systems of care for children with special health care needs. The federal response to the U.S. Supreme Court Olmstead decision furthered this responsibility by again defining the bureau as the lead agency for community service systems, helping to ensure the integration of children with special health care needs into communities (New Freedom Initiative). These community service programs are meant to help organize the complex variety of services that children with chronic conditions may need.
Children in foster care have particularly high rates of chronic health problems, both primary mental health conditions and a variety of chronic physical conditions (Chernoff et al., 1994; Halfon et al., 1992, 1995). Many of these children were born preterm, although the contribution of preterm birth to the numbers of children in foster care is not clear. Many children also experienced disorganized homes in which their parents’ own conditions limited their ability to nurture them, with child abuse and neglect common among children who are subsequently placed in foster care (Chipungu and Bent-Goodley, 2003).
Children in the juvenile justice system have demographics and clinical characteristics similar to those of children in foster care (although their median age is higher). They also have high levels of chronic health conditions, especially mental health conditions (particularly attention deficit-hyperactivity disorder) (Chernoff et al., 1994).
A recent report from the Urban Institute highlights the interactions among disability, dependence on public income support, and other programs by noting that almost half of adolescents with SSI support transitioning to young adulthood have dropped out of school, and a third have been arrested or have been reported to have some troubles that resulted in their participation in the court system (Loprest and Wittenburg, 2005). Although the increased risk of chronic health conditions and behavioral problems would appear to place children and adolescents born preterm at greater risk for foster care placement and delinquent behavior, the limited literature does not appear to support this concern (Hack et al., 2002; Leventhal, 1981; Leventhal et al., 1984). However, studies have not examined whether preterm birth incurs added costs in foster care and juvenile justice systems.
Finding 14-1: The distribution of the costs of preterm birth between the public and the private sectors and among constituencies within these sectors has not been determined. Children born preterm may require a wide array of publicly supported services.