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 The
health status of children in foster care is substantially affected
by their environment. These children often come from families juggling
with substance abuse problems, family and neighborhood violence,
and parental mental illness. They are also families with the fewest
psychosocial and financial resources as well as little, if any,
social or family support. As a result, these children have higher
rates of serious emotional and behavioral problems, chronic physical
disabilities, birth defects, developmental delays and poor school
performance compared to other children from similar socioeconomic
background not in foster care. They are also more likely to lack
adequate routine preventive health care prior to placement.
- Developmental and Behavioral Health
During the first 3 to 4 years of life, brain development gives
rise to personality traits, learning processes, and coping
with stress and emotions.
- Negative environmental conditions like neglect, child abuse,
and/or violence influence these processes and thus may impair
neurodevelopment, resulting in various mental and behavioral
problems such as depression, ADHD, dissociative disorders
and memory impairments
- Neglect has a tremendous impact on a child's development
and contributes to:
- Poor attachment formation
- Developmental delay
- Poor physical development
- Antisocial behavior
- Impaired communication skills due to poor environmental
stimulations needed to facilitate language and vocabulary
development
- Attachment:
- Forming healthy attachments, especially to a primary
caregiver, is crucial in the development of emotional
security
- Abuse, neglect, multiple placements or disruptions all
contribute to the lack of opportunities for children to
form healthy attachments to a primary caregiver who can
provide nurture and protection
- As a result, children may have emotional disturbances,
attachment disorders, and an inability to trust and love
- Hyperarousal
- Exposure to chronic, traumatic stress can cause a child's
brain to sensitize the pathways for the fear response
- Physical and mental abuse can create memories such that
fear responses become automatic resulting in the child
having a hyper-aroused state of mind.
- As a result, these children often respond to the environment
in a hyper-vigilant manner, experiencing hyperactivity,
mood swings, anxiety, impulsivity and/or sleeping problems.
- How a child responds to stress depends on his/her age
- An infant exposed to chronic stress may be apathetic,
exhibit poor feeding, withdrawn, or have failure to thrive
- An older child may appear disengaged and exhibit detachment,
apathy, and excessive daydreaming
- Some children reflexively react to alarm and stress
by freezing and may come across as oppositional or defiant
when interacting with others around them
- How children react to separations depend on their age
- Children between 6 months and around 3 years of age
- These children fall into the normal developmental
period where they feel anxious around strangers and
possess limited language abilities to express themselves,
placing them at a higher risk of developing subsequent
emotional disturbances
- Children older than 3-4 years of age
- Because their language skills are more developed,
these children have the advantage of using language
to cope and adjust to change
- Mental Health
- Foster care children are often in great need of mental
health services due to abuse, neglect, and trauma of being
taken away from their families
- Estimates of the prevalence of mental health problems range
from 29% to 98% and include:
- Depression, conduct disorder, oppositional defiant disorder,
ADHD, attachment and anxiety disorder
- Why do these children experience psychological difficulties
at time of placement?
- It's a difficult transition for an infant/youth; it
may be ill-planned; may be traumatic
- Children may feel fear, guilt of doing something to
have caused separation from their family, and/or sense
of being punished
- How do they react at time of placement?
- Varies with age and from child to child, though there
are common themes
- Some children may have an initial period of adapting
well to a foster home with no manifestations of overt
behavioral disturbances
- Some months later, usually 3 months, they may
begin exerting negative behaviors and acting-out
or testing their limits
- This behavioral change may appear as if these
children want proof their foster parents truly
care for them before opening themselves to a trusting
relationship
- Others are withdrawn, depressed, angry, aggressive
and resist any effort of the new foster parent to
comfort them
- They are cautious of new surroundings and not
willing to let themselves get too close to new
foster parents
- Physical health
- Several studies have been conducted to evaluate the
health status of children in foster care. Problems include:
fractures, acute infections, anemia, and lead poisoning.
- Risk for HIV infection
- The number of women infected with HIV has risen, and
many of their children enter foster care as a result of
maternal death or disability.
- Children and adolescents in foster care may have been
sexually abused, thus at a high risk of acquiring HIV
infection
- Challenges facing the health care system:
- Difficulty in obtaining a child's health care information
and medical history before placement
- Contact with health care providers prior to placement
may have been erratic
- Continuity of care often is lacking, since these children
often move from one foster home to another
- Foster parents cannot provide health care consent for
children.
- Social workers often need to locate and obtain consent
from biological parents, thus delaying evaluations
and treatments
- Comprehensive and coordinated health programs are lacking,
despite requirements by state and county regulations
- Why?
- Diverse characteristics of child welfare agencies
- Wide geographic distribution of foster care
homes
- Lack of funding for physical and mental health
care services for these children
- Inadequate physician compensation
- Appropriate referrals often are not made with adequate
follow-up
- Community providers may identify medical and educational
needs, but not developmental and mental health needs
of children entering foster care
- Some practitioners are deterred from being involved
in the care of these children
- Complex social situations
- Extra time required to provide care
- Modest reimbursements
- The AAP District II task force on health care for children
in foster care has developed a comprehensive resource manual
outlining areas of health concerns and provided guidelines in
assessing and evaluating physical, developmental, mental health,
and educational needs of foster care children. This can be obtained
on the AAP website.
References:
Committee on Early Childhood, Adoption, and Dependent Care. American
Academy of Pediatarics. Health care of young children in foster
care. Pediatrics. 109(3):536-41, 2002 Mar.
Committee on Early Childhood and Adoption and Dependent Care. American
Academy of Pediatrics. Developmental issues for young children in
foster care. Pediatrics. 106 (5): 1145-1150, 2000 Nov.
Simms, MD, Dubowitz H, Szilagyi MA. Health care nees of children
in the foster care system. Pediatrics. 106 (4):909-918, 2000 Oct.
Horwitz SM. Owens P. Simms MD. Specialized assessments for children
in foster care. Pediatrics. 106(1 Pt 1):59-66, 2000 Jul.
National Information Clearinghouse on Child Abuse and Neglect.
Understanding the effects of maltreatment on early brain development.
October 2001. http://nccanch.acf.hhs.gov/pubs/focus/earlybrain/
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ISSUE ALERT #1
(Winter 2004) - Foster Care Children
 Issue
at a Glance Issue
in Context
Health
Care Issues
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