The prevalence of special health care needs (SHCN) among children who are investigated for maltreatment
is very high (Ringeisen, Casanueva, Urato, & Cross, 2008; Stein, et al., 2013). Therefore, the current study uses data from the second National
Survey of Child and Adolescent Well-being to (1) describe the prevalence of special health care needs of children involved in the US child welfare system and (2) to identify which specific needs are predictors of out-of-home placement. Results show that the most prevalent SHCN for this population is ADHD at 16.5% of children investigated for maltreatment. The least prevalent needs are muscular dystrophy and cystic fibrosis. Behavioral SHCNs are more predictive of out-of-home placement than physical needs. Such behavioral needs include emotional development delay, ADHD, mental retardation or developmental delay, and emotional problems such as depression or anxiety. These four health needs are associated with an increased likelihood of out-of-home placement. Implications for child welfare agencies may include: re-examining decision making processes that lead to out-of-home placement for children with SHCNs, ensuring the availability of behavioral health services for system-involved children, and providing supports for foster parents whose children exhibit behavioral SHCNs.