Foster Child Health and Development
Foster Child Health and Development
Children in foster care are the most vulnerable to experiencing poor health compared with any other group of children in the United States. Children enter foster care due to experiences that have been detrimental to their health and well-being, including child abuse and neglect. They have significantly higher rates of all health problems than the general population of children, including acute and chronic illnesses, growth and developmental problems, serious mental health problems, and difficulties accessing health services. Additionally, they often experience multiple foster care placement transitions, involvement in multiple systems of care (e.g., mental health, juvenile justice, special education), and aging-out of foster care at age 18 before they are developmentally ready for independent living. While management of the complex health and developmental needs of these children is challenging, nurses in primary care have the expertise and obligation to serve these vulnerable children. Priorities for clinical practice include care coordination and interdisciplinary collaboration; maintenance of adequate, up-to-date health records; vigorous follow-up; and health-targeted advocacy.
There are approximately 530,000 children living in foster care in the United States today (Child Welfare League of America [CWLA], 2001). The incidence of foster care placement continues to rise each year and has actually tripled since 1980 (CWLA, 2001; Halfon, Berkowitz, & Klee, 1992). Factors that contribute to the number of children in foster care include increases in the incidence and reporting of child abuse and neglect, parental substance abuse, family homelessness, and a lack of services that emphasize placement prevention and family reunification (American Academy of Pediatrics [AAP], 1994; Klee, Kronstadt, & Zlotnick, 1997; Rosen, 1997; Simms, Dubowitz, & Szilagyi, 2000; U.S. Congress, 1990). The average length of stay in foster care is just under 3 years, with 34% of children remaining in care for greater than 3 years (United States Department of Health and Human Services [USDHHS] Administration for Children and Families, 2001). In large urban areas, the median stay is 5 years (Goerge, Wulczyn, & Harden, 1999). Some children spend the duration of childhood in long-term foster care (CWLA, 1998; U.S. Congress, 1990).
Multiple foster home placements are commonplace. There is a clear relationship between length of time in care and number of placements. The Adoption and Foster Care Analysis Reporting System (AFCARS) most recently reported the following placement trends based on an analysis of 30 states: for children in foster care less than 1 year, 81% had two or fewer placements. In contrast, children in long-term care had three or more placements at these rates: 1-2 years in care - 40%, 2-3 years - 47%, 3-4 years - 52%, 4+ years - 61% (AFCARS, 1998). Other important correlates to placement instability include the child's behavioral and emotional problems, removal from home at a younger age, and parental substance abuse (Cooper, Peterson, & Meier, 1987; Pardeck, 1985; Runyan & Gould, 1985). By adolescence, the risk for multiple placements is greater with increased time in care, as is the risk for deepening behavioral and emotional problems (U.S. General Accounting Office [GAO], 1999).
Finally, there is an overrepresentation of children from minority groups (especially African-American) in the foster care system (CWLA, 1998; Sheppard, 1998). The ethnicity of children in foster care includes 35% African-American, 40% White, and 16% Latino; this is in great contrast with the total population of children in the U.S.: 15% African-American, 68% White, and 17% Latino (U.S. Bureau of the Census, 2000).
Children in foster care are the most vulnerable to experiencing poor health compared with any other group of children in the United States. Children enter foster care due to experiences that have been detrimental to their health and well-being, including child abuse and neglect. They have significantly higher rates of all health problems than the general population of children, including acute and chronic illnesses, growth and developmental problems, serious mental health problems, and difficulties accessing health services. Additionally, they often experience multiple foster care placement transitions, involvement in multiple systems of care (e.g., mental health, juvenile justice, special education), and aging-out of foster care at age 18 before they are developmentally ready for independent living. While management of the complex health and developmental needs of these children is challenging, nurses in primary care have the expertise and obligation to serve these vulnerable children. Priorities for clinical practice include care coordination and interdisciplinary collaboration; maintenance of adequate, up-to-date health records; vigorous follow-up; and health-targeted advocacy.
There are approximately 530,000 children living in foster care in the United States today (Child Welfare League of America [CWLA], 2001). The incidence of foster care placement continues to rise each year and has actually tripled since 1980 (CWLA, 2001; Halfon, Berkowitz, & Klee, 1992). Factors that contribute to the number of children in foster care include increases in the incidence and reporting of child abuse and neglect, parental substance abuse, family homelessness, and a lack of services that emphasize placement prevention and family reunification (American Academy of Pediatrics [AAP], 1994; Klee, Kronstadt, & Zlotnick, 1997; Rosen, 1997; Simms, Dubowitz, & Szilagyi, 2000; U.S. Congress, 1990). The average length of stay in foster care is just under 3 years, with 34% of children remaining in care for greater than 3 years (United States Department of Health and Human Services [USDHHS] Administration for Children and Families, 2001). In large urban areas, the median stay is 5 years (Goerge, Wulczyn, & Harden, 1999). Some children spend the duration of childhood in long-term foster care (CWLA, 1998; U.S. Congress, 1990).
Multiple foster home placements are commonplace. There is a clear relationship between length of time in care and number of placements. The Adoption and Foster Care Analysis Reporting System (AFCARS) most recently reported the following placement trends based on an analysis of 30 states: for children in foster care less than 1 year, 81% had two or fewer placements. In contrast, children in long-term care had three or more placements at these rates: 1-2 years in care - 40%, 2-3 years - 47%, 3-4 years - 52%, 4+ years - 61% (AFCARS, 1998). Other important correlates to placement instability include the child's behavioral and emotional problems, removal from home at a younger age, and parental substance abuse (Cooper, Peterson, & Meier, 1987; Pardeck, 1985; Runyan & Gould, 1985). By adolescence, the risk for multiple placements is greater with increased time in care, as is the risk for deepening behavioral and emotional problems (U.S. General Accounting Office [GAO], 1999).
Finally, there is an overrepresentation of children from minority groups (especially African-American) in the foster care system (CWLA, 1998; Sheppard, 1998). The ethnicity of children in foster care includes 35% African-American, 40% White, and 16% Latino; this is in great contrast with the total population of children in the U.S.: 15% African-American, 68% White, and 17% Latino (U.S. Bureau of the Census, 2000).
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