk for foster care involvement across all groups, with the highest risk among females in the ASD-only group.
- Black youths were at an increased risk for foster care involvement in all groups, emphasizing the need for research addressing system-level factors to mitigate these disparities.
A cross-sectional study recently published in JAMA Pediatrics revealed that Black youths and females with intellectual and developmental disabilities (I/DD) are at a higher risk to be involved in foster care compared to White youth and males.
The study also revealed foster care associations increased with age.
It is known that youth with I/DD are more likely to be placed in foster care compared to other youth. To identify disparities, investigators stated it is critical to examine sociodemographic and clinical characteristics of youth with I/DD in the foster care system.
Initial research for Medicaid-enrolled children from 2001 to 2007 demonstrated that foster care entry was 2.4 times greater for youth with autism spectrum disorder only (ASD) compared to typically developing youth, the study authors stated.
Foster care entry was 1.9 times greater for youth with ID and 1.6 times greater for youth with ASD and co-occurring ID compared to typically developing children, said the investigators.
To produce a population-level analysis of youth with I/DD in foster care that examined differing rates of foster care involvement based on race, ethnicity, age, and sex, (primary outcome) investigators included individuals aged 21 years and younger enrolled in Medicaid in 2016 through data from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF).
TAF data was from all 50 states and Washington, DC. Youth with I/DD were categorized into diagnostic subgroups of ASD only, intellectual disability (ID) only, or ASD and ID.
The primary outcome was determined by the aforementioned diagnostic subgroups using an intersectional approach across race, ethnicity, age, and sex, while logistic regression examined the associations for foster care involvement risk. Data analysis occurred from July 2022 to September 2023.
In 2016, a total of 39,143 youth with I/DD had foster care involvement, with 28,422 youth in the ASD group and 16,125 in the ID group. One in 5 youths with ASD and foster care involvement had co-occurring ID as well.
Among all youths with I/DD enrolled in Medicaid, 23,018 with ASD only had foster care involvement, compared to 10,701 youth with ASD and ID.
Females were at increased risk for foster care involvement across all groups. The highest risk among females emerged from the ASD-only group (adjusted odds ratio [aOR], 1.35; 95% CI, 1.39-1.4).
Despite all diagnosis groups being predominantly White compared to other racial and ethnic groups, "a sizable proportion of all groups was Black, totaling more than 6400 (27.9%) foster care–involved youth with ASD, 1735 (32%) foster care–involved youth with ASD and ID, and 4173 (39%) foster care–involved youth with ID only," stated the investigators.
In all groups, Black youths were at an increased risk for foster care involvement for those with ASD only (aOR, 1.37; 95% CI, 1.32-1.42), those with ASD and ID (aOR, 1.37; 95% CI, 1.28-1.47), and for those with ID only (aOR, 2.32; 95% CI, 1.26-1.39).
Relative to the 0 to 5-year-old youth, the likelihood of foster care involvement increased with all age groups. Those aged 13 to 17 years were more than twice as likely to have foster care involvement in all groups compared to the youngest age group.
For those aged 18 to 21 years, foster care involvement odds slightly decreased among all diagnosis subgroups.
The cross-sectional study revealed that Black youths and females faced higher risk for foster care involvement, with odds increasing with age.
The study investigators concluded that there "is an urgent need for research that focuses on addressing system-level factors that drive increased risk. Understanding the specific health needs of Black and female youth with I/DD is critical to ensure the formation, implementation, and monitoring of equitable delivery of health services."
Reference:
Shea L, Villodas ML, Ventimiglia J, Wilson AB, Cooper D. Foster care involvement among youth with intellectual and developmental disabilities. JAMA Pediatr. Published online February 12, 2024. doi:10.1001/jamapediatrics.2023.6580
