Abstract and Introduction
Abstract
Adolescents in foster care experience complex health care needs and face multiple barriers in receiving the necessary and appropriate health care services. When the adolescent ages-out of foster care at 18 or 21 years-old they are expected to make a transition to independence with no financial resources, poor access to health care, few personal and family connections and little if any support from the foster care system. This places them at risk for poor physical and mental health status, poverty, unemployment, homelessness, and incarceration. No formalized system of transition planning has yet been established to meet the needs of adolescents before discharge from the foster care system.
Introduction
Health care providers in the primary care setting, including pediatric nurse practitioners, are in a position to address the health needs of adolescents aging-out of foster care. This article will provide recommendations for primary care providers in guiding the adolescent through the transition process by: 1) assessing health care needs; 2) providing care coordination; 3) increasing the adolescent's knowledge of their health conditions and ability to problem solve health care issues; 4) assisting the adolescent in accessing health insurance; 5) setting up community services - employment, housing, education through social work, and 6) identifying an adult primary and specialty provider for continued health care. Through effective care coordination, the primary care provider can facilitate transition of health care from pediatric to adult care in order to achieve better health outcomes.
In 2005, over half a million children in the United States were in foster care due to abuse and/or neglect (U.S. Department of Health & Human Services [USDHHS], 2006). Of those, an estimated 20,000 youth exit out of foster care each year, many without family or economic support (USDHHS, 2006). The challenges faced by adolescents during transition into adulthood can be daunting for any adolescent but are magnified for those in foster care who "age out" of the system. In most states when an individual turns 18 or 21 years old, they are no longer considered eligible for services such as health care access and public assistance. These adolescents are expected to suddenly make the transition to independence with no financial resources, poor access to health care, few personal and family connections and little if any continuing support from the foster care system.
This is a troubling prospect considering the high degree of health care needs that foster care youth require (American Academy of Pediatrics [AAP], 2002; Diaz, Edwards, & Neal, 2004; Freundlich & Avery, 2006; Kools & Kennedy, 2003; Leslie, Hurlburt, Landsverk et al., 2003; Simms, Dubowitz, & Szilagyi, 2000). Adolescents in foster care have complex health care needs that call for more intensive and comprehensive services compared to those not in foster care (Diaz et al., 2004; Massinga & Percora, 2004). An estimated 1 in every 2 youths in foster care has chronic medical problems unrelated to behavioral concerns (Rubin, Halfon, Raghavan, & Rosenbaum, 2005). In addition, the impact of their past traumatic experience of abuse or neglect places them at risk for behavioral issues such as attachment issues, regulatory disorders, anxiety, post-traumatic stress disorder (PTSD), depression, and aggression (Kools & Kennedy, 2003; Vig, Chinitz, & Shulman, 2005). Adolescents in foster care are also at higher risk for unintended pregnancies, sexually-transmitted infections (STIs), and substance abuse (Massinga & Percora, 2004). Lack of adequate preparation for transitioning out of foster care increases the risk for continued poor health status, unemployment, and homelessness (Massinga & Percora, 2004).
There is generally little training for health care providers regarding issues specific to adolescents in foster care (Simms et al., 2000). Health care providers in the primary care setting, including pediatric nurse practitioners, are in a position to address the complex health needs of adolescents aging-out of foster care (AAP, 2002; Gitlitz & Kuehne, 1997; Kools & Kennedy, 2003; Simms et al., 2000). The importance of transitioning adolescents with complex health needs and chronic conditions has been well studied in the health literature, however, current research on facilitating the transition process among adolescents aging-out of foster care in the primary care setting is limited. This article will examine the issue of transition among adolescents aging-out of foster care, and suggest how the pediatric primary care provider can facilitate transition of health care from pediatric to adult care through effective care coordination.