Child welfare caregivers: An evaluation of access to pediatric health care

This study's purpose was to identify differences in pediatric health care barriers and utilization among children in child welfare by caregiver type (birth parents, kin, and unrelated foster). Surveys were administered to 237 caregivers in the waiting room of an outpatient pediatric clinic in Los Angeles, California. Least-square means of access-to-care barriers derived from general linear models were compared across three types of caregivers. Multiple logistic regression models were employed to compare odds of good health status, availability of regular physician, and up-to-date vaccination across caregiver types. In the multivariate analysis, birth parents with children in child welfare were more likely to rate transportation as an access barrier (p = 0.05) and unrelated caregivers were less likely to rate clinic hours inconvenient (p = 0.03) than other caregivers. Children with unrelated foster caregivers were less up-to-date on their vaccinations. All caregivers rated "difficulty understanding doctor's explanation", "wait too long to see a doctor", and "clinic hours inconvenient" as the most difficult access barriers. Children who remain at home with their birth parents and receive child welfare services have similar pediatric health access barriers as children in foster care and should be included in policy initiatives about improving health care for children in child welfare.