PGY 3 Resident Brookdale University Hospital and Medical Center Brooklyn, New York, United States
Background: Children of color are disproportionately represented & treated inequitably by the foster care system. The impact of COVID-19 pandemic on these inequities has not been explored yet. Objective: To study the impact of COVID-19 pandemic on racial inequities in national entry rates, exit rates, & adverse exits from foster care (death, runaway, or transfer to another agency) in the US. Design/Methods: Dataset: Adoption & Foster Care Analysis Reporting System (AFCARS), maintained by National Data Archive on Child Abuse & Neglect. Population:1. Children < 25 years entering foster care during 2017-21 for entry rates & 2017-22 for exit rates. 2. Children < 25 years exiting foster care during 2017-22 for adverse exits from foster care. Latest entry/exit for each child was included; prior entries removed. COVID time-period: before versus after 3/13/2020. Analysis: Age, sex, & race-specific entry rates per 10,000 children calculated using census data were compared using Fisher’s exact test. Exit rates were compared using a Cox proportional hazard model. The hazard of exit was regressed on racial/ethnic group, COVID time-period, interaction between race & covid time, age & sex of the child, existing medical condition/disability, & previous foster care stay. For adverse exits, log-odds of adverse exits were regressed on the same covariates as the Cox model. Interaction terms in each model provided difference in difference estimates for racial inequities. With >1 million entries & exits, there was ample power to detect these inequities. Results: Inequities in population-based entry rates increased for American Indian/Alaska Native (AIAN) children, especially those < 1 years of age during COVID (fig 1). Exit rates decreased for all children during the pandemic [exit ratio = 0.419, 95% CI (0.415, 0.423), P< 0.001] with persistent inequities in exit rates for AIAN [exit ratio=0.86(0.82, 0.90)] & Hispanic children [exit ratio =0.97(0.95, 0.98)] compared to white children (fig 2). Overall, adverse exits were not significantly different during the pandemic [OR= 1.01 (0.99, 1.03), P= 0.34] although, the inequities in adverse exits increased for African American (AA) children compared to white children [OR=1.15(1.05, 1.25), p= 0.002] (fig 3).
Conclusion(s): The pandemic inequitably impacted children of color in foster care. The inequities increased for AIAN children for entry rates during the pandemic. Inequities persisted for AIAN & Hispanic children for exit rates & for AA children for adverse exits during the pandemic. Our findings are a call for a more equitable & resilient foster care system.
