The medical and psychosocial needs of children entering foster care

Hochstadt, Neil J.; Jaudes, Paula Kienberger; Zimo, Deborah A.; Schachter, Jayne Ellen

doi:10.1016/0145-2134(87)90033-0

Cited by 161 publications

(71 citation statements)

References 22 publications

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“…7-9 Studies examining behavior problems report that as many as 25% to 40% of children under the age of 6 who enter out-of-home care have significant behavioral issues. 4,5,10 This is much higher than the overall prevalence rate of behavioral issues in the general population of preschoolers, which has been estimated at between 3% and 6%. 11,12 Greater attention has been focused on children in out-of-home care despite the fact that nearly 90% of children whose reports of abuse and neglect are serious enough to trigger an investigation will remain at home after the close of the investigation.…”

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confidence: 80%

Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare

et al. 2005

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Objective-To determine the level of developmental and behavioral need in young children entering child welfare (CW), estimate early intervention services use, and examine variation in need and service use based on age and level of involvement with CW by using a national probability sample in the United States.Methods-As part of the National Survey of Child and Adolescent Well-Being, data were collected on 2813 children <6 years old for whom possible abuse or neglect was investigated by CW agencies. Analyses used descriptive statistics to determine developmental and behavioral needs across 5 domains (cognition, behavior, communication, social, and adaptive functioning) and service use. Logistic regression was used to examine the relationship between independent variables (age, gender, race-ethnicity, maltreatment history, level of CW involvement, and developmental or behavior problems) and service use.Results-Results indicate that age and level of CW involvement predict service use when controlling for need. Both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental and behavioral needs; however, few children are receiving services for these issues (22.7% overall). Children that remain with their biological parents have similar needs to those in outof-home care but are less likely to use services. Children <3 years of age are least likely to use services.Conclusions-Children referred to CW have high developmental and behavioral need regardless of the level of CW involvement. Both age and level of involvement influence service use when controlling for need. Mechanisms need to be developed to address disparities in access to intervention.Address correspondence to Aubyn C. Stahmer, PhD, Child and Adolescent Services Research Center, 3020 Children's Way, MC 5033, San Diego, CA 92123. E-mail: astahmer@casrc.org. No conflict of interest declared.The information and opinions expressed herein reflect solely the position of the authors. Nothing herein should be construed to indicate the support or endorsement of its content by the Administration on Children, Youth and Families/Department of Health and Human Services. Each year ~2.6 million referrals regarding 4.5 million children are made to child welfare (CW) agencies throughout the nation, and 1.8 million of those referrals are accepted for investigation. 1 Overall, at least 12.3 children in every 1000 have been victims of child abuse or neglect. The highest rates of abuse and neglect occur in children under the age of 6. In 2001, >30% of children in CW were between the ages of 0 and 5. 2 Because these same children are frequently seen in medical offices throughout the country, both before and after allegations of abuse are made, the medical, developmental, and behavioral issues that face them are important to pediatricians. NIH Public AccessAlthough limited data exist, local studies suggest that this population of young children is at higher risk for developmental and behavioral problems than children who have not interacted with CW. This is p...

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confidence: 80%

Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare

et al. 2005

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“…Rates of physical and developmental health problems were comparable with those of previous studies with children in foster care 13,22,41-43 ; rates of mental health problems reported were more comparable with reports in community samples than rates in children in foster care. 13,22,42,44,45 When we examined types of problem by initial placement type, no physical health problems were significant when using a Bonferroni adjustment for multiple comparisons. Whereas children entering nonrelative foster care were found to be more likely to have "Suspect" scores on the initial Denver-II screening test, no differences between placement types were observed on full evaluation using either the Bayley Scales of Infant Development II (Bayley-II) or the Stanford-Binet IV (SB-IV).…”

Section: Discussionmentioning

confidence: 99%

“…Studies assessing the physical health of these children suggest that nearly all (87 to 95%) enter out-of-home care with at least one physical health problem and that a majority (50 to 60%) enter with multiple physical needs. 12,13 Studies indicate that developmental delays are also extremely common among children younger than the age of 5 years in out-of-home care, with estimated rates of children exhibiting some developmental delay ranging from 13 to 62%, 11-21 compared with the prevalence of delay in the general pediatric population (4-10%). 22,23 Mental health problems among children in outof-home care are similarly pervasive, having been detected in 48 to 80% of these children, compared with the 10% community-based rate 24 ; these problems include high rates of comorbidity (up to 50%) with other psychological disturbances.…”

Section: Index Termsmentioning

confidence: 99%

The Physical, Developmental, and Mental Health Needs of Young Children in Child Welfare by Initial Placement Type

Leslie¹,

Gordon²,

Meneken³

et al. 2005

Journal of Developmental & Behavioral Pediatrics

171

122

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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...

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“…16,17 Just over 50% of placements are now attributed to abuse and neglect of children, 16,18,19 and these causes have justified increasing placements since 1987. 20 The result is that children in foster care have more chronic medical problems, 16,[21][22][23] and a substantial proportion exhibit emotional and psychologic disorders. 16,18,19,[22][23][24] Research indicates that between 40% and 60% of youths in foster care have at least 1 psychiatric disorder, and approximately 33% have 3 or more diagnosed psychiatric problems.…”

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confidence: 99%

“…20 The result is that children in foster care have more chronic medical problems, 16,[21][22][23] and a substantial proportion exhibit emotional and psychologic disorders. 16,18,19,[22][23][24] Research indicates that between 40% and 60% of youths in foster care have at least 1 psychiatric disorder, and approximately 33% have 3 or more diagnosed psychiatric problems. 25 There is a considerable body of literature on mental health services among youth Medicaid populations.…”

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confidence: 99%

Mental health services for youths in foster care and disabled youths

dosReis

Zito

Safer³

et al. 2001

Am J Public Health

193

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OBJECTIVES: This study assessed whether mental health services for youths differ with respect to medical assistance aid category. METHODS: Computerized claims for 15,507 youths with Medicaid insurance in a populous county of a mid-Atlantic state were used to establish population-based prevalence estimates of mental disorders and psychotherapeutic treatments during 1996. RESULTS: An analysis of service claims revealed that the prevalence of mental disorders among youths enrolled in foster care (57%) was twice that of youths receiving Supplemental Security Income (SSI; 26%) and nearly 15 times that of other youths receiving other types of aid (4%). Rates of mental health service use were pronounced among foster care youths aged 6 to 14 years. Attention deficit/hyperactivity disorder, depression, and developmental disorders were the most prevalent disorders. Stimulants, antidepressants, and anticonvulsants were the most prevalent medications. CONCLUSIONS: Youths enrolled in foster care and youths receiving SSI use far more mental health services than do youths in other aid categories. Additional research should evaluate the complexity and outcomes of mental health services for youths in foster care.

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The medical and psychosocial needs of children entering foster care

Cited by 161 publications

References 22 publications

Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare

Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare

The Physical, Developmental, and Mental Health Needs of Young Children in Child Welfare by Initial Placement Type

Mental health services for youths in foster care and disabled youths

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