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

Primary caregivers (n=237) of children in the child welfare system were administered a modified Pediatric Access Survey (PAS) to identify barriers to accessing pediatric care. The participants interviewed were 28% birth parents (mean age: 33.7 years) in family maintenance, 25% related caregivers (mean age: 45.2 years) in foster care, and 46% unrelated caregivers (mean age: 46.6 years) in foster care. The results indicate that the access barriers most often identified was 1) difficulty understanding physicians and, in order of frequency, 2) wait too long to see a doctor, 3) clinic hours inconvenient and 4) too difficult to make an appointment. Birth parents were more likely to rate transportation as an access barrier (p=.00) and less likely to have used pediatric services (p=.05) than related or unrelated foster caregivers. Caregivers may have an unrealistic view of their child's health status since almost 87% rate their child's health as excellent or good when research has shown that these children have serious chronic health problems. These findings suggest that access barriers are not only a problem for foster parents, but important for birth parents of children in family maintenance, since birth parents identified similar access barriers but reported less usage of health services than foster parents. A majority of the participants (54%) felt that child welfare system fulfilled their responsibility in helping caregivers get the pediatric medical care needed although they felt caseworkers could assist more fully in transitions to new home placements (including securing Medicaid cards) and better referrals for specialty care.