Readmission of children in foster care to psychiatric residential treatment facilities.

Abstract

Psychiatric residential treatment facilities (PRTFs) serve as nonhospital inpatient treatment environments for Medicaid beneficiaries under the age of 21. Children in foster care, as a group, exhibit a heightened need for mental health services and are disproportionately represented in residential treatment settings. Despite their high cost and restrictive nature, PRTFs offer a comprehensive approach that facilitates assessment, treatment, discharge planning, and aftercare. Readmission to PRTFs is an unfavorable utilization outcome that may reflect multiple mechanisms, including unmet clinical need, placement instability, and system-level factors. Although there are concerns about the overuse of PRTFs for youth in foster care, few studies have explored readmission rates and whether youth in foster care face a different risk of readmission compared to those not in the foster care system. This study conducted a secondary analysis of Medicaid claims data (2018-2021) for youth in one southeastern state who exited PRTFs (N = 2,434), 34% of whom were also in foster care. Multivariable landmark Cox regression models were used to assess the risk of readmission, calculated as a hazard ratio (HR). Foster care status was linked to a higher risk of PRTF readmission across all landmark time periods (0-180 days: HR = 1.36; 95% CI [1.10, 1.69]; 181-360 days: HR = 2.05; 95% CI [1.44, 2.93]; 361+ days: HR = 1.56; 95% CI [1.06, 2.29]), after adjusting for demographic characteristics, diagnoses, and prescription history. The findings indicate that youth in foster care are at an elevated risk of PRTF readmission, necessitating targeted strategies to address the unique clinical, psychosocial, and system-level factors associated with child welfare involvement. (PsycInfo Database Record (c) 2026 APA, all rights reserved).