Children and Caregivers in Kinship Care Experience High Rates of Mental Health Problems

Jim Kling

October 13, 2010

October 13, 2010 (San Francisco, California) — Children and caregivers in kinship care (KC) — in which a child lives with a relative other than a birth parent — have high rates of mental health problems, according to research presented here at the American Academy of Pediatrics 2010 National Conference and Exhibition.

Unlike children in foster care, children in KC typically receive little or no oversight from welfare agencies. Foster care children experience increased health risks, but little is known about the prevalence of health risks or the health status of children in KC, noted Sara Beth Eleoff, MD, a pediatrician at the University of Rochester School of Medicine and Dentistry, in New York, during her presentation of the study's findings.

"Studies to date have been mostly descriptive and suggest that this population is larger and more fluid than the population in foster care, and there is some evidence for high numbers of medical problems," she explained.

The researchers used the 2007 National Survey of Children's Health, which is a nationally representative cross-sectional survey that includes more than 91,000 US children aged 0 to 17 years. The team identified children living in KC using family structure variables and then compared them with children living at home with at least 1 birth parent. Dependent measures included prevalence of KC, children with special healthcare needs (using the validated Children with Special Healthcare Needs screener), health status, and caregiver characteristics. Analysis was conducted using bivariate analyses for associations and multivariate logistic regression to adjust for child demographics.

Dr. Eleoff and colleagues identified 2.8 million children (3.8%) in KC across the United States. Differences between children in KC and children living with 1 parent included: greater likelihood that children in KC were black (48% vs 17%), KC children were more likely to be older than 9 years (59% vs 48%), KC children were more likely to live at or below 100% of the poverty level (31% vs 18%), and KC children were more likely to have public health insurance (72% vs 30%; all P values < .001).

Compared with children living with at least 1 birth parent, children in KC were found to have a higher rate of special healthcare needs (29% vs 18%; odds ratio, 1.9; P < .0001) and mental health problems (anxiety, depression, attention-deficit/hyperactivity disorder, or conduct disorder; 23% vs 10%; odds ratio, 2.5; P < .0001). Among caregivers, those involved in KC had greater odds of fair or poor mental health than parents (12% vs 2%; odds ratio, 3.8; P < .0001), as well as fair or poor overall health (26% vs 3%; odds ratio, 6.1; P < .0001).

"Children in [KC] are likely to benefit from increased tracking and additional resources. We need to do much additional research to understand this vulnerable population," said Dr. Eleoff.

"This is really a first step. It shows who [children in KC] are, and evidence that they really have problems. They are poorer, they are sicker, and they get fewer resources. The big question is, What are we going to do to provide the services these families need?" observed Linda Sagor, MD, MPH, division director of general pediatrics and director of the Foster Children Evaluation Services Clinic at the University of Massachusetts Medical School in Worcester. Dr. Sagor moderated the session at which Dr. Eleoff presented her findings.

Dr. Eleoff and Dr. Sagor have disclosed no relevant financial relationships.

American Academy of Pediatrics 2010 National Conference and Exhibition: Abstract 9042. Presented October 4, 2010.

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