Evidence-Based Practice in Foster Parent Training and Support ...

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EBP in Foster Parent Training and SupportRecent studies have indicated that many children do not have access to the medicalservices they need. One study found that over a third of the children with autism, over a fifthwith mental retardation, and over a fifth with other types of special health care needs hadproblems obtaining needed care from specialty doctors in the preceding year (Krauss, Gulley,Sciegaj, & Wells, 2003). The most common problems included getting referrals and findingproviders with appropriate training. Adolescents with special health care needs tend to have onemore annual office visit per year and report three times the rate of unmet medical needs, despitehigher rates of insurance coverage, than adolescents without those needs (Okumura, McPheeters,& Davis, 2007). Children in foster care, especially those receiving SSI benefits, account for adisproportionate share of medical expenditures (Rosenbach, Lewis, & Quinn, 2000).Health insurance is imperative for children and youth with special health care needs in atreatment foster care population. In this population, health insurance is positively associated withboth access and utilization of services (Jeffrey & Newacheck, 2006; Kraus et al., 2004). Thefamilies of insured children also experience significantly lower out-of-pocket burden andfinancial problems as compared to those families whose children are uninsured. Because of thelarge proportion of children with special health care needs who reside in treatment foster care,having insurance for these children is a significant support for treatment foster parents.Among those children with health insurance, the role of managed care is widely debated.Medicaid coverage and public secondary health coverage have been associated with fewer accessproblems (Kraus et al., 2004). However the utilization of services within managed care healthinsurance is disputed. Some studies link Medicaid managed care insurance plans to reducedservice utilization, which is interpreted as improved care coordination rather than a lack of careCenter for Advanced Studies in Child Welfare (CASCW)University of Minnesota School of Social WorkContact: Kristine N. Piescher, Ph.D. kpiesche@umn.edu 93
EBP in Foster Parent Training and Supportresources (Davidoff, Hill, Courtot, & Adams, 2008). Studies which consider all managed careplans (not just Medicaid) find that service utilization differences don’t exist between managedcare and fee-for-service plans (Newacheck et al., 2001). Clearly research findings have notreached a consensus in this area.Treatment foster care providers, although benefited by having insurance support, may beconcerned with the continuation of care for adolescents once they reach adulthood. A recentstudy found that over 27% of adolescents with special health needs have public coverage(Okmura et al., 2007), and young adults who have coverage through a state health plan such asTitle V (special health care needs), Medicaid, or a State Children’s Health Insurance Program(SCHIP) face the prospect of discontinued coverage as they leave adolescence.Managed Care & Service ProvisionAgencies which operate under a performance-based, managed care purchase-of-servicecontract have been associated with reduced service utilization, which is interpreted as suppressedservice provision that may lead to service disparities between foster children and families servedunder different market environments (McBeath & Meezan, 2008). Children in performancebasedenvironments are also significantly less likely to be reunified and more likely to be placedin kinship foster homes and adopted, as compared with children in fee-for-service foster careagencies. Clearly the effect of managed care has ramifications for treatment foster careproviders.Center for Advanced Studies in Child Welfare (CASCW)University of Minnesota School of Social WorkContact: Kristine N. Piescher, Ph.D. kpiesche@umn.edu 94
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