Foster and Kinship Care

Chapter 35 Foster and Kinship Care



Moira Szilagyi, Sara B. Eleoff



The mission of foster care is to provide for the health, safety, and well-being of children while assisting their families with services to promote reunification. The placement of children in another family has served the needs of children in many societies worldwide throughout history. The institution of foster care was developed in the USA as a temporary resource for children during times of family crisis and is rooted in the principle that children fare best when raised in family settings. The 1989 United Nations Convention on the Rights of the Child, a legally binding international instrument, addresses the need for such care for all children worldwide.



Epidemiology


The number of children in foster care worldwide is unknown, although it has been estimated that 8 million may be in foster and residential care. In 2007 in the USA, approximately 783,000 children spent some time in foster care; 496,000 children were in foster care on any given day. These numbers represent a downward trend since 1999 when the daily average of children in care was 567,000. This decrease results from fewer admissions and more reunifications, placements with relatives or close family friends (kinship care), and adoptions of children who had been in foster care (Chapter 34). There may be up to 4 times as many children in informal kinship care as in certified foster care.


A large number of children entering foster care in the USA are young; approximately 40% of children entering foster care are under the age of 5 yr. The majority are white (46%); significant percentages are black (28%) and Latino (17%). Children continue to remain in care for significant periods of time; the average for children who enter foster care is about 18 mo. Importantly, about 44% of the children in foster care have been in foster care for ≥2 yr.


Only about 50% of children achieve reunification. Annually, approximately 50,000 children (17%) are adopted out of foster care. Among remaining children, 11% return to extended family, 9% emancipate, 5% enter into long-term state guardianship, 2% run away, and 2% transfer to other institutions. In 2006, there were 509 deaths in foster care.


Most children live in foster family or certified kinship family care. Approximately 18%, mostly adolescents, live in group homes or residential settings. The average length of stay in foster care has decreased from a high of over 5 yr in the 1980s to 28 mo. Currently, 42% of children stay less than 12 mo, 34% spend 1-3 yr, and 29% remain in care for 3 yr or more. Important predictors of the number of foster care placements for a child include: severe behavioral or developmental problems, larger sibling group size, and longer time spent in foster care.



Legislation in the USA


In the USA, the Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be made for each child no later than 12 mo after entry to foster care and that a petition to terminate parental rights typically must be filed when a child has been in foster care for at least 15 of the previous 22 mo.


The Foster Care Independence Act of 1999 (P.L. 106-169) was intended to promote the successful transition of the nearly 20,000 youth emancipating from foster care annually by providing states with additional funding for independent living services. Within 12 mo, many have experienced at least 1 homeless night. Within a decade after leaving foster care, less than half have a high school degree, most are living in poverty, and there are high rates of post-traumatic stress disorder and depression.


In 2008, the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351) was enacted. This law provides increased financial incentives for kinship caregivers and adoptive families. Equally important, this law requires states to develop health care systems to improve the health outcomes of children in foster care.



Early Childhood Trauma Leads to Poor Health Outcomes


Children entering foster care have frequently experienced early childhood trauma. More than 70% have a history of abuse, neglect, or both. Over 80% have experienced significant domestic and/or community violence. Birth parents have high rates of mental illness, criminal justice system involvement, substance abuse, unemployment, and cognitive impairment. Many children have had prenatal substance exposure, multiple caregivers of varying quality, and are from families with long involvement with child protective services.


Removal from the family of origin is usually traumatic for children. A few children experience relief at removal from a chaotic, abusive, or dangerous home. Nonetheless, most children miss their family, worry about their parents and siblings, and long for reunification. Previous traumatic experiences are compounded by the separations and feelings of loss surrounding removal, unpredictable contact with birth parents, placement changes, and the process of terminating parental rights.


Early childhood trauma is correlated with poor developmental and behavioral outcomes. Early trauma and chronic stress affect the neurobiology of the developing brain by inducing long-standing hyperreactivity of corticotropin-releasing factor and neurotransmitters. These changes adversely affect the development of areas of the brain involved in attention and emotional regulation, and can result in shortened attention span, hyperactivity, poorer cognitive function, aggression, and dissociation, problems encountered frequently among children in foster care.



Health Issues


A variety of factors act as barriers to the health care of children in foster care. Most public and private child welfare agencies do not have formal policies or arrangements to provide health care services and rely on local physicians and/or health clinics funded by Medicaid. It is often difficult to obtain complete information on the health histories of children who enter foster care because they often have erratic contact with various health care providers before they enter foster care, and social workers are not always able to obtain detailed information from biological parents at the time children enter care. Once children enter foster care, there is often a diffusion of responsibility regarding obtaining health care services. Foster parents are often given very little information about the health care needs of the children for whom they are caring, but they are typically expected to decide when and where children receive health care services. In some cases, social workers may oversee the health care of children in foster care, but coordination with health care providers is often lacking. Uncertainty as to who may make health care treatment decisions for children may further delay health care or result in the denial of health care services.

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Jun 18, 2016 | Posted by in PEDIATRICS | Comments Off on Foster and Kinship Care

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