| Description |
Girls that are emancipated from foster care upon reaching adulthood represent an underserved U.S. population. Acute and chronic health disparities seen among emancipated girls include increased rates of unplanned and early pregnancy, STIs, intimate partner violence, mental illness, and substance abuse. Ecological factors contributing to health disparities among transitioning foster girls include higher rates of being uninsured, homeless, and unemployed, live in poverty, and attain lower education. The transition from foster care into adulthood is a critical time in the lives of these young women. Unfortunately, transition is also the time during which these women are lost to appropriate healthcare follow up; further contributing to poor health outcomes. Clinical and policy significance regarding this gap in healthcare for transitioning foster girls include significant health insurance barriers, organizational fragmentation during transition, and healthcare reform calling for integrated, holistic primary care. An attempt at addressing this gap was initiated through this DNP project. A literature review to define national and local epidemiological outcome data for emancipated foster girls defined the risks. Critical appraisal of the highest level research of interventions to address the identified risks created best practice recommendations for transitioning adolescent girls. These recommendations were presented using a holistic framework; seven domains of women's health: physical, environmental, social/cultural, intellectual, financial, and spiritual. Evidenced based interventions included using motivational interviewing along with multiple educational interventions to increase health literacy, prevent STIs and prevent unintended pregnancies. LARC contraception option is considered first line choice in transitioning adolescent foster girls. Trauma informed care is a fundamental practice framework that is essential for social-cultural sensitivity. Screening for intimate partner violence and abuse is recommended to all individuals. Pursuing further education should be encouraged by PCPs, as it is critical to the empowerment of women and reduction of health disparities. Resources are available for educational assistance that emancipated foster children are eligible. Financial literacy educational programs are effective in improving financial outcomes and many resources are available. Post Traumatic Stress Disorder, Depression, and Anxiety are the most common mental health diagnosis in emancipated females. Psychotropic medication management should be in collaboration with a psychotherapist, and attempts to avoid complex medication regimens and polypharmacy should be made to reduce non-adherence. Mindfulness medication practices effectively improve spiritual health. Posting of best practice recommendations for transitioning adolescent foster girls on an independent website was carried out in order to facilitate dissemination of relevant information to providers and other stakeholders. Presentations were given at the Utah DCFS Child Welfare Institute, the Utah DWS and DCFS quarterly coordination meeting, Utah JJS, as well as to the executive directors at AUCH, University of Utah COE in Women's Health, Wasatch Homeless Clinic, and Utah Partners for Health. Best practice recommendations were disseminated to the medical directors and providers following these presentations. Future presentations are scheduled for DWS case manager 1/58/12 and Utah Health Safety Net Summit April, 2013. |
