Foster care is a challenging environment, and it is taking in many children who are already burdened in a number of ways. And we’re just now starting to study and quantify how foster care affects the health of the children involved. In this piece, we’re going to take a closer at some of the health challenges facing the more than 700,000 children in the foster care system. We’ll also outline some of the potential ways to alleviate the harm that often comes from being bounced around foster homes and the unaddressed issues too many of these children suffer.
An Overview of the Foster Care System — and Foster Kids
Most children entering foster care are truly disadvantaged. They are much more likely to have come from single parents who couldn’t provide a safe, nurturing and stable home environment. Abuse and neglect cause psychological problems, and around seventy percent of children in foster care were abused or neglected.
Another thirty percent of children are placed in foster care by the juvenile justice system, and they have serious mental health needs that are rarely met. Perhaps half eventually return to their birth families. Another 20 percent are adopted. Most of these are adopted by foster parents. And the older the child is, the less likely they are to be adopted. Tragically, nearly a fifth age out of the system without any connection with family. Let’s look at some of the issues these children face.
The Problems They Bring with Them
Neglect and poverty can contribute to serious health problems. For example, medical and dental needs are often unmet before the children are put in foster care. Unfortunately, these children are less likely than average to get proper medical care for existing medical problems, though they’re more likely to have chronic health problems.
They’re twice as likely to have asthma, obesity and speech problems. They are three times as likely to have hearing and vision problems on average. They’re also much more likely to have mental health problems, but it can take months to find a qualified mental health provider for specific disorders. Yet exposure to complex trauma like addiction and abuse creates complex problems for many of these kids. A greater percentage of children in foster care have developmental problems as well. For example, twice as many children in foster care have learning disabilities and developmental delays than the average population. All of this is exacerbated by the unpredictability of foster care and separation from family.
The Challenges in Getting Adequate Health Care
Foster parents regularly struggle to find adequate healthcare for their foster children. Yes, foster children are typically covered by Medicaid, and that usually continues if the kids are adopted regardless of the parents’ income. Furthermore, foster kids on Medicaid can typically keep the coverage until they turn 26. However, this program isn’t enough.
First, too few doctors accept Medicaid. That makes it difficult to find doctors who provide healthcare for foster children. Second, very few mental health specialists accept Medicaid, yet foster children have a far greater rate and higher average number of mental health issues.
One industry magazine said that almost half of foster children between two and fourteen were diagnosed with clinically significant mental health problem, and more than forty percent of teens had at least one mental health disorder. A much greater number than average has two or three mood disorders.
To put this in perspective, the rate of mental disorders is one in five in the general population. They’re in greatest need for mental health services and often can’t get it. On top of all of this, foster parents have to coordinate treatment decisions between themselves, the government welfare agencies and, often, the biological parents. This results in a delay in getting care, or even receiving less than ideal care. Every time the children change doctors or foster parents, they risk falling out of treatment or critical information is lost.
The Lack of Adequate Mental Health Care
The removal from their families causes intense emotional pain. They don’t just lose access to parents but classmates, neighbors and an entire community of connections. In worst case scenarios, they’re separated from siblings, too.
This creates feelings of anxiety, uncertainty and helplessness. It may make them feel angry, rejected or depressed, and some feel guilty that they broke up their birth family. Foster children are also five times as likely to have anxiety, six times as likely to have general behavioral issues, and seven times as likely to have depression. The odds of having ADHD are triple too. They may have suffered these disorders before being put in foster care or developed it afterward.
Because they’re the new kid, and lack the protective shelter of family, they’re prone to being teased or isolated at their new home. We’ve already addressed the obstacle Medicaid causes — there are too few mental health providers who accept Medicaid. All of this together explains why mental health issues were called the largest unmet health need for children in foster care by the American Academy of Pediatrics.
The foster care system impacts their mental health care in other, subtle ways. For example, foster children are prescribed medication for their mental illnesses at a much higher rate than children with the same disorders that are not in foster care. It is easier to give them pills than keep up with counseling sessions.
The Impact of the Revolving Door on All These Fronts
The revolving door hurts foster children in a number of ways. The high rate of turnover for social workers makes the continuity of services for foster care that much harder. It also interferes in providing adequate levels of supervision and care.
Yet the high caseloads of social workers result in both insufficient supervision and higher burnout rates. That is one reason why improving quality of care for kids in foster care depends on getting more social workers and improving their retention. A shortage of qualified foster homes creates problems, as well. For example, there is an acute shortage of foster homes, especially those that can take sibling groups and older teens.
This increases the odds a sibling group is split up and that older kids are sent to institutions instead of surrogate families. The lack of adequate foster homes leads to less qualified homes being tolerated and greater churn for kids, though they suffer every time they have to move.
This actually results in kids in foster care being at greater risk of developing mental health problems than their peers in the general population. And every time they move, they have to deal with adjustment to a whole new environment along with the loss of their biological or foster family. That’s hard for any child to do, but it is harder for kids without an adequate social support system or good coping skills.
Less experienced social workers don’t have the knowledge necessary to find foster homes that are an ideal fit. However, these children need a foster home that can meet their physical and mental needs. Rushed assessments can result in children being placed in a home that can’t meet their needs, resulting in a disruptive move and delays in getting adequate support.
A lack of time and resources also reduces the odds the children are put in kinship arrangements, staying with stable, supportive relatives. Note that kinship arrangements are the least disruptive to the average child, assuming the adults involved are stable and have access to adequate resources.
At the same time, caseworkers spend time trying to find suitable foster homes or stabilize children as they move through placements, which is time that would be better spent on service coordination, family engagement, or intervention. School changes and relocations interrupt the delivery of services to kids who need mental health services, though these children often have multiple mental, emotional and developmental issues.
The lack of social workers and high workload can even contribute to kids spending more time than necessary in foster care, because social workers don’t have as much time to resolve the issues that created an unsafe home environment, or get parents proper help. In short, trying to find a place for everyone and bouncing them around prevents proper guardianship, adoption and family reunification.
A Few Potential Solutions to These Problems
Here are some potential solutions to the problems highlighted:
- Make relationships the priority and try to keep siblings together. Wherever possible, place children within their extended family network – don’t lose sight of this despite high caseloads and paperwork demands; don’t put kids into a series of foster homes when a little work may let them stay with a grandparent or aunt.
- When kids are in foster care, prioritize maintaining a working relationship within the family. Foster care should be a last resort.
- When children must go into foster care, find a home that fits. This requires a comprehensive pre-placement assessment and tailored foster home matching of the home with the child’s developmental needs.
- Prioritize sibling co-placement if kinship care isn’t an option. Simply increasing rates of sibling co-placement can preserve family attachment, promote continuity, and minimize the emotional harm that being put into foster care can cause. It also reduces the odds of children developing behavioral problems that often lead to reassignment.
- Strengthen assessments. Social workers need much better assessment tools that are kept up to date. Give caseworkers all the resources they need and the education in how to use them. Continue assessing families and children so that children aren’t suffering from conditions that are unaddressed or left in foster care longer than necessary. For example, children need to be screened for trauma and triggers so they don’t melt down at contact with something in the foster home. At the same time, the foster family needs to know what trauma the child has and have adequate resources to treat it and deal with its effects.
- Enhanced education for social workers is another potential solution. Better education for social workers would improve their ability to handle complex issues and balance their workload without sacrificing quality of service. There is also an increased need for people in fields like research, and in specialized social work positions such as school social worker, clinical mental health social worker, and child welfare case worker. This could come in the form of online education. Institutions like Florida University, for instance, give those with a bachelors in social work a chance to get their MSW online, which allows them to pursue an advanced degree while continuing to serve. Promoting these could be one of the options for the lack of specialized workers in the field, and allow current workers to serve a greater need.
- There is also a need for more integrated services. Create networks that can meet the physical, relational, emotional, mental and behavioral needs of foster children and their families. This includes foster families. If at all possible, continue that support if and when children are returned to their biological families. This has a significant, positive impact on families. It also reduces the odds the children will land in the system again. This is common when parents are in deep poverty or struggling with addiction.
- Give foster families adequate support and resources. Texas and Florida are addressing this by creating healthcare programs just for foster children with far better mental health services. Florida’s plan goes even further, providing extra benefits like art therapy and an over the counter medical allowance.
However, that’s not good enough, and finding new foster parents isn’t sufficient, either. For example, ongoing recruitment currently barely keeps up with the rate at which people drop out, though a larger number of foster homes increases the options for placement and the odds of a good match.
We need to provide more training for foster parents so they can handle their charges. Provide more support for them so that they aren’t left burned out or overwhelmed by children in their care. Minimize the odds children are removed from one neglectful or abusive environment, attach to new foster parents and then forced to change environments yet again. Help foster parents know what mental health problems look like and what to do when they see the signs.
Children in foster care come from some of the most difficult situations imaginable. Tragically, the foster care system often compounds issues they have and may cause new ones. There are possible solutions on an individual and societal level that can address these issues. And for the sake of these kids, we need to deliver on as many of them as possible.