O3220: The Effect of Initial Disability on Permanency Outcomes of Children in Foster Care

Background: Children with disabilities in foster care (FC) are an exceptionally vulnerable group. In addition to significant physical, mental, and/or developmental health challenges, they also face risk factors related to maltreatment and removal from their homes and greater need for healthcare services. The few studies that have explored disability and FC status have shown that having a disability is a barrier to permanency and associated with other poor outcomes. These studies, however, have been limited by single-state or small samples, exclusive focus on older youth, and/or cross-sectional data.

Methods: To address this gap, this study merged data from the federal Adoption and Foster Care Reporting System (AFCARS) from fiscal year (FY) 2005 to 2019 to provide longitudinal data on children with disabilities, and by disability type, in foster care and comparison data for children without disabilities in FC. The state ID and record number were used to find 3.24 million unique participants aged 0 to 16 when they first entered FC and link records among different FY data. The participants who first entered FC were selected based on their first removal date and excluded if seen in previous FY data (Table 1). They were divided into disability groups pre-defined by the AFCARS Code Book. Participants' longitudinal outcomes were collected from the time when they first entered FC to FY 2021. Any participants, if they stayed in FC, had at least 2-year follow-up time since they first entered FC. The study estimated the relative risk of different discharge types from FC for participants with various disabilities, using participants without disability as the reference (Figure 1).

Results: Findings show that children in FC with disabilities are associated with greater risk for negative outcomes and that risk profiles vary by disability type. Participants with disabilities, except those with other medical conditions, were less likely to get permanence discharge (RR < 1, p< 0.0001). Participants with mental retardation, visual/hearing impairment, or emotional disturbance were more likely to get a non-permanence discharge (RR=1.79, 1.72, 3.01 respectively, p< 0.0001). Participants with physical disability had a surprisingly high risk of death in the follow-up period (RR=9.07, p< 0.0001) as compared to participants without disability. Participants with mental retardation or other medical conditions also had a significantly high risk of death (RR=3.12, 3.31, respectively, p< 0.0001).

Conclusion: This study showed that children in FC with different disabilities had different risk characteristics for non-permanence discharge or death. Given that children in FC have higher rates of disability than children not in care, specialized effort is needed from the child welfare and healthcare systems to recognize and address the health-related needs of this population and to support their caregivers.