Barriers in permanency planning for medically fragile children: Drug affected children and HIV infected children

Abstract

This article discusses the problems of medically fragile children, drug affected and/or HIV infected. Passage of the Adoption Assistance and Child Welfare Act of 1980 markedly increased the number of these children in foster care. The specific barriers to permanency planning for this group of children are discussed and include interviews with staff people, review of the literature and integration of material from pilot studies of families fostering and adopting children with HIV.The passage of P.L. 96-272, the Adoption Assistance and Child Welfare Act of 1980, established a national policy affecting permanency initiatives for children in the foster care system and those at risk of entrance into the Child Welfare System. The legislation emphasized, in order of preference, preservation of the family at risk of disintegration, reunification of children with the biological family if children are in out-of-home care, promotion of adoption if reunification cannot be achieved, guardianship, and long-term foster care. Child welfare service providers were legally mandated to provide effective and timely permanency planning of these options. The passage of this legislation had particular relevance for children with special needs. The

Barriers to Permanency Planning for Older HIV-Affected Caregivers

“…These findings also support scholarship findings that informal social support is important in permanency planning (Draimin, 1995;Draimin et al, 1998;Taylor-Brown et al, 1998) and that HIV-related stigma may act as a barrier to permanency planning (Committee on Pediatric AIDS, 1999;Groze et al, 1994). Social support and stigma are intertwined in HIV-affected families when protecting the HIV secret precludes asking for help.…”

Placement Stability and Mental Health Costs for Children in Foster Care

“…1,[7][8][9][10][11][12][13][14][15][16] Children's experiences in the foster care system are also linked to their overall health. A child with medical problems, 9,17 developmental problems, 18 and mental health problems 5,8,12,[19][20][21][22][23][24][25] is more likely to drift from placement to placement and spend considerable time in the foster care system. The stability of a child's placements might also modify the increased needs 5,[26][27][28][29][30][31] and service use by this population and in part may explain why children in foster care account for 25% to 41% of the annual expenditures for Medicaid mental health services.…”

Kinship Care in the United States

“…Most analysts of child welfare in the USA agree that societal factors such as poverty, racism and homelessness continue to be underlying causes of child placement in out-of-home care. The crack cocaine 'epidemic' beginning in 1986 has contributed significantly to the dramatic increase in foster care placements (Besharov, 1994;Groze et al, 1994). In a national policy study of kinship care, it is estimated that from 80 to 99 per cent of all removals of children from their parents were related to drugs (Hornby et al, 1995).…”