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 system-involved youth has been well documented, the health status of these young people as they become pregnant and enter 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 before, during and after pregnancy.

Description

In order to understand the risks for poor outcomes among young mothers with a history of child welfare involvement, PolicyLab—supported by the Stoneleigh Foundation—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). Our findings, published in 2016, included:

  • 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 two percent among mothers with a history of child welfare involvement, and more than three percent 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 young mothers are experiencing substance use disorders, chronic conditions, which require prolonged self-management, and these mothers may be vulnerable to poor self-care during the postpartum period.

Next Steps

We are interested in learning more about our finding highlighting the prevalence of substance abuse disorders among low-income young mothers. Through a Leonard Davis Institute of Health Economics small grant, we plan to investigate if young mothers with a history of child welfare involvement and other vulnerable populations of young women are at higher risk for becoming persistent opioid users after they receive a prescription for opioids at childbirth. We expect to complete this phase of the research in 2020.

With this body of research, we hope we can contribute to an increased understanding of the risks for poor outcomes among young mothers, particularly those most vulnerable to poor health. Ultimately, with our research, we seek to improve policies and programs at the hospital, local, state and federal levels to ensure these youth have access to high-quality care, aren’t unjustly impacted by social determinants of health and have successful interactions with the health care system.  

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Addressing the Health Needs of Young Adult Mothers with a History of Child Welfare Involvement [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

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