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

10/08/2008

In 2005, there were an estimated 470,000 adopted children with special health care needs in the United States, 4.6% of all children with special health care needs.  Other analyses have found adopted children to be 2.5% of all children if step parent adoptions are included (U.S. Census Bureau, 2003), and 1.7% when defined, as here, to exclude step parent adoptions (Bramlett & Blumberg, 2007).  Adopted children are over-represented among CSCHN, indicating that they have a higher prevalence of SHCN than nonadopted children.  However, because the sample for this study includes only CSHCN we cannot determine the magnitude of the overrepresentation using these data.

Table 1:
Number and Percent of Children with Special Health Care Needs (CSHCN)
with Selected Child-level Characteristics, by Adoptive Status and Adoption Type
Characteristic All CSHCN Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
  Frequency Count (Percent)
Total
   Unweighted Sample Size 40,723 1,898 (4.7) 863 (45.5) 664 (35.0) 371 (19.5)
   Weighted Population Estimate 10,221,439 469,564 (4.6) 217,365 (46.3) 163,093 (34.7) 89,106 (19.0)
  Weighted Percent (standard error)
Age at interview
   0-5 years 20.9 (0.36) 15.6 (1.43)* 14.3 (2.33) 13.1 (1.89) 23.2 (3.46)†
   6-11 years 37.2 (0.41) 41.2 (1.89)* 43.4 (2.75) 35.9 (3.21) 45.6 (4.12)
   12-17 years 41.9 (0.42) 43.2 (1.95) 42.3 (2.66) 51.0 (3.54)† 31.2 (3.74)†
Sex
   Male 59.4 (0.42) 55.7 (1.91)* 56.2 (2.73) 58.0 (3.43) 50.4 (4.12)
   Female 40.6 (0.42) 44.3 (1.91)* 43.8 (2.73) 42.0 (3.43) 49.6 (4.12)
Race & Ethnicity
   Hispanic 11.8 (0.30) 11.4 (1.24) 11.5 (1.93) 10.2 (1.97) 13.3 (2.75)
   Non-Hispanic White 65.5 (0.42) 51.0 (1.96)* 48.4 (2.77) 65.6 (3.25)† 30.8 (3.68)†
   Non-Hispanic Black 16.3 (0.34) 20.5 (1.62)* 31.8 (2.69) 15.8 (2.52)† 1.5 (0.79)†
   Non-Hispanic Asian 1.6 (0.12) 10.2 (1.20)* 0.9 (0.77) 0.9 (0.57) 49.9 (4.16)†
   Non-Hispanic Other 4.8 (0.18) 6.9 (0.96)* 7.5 (1.62) 7.5 (1.54) 4.5 (1.42)
Type of Health Insurance
   Private/Employment-based 59.1 (0.42) 50.9 (1.95)* 23.0 (2.14) 68.6 (3.10)† 86.7 (3.11)†
   Public 28.1 (0.40) 31.6 (1.86) 48.8 (2.78) 21.7 (2.83)† 7.6 (2.85)†
   Private & Public 7.4 (0.22) 14.1 (1.25)* 26.4 (2.37) 3.6 (1.01)† 3.2 (1.23)†
   Other Comprehensive Insurance 2.0 (0.12) 1.8 (0.37) 1.1 (0.39) 2.6 (0.81) 1.9 (0.85)
   Uninsured 3.5 (0.15) 1.7 (0.39)* 0.7 (0.45) 3.4 (0.92)† 0.7 (0.43)
Number of Siblings
   0 30.9 (0.37) 41.6 (1.88)* 35.2 (2.52) 48.4 (3.55)† 44.6 (4.06)†
   1 37.4 (0.41) 28.7 (1.67)* 25.9 (2.33) 28.5 (3.05) 36.0 (3.75)†
   2 or more 31.7 (0.42) 29.7 (1.96) 38.9 (2.82) 23.1 (3.51)† 19.5 (3.93)†
Number of Siblings with Special Health Care Needs
   0 67.4 (0.44) 67.5 (1.92) 57.8 (2.82) 75.6 (3.16)† 76.2 (3.98)†
   1 24.9 (0.40) 22.3 (1.73) 24.8 (2.57) 22.2 (3.12) 16.3 (3.21)†
   2 or more 7.7 (0.30) 10.2 (1.29)* 17.4 (2.31) 2.2 (0.73)† 7.4 (3.02)†

Note: italicized cells contain unreliable estimates (Relative Standard Error >0.3)
* Significantly different at the 0.05 level from the estimate for all CSHCN
 Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
Source: National Survey of Children with Special Health Care Needs, 2005-2006


Characteristics of the Child — Table 1 shows child-level characteristics for all CSHCN, for adopted CSHCN, and for adopted CSHCN by adoption type.  Almost half (46%) of adopted CSHCN were adopted from foster care, with 35% adopted from private domestic sources and 19% adopted internationally (figure 1).  Adopted CSHCN were less likely to be very young as compared with all CSHCN.  In addition, while both adopted CSHCN and all CSHCN were more likely to be male than female, the over-representation of males was less pronounced among adopted CSHCN.  Race/ethnicity varies widely by adoption type:  half of internationally adopted CSHCN were non-Hispanic Asian, compared with 1% of other adopted CSHCN; 32% of CSHCN adopted from foster care were non-Hispanic black, compared with 1.5% of internationally adopted CSHCN and 16% of other adopted CSHCN; and 66% of CSHCN adopted from private domestic sources were non-Hispanic white, compared with 31% of internationally adopted CSHCN and 48% of CSHCN adopted from foster care (figure 2).

Figure 1.
Percent Distribution of Adoption Type,
for Adopted Children with Special Health Care Needs

Figure 1. Percent Distribution of Adoption Type, for Adopted Children with Special Health Care Needs

Figure 2.
Percent of Adopted Children with Special Health Care Needs
in Selected Race/Ethnicity Categories, by Adoption Type

Figure 2. Percent of Adopted Children with Special Health Care Needs in Selected Race/Ethnicity Categories, by Adoption Type

Type of health insurance also varies widely by adoption type:  internationally adopted CSHCN were overwhelmingly covered by private or employment-based insurance only, while 75% of CSHCN adopted from foster care were covered by either public insurance or a combination of private and public insurance (figure 3).  The proportion uninsured for adopted CSHCN was about half that of all CSHCN, although this difference is mainly due to the lower rates of uninsurance among CSHCN adopted from foster care or internationally.  Adopted CSHCN were more likely to have no siblings, although this varied by adoption type:  CSHCN adopted from foster care were more likely to have any siblings than CSHCN adopted from other sources.  Most CSHCN and adopted CSHCN had no siblings with special health care needs, but 10% of adopted CSHCN, and 17% of CSHCN adopted from foster care had two or more siblings with special health care needs.

Figure 3.
Percent of Adopted Children with Special Health Care Needs
with Selected Types of Health Insurance, by Adoption Type

Figure 3. Percent of Adopted Children with Special Health Care Needs with Selected Types of Health Insurance, by Adoption Type

Characteristics of the Household — Table 2 shows household-level characteristics for all CSHCN, for adopted CSHCN, and for adopted CSHCN by adoption type.  More than a quarter of CSHCN adopted from foster care lived in households with 3 or more adults, considerably more than among other adopted CSHCN.  Adopted CSHCN were more likely to live in single-mother or other family structure households and less likely to live in stepfamilies than all CSHCN.  The primary language in the household was more likely to be English among adopted CSHCN (at nearly 100%) than among all CSHCN.  The highest education in the household was higher among adopted CHSCN, compared with all CSHCN.  Eighty-six percent of internationally adopted CSHCN lived in households where the highest education was a college degree or higher, compared with 59% of CSHCN adopted from private domestic sources and only 47% of CSHCN adopted from foster care.  Household income relative to the poverty level was higher among adopted CSHCN than all CSHCN, although CSHCN adopted from foster care were considerably less likely to be in the highest income category than other adopted CSHCN (figure 4).  Although most adopted CSHCN live in households that receive no cash assistance from welfare, receipt of cash assistance was less prevalent among adopted CSHCN than all CSHCN, and less prevalent (near zero) among internationally adopted CSHCN than among CSHCN adopted from foster care.  Adopted CSHCN were a little more likely than all CSHCN to live in a Metropolitan Statistical Area.

 

Table 2:
Percent of Children with Special Health Care Needs (CSHCN)
with Selected Household-level Characteristics, by Adoptive Status and Adoption Type

Household Characteristic Weighted Percent (standard error)
All CSHCN Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
Number of Adults1 in Household
   1 16.4 (0.33) 14.5 (1.31) 12.4 (1.69) 18.5 (2.65) 12.5 (2.63)
   2 64.9 (0.41) 64.9 (1.80) 60.9 (2.68) 66.8 (3.15) 71.1 (3.66)†
   3 or more 18.8 (0.33) 20.6 (1.48) 26.8 (2.44) 14.7 (2.06)† 16.5 (2.98)†
Family Structure2
   Two-parent biological/adoptive 55.0 (0.43) 52.9 (1.94) 52.8 (2.78) 50.2 (3.56) 57.9 (4.07)
   Two-parent stepfamily 10.0 (0.26) 2.3 (0.49)* 2.2 (0.84) 2.5 (0.63) 2.0 (1.09)
   Single mother family 29.9 (0.41) 36.4 (1.87)* 36.2 (2.70) 39.6 (3.41) 31.2 (3.86)
   Other 5.2 (0.19) 8.5 (1.00)* 8.9 (1.63) 7.8 (1.42) 8.9 (2.23)
Primary Language in Household
   English 95.3 (0.21) 98.8 (0.40)* 98.8 (0.65) 99.6 (0.24) 97.3 (1.31)
   Not English 4.7 (0.21) 1.2 (0.40)* 1.2 (0.65) 0.4 (0.24) 2.7 (1.31)
Highest Education in Household
   Less than High School 6.8 (0.24) 4.5 (0.74)* 3.3 (0.91) 7.1 (1.64)† 2.5 (1.17)
   High School/GED 23.1 (0.38) 15.0 (1.44)* 17.9 (2.21) 16.2 (2.61) 5.6 (2.31)†
   Some College 25.3 (0.36) 22.0 (1.51)* 31.4 (2.55) 18.1 (2.26)† 6.0 (1.67)†
   4-year Degree or higher 44.8 (0.42) 58.6 (1.90)* 47.4 (2.76) 58.6 (3.40)† 85.9 (2.93)†
Household Income relative to Federal Poverty Level (FPL)
   0 to less than 100% FPL 19.0 (0.37) 11.5 (1.29)* 14.5 (2.12) 12.9 (2.31) 1.7 (0.82)†
   100 to less than 200% FPL 22.0 (0.38) 19.6 (1.59) 26.6 (2.61) 15.8 (2.35)† 9.7 (3.15)†
   200 to less than 400% FPL 30.1 (0.40) 30.8 (1.92) 34.2 (2.82) 26.4 (3.46) 31.0 (3.81)
   400% FPL and up 28.9 (0.39) 38.2 (1.94)* 24.7 (2.30) 44.9 (3.69)† 57.6 (4.17)†
Any Household Member has Received Cash Assistance from State/County Welfare 6.2 (0.23) 3.2 (0.61)* 3.3 (0.80) 4.3 (1.34) 0.9 (0.51)†
Metropolitan Statistical Area (MSA) Status
   In an MSA 82.7 (0.27) 85.6 (1.17)* 83.2 (1.90) 86.9 (1.79) 88.8 (2.28)
   Not in an MSA 17.3 (0.27) 14.5 (1.17)* 16.8 (1.90) 13.1 (1.79) 11.3 (2.28)

Note: italicized cells contain unreliable estimates (Relative Standard Error >0.3)
Includes biological, adoptive, step or foster parents as well as other adults in the household (adopted CSHCN have no biological parents in the household)
2 Based only on biological, adoptive, step or foster parents irrespective of other adults in the household
* Significantly different at the 0.05 level from the estimate for all CSHCN
† Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
Source: National Survey of Children with Special Health Care Needs, 2005-2006


Figure 4.
Percent of Adopted Children with Special Health Care Needs
in Selected Houshold Income Categories, by Adoption Types

Figure 4. Percent of Adopted Children with Special Health Care Needs in Selected Houshold Income Categories, by Adoption Types

Adoption-Related Characteristics — Table 3 shows characteristics related to adoption for adopted CSHCN and for adopted CSHCN by adoption type.  Age at adoption was comparable for internationally adopted CSHCN and CSHCN adopted from private domestic sources (and about two-thirds of each group were adopted at ages 0-1); but CSHCN adopted from foster care were much less likely to be adopted at 0-1 years of age and more likely to be adopted at older ages (figure 5).  More years had passed since the adoption for CSHCN adopted from private domestic sources, compared with CSHCN adopted from foster care.  That is, on average, their adoptions occurred longer ago.  Those adopted from private domestic sources were more likely to have been adopted in 1988-1996, and less likely to have been adopted in 2000-2006, compared with CSHCN adopted from foster care.  Almost half of adopted CSHCN had only one adoptive parent in the household.  The likelihood of having only one adoptive parent in the household did not differ significantly by adoption type. Although only 5% of adopted CSHCN had parents other than adoptive parents in the household, internationally adopted CSHCN were even less likely to have other parents in the household, compared with CSHCN adopted from foster care.

Table 3:
Percent of Adopted Children with Special Health Care Needs (CSHCN)
with Selected Adoption-specific Characteristics, by Adoption Type

Characteristic Weighted Percent (standard error)
Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
Child’s Age at adoption
   <1 year 30.9 (1.81) 13.7 (1.87) 51.5 (3.58)† 35.8 (4.08)†
   1 year 16.1 (1.57) 10.0 (1.50) 16.4 (3.33) 30.2 (3.89)†
   2-5 years 32.2 (1.76) 44.8 (2.79) 18.2 (2.20)† 26.8 (3.29)†
   6-9 years 13.0 (1.32) 19.4 (2.18) 9.1 (2.10)† 4.6 (2.00)†
   10 years or older 7.8 (1.02) 12.1 (1.83) 4.8 (1.43)† 2.7 (1.01)†
Years since adoption1
   0-2 16.8 (1.55) 21.3 (2.52) 11.9 (2.25)† 15.2 (3.22)
   3-5 22.1 (1.60) 26.7 (2.67) 15.7 (2.19)† 22.8 (3.20)
   6-8 20.8 (1.46) 24.4 (2.37) 17.0 (2.17)† 19.1 (3.06)
   9-11 18.0 (1.43) 15.2 (1.89) 18.5 (2.48) 23.8 (3.71)†
   12 or more 22.3 (1.83) 12.4 (1.55) 36.9 (3.83)† 19.1 (3.35)
Year of Adoption2
   1988-1990 5.5 (0.87) 3.5 (1.04) 7.9 (1.87)† 6.1 (1.70)
   1991-1993 11.4 (1.14) 6.4 (0.97) 18.1 (2.47)† 11.7 (3.04)
   1994-1996 16.9 (1.70) 12.6 (1.69) 25.7 (3.88)† 11.4 (2.17)
   1997-1999 18.7 (1.38) 17.4 (1.92) 16.8 (2.18) 25.4 (3.70)
   2000-2002 21.1 (1.51) 26.6 (2.51) 13.4 (1.78)† 21.7 (3.36)
   2003-2006 26.3 (1.77) 33.5 (2.78) 18.2 (2.65)† 23.6 (3.54)†
Number of Adoptive Parents in Household
   1 45.6 (1.93) 45.2 (2.77) 49.3 (3.55) 39.8 (4.04)
   2 54.4 (1.93) 54.8 (2.77) 50.7 (3.55) 60.2 (4.04)
Presence of Parents3 other than Adoptive Parents in Household 4.7 (0.79) 5.9 (1.43) 4.7 (1.08) 2.1 (0.94)†

Note: italicized cells contain unreliable estimates (Relative Standard Error >0.3)
1 Years since adoption calculated as (age in months at interview) – (age in months at adoption), divided by 12, then rounded to nearest whole integer
2 Year of adoption derived by subtracting the number of months between adoption and interview from the century-month code for date of interview to derive the century-month code for date of adoption; older children adopted in the earliest years would have been older than 17 when CSHCN interviews were conducted in 2005 (and would have screened out of the survey).  This results in an undercount of adoptions, particularly foster care adoptions, that occurred during the late 1980s and early 1990s
3 Step or foster parents or other adults in the household who were reported to act as parents to the child
* Significantly different at the 0.05 level from the estimate for all CSHCN
† Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
Source: National Survey of Children with Special Health Care Needs, 2005-2006


Figure 5.
Percent Distribution of Age at Adoption,
for Adopted Children with Special Health Care Needs, by Adoption Type

Figure 5. Percent Distribution of Age at Adoption, for Adopted Children with Special Health Care Needs, by Adoption Type

Figure 6 shows the number of adoptions of CSHCN per year, relative to the timing of various policy initiatives designed to encourage adoption.  Overall, foster care adoptions of CSHCN have been increasing over time, while the trends for international and private domestic adoptions of CSHCN have remained flatter.  The federal Adoption Tax Credit was established in 1996 and expanded in 2001, allowing adoptive parents to recoup adoption costs on their federal tax returns.  Following the 2001 expansion, parents adopting children with special needs within the U.S. could claim a credit of $10,000 regardless of actual expenses incurred (special needs, for the purposes of the adoption tax credit, includes children with special health care needs, but is broadly defined as noted in footnote 1).  The amount of the tax credit is indexed for inflation and is phased out at higher income levels (U.S. Department of Treasury, 2007; Mickelson and Scott, 2006).  The Adoption and Safe Families Act of 1997 (ASFA, P.L. 105-89) was intended to speed permanency decisions for children in foster care.  Among other reforms, it established timelines within which child welfare agencies were required, under most circumstances, to file for termination of parental rights and seek an adoptive home for the child if reunification with parents was not possible.  ASFA also established the Adoption Incentives Program under which states receive additional funds for increasing the number of children adopted from foster care. The Adoption Incentives Program was reauthorized and expanded in 2002 (U.S. House of Representatives, Committee on Ways and Means, 2004).  The number of CSHCN adopted from foster care increased following both these initiatives and follows a generally upward trend since 1997, with most of the increase occurring in the period between 1997 and 2000.  Readers are reminded that the study sample includes only children with at least one special health care need and trends shown here may not represent the broader population of adopted children.

Figure 6.
Number of Adopted Children with Special Health Care Needs
for Selected Years of Adoption, by Adoption Type

Figure 6. Number of Adopted Children with Special Health Care Needs for Selected Years of Adoption, by Adoption Type

 

Special Health Care Needs, Health Conditions, and Functional Status — Table 4 shows type and number of CSHCN Screener criteria, type of health conditions, and functional status for all CSHCN, for adopted CSHCN, and for adopted CSHCN by adoption type.  Compared with all CSHCN, adopted CSHCN were more likely to be identified as CHSCN on the basis of elevated need for services, physical/occupational/speech therapy, behavioral/developmental/emotional problems requiring treatment or counseling, or limitation in activity (figure 7).  CSHCN adopted from foster care were more likely than other adopted CSHCN to be identified due to behavioral/ developmental/emotional problems, more likely than internationally adopted CSHCN to have been identified as having limitations in activity, and more likely than CSHCN adopted privately within the U.S. to have elevated service use and need for specialized therapies. Compared with all CSHCN, adopted CSHCN were less likely to meet only 1 CSHCN screening criterion, and more likely to meet 3, 4, or 5 screening criteria (figure 8).  CSHCN adopted from foster care had more special health care needs, on average, than other adopted CSHCN.  All of the types of health conditions that showed significant differences between adopted CSHCN and all CSHCN followed the same pattern:  physical health conditions (asthma, allergies, migraines) were less prevalent among adopted CSHCN, and mental health conditions (ADD/ADHD, autism, mental retardation, and emotional problems) were more prevalent among adopted CSHCN (figure 9).

Table 4:
Percent of Children with Special Health Care Needs (CSHCN)
with Selected Types and Numbers of Special Health Care Needs (SHCN), Health Conditions, or Functional Status Characteristics,
by Adoptive Status and Adoption Type

Type or Number of SHCN or Health Condition or Functional Status Weighted Percent (standard error)
All CSHCN Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
CSHCN Screener Item
   Prescription Medications 78.4 (0.36) 76.6 (1.59) 75.7 (2.39) 80.1 (2.58) 72.3 (3.67)
   Elevated Service Use 38.8 (0.41) 52.3 (1.94)* 56.7 (2.72) 47.3 (3.55)† 50.7 (4.11)
   Physical/Occupational/Speech Therapy 17.7 (0.32) 24.5 (1.60)* 26.4 (2.45) 18.4 (2.33)† 31.2 (3.79)
   Treatment for Behavioral/ Developmental/Emotional Problem 28.6 (0.38) 49.5 (1.95)* 56.5 (2.74) 45.6 (3.57)† 39.7 (3.97)†
   Limitation in Activity 21.5 (0.35) 28.2 (1.81)* 32.5 (2.64) 25.5 (3.30) 22.8 (3.51)†
Number of SHCN
   Any 1 55.0 (0.42) 38.8 (1.90)* 34.4 (2.63) 42.0 (3.54) 43.4 (4.06)
   Any 2 20.6 (0.35) 22.2 (1.60) 20.2 (2.23) 25.4 (2.98) 21.0 (3.41)
   Any 3 12.8 (0.28) 16.6 (1.31)* 19.2 (2.05) 13.0 (1.90)† 16.8 (3.12)
   Any 4 7.7 (0.23) 14.3 (1.52)* 15.5 (2.02) 13.4 (3.05) 12.9 (3.02)
   All 5 3.9 (0.15) 8.2 (1.05)* 10.6 (1.89) 6.3 (1.36) 5.9 (1.50)
   Average # SHCN (1-5) 1.85 (0.01) 2.31 (0.05)* 2.48 (0.08) 2.17 (0.09)† 2.17 (0.10)†
Type of Health Condition
   Asthma 38.8 (0.42) 28.8 (1.76)* 30.0 (2.68) 30.3 (3.01) 22.8 (3.66)
   ADD/ADHD 29.8 (0.39) 53.8 (1.97)* 60.1 (2.73) 54.0 (3.60) 38.2 (4.05)†
   Autism 5.4 (0.19) 8.0 (1.36)* 7.5 (1.56) 11.1 (3.19) 3.9 (1.34)
   Mental Retardation 11.4 (0.28) 21.6 (1.53)* 28.3 (2.50) 14.6 (2.13)† 18.1 (3.02)†
   Emotional Problems 21.1 (0.35) 34.6 (1.90)* 40.3 (2.71) 34.4 (3.65) 20.8 (2.91)†
   Seizure Disorder 3.5 (0.14) 4.2 (0.71) 6.0 (1.33) 2.0 (0.55)† 3.6 (1.49)
   Migraine/Frequent Headaches 15.1 (0.31) 10.2 (1.09)* 8.8 (1.28) 13.3 (2.21) 8.0 (2.66)
   Joint Problems 4.3 (0.18) 3.4 (0.61) 3.6 (0.93) 3.7 (1.07) 2.3 (1.17)
   Allergies 53.0 (0.42) 41.5 (1.90)* 42.0 (2.78) 43.0 (3.41) 37.6 (3.86)
   Other condition(s)1 10.0 (0.26) 9.3 (1.12) 11.5 (1.88) 5.8 (1.19)† 10.4 (2.87)
   Average # of Conditions (0-16) 1.92 (0.01) 2.14 (0.06)* 2.37 (0.09) 2.11 (0.09)† 1.65 (0.09)†
Functional Status
   Bodily Function Difficulties 57.4 (0.42) 46.7 (1.94)* 49.3 (2.77) 44.7 (3.44) 43.9 (4.16)
   Activity/Participation Difficulties 49.3 (0.42) 72.6 (1.68)* 76.8 (2.38) 71.9 (2.83) 63.7 (4.08)†
   Emotional/Behavioral Difficulties 41.9 (0.43) 58.2 (1.93)* 68.1 (2.57) 56.4 (3.54)† 37.4 (3.76)†

Note: italicized cells contain unreliable estimates (Relative Standard Error >0.3)
* Significantly different at the 0.05 level from the estimate for all CSHCN
† Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
1 Other conditions include Down syndrome, diabetes, heart problems, blood problems, cystic fibrosis, cerebral palsy and muscular dystrophy
Source: National Survey of Children with Special Health Care Needs, 2005-2006


Figure 7.
Percent of Children with Special Health Care Needs (CSHCN)
Qualifying on each CSHCN Screener Criterion, by Adoptive Status

Figure 7. Percent of Children with Special Health Care Needs (CSHCN) Qualifying on each CSHCN Screener Criterion, by Adoptive Status

Figure 8.
Percent Distribution of Number of Special Health Care Needs
Screener Qualifying Criteria, by Adoptive Status

Figure 8. Percent Distribution of Number of Special Health Care Needs Screener Qualifying Criteria, by Adoptive Status

Figure 9.
Percent of Children with Special Health Care Needs
with Selected Health Conditions, by Adoptive Status

Figure 9. Percent of Children with Special Health Care Needs with Selected Health Conditions, by Adoptive StatusCSHCN adopted from foster care had more health conditions, on average, than other adopted CSHCN.  Adopted CSHCN were less likely to have bodily function difficulties and more likely to have activity/participation and emotional/behavioral difficulties, compared with all CSHCN (figure 10).  CSHCN adopted from foster care were more likely than other adopted CSHCN to have emotional/behavioral difficulties and more likely than CSHCN adopted internationally to have activity/participation difficulties.

Figure 10.
Percent of Children with Special Health Care Needs with Selected Functional Status Difficulties, by Adoptive Status

Figure 10. Percent of Children with Special Health Care Needs with Selected Functional Status Difficulties, by Adoptive Status

Health Status, Insurance, Access to Care and Impact on the Family — Table 5 shows indicators of health status, insurance coverage, access to health care, and the impact of the child’s condition(s) on the family for all CSHCN, for adopted CSHCN, and for adopted CSHCN by adoption type.  Adopted CSHCN were more likely to have conditions that greatly or consistently affected their activities, but less likely to miss more than 10 days of school due to illness, compared with all CSHCN.  CSHCN adopted from foster care were more likely to miss more than 10 school days than other adopted CSHCN.  Adopted CSHCN were less likely to experience gaps in insurance coverage the previous year and less likely to have inadequate insurance, compared with all CSHCN.  CSHCN adopted internationally were more likely to have problems getting a referral to see a specialty doctor than CSHCN adopted from foster care.  Having a usual source of care did not differ by adoptive status or adoption type, but adopted CSHCN were less likely to lack a personal doctor or nurse.  Receipt of family-centered care did not vary significantly by adoptive status or adoption type, except that adopted CSHCN were less likely to have problems with doctors not spending enough time or listening carefully, relative to all CSHCN.  Although families of adopted CSHCN were more likely to pay more than $1,000 out of pocket for medical care, compared with all CSHCN, they were not more likely to have financial problems due to the child’s health.  Similarly, although families of adopted CSHCN were more likely to cut back on work in order to provide care for the child, they were not more likely to spend 11 or more hours per week providing, arranging or coordinating health care for the child.

Table 5:
Percent of Children with Special Health Care Needs (CSHCN) 
with Selected Health Status, Insurance, Access to Care or Impact on the Family Characteristics, by Adoptive Status and Adoption Type

Health Status, Insurance, Access to Care or Impact on the Family Indicator Weighted Percent (standard error)
All CSHCN Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
CSHCN whose health conditions affect daily activities consistently/a great deal 24.0 (0.37) 30.9 (1.69)* 35.3 (2.58) 26.3 (2.71)† 28.2 (3.65)
CSHCN who missed >10 school days due to illness 14.3 (0.33) 9.7 (1.08)* 13.2 (1.93) 8.2 (1.46)† 3.4 (1.17)†
CSHCN ever uninsured during past year 8.8 (0.24) 4.8 (0.70)* 3.7 (0.92) 6.2 (1.35) 5.1 (1.60)
CSHCN currently uninsured 3.5 (0.15) 1.7 (0.39)* 0.7 (0.45) 3.4 (0.92)† 0.7 (0.43)
Insured CSHCN with inadequate insurance 33.1 (0.41) 29.2 (1.88)* 26.0 (2.46) 31.9 (3.62) 32.4 (4.19)
   Benefits don’t meet child’s needs 12.7 (0.30) 13.4 (1.61) 11.4 (1.97) 18.0 (3.56) 9.8 (2.20)
   Non-covered costs aren’t reasonable 30.4 (0.42) 26.1 (1.90)* 22.5 (2.49) 29.0 (3.67) 28.5 (3.95)
   Plan doesn’t allow needed providers     9.3 (0.27) 10.3 (1.48) 9.5 (1.62) 12.0 (3.34) 9.0 (2.84)
CSHCN who had difficulty getting a referral 21.1 (0.64) 19.8 (3.10) 13.4 (2.40) 24.9 (7.39) 25.9 (5.74)†
CSHCN without a usual source of care 5.7 (0.21) 4.3 (0.74) 4.4 (1.15) 4.4 (1.21) 4.0 (1.49)
CSHCN without a personal doctor/nurse 6.5 (0.22) 4.0 (0.65)* 4.5 (1.10) 3.9 (1.02) 2.8 (0.97)
CSHCN without family-centered care1 34.5 (0.42) 31.5 (1.90) 31.2 (2.52) 32.9 (3.62) 29.5 (4.20)
   Doctors don’t spend enough time 21.3 (0.37) 18.0 (1.53)* 17.2 (2.05) 19.1 (2.71) 18.0 (3.88)
   Drs. don’t listen carefully 11.2 (0.28) 8.9 (1.06)* 9.4  (1.64) 8.7 (1.88) 8.0 (1.88)
   Drs. aren’t sensitive to customs/values 11.1 (0.28) 9.3 (1.07) 9.6 (1.45) 10.2 (2.19) 7.0 (1.71)
   Drs. don’t provide enough information 16.9 (0.32) 17.3 (1.65) 17.1 (2.09) 20.2 (3.45) 12.7 (2.81)
   Respondent doesn’t feel like partner 12.4 (0.29) 11.3 (1.27) 11.9 (1.86) 11.3 (2.33) 9.9 (2.52)
CSHCN whose families pay >$1000 out of pocket for health care 20.0 (0.32) 26.1 (1.87)* 17.1 (2.12) 32.9 (3.84)† 35.7 (3.80)†
CSHCN whose families had financial problems due to child’s health 18.1 (0.32) 17.1 (1.57) 15.9 (2.06) 17.8 (3.08) 18.5 (3.30)
CSHCN whose families spend 11+ hours per week providing/ coordinating care 9.7 (0.26) 9.1 (1.06) 12.2 (1.82) 7.7 (1.63) 4.3 (1.43)†
CSHCN whose family members had to cut back or stop work to care for child 23.8 (0.36) 27.5 (1.71)* 33.3 (2.65) 21.2 (2.57)† 25.2 (3.80)

Note:  italicized cells contain unreliable estimates (Relative Standard Error >0.3)
1 Only 8 adopted children were eligible for the 6th component, whether the family gets an interpreter if needed
* Significantly different at the 0.05 level from the estimate for all CSHCN
 Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
Source:  National Survey of Children with Special Health Care Needs, 2005-2006


Health Care Services, Family Support Services, and Special Services — Table 6 shows need for and receipt of health care services, family support services, and special services for all CSHCN, for adopted CSHCN, and for adopted CSHCN by adoption type.  All the specific health care services that showed a significant difference, except durable medical equipment, indicated a greater need for the service among adopted CSHCN, relative to all CSHCN (figure 11).  Few health care services showed a significant difference by adoption type.  Unmet need for health care services did not significantly differ by adoptive status or adoption type.  The families of adopted CSHCN were more likely to need respite care and family mental health care, and were twice as likely to have any unmet need for family support services, relative to all CSHCN.  CSHCN adopted from foster care were more likely than other adopted CSHCN to have need and unmet need for family support services, although differences between CSHCN adopted from foster care and CSHCN adopted from private domestic sources were largely not significant (figure 12).  Adopted CSHCN were more likely to receive Early Intervention and Special Education services, relative to all CSHCN.

Table 6:
Percent of Children with Special Health Care Needs (CSHCN) with Need for and Receipt of Health Care Services, Family Support Services, and Special Services, by Adoptive Status and Adoption Type
  Weighted Percent (standard error)
All CSHCN Adopted CSHCN Adopted CSHCN by Adoption Type
Foster Care Private Domestic International
CSHCN with need for Health Care Services
   Routine preventive care 77.9 (0.35) 82.7 (1.45)* 79.8 (2.35) 81.7 (2.48) 91.6 (1.82)†
   Specialty care 51.8 (0.42) 56.4 (1.91)* 52.2 (2.76) 58.7 (3.38) 62.6 (4.07)†
   Preventive dental care 81.1 (0.34) 87.3 (1.23)* 88.6 (1.70) 83.4 (2.48) 91.2 (2.09)
   Other dental care 24.2 (0.36) 27.9 (1.76)* 24.2 (2.35) 29.1 (3.35) 34.7 (3.89)†
   Prescription medication 86.4 (0.30) 88.6 (1.07)* 87.3 (1.58) 91.0 (1.92) 87.2 (2.22)
   Physical/occupational/speech therapy 22.8 (0.36) 33.8 (1.86)* 36.3 (2.69) 26.7 (3.30)† 40.7 (4.05)
   Mental health care 25.0 (0.37) 46.4 (1.95)* 52.8 (2.75) 46.0 (3.60) 31.5 (3.54)†
   Substance abuse treatment 2.8 (0.19) 3.6 (0.66) 3.1 (0.76) 4.2 (1.37) 3.5 (1.44)
   Home health care 4.5 (0.19) 4.8 (0.80) 6.9 (1.49) 2.2 (0.78)† 4.2 (1.49)
   Eyeglasses/vision care 33.3 (0.39) 40.5 (1.91)* 44.0 (2.74) 37.3 (3.49) 37.9 (3.96)
   Hearing aids/hearing care 4.7 (0.19) 5.4 (0.77) 5.0 (1.21) 4.6 (1.09) 7.6 (1.90)
   Mobility aids 4.4 (0.18) 4.3 (0.80) 3.7 (1.00) 2.7 (0.75) 8.9 (3.11)
   Communication aids 2.2 (0.13) 3.0 (0.66) 3.9 (1.19) 2.3 (0.79) 1.9 (1.18)
   Medical supplies 18.6 (0.32) 16.3 (1.37) 18.0 (2.22) 14.3 (1.89) 15.9 (3.23)
   Durable medical equipment 11.4 (0.27) 9.0 (1.14)* 8.8 (1.69) 8.2 (1.68) 10.8 (3.04)
CSHCN with 1 or more unmet need for specific health care services 16.1 (0.32) 15.9 (1.52) 16.5 (1.94) 16.7 (3.23) 12.8 (2.43)
CSHCN whose families have need for Family Support Services
   Respite Care 4.5 (0.19) 11.1 (1.20)* 16.6 (2.07) 7.6 (1.84)† 4.4 (1.45)†
   Genetic Counseling 5.7 (0.21) 7.8 (1.13) 10.9 (2.02) 6.0 (1.57) 3.8 (1.31)†
   Family Mental Health Care 12.3 (0.28) 24.8 (1.68)* 30.1 (2.61) 22.5 (2.89) 15.8 (2.67)†
CSHCN with 1 or more unmet need for family support services 4.9 (0.19) 10.0 (1.15)* 12.9 (1.88) 8.5 (1.97) 5.6 (1.38)†
CSHCN who receive Special Education services (children ages 3+) 28.5 (0.40) 42.8 (1.94)* 46.7 (2.78) 38.7 (3.46) 40.5 (4.17)
CSHCN who receive Early Intervention services (children under age 3) 22.6 (1.37) 49.8 (9.01)* 60.2 (18.7) 49.7 (13.5) 42.3 (15.6)

Note: italicized cells contain unreliable estimates (Relative Standard Error >0.3)
* Significantly different at the 0.05 level from the estimate for all CSHCN
† Significantly different at the 0.05 level from the estimate for CSHCN adopted from Foster Care
Source: National Survey of Children with Special Health Care Needs, 2005-2006


Figure 11.
Percent of Children with Special Health Care Needs
with Selected Health Care Service Needs, by Adoptive Status

Figure 11. Percent of Children with Special Health Care Needs with Selected Health Care Service Needs, by Adoptive StatusFigure 12.
Percent of Adopted Children with Special Health Care Needs
with Selected Family Support Service Needs, by Adoption Type

Figure 12. Percent of Adopted Children with Special Health Care Needs with Selected Family Support Service Needs, by Adoption Type

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