The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%), Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a development evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation. Index termsfoster care; child welfare; developmental delay; mental health; physical healthThe estimated 826,000 children currently served by the child welfare/child protective services system 1 (hereafter termed child welfare) are more susceptible to poor health outcomes than any other subpopulation of youth in the United States. These children are removed from their homes when parents are unable to care for them due to prenatal drug/alcohol exposure, abuse, neglect, and/or violence. These background risk factors predispose these children to a myriad of physical, developmental, and mental health problems. Infants and toddlers, who are dependent on the care of others during a critical phase of brain development, 2-5 are especially vulnerable to both the experience and consequences of maltreatment 6-9 and are the most rapidly expanding age group entering child welfare. 3,10 Overall, the largest age group in child welfare (30%) is composed of children younger than 5 years of age. 1 Out-of-home placement can compound these problems if services are not provided effectively. Recent federal amendments to the Child Abuse Prevention and Treatment Act (CAPTA) in 2003 recommend that states enhance collaboration among public health agencies, child welfare, and community programs to address the comprehensive...
Research over the past two decades has consistently documented the high rates of young children entering the child protective services/child welfare system with developmental and mental health problems. There is an emerging evidence base for the role of early intervention services in improving outcomes for children with developmental and mental health problems in the general population that heavily relies on accurate and appropriate screening and assessment practices. The Child Welfare League of America, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry have all published guidelines concerning the importance of comprehensive assessments and appropriate referral to early intervention services for children entering out-of-home care. Recent federal legislation (P.L. 108-36) calls for increased collaboration between child welfare and public agencies to address the developmental and mental health needs of young children in foster care. This paper provides a framework for health, developmental, and mental health professionals seeking to partner with child welfare to develop and implement programs addressing these critical issues. Index termsfoster care; developmental delay; mental health; child protective services; early intervention There are more than 580,000 children 1 in the U.S. foster care system; these children represent an important and vulnerable subpopulation of youths. Especially disconcerting is the fact that a large proportion (30%) of these children are younger than 5 years of age. 2 Many children enter foster care during the early years of life when neurological development is most active and vulnerable. 3-6 Experiences before entry and while in foster care have the potential to dramatically affect a child's short-and long-term development and their emotional well-being. 7,8It is not surprising that studies have found disproportionately high rates of developmental and mental health problems among children in foster care. 9,10 These problems can have tragic and costly sequelae, including frequent placement failures, academic difficulties, increased high NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript school dropout rates, and later delinquency. 11-15 A large proportion of children enter the foster care system at ages of developmental malleability, conceptualized as ranging from 0 to 5 years. 16 There is a growing body of scientific evidence pointing to the potential of early intervention for the amelioration of developmental and behavioral problems in young children before such detrimental consequences occur. 17-19The theoretical importance of identifying young children with developmental and behavioral problems and linking them to services has been recognized by a number of professional organizations including the The importance of collaboration between social welfare agencies and health, developmental, and mental health professionals was also recently recognized by the federal government. The "Keeping Children and Families...
Estimates of developmental delay in children in out-of-home foster care range from 13-62%. Overlooked in these studies are comparisons of developmental delay differentiated by a child's initial placement type (i.e., biological parent, kinship care, or nonrelative foster care) following evaluation for possible abuse and/or neglect. The developmental status of children residing in these different placement types warrants further scrutiny by clinicians and policy makers, especially due to the recent trend towards family preservation efforts and the growing use of kinship care. Data were collected on 798 children, ages 3-36 months, who were admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998 through June 30, 1999 for investigation of alleged maltreatment. Children admitted received a physical exam and developmental screening using the Denver Developmental Screening Test (Denver-II). Sixty two percent of children (491) scored "suspect" on the Denver Developmental Screening Test II (Denver-II). Of these children, 73% received a developmental evaluation using the Bayley Scales of Infant Development II (Bayley-II). Over 34% of these children evaluated scored more than 2 standard This project was approved by the Institutional Review Board Children's Hospital, San Diego, and the San Diego County Health and Human Services Agency. Funding for the Developmental Screening and Evaluation Project's (DSEP) clinical component was provided by Children's Hospital San Diego, the Child Abuse and Prevention Foundation (CAPF), the San Diego County Health and Human Services Agency (HHSA), and the San Diego County Office of Education. The evaluation component of the project was funded by the Center for Healthier Communities for Children, Children's Hospital, San Diego. The project is indebted to the staff at Polinsky Children's Center (Polinsky) for their dedication to improving service delivery for children in child welfare, particularly those people who worked on the DSEP Project: Nancy Graff, M.D., James Wilkes, Ph.D., John Peoples, and Julie Webster, P.H.N. In addition, Patti Rahiser (HHSA) and Regina Meyer (CAPF) have worked tirelessly to build a multiagency collaborative effort to support this project. We also thank the children at Polinsky for helping us learn more about the needs of children in child welfare. We also want to especially thank Lynn Martin for her commitment to every aspect of this project. We are grateful for the research mentorship provided by John Landsverk, Ph.D., Director of CASRC, and the administrative and statistical support provided by Jennifer Green, James Gearity, M.S.W., and Jennifer A. 497deviations below the mean on at least one component of the Bayley-II regardless of placement type. Although children with "suspect" scores on the Denver-II were more likely to be placed in nonrelative foster care (p Ͻ .013), there was no difference between placement types for children with delay on the Bayley-II. Results for children released to their biological parent(s) shou...
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