Differences in ambulance attendances between children with and without an identified history of out-of-home-care

Background: Children in out-of-home-care (OOHC) are a vulnerable population, typically with complex needs, however there is minimal research examining the behavioural presentations that lead to the increased use of acute emergency care by OOHC children. Objective: This study aimed to describe differences in lifetime complexity factors identified during ambulance attendances between children with and without an identified history of OOHC. Further, this study aimed to describe whether having an identified history of being in OOHC was associated with increased utilisation of emergency care resources and increased likelihood of multiple ambulance attendances. Method: Electronic patient care records from ambulance attendances during the period January 2017 and June 2023 for 27,565 children 0-17 years in Victoria, Australia were examined. Results: Children with an identified history of OOHC had a substantially higher co-occurrence of substance-related harms, violence, self-harm, suicide ideation and attempts, a developmental or intellectual disability and mental health conditions compared with children where there was no identified OOHC history. As hypothesised, logistic regression found, after controlling for all complexity factors, an identified history of OOHC increased likelihood of multiple ambulance attendances (OR = 2.65; 95 % CI: 2.17-3.24, p < .001). Conclusions: The findings suggest children within OOHC have increasingly complex comorbidities, and this may be associated with increased emergency care utilisation. Development of tailored support to these multiple and complex needs is necessary to help reduce repeated emergency care responses for this at-risk population.