Overview of Foster Care in the US

In the U.S. more children are being removed to foster care, seriously stressing the child welfare system and becoming new statistics in the child welfare debates. Many changes in the family appear to have had a destructive impact on the socialization of children and youth. Among the consequences that social scientists have been most worried about are the following:

1.Some research indicates that the “total contact time” between parents and children has declined as much as 40 percent during the past few decades.

2.Many social agencies established to help children and youth are too overload with problems to provide services effectively. William Zinsmeister has described how “many child protection agencies are now doing little more than preventing murder, and sometimes they fail even to do that.” For example, one Maryland social worker, when asked why a six-year-old had not been removed from a known crack house run by his mother, responded that there were “twenty similar cased on his desk, and that he didn’t have time to go through the time-consuming process of taking a child from a parent” unless there was an immediate emergency” (Zinsmeister, 1992, pp. 30-37).

Child welfare has been a category that has covered child abuse, child neglect, foster, care and adoption, but not welfare, or Aid to Families with Dependent Children. In public opinion and public policy, the universe of child welfare is peopled by deviated parents and unlucky children from families of all income groups, while welfare is a program for poor people. This division tends to downplay the reality that children in foster care and at risk of entering foster care are overwhelming the children of the poor (Lamer, Stevenson, & Behrman. 1998).

Temporary Foster Care
The traditional foster care system is relatively commonly referred to, and thus the length requirements of this paper restrict a discussion of the well-known system that in summary, consists of children remaining with foster parents until age 18. In the U.S., temporary foster care has typically been used to treat children in out-of-home care who have more demanding emotional and behavioral needs and who require more intensive structure and mental health services than those in traditional foster care settings (Kutash & Rivera, 1996). On average, youth referred to foster care have spent 4 years in a variety of placements and residential settings prior to entering the foster care placement (Timbers, 1990).

With more demanding emotional and behavioral needs and a history of instability, youth placed in temporary foster care appears to be at high risk for placement disruption. Data on disruption rates for temporary foster care populations are even more sparse than for traditional foster care but are estimated to range from 38% to 70% (Timber, 1990).

Over the past 30 years temporary foster care has been increasingly used as a treatment option for youth who have a variety of attachment, emotional, and behavioral problems. Temporary foster care appeals to both clinicians and policymakers because it is less intrusive and expensive and has been shown to produce greater behavioral improvements compared to residential treatment (Meadowcroft, Thomlinson, & Chamberlain, 1994).

Challenges of the Foster Care System
Ensuring that the health care needs of children in out-of-home care are met is a recognized responsibility of child welfare agencies. Although some health care services are provided by a number of substitute care agencies, in general, health care for children in out-of-home care has received low priority. Standardizing the provision of health care services for children in care has been advocated by such professional organizations as the American Academy of Pediatrics, Committee on Early Childhood, Adoption and Dependent Care, and the Child Welfare League of America. Nonetheless, the probability of the comprehensive health care needs of these children being served is often small, with medical and mental health care services to children in out-of-home care falling victim to duplication, inefficiency, and fragmentation (Gelles, 1990)

Many children, regardless of the type of out-of-home care in which they are placed, are not in good health. An estimated 87% to 95% of children entering child care have at least one physical health problem, and 50% to 60% have multiple physical abnormalities (Chernoff et al. 1994). Children already in care continue to be at high risk for multiple health problems while in placement. The most prevalent problems have been psychological and behavioral (Dubowitz et al. 1990). Dubowitz and colleagues (1990) reported that of 144 children in kinship care diagnosed as depressed or having emotional problems, only 18 (12.5%) were receiving treatment. They concluded that:

“The frequency of mental health services currently received by these children is alarmingly low…few children have received a mental health evaluation and even fewer are receiving mental health services” Dubowitz, 1990, p. 67).

The increased involvement of illegal drug use by parents adds another critical dimension to the problem, one that should be viewed as a “chronic, relapsing syndrome” continuing to endanger children. Child protective services professionals, who have heavy caseloads, acknowledge the need for change, particularly for the development of more accurate criteria for evaluating those families at risk, and professionals throughout the field are unanimous in calling for greater decision making on a case-by-case basis. Over time, the fundamental question in the child welfare debates has shifted away from family preservation as a first priority, and the numerous and varied voices of concern unite in asking: How can we protect those children at greatest risk? (Gelles, 1996).

Addressing the Challenges of Foster Care
A variety of obstacles prevent successful solutions to meeting the health care needs of children in out-of-home care. These include the structure and function of both the out-of-home care and the health care systems. For example, financing issues have been cited as presenting an obstacle to accessing health care services. The problem seems to be less one of eligibility for funds (most children are eligible for some type of Medicaid funding) than of timing, type of services covered, and reimbursement rates. Long delays can occur between the time a child is removed from his or her home and the time a petition is filed for dependency: the child may be ineligible for Medicaid during this time. Additionally, many health care providers refuse to accept Medicaid as payment for services due to low reimbursement rates. Finally, Medicaid often does not cover a broad enough array of services such as dental and mental health care, or does not provide for an adequate level of service. Few published studies have addressed the extent to which states have implemented the Child Welfare League of America Standards for Health Care Services for Children in Out-of-Home Care, and how health care services are organized and monitored (Halfon et al. 1994).

Lack of health care policies, a fragmented health and human service system, and lack of advocacy by caring adults have also been identified as contributing to the underutilization of health care services by children in care (Halfon et al. 1994). For instance, caseworker and caregiver turnover and lack of training may contribute to not recognizing children’s problems and consequently, to a lack of advocacy for such children. Halfon and colleagues (1994) report that few child welfare agencies at the federal, state, or local levels have specific policies or programs to address children’s health care needs. They also report that not enough is known about the current extent of health care policies and programs in out-of-home care programs.

Among the fallout associated with single-parent families, homeless, child abuse, and the feminization of poverty has been a rapid increase in the number of children in foster-care homes and institutions. These interrelated trends have helped bring about a significant change in the structure and function of families in the United States. These trends are associated, on the one hand, with improvements in women’s educational and occupational attainment, and on the other hand, with a decline in economic power among many families headed by women with low incomes. George Miller, Chairman, Committee on Children, Youth, and Families reported that inadequate financing and operation of the foster-care system means that “we are devastating” hundreds of thousands of children, who are “becoming candidates for long-term dependency” on social-welfare agencies (Gross, 1992, pp. 1, 20).

Historically, the relationship between poverty and family breakup was ambiguous, with no public relief, parents too poor to support their children had to put them into orphanages or up for indenture or adoption. The old and familiar conviction underlying such policies, that parents who cannot rear their children without public aid, are almost by definition unfit to bring up the next generation, still holds true in this age of welfare reform. The effort to sever the destiny of needy children from the fate of their unworthy parents repeatedly goes against unyielding truths of child development, the need for intensive human attachment, the traumatic effect of childhood separations, the transformation of yesterday’s children into today’s childbearers. It defies hard economic realities, like the fact that even mediocre substitute for child care for children, whether in a foster home or institution, costs much more than family subsidies, and that adoption, which is ideally both cost-effective and humane, is also governed by laws of supply and demand (Gelles, 1996).

Responding to numerous concerns about the status of American children and families, the National Commission on Children, issued a report calling for comprehensive and expensive improvements in health care, education, income security, and foster care. While recognizing that most American children are “healthy, happy, and secure,” the commission acknowledged the many children “in jeopardy.” Even children who are free from extreme misfortune, the report pointed out,
Confront circumstances and conditions that jeopardize their health and well-begin. They too attend troubled schools and frequent dangerous streets. The adults in their lives are often equally hurried and distracted�The combined effects are that too many children enter adulthood without the skills or motivation to contribute to society. (National Commission on Children, 1991, pp. xvii-xviii)

The only hope for the future well-being of children is to make American child welfare fulfill its promise of benevolence.

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Timbers, G. (1990). Describing the children served in treatment homes. In P. Meadowcroft & B. Trout (Eds.), Troubled youth in treatment homes: A handbook of therapeutic foster care (pp. 21-32). Washington, DC: Child Welfare League of America.

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