50 Healthcare related needs for youth in care: A mixed methods study

Abstract Background Youth living in out-of-home care have various physical, mental and developmental needs. [Society] provides residential facilities for youth aged 12-18 years who are under the temporary or permanent care of the [Government] or [Indigenous equivalent]. Development of a general paediatrics clinic on-site at [Society] is underway. Objectives The objectives of this mixed methods study were to characterize the population and health-seeking behaviours of youth residing at [Society]; and to understand the healthcare needs of youth in care at [Society] through interviews with youth and key informants. Design/Methods Youth in care living at [Society] and key informants were recruited to participate in semi-structured interviews. Anonymized transcripts were coded using thematic analysis, with key themes identified. For the quantitative component, we conducted a chart review to determine demographics and healthcare utilization for youth living at [Society] over the course of a year. Results The quantitative study captured 94 youth aged 10-18, with a mean age of 14.4 years old. A small majority (51%) were male. 39% of youth lived within 0-50km of their home community, with 22% living more than 200km from their home community. 30% of youth did not have a primary care provider. The mean number of outpatient (walk-in clinic and emergency department) visits per child per year was 0.7. 44% of youth at [Society] had a diagnosis of ADHD, 47.9% had a diagnosis of neuro-developmental disorder, and 43% had a diagnosed mood disorder. 17% of youth had a substance use disorder. Thematic analysis of interviews revealed that the living environment of youth at [Society] had a large impact on their healthcare: frequent relocation, congregate living, and distance from established healthcare relationships. Mental health was identified as an unmet health need. Additionally, systemic issues such as transportation challenges and a lack of frequent contact disconnect between legal guardians and daily caregivers limited the ability of caring adults to help youth seek care. Traumatic events preceding out-of-home care, including negative experiences with healthcare personnel and other perceived authority figures, were also noted to impact the way youth interact with healthcare. Many young people desired immediate and flexible access, as well as autonomy, along with the support of adults. Conclusion Youth in care have complex medical and mental healthcare needs. Many are living far from their healthcare providers. The high incidence of complex mental health needs suggests a need for regular access to multidisciplinary, specialized healthcare. Integrating healthcare delivery with living facilities could address many of participants' desires for healthcare, such as easy transportation, privacy, and flexibility. Paediatricians are well positioned to advocate for continued resources to support the health of youth in residential facilities.