Access to Care

A short homeless period among youth "aged out" of the foster care system affects care access, but not health

About 20,000 youth "age out" of the foster care system each year, without being reunited with families. Many of these youth become homeless for a time. For example, 40 percent of homeless young adults (18 to 20 years old) were in the foster care system as youth. Being homeless for an average of a month after leaving the foster care system is associated with worse care access, but not worse health, according to a new study.

Margot Kushel, M.D., of the University of California, San Francisco, and colleagues interviewed 749 foster youth aged 17 or 18 years from Illinois, Wisconsin, or Iowa between May 2002 and March 2003 (and 643 between March and December 2004) about access to care and two health outcomes. Most of these youth had been placed in foster care because of abuse or neglect or because they were adjudicated delinquents. Among the 345 individuals who had aged out of the foster care system, 14 percent experienced an episode of homelessness (average of 28 days) and 39 percent were unstably housed (had moved 3 or more times since leaving foster care or spent more than 50 percent of income on rent).

Foster care youth who had been homeless at some point were 3.4 times more likely to be uninsured and 3.3 times more likely to have an unmet need for health care than those who had not been homeless. However, homelessness was not associated with not having had an outpatient visit in the past year. Housing status was not associated with reporting fair or good health 1 to 2 years later, or among women, with having had a pregnancy. Nevertheless, nearly half (46.3 percent) of homeless persons met criteria for drinking problems compared with 23.5 percent of stably housed, 12.8 percent of unstably housed, and 7.9 percent of those still in the foster care system. Similarly, 46.3 percent of homeless youth met criteria for drug problems, compared with 20, 10.7, and 7.9 percent of stably housed, unstably housed, and still-in-system persons, respectively.

The study was supported in part by the Agency for Healthcare Research and Quality (HS11415).

More details are in "Homelessness and health care access after emancipation," by Dr. Kushel, Irene H. Yen, Ph.D., Lauren Gee, M.P.H., J.D., and Mark E. Courtney, Ph.D., in the October 2007 Archives of Pediatric and Adolescent Medicine 161(10), pp. 986-993.

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