The medical and psychosocial needs of children entering foster care

doi:10.1016/0145-2134(87)90033-0

Child Abuse & Neglect

Volume 11, Issue 1, 1987, Pages 53-62

https://doi.org/10.1016/0145-2134(87)90033-0 Get rights and content

Abstract

The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population. require significant amounts of medical sub-specially care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.

Résumé

Les quelques 300 à 400.000 enfants qui, aux Etats-Unis, vivent en foyers nourriciers, représentent une population à risque élevé de problèmes psycho-sociaux et médicaux. Ces problèmes sont compliqués par la déficience en moyens adéquats déstinés à les aider pendant leur séjour en placement. La présente étude avait pour but de dépister les problèmes médico-sociaux présentés par 149 enfants victimes de maltraitance-négligence au moment où ils entraient dans le système de placement nourricier. L'idée de l'élude était de dériver le profil des besoins médicaux et psycho-sociaux des enfants entrant dans le système de placement afin d'améliorer le système de santé mis à leur disposition. L'enquête a révélé que ces enfants ont, avec une grande fréquence, des affections médicales chroniques: ont tendance à avoir un poids en-dessous de la moyenne et d'être un peu plus petit que leur père au même âge; ces enfants ont besoin également de soins médicaux spécialisés considérables, ils ont avec une grande fréquence un retard psycho-moteur, des déficiences dans leur comportement adaptatif et un nombre élevé de problème comportementaux mêlés à des syndromes franchement psychiatriques. Les auteurs discutent leurs résultats d'où devrait dériver un modèle de prise en charge des besoins de santé des enfants entrant dans le système régional de placement.

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“Great day! But now what?” Adolescents’ and foster carers’ experiences of a comprehensive health assessment for children in out-of-home care
2024, Children and Youth Services Review
Children in out-of-home care have extensive mental and physical health care needs. Best practice guidelines recommend comprehensive health assessments to all children entering out-of-home care, as their needs are often unidentified and unmet. The aim of this study was to explore adolescents’ and foster carers’ experiences and expectations after participating in a comprehensive multi-disciplinary health assessment. Within two weeks of the assessment day, nine adolescents (aged 11–17 years), and 12 foster carers were interviewed, and asked to share what they thought about the encounters and the tasks from the assessment day. Based on these experiences, further conversations explored relevant issues from contemporary life, and prospects for the future. Through Interpretative Phenomenological Analyses, three major themes were identified as the main findings. First, the participants felt seen and involved, taken care of and taken seriously throughout the assessment day. Adolescents and carers had concordant views on what made the environment feel safe, despite the potentially demanding comprehensiveness and topics of the assessment. Second, the assessment was perceived as relevant, and gave access to enhanced understanding, although the adolescents and the carers expressed divergent views on the perceived importance of the assessment and how it related to their daily lives. The third theme referred to feeling hopeful, but powerless facing the future, and the uncertainty regarding what would happen with the identified needs and recommendations for services. Our results suggest that the assessment day was manageable, understandable and acceptable, but the engagement and involvement from the assessment day did not transfer to the expectations for follow-up.
Developmental Service Referrals and Utilization Among Young Children in Protective Custody
2021, Journal of Pediatrics
Wellbeing of children and adolescents with special health care needs in the child welfare system
2016, Children and Youth Services Review
Citation Excerpt :
The American Academy of Pediatrics recognized that all children and adolescents in child welfare are truly youth with special health care needs (AAP, 2005). Three decades of research clearly demonstrates that 30% to 80% of youth who enter child welfare have at least one physical health problem, with one third having a chronic condition (Halfon, Mendonca, & Berkowitz, 1995; Hochstadt et al., 1987; Jee et al., 2006; Leslie et al., 2005; Ringeisen et al., 2008; Takayama, Wolfe, & Coulter, 1998). This study identified 10% of children and adolescents entering child welfare to have moderate to severe disabilities and/or chronic medical problems, reflecting those children with the greatest need for quality, coordinated health care.
Children and adolescents in child welfare have the highest rates of chronic conditions and disabilities of any studied child population. The purpose of this study is to determine the wellbeing of children and adolescents with special health care needs (SHCN) in child welfare compared to their peers without SHCN. Wellbeing was measured using the Child and Adolescent Needs and Strengths (CANS) assessment; children and adolescents were assessed on the domains of Life Domain Functioning, Traumatic Stress Symptoms, Behavioral/Emotional Needs, Risk Behaviors, and Child Strengths. Scores on the CANS were compared between initial entry into the child welfare system and 18 months later. This is the first study to assess wellbeing over time of children and adolescents with SHCN in the child welfare system. This study found that children and adolescents with SHCN had increased wellbeing over an 18-month period. By the 18-month assessment, children and adolescents with SHCN presented similarly to their healthy peers, indicating that wellbeing improved more for children and adolescents with SHCN than those without SHCN across several domains of wellbeing. Children and adolescents with SHCN still had significant needs compared to children and adolescents without SHCN in the area of Life Domain Functioning. Adolescents (ages 12–18), with and without SHCN, had greater needs and fewer strengths compared to children (ages 6–11) both initially and 18 months later. Children and adolescents without SHCN also improved over the 18-month period. While this study specifically measured needs and strengths, the findings show that the wellbeing of children and adolescents, as measured across a variety of domains, improved while in child welfare.
For Better or Worse? Change in Service Use by Children Investigated by Child Welfare over a Decade
2016, Academic Pediatrics
Children, particularly minority children, referred to child welfare because of suspected maltreatment are vulnerable and need many services. We sought to assess whether service use has improved over the past decade and whether racial-ethnic disparities in service use have decreased.
We used 2 national data sets (the National Survey of Child and Adolescent Well-Being [NSCAW] I and II) collected a decade apart to assess changes over time in health, education, mental health (MH), and dental services and overall service use.
In NSCAW II more children were young, had lower Child Behavior Checklist (CBCL) scores, and were Hispanic. We found significant increases in dental services, a decrease in special education services, and a decrease in MH services on the bivariate level (all P < .01). A large proportion of the change in MH services occurred in school settings, but the pattern continued when examining only those services delivered outside of school. The greatest decrease occurred for children with CBCL scores <64. However, in multivariate analyses, older children, white non-Hispanic children, and children placed out of the home were significantly more likely to receive MH services. Rates of MH services controlling for CBCL scores showed no improvement over the decade, nor was there a decrease in racial and ethnic disparities.
These data showed no change in MH services over time for children referred for child welfare evaluation, but improvement in dental services was noted. Racial and ethnic disparities persist. Decrease in MH services occurred predominantly among children whose MH symptoms were below the clinical range.
Quality improvement learning collaborative to examine foster care guidelines
2015, Children and Youth Services Review
Learning collaboratives (LC) are an important method of implementing quality improvement by serving as laboratories to translate research into practice and sharing knowledge. We created a Foster Care Learning Collaborative (FCLC) of 11 foster care health sites to share best practices on providing health services for children in foster care. Using a collaborative approach involving monthly conference calls, we invited each health site to present specific health care delivery issues for the purpose of developing collaborative quality improvement projects regarding the delivery of healthcare to children placed into foster care. For health sites providing primary care (n = 8 of 11 sites), we examined adherence to two American Academy of Pediatrics (AAP) guidelines for children entering foster care: a) the initial health screen, and b) the comprehensive medical evaluations. At least four distinct types of health care models that provide either direct primary care or administrative oversight for children in foster care were identified: 1) medical home sites (n = 3); 2) foster care evaluation/intake sites (n = 2); 3) specialized primary care sites (n = 1); and, 4) state administrative programs (n = 2). Data from the six direct primary care sites (n = 586 children) and two state administrative models (n = 3855 children) was collected. The time-frame for the initial health screen was adjusted to 7 days after entry and adherence (31%) was comparable among primary care sites. Adherence to AAP guidelines regarding completion of a comprehensive medical evaluation within 30 days of intake varied among medical homes (30%–86%), intake models (23%–33%), specialized primary care site (43%), and state models (43%–73%). No site was fully compliant with the AAP guideline for universal comprehensive medical evaluation within 30 days, and there is variation within and among care models. A foster care learning collaborative identified significant variability in adherence to a commonly accepted guideline for timely access to healthcare for children placed into foster care. The LC c model offers the opportunity to evaluate best practices, identify barriers to care, and provide objective feedback for improvement.
Physical Health Problems and Barriers to Optimal Health Care among Children in Foster Care
2015, Current Problems in Pediatric and Adolescent Health Care
Citation Excerpt :
Although lapses in primary or preventive care may precede foster care entry, care discontinuity often persists while in foster care.12 Children and adolescents entering foster care frequently have irregular growth parameters, including both growth failure and more recently, overweight/obesity.2,3,5,10,11,21,22,25 In the 1990s, being underweight (<fifth percentile on Centers for Disease Control and Prevention growth charts) was a frequent medical problem for children in foster care, including a large proportion of children with abnormally low height, weight, and head circumference measurements2,10; however, more recently, there is a growing prevalence of overweight/obesity in this population, paralleling national trends.3,32
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.

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The medical and psychosocial needs of children entering foster care

Abstract

Résumé

Advances in Pediatrics

Child Abuse & Neglect

Journal of the American Academy of Child Psychiatry

Journal of the American Academy of Psychiatry

Child Abuse & Neglect

Characteristics of Children in Substitute and Adoptive Care

Treatment needs of children in foster care

American Journal of Orthopsychiatry

Length of time in foster care: A measure in need of analysis

Journal of Social Work

Committee on Adoption and Dependent Care: The needs of foster children

Pediatrics

On foster child health care

Child Welfare

The health status of foster children

Child Welfare

Health supervision of children in foster care

Child Welfare

Health supervision of foster children

Child Welfare

The foster care system and health status of foster children

Pediatrics

Health care delivery to foster children: A study

Health and Social Work

Foster care for child maltreatment: Impact on delinquent behavior

Pediatrics

Foster care for child maltreatment. II, Impact on school performance

Pediatrics

Developmental characteristics of abused children

Pediatrics

Infant injuries: Accidents or abuse

Pediatrics

A three-year follow-up study of abused and neglected children

American Journal of Diseases of Children