You’re barely out of your teens when amid the COVID-19 pandemic, you start to feel rundown. You go to bed and convince yourself it’s just a cold, but you are worried. You begin to feel worse, weaker, shorter of breath and in severe pain, so you look to your loved ones. A parent, a sibling, someone you trust to help alleviate your anxiety and to care for you as you feel unable to care for yourself. Luckily, your loved ones take over, get you to the hospital, and advocate with and for you while you await the inevitable diagnosis.
Now, imagine instead you’ve spent your life in foster care. You aged out of the system without any family or support, have lost your job, and are homeless. What do you do then, when you are sick, young, afraid, and alone?
Before COVID, youth involved in the child welfare system fell through the gaps, especially those aged 18 to 21 who become foster youth alumni and homeless simultaneously. Very likely to have a chronic medical condition but without a doctor or insurance, they are left finding ways to survive. They face challenges transitioning to adulthood with sufficient practical knowledge, education, and skills to support themselves. These challenges have only worsened with the pandemic.
As an emergency room physician, I treat and hear the stories of too many foster youths affected by COVID. One of those stories is Kevin’s. He came alone to our hospital on a Friday night, looking like a man, but at 21 years old still very much a boy. New to the area, recently laid off from his job, and couch-surfing for a place to sleep, he was truly afraid of what I was about to tell him. It wasn’t just his asthma; he was my newest COVID-positive patient.
Foster youth diagnosed with COVID are vulnerable. Access to testing and a vaccine require technology and transportation, potential challenges for young foster youth alumni. ER visits for dehydration and malnourishment are far too common, as youth with underlying medical conditions become too sick to care for themselves. Recommended therapies such as over the counter pain and fever medications, vitamins or steroids are often not affordable.
During COVID-19, the Field Center for Children’s Policy, Practice, and Research collected the experiences of almost 300 current and recently aged-out foster youth aged 18 to 23 across the country. The results are alarming:
- 43% reported housing instability
- 55% reported food insecurity
- 33% reported wishing they had more connections to help them through the crisis or feeling that they were on their own or almost entirely on their own.
“This study is an important first step,” shared Dr. Johanna Greeson, associate professor at the University of Pennsylvania’s School of Social Policy and Practice who led the study. “I hope we can use this learning to inform policy and practice changes so that when disaster strikes again, all our systems, including health care, can more effectively respond to the safety, health, and well-being needs of these marginalized young people. I hope one day Dr. Bell is no longer meeting the ‘Kevins’ in her ER.”
Risk factors that cause children to enter the child welfare system, including loss of a parent, have occurred at higher rates in the Black population. It is estimated that 40,000 children have lost a parent to COVID, with Black children being unfairly affected. Although Black children comprise 14% of the US population, 20% of Black children have lost a parent during COVID. For all these reasons, the impact of COVID on foster youth has been great.
Address disparities with policy
To curb the effects of COVID-19 on foster youth and remedy the above-described outcomes, foster youth advocates suggest the following interventions:
- Suspend aging out to allow foster youth to stay in care past the state-mandated emancipation date
- Waive conditions such as employment and educational requirements for the continuation of child welfare services
- Extend resources including financial, housing, employment, education, and other supports and services to former foster youth.
Although several state legislatures (including Georgia’s) have acted to assist transitioning youth, most have not.
The power of connection
The importance of less-formal interventions to mitigate the effect of COVID-19 on aged-out foster youth cannot be overstated. Physicians with teenage and young adult foster youth in their practices can reach out to ensure their patients are:
- Knowledgeable about ways to protect themselves from COVID-19
- Able to access resources such as masks
- Advocated-for within their workplace, school, or with child welfare services
- Knowledgeable about symptoms, testing, quarantine requirements, when to seek medical help, vaccine information, and treatment options
Connectedness and the ability to access employment opportunities or stay in school is dependent on technology such as smartphones, computers, and internet access. Ensuring aged-out foster youth have these resources is critical. Donations of gift cards, groceries, or financial support either directly to foster youth or through foster youth advocacy agencies are easy ways communities can help.
Let’s reimagine the future
Kevin recovered from COVID and has moved on. I think of him often and even worry about how he is doing. I hope he has found health and happiness. I hope he is enveloped in the support everyone needs to flourish. I also know that is most likely not the case. While he survived the child welfare system, he also aged out of that same system offering a minimal path to survival. He deserves more and we can do better.
May is National Foster Care Month and there is no better time to act. Visit childwelfare.gov to find your local child welfare agency or learn more. Follow @underdogDREAMS for innovative approaches to improving outcomes for foster youth.
Annette Bell, M.D., is a board-certified family physician currently practicing emergency medicine in the Baptist Health System in northeast Florida. She is also a collaborator with Underdog Dreams, a nonprofit engaged in research, advocacy and education on the challenges facing youth aging out of the child welfare system.
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