Adopted Children with Special Health Care Needs: Characteristics, Health, and Health Care by Adoption Type. Discussion


Adopted CSHCN are a distinct group among the larger population of CSHCN.  They are less likely to have physical health conditions or bodily function difficulties, but are more likely to have mental health conditions, activity/participation and emotional/behavioral functional difficulties.  They are more likely to have most of the special health care needs assessed in the CSHCN Screener and more likely to need a variety of health care and family support services, relative to all CSHCN.  They also have a number of advantages in terms of their families’ ability to meet these challenges.  They are more likely to be insured, to have consistent and adequate insurance coverage, and to live in households with higher income and education.  In addition, although their families pay more out of pocket for their health care, they do not appear to suffer greater financial difficulties as a result.

That adopted CSHCN were somewhat more likely to live with single mothers than other CSHCN and that almost half of adopted CSHCN had only one adoptive parent in the household may suggest a propensity for single individuals to adopt children with special health care needs.  Alternatively, it may reflect a preference on the part of adoption agencies to place children with married couples, making CSHCN and other children for whom it is harder to find adoptive homes more available to individual adopters.  Another possibility is that the stress placed on adoptive parents by their children’s special health care needs may contribute to separation or divorce among couples who have adopted CSHCN.

Adopted CSHCN differentiated by adoption type are distinct groups in many ways as well.  Demographically, the groups vary by race, income and age at adoption.  Their racial differences reflect those of the populations available for adoption from various sources.  African American children are overrepresented among children available for adoption from foster care, and Asian children are overrepresented among those available for adoption internationally.  Income differences among adoption types are likely related to the cost of adoption for private and (especially) international adoptions, and are likely related to health insurance status and other health care issues that correlate with income.  Age at adoption is likely related to differences in the prevalence of special health care needs, though disentangling relationships among age, adoption type, and the prevalence of special health care needs is beyond the scope of this analysis.

That former foster children are much more likely than other adopted CSHCN to rely exclusively on public insurance or to combine public and private insurance appears to reflect federal and state policies that provide Medicaid coverage to children adopted from foster care as part of adoption assistance agreements (Child Welfare Information Gateway, 2004).  Because families sometimes fear the potential health care costs of conditions that are not apparent at the time of adoption, the findings that relatively few families report financial difficulties as a result of their children’s special health care needs, and that adoptive parents are no more likely than other parents of CSHCN to report such difficulties, are important and encouraging.

Despite their demographic differences, in some ways CSHCN adopted from different sources are more similar to one another than they are to the general population of CSHCN.  Adopted CSHCN from all sources had high rates of activity/participation difficulties, ADD/ADHD, and treatment for an emotional/developmental/behavioral condition.  It is interesting that the rates were high both among CSHCN adopted from foster care and those adopted from private domestic sources, although interpretation is complicated by this being a sample only of CSHCN.  That internationally adopted children had lower rates of these problems may in part be related to age differences, since internationally adopted CSHCN were younger overall and these diagnoses are less common in preschool children.

On the other hand, CSHCN adopted from different sources do differ on some dimensions of health and health care.  In every instance of a significant difference by adoption type in type or number of special health care needs, type or number of health conditions, functional status or health status, CSHCN adopted from foster care had a higher prevalence of the problem or poorer status than other adopted CSHCN.  Families of CSHCN adopted from foster care were more likely than families of internationally-adopted CHSCN to report needing mental health care for the child, needing all three family support services, and having an unmet need for family support services.  However, they were less likely to report having difficulty getting a referral to a specialty doctor, paying more than $1,000 out of pocket for health care services, or needing certain health care services.

Many adopted CSHCN have multiple special health care needs and/or multiple health conditions.  Adopted CSHCN have more health care needs and more health conditions, on average, than other CSHCN, and CSHCN adopted from foster care have more special health care needs and more health conditions, on average, than other adopted CSHCN.  This affirms the recent attention (The Casey Center for Effective Child Welfare Practice, 2003a; The Casey Center for Effective Child Welfare Practice, 2003b; Gibbs et al., 2002) to ensuring the availability of service providers, particularly mental health professionals, who understand adoption issues, and suggests that recent attention to ensuring the availability of post-adoption services is well grounded, especially for children adopted from foster care (Wind et al., 2007; Grogg and Grogg, 2007; Raghavan et al., 2007).

In interpreting the findings reported here it is important to recognize that this sample includes only CSHCN.  The underlying prevalence of particular conditions or health care needs in the full population of adopted children cannot be assessed with these data.  Data from a representative sample of all adopted children would be necessary to examine questions of population prevalence.  Such data will be available when the 2007 National Survey of Children’s Health is released in 2009.

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