WHO CARES?

In the United States the estimated number of children in foster care today is 500,000.  Between 1984 and 1993 the need for out-of-home care for children increased by 61%.  Who are these children? How did they enter foster care? Who cares for them?

Most children in foster care are young. The fastest growing group are infants. About 60 percent of the children are under the age of four. The number of children of color is three times the proportion they represent in the general population.

About 27% of the children will stay in care less than six months and 33% will be in care longer than two years. They are also children with significant health care and educational needs. (Szilagyi, 1998). A federal government report (GAO, 1995) indicates that children in foster care have the poorest physical and mental health in the nation. The circumstances of abuse and neglect that bring them into care necessitate immediate attention to their health and well-being and the provision of comprehensive services.

The reason for the increase in out-of-home care has been attributed to the increase in the number of children being raised in poverty, to increased homelessness, to the increase in substance abuse and to the rise in the incidence of persons with HIV (Rosenfeld et al., 1997). The growing number of children, the increases in the length of stay in care and changes in the health care system are putting extreme stresses on the health, education and welfare systems that have the responsibility for their well-being. There are many people who will be involved in the care of a child from the initial placement until a child is reunited with the birth family, is placed in permanent foster care or is emancipated from the system.

If the goal is reunification or emancipation, in many cases the child remains close to the birth family, relatives and extended family members. Kinship care is often used instead of traditional foster care if the extended family members can care for the child. Most children live in foster homes with foster families and the foster family’s network. Service providers find, give and ensure services on a daily basis. Social workers protect and place children. They work with foster parents to obtain and provide health and educational services.

If a child is placed in a therapeutic foster home, more than one social worker may be involved: one who monitors services on a regular basis and a social worker who oversees the child’s placement and responds to the court system. Teachers provide regular and special education services. Medical providers give physical and mental health services. The attorneys, guardians ad litem, and/or court appointed special advocates (CASA) ensure that judicial services are in place to support the needs of children.

These services are funded under the auspices of the agencies whose global responsibility is to protect and serve the children and families. The social service agency finds and funds appropriate out-of-home care. Health and education agencies pay for and provide physical health, mental health and education services. The judicial system protects the rights of the child and family. All these caregivers and agencies create a complex, community safety net to address the needs of children in foster care.

A critical agency funding medical care is the Health Care Financing Administration (HCFA) and its provision of Medicaid. Children in foster care have an estimated five to seven times greater use of health care services than the typical population. In order to contain rising medical costs these services are increasingly being provided through managed care. Because of the high need for physical and mental health care services, the traditional fee-for-service health care for foster children may be included in this move to managed care.

WHAT IS A MEDICAL HOME?

A medical home is not a building, house or hospital, but rather an approach to providing health care services in a high-quality and cost-effective manner. When children have extraordinary healthcare needs, having a medical home can ensure that those needs are met. Ideally, a medical home provides community-based medical care for infants, children, and adolescents that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally competent. Pediatricians and parents act as partners in a medical home to identify and access all the medical and non-medical services needed to help children and their families achieve their maximum potential.

American Academy of Pediatrics (1995)

Changes in legislation are affecting service provision for children in foster care. The Adoption Assistance and Child Welfare Act of 1980 provided services to protect children and preserve families. With the safety of the children in mind, social service efforts have tried to reunify children with their birth families. The increasing numbers of children in care and the length of stay of children in foster care prompted a rethinking of policy that resulted in the Adoption and Safe Families Act of 1997. There are now shorter timelines to initiate permanency planning for children that will allow social service agencies to begin adoption proceedings for children in need of permanent homes.

With so many community members and agencies involved there are also clear implications. In order for children to have access to coordinated care, members of the caring community must be clear about the role they play on behalf of the children. They must also be cognizant of the roles that other members of the community play. It will be necessary to form trusting relationships among community members; that is, to really listen to each other and to work closely together so children do not slip through the heavily manned net.

CRITICAL LEGISLATION 

FOR CHILDREN IN FOSTER CARE

 

Child Abuse and Prevention Act of 1974 All states must have statutes protecting children under 18 from physical, sexual, mental injury and from abandonment and neglect by their parents or caretakers.

Adoption Assistance and Child Welfare Act of 1980 (P. L. 96-272) The federal government supports and assists states in protecting and caring for abused and neglected children. Each state must have procedural safeguards to ensure that children enter foster care only when necessary, are placed appropriately and are moved to permanent families in a timely fashion.

Adoption & Safe Families Act of 1997 (P. L. 105-89) This legislation is to improve the safety of children, to promote adoption and other permanent homes for children who need them and to support families. New timelines to expedite permanency planning for the child are created.

REFERENCES

Government Accounting Office. (1995). Foster Care Health Needs Of Many Young Children Are Unknown And Unmet. Washington, D. C.: Author. (GAO/HEHS-95-114).

Rosenfeld, et al. (1997). Foster care; An update. Journal Of The American Academy Of Child And Adolescent Psychiatry. 36 (4), 448-457.

Szilagyi, M. (1998). The pediatrician and the child in foster care.Pediatrics in Review. 19 (20), 39-50.

RESOURCES

Batistelli, E. S. (1996). Making Managed Health Care Work For Kids In Foster Care: A Guide To Purchasing Services. Washington, D. C.: CWLA Press.

Batistelli, E. S. (1997). Managed Health Care Guide For Caseworkers And Foster Parents. Washington, D. C.: CWLA Press.

WEB SITES

www.cwla.org

www.acf.dhhs.gov/programs/cb/

 www.fostercare.net/