Dental Service Utilization Among Children in the Child Welfare System
To examine predisposing, enabling, and need-related factors associated with dental utilization by children involved with the child welfare system (CWS).
Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW; Wave II), a national probability sample of children (2–17 years) following a welfare assessment during 2008–2009 (n = 2806). Caregiver-reported child receipt of dental services in the past year was the outcome in weighted logistic regression models.
Two-thirds of children had a recent dental visit. Older children (OR 2.95, 95% CI 2.06,4.21 for ages 6–11; OR 2.47, CI 1.82, 3.37 for ages 12–17, compared to ages 2–5) were more likely to have visited the dentist, as were children of more educated caregivers (OR 1.68; CI 1.20, 2.36 for high school, OR 2.45; CI 1.71, 3.52 for more than high school). Children without a usual source of care (OR 0.50; CI 0.27, 0.94) and those living with non-biological parents had lower odds of a recent visit (OR 0.64; CI 0.43, 0.97). Children with dental problems were twice as likely to have a recent visit (OR 2.02; CI 1.21, 3.38), while children with unmet needs who could not afford care had lower odds of utilizing services (OR 0.28; CI 0.16, 0.46).
Conclusions for Practice
Many children in the CWS, especially younger children (ages 2–5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care.
KeywordsOral health Utilization Children Child welfare
The National Survey on Child and Adolescent Well-Being was developed under contract with the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services (ACYF/DHHS). The data have been provided by the National Data Archive on Child Abuse and Neglect. The information and opinions expressed herein reflect solely the position of the authors.
Funding was provided by National Institute on Drug Abuse (Grant No. R03 DA032863-01) to Dr. Chuang.
- Achenbach, T. M. (1991). Manual for the Child Behavior Checklist: 4–18 and 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry.Google Scholar
- Allen, K. (2010). Health screenings and assessment for children and youth entering foster care: state requirements and opportunities, Center for Health Care Strategies, Inc. Retrieved March 1, 2017 from http://www.chcs.org/media/CHCS_CW_Foster_Care_Screening_and_Assessment_Issue_Brief_111910.pdf.
- American Academy of Pediatric Dentistry (2010). Definition of dental neglect. Pediatric Dentistry 25(suppl): 7.Google Scholar
- American Academy of Pediatric Dentistry, Clinical Affairs Committee (2013). Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Clinical Guidelines Reference Manual 35(6): 114–122.Google Scholar
- American Academy of Pediatrics. (2007). AAP strategic plan guides activities on behalf of children, members. AAP News, 28, 36. http://aapnews.aappublications.org/content/28/12/36.full.
- American Academy of Pediatrics. Policy on dental home. Retrieved from http://aappolicy.aappublications.org/cgi/content/full/pediatrics; 111/5/1113.
- Center for Health Care Strategies. (2013). Making medicaid work for children in child welfare: Examples from the field. Retrieved March 1, 2017 from http://www.chcs.org/media/Making_Medicaid_Work.pdf.
- Chi, D. L., Momany, E. T., Jones, M. P., Kuthy, R. A., Askelson, N. M., Wehby, G. L., & Damiano, P. C. (2013). Relationship between medical well baby visits and first dental examinations for young children in Medicaid. American Journal of Public Health, 103(2), 347–354.CrossRefPubMedPubMedCentralGoogle Scholar
- Dale, G. Jr., Kendall, J. C., & Schultz, J. S. (1999). A proposal for universal medical and mental health screenings for children entering foster care. In G. D. J. P. A. Curtis, J. C. Kendall & J. D. Rockefeller IV. (Ed.), The foster care crisis: Translating research into policy and practice (pp. 175–192). Lincoln: University of Nebraska Press.Google Scholar
- DeLeeuw, J., & Meijer, E. (2008). Handbook of multilevel analysis. New York: Springer.Google Scholar
- DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment, and intervention. Washington DC: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect.Google Scholar
- Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, P., Aragon-Logan, E., et. al (2010). National survey of child and adolescent well-being II: Data file user’s manual restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect.Google Scholar
- Fortin, K. (2010). Caring for foster children. In C. Jenny (Ed.), Child abuse and neglect diagnosis, treatment, and evidence (pp. 610–614). St Louis: Elsevier Saunders.Google Scholar
- Griffin, S. O., Barker, L. K., Wei, L., Li, C., Albuquerque, M. S., & Gooch, B. F. (2014). Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents—Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. MMWR, 63(2), 54–60.Google Scholar
- Health, U. S. (2015). Dental visits in the last year, by selected characteristics: United States, selected years 1997–2014. National Center for Health Statistics. Retrieved March 1, 2017 from http://www.cdc.gov/nchs/hus/contents2015.htm#078.
- Kortenkamp, K., & Macomber Ehrle, J. (2002). The well-being of children involved with the child welfare system: A national overview. Washington, DC: The Urban Institute Series B.Google Scholar
- Landsverk, J. A., Garland, A. F., & Leslie, L. K. (2002). Mental health services for children reported to child protective services. In J. E. Myers, L. Berliner, J. Briere, et al. (Eds.), APSAC handbook on child maltreatment (pp. 487–507). Thousand Oaks, CA: Sage.Google Scholar
- Leve, L. D., Harold, G. T., Chamberlain, P., Landsverk, J. A., Fisher, P. A., & Vostanis, P. (2012). Practitioner review: Children in foster care—vulnerabilities and evidence-based interventions that promote resilience processes. Journal of Child Psychology and Psychiatry, 53(12), 1197–1211.CrossRefPubMedPubMedCentralGoogle Scholar
- U.S. Department of Health and Human Services. (2013). Health Resources and Services Administration, Maternal and Child Health Bureau. Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau. Child maltreatment 2012. Retrieved March 1, 2017 from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.
- U.S. Government Accountability Office. (2010). Oral health: Efforts under way to improve children’s access to dental services, but sustained attention needed to address ongoing concerns: Report to Congressional Committees. Washington, DC: U.S. Government Accountability Office.Google Scholar