Barriers and facilitators to healthcare access among youth transitioning out of foster care: A scoping review

Youth transitioning from the foster care system experience significant healthcare needs. Healthcare access is a critical component of well-being among youth leaving foster care. Yet, few studies have sought to synthesize knowledge focused on healthcare access for youth leaving foster care, specifically and comprehensively. This scoping review aims to identify and analyze the gaps in the knowledge base regarding barriers to and facilitators of healthcare access for youth transitioning out of foster care in the U.S. The authors used the JBI Scoping Review Protocol and engaged in reference harvesting to evaluate the existing literature (n = 33 articles) to understand what hinders and facilitates healthcare access among this population. Studies were included if they explored factors affecting healthcare access among U.S. youth transitioning out of foster care and were published between 2013–2023. Barriers to access included lacking knowledge or experience, insufficient support systems, concerns with confidentiality and trust, treatment accessibility, availability and coverage, stigma and judgment, housing and community instability, as well as provider- (e.g., being inconsistent) and intervention-specific (e.g., manuals too wordy) characteristics. Facilitators to access included encouraging support systems, quality and legitimacy of services, intervention-specific factors (e.g., web-based), health insurance, the necessity of healthcare services, and finances. The findings highlight multitude of complex personal, social, and structural barriers and facilitators impacting youth’s ability to access healthcare while transitioning out of foster care. Practice, policy, and research recommendations are extensively discussed, including increased education for youth and caregivers, expansion of Medicaid, and continued evaluation of underlying drivers of healthcare service use.