Homelessness and health care access after emancipation: results from the Midwest Evaluation of Adult Functioning of Former Foster Youth.

OBJECTIVE

To estimate the association between housing status and health care access and outcomes among young adults aging out of the child welfare system.

DESIGN

Prospective cohort study

SETTING

Illinois, Iowa, and Wisconsin. Baseline interviews were conducted between May 2002 and March 2003 and follow-up interviews, between March and December 2004.

PARTICIPANTS

Participants were foster youth aged 17 or 18 years in Illinois, Wisconsin, or Iowa. We invited a random sample of 67% of eligible Illinois youth and all eligible youth from Wisconsin and Iowa to participate. Researchers interviewed 749 at baseline (94.7% response) and 643 at follow-up (85.8%); we excluded 8 participants without housing data (n=635). We included only the 345 emancipated participants in analyses of health care access. MAIN EXPOSURE Housing status after emancipation: stable housing; unstable housing; or homeless.

MAIN OUTCOME MEASURES: Multivariate adjusted odds ratio (AOR) of association between main exposure variables with 3 measures of access to care and 2 health outcomes.

RESULTS

Among the 345 emancipated participants, 14.2% experienced homelessness and 39.4% were unstably housed. In multivariate analysis of emancipated participants, homelessness was associated with being uninsured (AOR, 3.41; 95% confidence interval, 1.52-7.63) and having unmet need for health care (AOR, 3.26; 95% confidence interval, 1.40-7.56); it was not associated with not having had ambulatory care. In multivariate analysis of all participants, housing status was not associated with reporting fair or poor health at follow-up or, among women, with having had a pregnancy.

CONCLUSION

Having had an episode of homelessness after emancipation is associated with worse health access, but not worse outcomes, among youth emancipated from foster care.