Understanding “Service Cliffs” Following Reunification from Foster Care for Children and Mothers

• In Event: Economic Policy and Child Welfare Trajectories: From System Involvement to Reunification

Abstract

Background: When children enter foster care, CWS agencies are responsible for providing services that enable safe reunification. Yet, once reunification is achieved, many families continue to face challenges, and children return to care at high rates. In many states, court jurisdiction is dissolved and cases are closed quickly following reunification. Consequently, ongoing stability services become voluntary and may lack active CWS support. This disengagement from services may play an important role in poor reunification outcomes, though little is known about service trajectories of parents and children pre- and post-reunification.  Behavioral health concerns of the child or parent are a primary reason for foster care entry in Pennsylvania, the site of this study. For most of these services, Medicaid – not CWS directly –is the payor of first resort. Thus, this study examines how Medicaid-covered behavioral health services utilization changes pre- and post-reunification, both for children and their biological mothers.

Methods: Leveraging linked CWS and Medicaid data from Pennsylvania, we identified a sample of both children and their biological mothers who experienced reunification between 2015 and 2018 from foster care. Spells were limited to at least 6 months. In the 6 months prior to the month of reunification and 12 months following (a 19-month window), mothers and children were identified as having engaged in any mental and behavioral health treatment using their Medicaid records. Among children 10 and younger, developmental services engagement was also identified. Both children and mothers were kept in the sample if they were enrolled in Medicaid in the 6 months prior to reunification and in each of the two subsequent 6-month periods following reunification. This yielded samples of 3,606 children and 2,094 biological mothers. Average rates of service utilization were calculated for each of the 19 months. 

Results: Among mothers, treatment utilization remained stable at approximately 70% in the six months prior to reunification but declined linearly to 50% by 12 months post-reunification. For children, mental/behavioral health service utilization rose from 40% to 50% just prior to reunification, then dropped linearly to under 30% at the 12-month post-reunification. This decline was even more precipitous for children who initially entered care for behavioral health reasons. Similarly, developmental services utilization began to drop two months prior to reunification, falling from 14% to just 5% by the end of the observation period.

Conclusions and Implications: For both mothers and children, treatment utilization drops immediately following reunification and continues to decline for the following year. These results identify treatment discontinuation as a potential driver of system reentry and long-term poor mental health outcomes for children with foster care experience.

Author

• Dylan Jones, University of Wisconsin System
  Presenting Author