Improving healthcare for children entering foster care

Despite the fact that children in foster care are, perhaps, the most vulnerable children, healthcare for them has been lacking woefully for many years. A growing body of research has documented the need for such care as well as the failure of child welfare agencies to make major improvements in providing healthcare to foster children. Nonetheless, current efforts are being made to change this situation. This article reports on one effort to improve the provision and timeliness of health exams for children entering care. One rural and one urban county served as project treatment sites, with two additional rural and urban counties serving as control sites. The treatment sites achieved a statistically significant improvement in their rate of exam completion as compared to the control sites. The study finds that despite an existing policy for healthcare for children entering foster care, legislation mandating additional efforts, shortened time frames, and provision for judicial oversight are needed for improvement.     

The need for revaluation and assessment of Australian foster care programmes

This is a brief report on one aspect of a programme of applied research, in a large social welfare agency, designed to provide a basis for the evaluation of the policies, activities and structure of the agency.     

Medical foster care for seriously medically ill children: A growing need

This article identifies and lists the problems of children with complex medical conditions and/or complex home health case needs. Five categories of seriously chronically ill children are identified and programs to meet their needs discussed. The authors believe many of these children could benefit from foster home placements; they discuss one project in which there is collaboration between a pediatric medical center and a social service agency.     

Preschoolers entering foster care in New York City: the need to stress plans for permanency.

Analysis of data furnished by a computer system makes clear the need for special programs to plan permanency for infants and young children in foster care. A report on New York upstate data is appended to this article.     

Genetic services for foster children: an unmet need?

The genetics revolution has significant ramifications for child welfare. An overview of genetic disorders and of the expanding array of genetic services is given. Findings of an exploratory study of the proportion of children in out-of-home care in two cities who had diagnosed genetic disorders and who met criteria for referral to genetic services, and utilization of genetic services are presented. The findings suggest that genetic services that might be beneficial to foster children and their biological families are not being offered. Implications for foster care are discussed.     

The economics of adoption of children from foster care

Federal initiatives since 1996 have intensified the efforts of states to achieve adoption for children in foster care. For many waiting children, the path to adoption is long. The authors offer an economic analysis of adoption from foster care, with an emphasis on the reasons why achieving the goal of adoption for all waiting children may be so difficult. The authors then estimate the determinants of adoptions from foster care across the states using data for fiscal years 1996 and 1997. Adoption assistance subsidy rates stand out as the most important determinant of adoptions from foster care, followed by use of alternatives (e.g., intercountry adoption). Adoptive matching on the basis of race does not appear to prevent adoptions from foster care in the aggregate, leaving flaws in the matching process, such as a lack of information and difficulty using the Interstate Compact on the Placement of Children (ICPC), as a primary reason why children wait.     

Bibliotherapy for children in foster care and adoption

The bibliotherapeutic technique can help children adjust to the foster care and adoption experience. Appropriate children's books are described and the application and limitations of bibliotherapy are discussed.     

Interjurisdictional placement of children in foster care

As the population of children in foster care has increased and more children are freed for adoption, foster and adoptive families are needed in ever increasing numbers. One avenue for expanding the pool of families is through placement of children with families in other counties and states. This article considers the policy and practice implications of interjurisdictional placement in the context of foster care, adoption, and kinship care and suggests directions for interjurisdictional adoption practice and policy.     

An intensive reunification program for children in foster care

While the Intensive Family Preservation Services (IFPS) model is widely used in preventing out-of-home placement, its application to reunifying foster children with their families has produced mixed results. This pilot project combined elements of the IFPS model with foster care-related services that included foster parent training and support, foster parent-parent linkage, and frequent parental visiting. Of 42 participating foster children, 79% were successfully reunified. At follow-up one year after their exit from the project, 91% of reunified children were still living with their family. Reunification was significantly associated with several characteristics of the families studied.     

Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

Mental health assessment of infants in foster care

Infants placed in foster care are at high risk for emotional and behavioral problems. Assessment of their mental health must account for their often-adverse life experiences prior to placement and the involvement of multiple systems that shape their lives in lieu of parents' authority. This article presents practice guidelines for infant mental health evaluations with consideration of legal requirements and the unique issues conferred by foster care.     

Abused children and foster care—the need for specialist resources

Estimates vary on how many abused and neglected children are admitted to care and how many children in care are there because of abuse and neglect. Nevertheless, it is important to examine their special needs and the problems they present to carers. Although research findings are difficult to interpret, there is enough evidence to show that abused and neglected children in care have special needs in three particular areas: education, health and social behaviour. The evidence is available from research into children in care and research into child maltreatment. Children in care run the risk of disrupted educational careers; abused and neglected children have additional problems in school. Many children in care have a patchy and neglected medical history; abused and neglected children are seriously at risk of further ill-health. Abused and neglected children have been shown to have behaviour problems that jeopardize their relationships with peers and adults; they run the risk of placement breakdown. Foster care of abused and neglected children is a specialist and demanding task, requiring knowledge of, and sensitivity to special needs. Because many abused and neglected children return to their parents, foster carers also need to include the natural family in their task. High expectations of these foster carers, however, should not lead to exploitation but rather an enhancing of fostering assessment, preparation, support and training.     

What are the factors associated with educational achievement for children in kinship or foster care: A systematic review

Children in care lag behind their peers on a number of outcome measures, including education. Interventions have been developed to help them close the gap with their peers but these have had limited success to date. One possible reason for this may stem from our lack of understanding about underlying processes and mechanisms.This paper presents the findings of a systematic review of the factors associated with educational outcomes for children in foster and kinship care. It aims to inform the literature on risk and protective factors and inform the development of future interventions.Eight major databases and websites were searched between 1990 and 2016 using a combination of mesh terms. Studies were included if they tested the statistical association between any variable and educational outcomes for school age children in foster or kinship care in high-income countries. Children in other placement types were excluded. Titles and abstracts were screened for 7135 studies identified through searches. Full texts were obtained for 298 and 39 were retained for inclusion.Over 70 factors were identified. For the purposes of the narrative synthesis, factors were categorised into spheres of influence adapted from Bronfennbrenner's (1979) ecological framework. The findings reveal significant heterogeneity. Male gender, ethnic minority status and special educational needs were consistent predictors of poor educational outcomes, while carers' and young people's aspirations appeared to predict greater success. The findings are discussed with implications for future research and practice.     

The voices of youth formerly in foster care: Perspectives on educational attainment gaps

As a population, youth who experience foster care graduate from high school at rates well below their non-foster care peers (National Working Group for Foster Care & Education, 2014). A Consensual Qualitative Research (CQR) study was conducted to better understand the perspective of former foster youth on the graduation gap and their experience in school. Analysis of focus group data revealed one overarching domain, emotional consequences, as well as seven additional domains that related to youths' experiences surrounding their educational attainment: resilience, basic needs, internalized messages about education, educational stability, consequences of school mobility, fastest or easiest positive exit from K-12, and recommendations from youth. This research highlights the challenges faced by 16 former foster youth, their perspectives regarding the need to raise expectations, and their suggestions for closing the educational attainment gap.     

Building evidence to promote educational competence of youth in foster care

Although the academic difficulties of students living in foster care are well documented, few studies have examined factors influencing academic achievement of youth in foster care. This article reports the results of a study of educational competence in a sample of 152 foster youth in one midwestern state. Using five standardized instruments, the study explored predictors of reading ability of youth in foster care. Multiple regression analyses indicated that four factors--aspiration for higher education, placement in kinship care, participation in extracurricular activities, and drug use--accounted for 39% of the variance in reading ability scores. The article discusses implications of these findings for practice, research, and policy development.     

Health supervision of children in foster care.

The 1971--74 survey of the health needs and services provided to New York City children in foster care indicates a failure of the Medicaid program to ensure adequate routine care and treatment.     

Birthfamilies as permanency resources for children in long-term foster care

Provisions of the Adoption and Safe Families Act of 1997 mandated shorter time frames for making permanency decisions and facilitating adoption. Yet for many children, foster care continued to be a significant portion of their life experiences. This project explored the potential permanency option of birthfamilies and extended kin for children who languished in foster care while being free for adoption. Eighteen children achieved permanent placement with their birthfamilies. In addition, staff found that although many families could not provide permanent placements, they could offer appropriate relationships with the children. This project team recommends viewing family relationships as an integral component where placement is one option on a continuum that includes letters, phone calls, and visits.