Addressing the Health Needs of Young Adult Mothers with a History of Child Welfare Involvement

Statement of Problem

Half of youth with experience in foster care have a pregnancy by age 19, and many have multiple pregnancies by this same age. While adolescent childbearing itself is associated with numerous adverse outcomes for mothers and children, these problems may be particularly acute for young mothers with a history of child welfare involvement. These risks may also be exacerbated among maltreated youth, who are more likely to have social and health related adversities. In comparison to children without child welfare involvement, those in the child welfare system have increased rates of chronic physical as well as mental and behavioral health needs. While the burden of health challenges for youth with child welfare involvement has been well documented, the health status of these youth upon entry into pregnancy and parenthood is understudied. Given the high prevalence of chronic health needs among youth exposed to the child welfare system, it is likely that health risk factors persist during the reproductive period. 

In order to understand the risks for poor outcomes among young mothers with a history of child welfare involvement, PolicyLab conducted a retrospective cohort study of 16,000 mother-infant pairs in a large Mid-Atlantic city using linked administrative data files (vital statistics, medical assistance claims and child welfare records). Findings include:

  • Nearly half (43%) of Medicaid-financed births to mothers aged 15-24 in the Mid-Atlantic city occurred among women who were known to the child welfare system. 
  • Mothers experienced high prevalence of mental and behavioral conditions in the period surrounding the birth of a child. Substance use, depression and bipolar disorder were the most frequently diagnosed conditions. 
  • Medication treatment continuity for mental illness in the postpartum period was very low. For example, less than 50% of mothers receiving antipsychotic medications for diagnosed psychoses prior to pregnancy filled a prescription for antipsychotic medications in the postpartum year, leaving them at risk for poor health and maladaptive parenting.
  • Among physical health conditions, asthma, hypertension and anemia were common. In addition, HIV rates reached more than 2% among mothers with a history of child welfare involvement, and more than 3% among the subset of mothers with the highest intensity of past child welfare involvement (dependent placement and/or juvenile justice involvement).

Our data suggest that young adult women with prior child welfare involvement are in need of health care services as they transition into motherhood. These data also suggest that many mothers are experiencing chronic conditions, which require prolonged self-management, and these mothers may be vulnerable to poor self-care during the postpartum period.

Understanding the risks for poor outcomes among young mothers, particularly those most vulnerable to poor health, is fundamental for improving the services provided to this population. Additional PolicyLab research focusing on this population will determine the effect of discontinuing mental health treatment on maladaptive parenting outcomes, specifically child maltreatment and emergency department reliance. This work will also seek to identify opportunities for improved service delivery for this population of mothers in order to improve maternal well-being and parenting outcomes.