Foster Care Placement Among Medicaid-Insured Children with Autism

Background:  Existing literature suggests that children with disabilities are at increased risk for child maltreatment and subsequent involvement with child welfare. Little is known, however, about how entry into foster care differs for children with autism spectrum disorder (ASD) compared with children with other disabilities and children without disabilities.

Objectives:  to estimate the risk of foster care placement among children with autism ages 2 to 18 years and compare it with the risk for children with intellectual disabilities (ID) and children without either diagnosis.

Methods:  

We used National Medicaid claims data from 2001 through 2007. The sample included 117310 children who had been diagnosed with ASD (ICD code 299.xx) during the study period, 192378 children who had been diagnosed with intellectual disability (ICD codes 317.xx – 319.xx), 31487 children who had been diagnosed with both, and a sample of 336549 children who had been diagnosed with neither, matched to the rest of sample on state of residence. A washout period of 12 months was used to ensure that children in the sample had no previous foster care placement. The dependent variable, entry into foster care, was defined as three continuous months in which the reason for Medicaid eligibility was specified as “foster care.”

We compared the unadjusted risk of entering foster care for each of the four groups. Discrete time logistic regression analysis was used to estimate the adjusted associations between diagnostic group and risk of foster care entry, controlling for age, sex, race/ethnicity, other diagnoses and healthcare service use. In secondary analyses, we examined specific patterns of healthcare service use that were associated with foster care placement among children with autism.

Results:  Analyses are ongoing. Preliminary results suggest that 3.5% of children diagnosed with ASD entered foster care during the study period, compared with 1.6% of other children. Among children with ASD, those who experienced a psychiatric hospitalization or were on multiple psychotropic medications were more likely to end up in foster care. Those whose families received respite care were less likely to end up in foster care. 

Conclusions:  

Children with ASD are at twice the risk of entering foster care than other children. Hospitalizations especially may be an important warning sign of a family in crisis, and the need to provide additional supports. The results of this study beg the question of why children with ASD are entering foster care, and what treatments, family supports and policies could be put in place to prevent it.