Black Youth, Females with Autism Have Greater Odds of Being Placed in Foster Care

Melissa L. Villodas, PhD

Credit: George Mason University

Among children with intellectual and developmental disabilities, Black youth and females faced a greater risk of being put in the foster care system—and the risk increased with age—according to a new study.¹

“A strength of this work is in the important consideration of intersecting identities of race, ethnicity, gender, age, and disability,” said investigator Melissa L. Villodas, PhD, from George Mason University in the press release.² “The more we know about the unique challenges that are compounded by marginalization, the more responsive we can be in our efforts toward equitable policies and practices.”

Children in foster care often have special health care needs due to serious medical, mental health, and developmental issues linked to childhood trauma.¹ For instance, they may have anything from acute illness including infections and injuries caused by abuse and neglect to chronic health conditions including asthma and anemia. Foster-care children may also have developmental and intellectual disability diagnoses.

Previous research found the number of youths with an intellectual and developmental disability—including autism—is growing in the US foster care system. For children enrolled in Medicaid from 2001 – 2007, youth with autism spectrum disorder (ASD) had a 2.4 times greater entry rate in the foster care system than youth with typical development. Moreover, the number of children aged 8 years diagnosed with autism has risen from 1 in 125 children in 2004 to 1 in 36 children in 2020.

Investigators, led by Lindsay Shea, DrPH, from the Policy and Analytics Center at A.J. Drexel Autism Institute in Philadelphia, conducted a cross-sectional study of youth (≤ 21 years old) with intellectual and developmental disabilities in foster care to assess the rates of children based on race, ethnicity, age, and sex.

“This research centers around the experiences of an extremely vulnerable, and often invisible foster care youth,” said Amy Blank Wilson, PhD, from the University of North Carolina at Chapel Hill. ² “The first step to supporting these youth is ensuring that their experiences are visible.”

As youth included in the study had Medicaid through foster care in 2016, Shea and colleagues obtained Medicaid data from the Transformed Medicaid Statistical Information System Analytic Files from all 50 US states and Washington, DC.¹ In 2016, the foster care system had 39,143 youth with an intellectual or developmental disability. The sample included 27.9% of Black youth having ASD, 32% with ASD and an intellectual disability, and 39% with only an intellectual disability.

The team characterized into subgroups: autism spectrum disorder (ASD) only (4.3%), intellectual disability only (4.6%), or both ASD and intellectual disability (5.1%). Investigators analyzed the data from July 2022 – September 2023.

Investigators found Black youth (adjusted odds ratio [aOR], 1.37; 95% CI, 1.28– 1.47) and females (aOR, 1.18; 95% CI, 1.1 – 1.27) had an increased likelihood of being placed in foster care. Females in the ASD-only group had the greatest odds of being placed in foster care (aOR, 1.35; 95% CI, 1.39 – 1.4).

Additionally, the likelihood of being placed in foster care increased with age. Bivariate analyses showed, compared to the age group of 0 – 5 years, youth aged 13 – 17 years were more than twice as likely to have foster care involvement in all groups. Being in the foster care system reduced slightly after age 17 years in the 18 – 21 age group.

Limitations the team highlighted included not observing care received outside of the Medicaid system and small sample sizes could have disproportionately affected not examining other racial groups who could be a heightened risk for being placed in the foster care system, such as American Indian, Asiana, Pacific Islander, or Native American.

“Among all youth with [an intellectual or developmental disability], the continued lack of representation in research underscores a parallel lack of information for the foster care system,” investigators wrote. “Increased inclusion of Black, female, and older youth at a heightened risk for foster care involvement based on [an intellectual or developmental disability] diagnoses can enhance research exploring structural vulnerabilities that disproportionately place these youth in care … [It] would generate a more thorough picture of supports that facilitate prevention for placement among those most at risk for foster care involvement.”

^References

1. ^{Shea L, Villodas ML, Ventimiglia J, Wilson AB, Cooper D. Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities. JAMA Pediatr. Published online February 12, 2024. doi:10.1001/jamapediatrics.2023.6580}
2. ^{Number of At-Risk Youth with Intellectual Disability and Autism in the US Foster Care System is Growing. News Wise. February 12, 2024. https://www.newswise.com/articles/number-of-at-risk-youth-with-intellectual-disability-and-autism-in-the-u-s-foster-care-system-is-growing. Accessed February 20, 2024.}