P0086 - A Comparison Study of Mental Health Diagnoses of Foster and Non-Foster Children on Medicaid

Background: Each year in the United States, more than 400,000 children are involved in the foster care system. Children in foster care are a uniquely vulnerable population with increased mental health needs due to very high rates of complex trauma that arises from adverse childhood experiences both prior to and during foster care. It is well-described that children in foster care have higher rates of mental health illness than do non-foster children. Numerous studies have demonstrated higher rates of a wide variety of disorders, including ADHD, depression, anxiety, oppositional defiant disorder, conduct disorder, post-traumatic stress disorder, reactive attachment disorder, and behavioral problems. The purpose of this study was to examine Medicaid claims data from a sample of foster and non-foster patients within the greater Houston, Texas area.

Methods: Medicaid claims data were used to identify mental health diagnoses (MHD) and developmental disorders (DD). MHDs identified through ICD-10 codes included: depression; bipolar disorder; eating disorders; anxiety; trauma, dissociative, and stress-related disorders; disruptive, impulse control, and conduct disorders (conduct disorders); schizophrenia spectrum and other psychotic disorders; substance use disorder; personality disorder; obsessive compulsive disorder; somatic symptoms and related disorders; and elimination disorders. DD diagnoses included: attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD), autism, and developmental and motor disorders. All children were enrolled in their respective Medicaid plan for at least 30 days and had at least one health care encounter generating a claim. Prevalence was compared between children in foster care and children not in foster care overall and by age group.

Results: Of the 8,706 children in foster care, 19.1% had a MHD compared to 10.3% of the 233,278 children not in foster care. Prevalence of MHD and DD by age group is displayed in Table 1. The five most prevalent MHD and DD conditions among 1-18 year-old children in foster care were: depression (11.3%), ADD/ADHD (11.0%), developmental and motor disorders (7.4%), bipolar disorder (5.6%), and conduct disorders (3.4%). The most prevalent conditions among children not in foster care included: ADD/ADHD (7.7%); depression (3.3%); trauma, dissociative, and stress-related disorders (3.0%); anxiety (2.7%); and developmental and motor disorders (2.6%). Differences by age group are displayed in Table 2. Overall, children in foster care had a significantly higher prevalence of ADD/ADHD, depression, developmental and motor disorders, and bipolar disorder. Anxiety was significantly higher among children not in foster care.

Conclusion: Children in foster care had significantly higher rates of mental health disorder diagnoses compared to non-foster children. Mental health needs varied according to age, as did the disparities between the foster and non-foster care populations.