Thursday, December 6, 2012

Foster care

Foster care is the term used for a system in which a minor who has been made a ward is placed in an institution, group home, or private home of a state-certified caregiver referred to as a "foster parent". The placement of the child is usually arranged through the government or a social-service agency. The institution, group home or foster parent is compensated for expenses.[1] The state via the family court and child protection agency stand in loco parentis to the minor, making all legal decisions while the foster parent is responsible for the day-to-day care of said minor. The foster parent is remunerated by the state for their services. Contents 1 History 2 Foster care placement 3 State abuses 3.1 Drug testing 3.2 Unnecessary/over medication 3.3 Abuse and negligence 4 Negative effects 4.1 Neurodevelopment 4.2 Epigenetic effects of environment 4.3 Post traumatic stress disorder 4.4 Eating disorders 4.5 Disorganized attachment 4.6 Poverty and homelessness 4.7 Suicide-death rate 4.8 Poor academic prospects 5 Therapeutic intervention 6 Foster care in popular culture 7 See also 8 External links 9 References 10 Further reading 11 External links [edit] History [icon] This section requires expansion. (September 2012) Flyer seeking foster families for children on an Orphan Train. The foster care system in the modern sense had its beginnings in 1853 in both the United Kingdom and the United States. In the U.K. the Reverend John Armistead removed children from a workhouse in Cheshire, and placed them with foster families. The local council was legally responsible for the children and paid the foster parents for their maintenance. In the U.S. the Children's Aid Society founded by Charles Loring Brace started the Orphan Train Movement to help get orphaned, abused and neglected children off the streets of New York City, and afterwards other overcrowded cities on the East Coast of the United States, and sent via train to foster homes across the United States.[2] [edit] Foster care placement Foster care is intended to be a short term solution until a permanent placement can be made:[3] Generally the first choice of foster parents is a family member who is a relative such as an aunt, uncle or grandparent. If no related family member is willing or able to adopt, the next preference is for the child to be adopted by the foster parents or by someone else involved in the child's life (such as a teacher or coach). This is to maintain continuity in the child's life. If neither above option are available, the child may be adopted by someone who is a stranger to the child. If none of these options are viable the plan for the minor may be to enter OPPLA (Other Planned Permanent Living Arrangement). This option allows the child to stay in custody of the state and the child can stay placed in a foster home, with a relative or a long term care facility (for children with development disabilities, physical disabilities or mental disabilities). 547,415 children were in publicly supported foster care in the United States in September 2000.[4] In 2009, there were 423,773 children in foster care, a drop of about 20% in a decade.[5] In 2009, there were about 123,000 children ready for adoptive families in the nation's foster care systems.[6] African American children represented 41% of children in foster care, white children represented 40% and Hispanic children represented 15% in 2000.[4] Children may enter foster care via voluntary or involuntary means. Voluntary placement may occur when a biological parent or lawful guardian is unable to care for a child. Involuntary placement occurs when a child is removed from their biological parent or lawful guardian due to the risk or actual occurrence of physical or psychological harm. In the US, most children enter foster care due to neglect.[7] If a biological parent or lawful guardian is unwilling to care for a child, the child is deemed to be dependent and is placed under the care of the child protection agency. The policies regarding foster care as well as the criteria to be met in order to become a foster parent vary according to legal jurisdiction. Especially egregious failures of child protective services often serve as a catalyst for increased removal of children from the homes of biological parents. An example is the brutal torture and murder of 17-month-old Peter Connelly, a British toddler who died in London Borough of Haringey, North London after suffering more than 50 severe injuries over an eight-month period, including eight broken ribs and a broken back. Throughout the period of time in which he was being tortured he was repeatedly seen by Haringey Children's services and NHS health professionals.[8] Haringey Children's services already failed ten years earlier in the case of Victoria Climbié.[9]In the time since his death in 2007 cases have reached a record rate in England surpassing 10,000 in the reporting year ending in March 2012.[10] [edit] State abuses [edit] Drug testing Throughout the 1990s, experimental HIV drugs were tested on HIV-positive foster children at Incarnation Children’s Center in Harlem. The agency has also been accused of racism, some comparing the trials to the Tuskegee syphilis experiment, as 98 percent of children in foster care in New York City belong to ethnic minorities.[11] [edit] Unnecessary/over medication Studies[12] have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate that was 3 times higher than that of Medicaid-insured youth who qualify by low family income. In a review (September 2003 to August 2004) of the medical records of 32,135 Texas foster care 0–19 years-old, 12,189 were prescribed psychotropic medication, resulting in an annual prevalence of 37.9% of these children being prescribed medication. 41.3% received 3 different classes of these drugs during July 2004, and 15.9% received 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). "Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety".[12] — Psychotropic medication patterns among youth in foster care., Pediatrics 2008 Psychiatrists prescribed 93% of the psychotropic medication, and it was noted in the review of these cases that the use of expensive, brand name, patent protected medication was prevalent. In the case of SSRIs the use of the most expensive medications was noted to be 74%, in the general market only 28% are for brand name SSRI's vs generics. The average out-of-pocket expense per prescription was $34.75 for generics and $90.17 for branded products, a $55.42, difference.[13] [edit] Abuse and negligence Only known photograph of five-year-old Georgia resident Terrell Peterson while alive, taken shortly before his murder at the hands of his foster parent. The case was covered up by the Georgia Department of Children and Family Services. Children in foster care experience high rates of child abuse, emotional deprivation, and physical neglect. In one study in the United Kingdom "foster children were 7–8 times, and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population".[14] One study by Johns Hopkins University found that the rate of sexual abuse within the foster-care system is more than four times as high as in the general population; in group homes, the rate of sexual abuse is more than 28 times that of the general population.[15][16] An Indiana study found three times more physical abuse and twice the rate of sexual abuse in foster homes than in the general population.[16] A study of foster children in Oregon and Washington State found that nearly one third reported being abused by a foster parent or another adult in a foster home.[17] These statistics do not speak to the situation these children are coming from, but it does show the very large problem of child-on-child sexual abuse within the system. In the United Kingdom a convicted pedophile was allowed to become a foster parent despite having served three years in prison for sexually abusing a Boy Scout. The convicted pedophile – David Mason – was allowed to have a foster child placed with him because the Kent County Council did not have his identity checked. Mason is currently incarcerated for numerous charges including rape.[18] In Nottinghamshire County in the UK an ex-foster father was convicted in 2010 of raping and sexually abusing vulnerable boys for more than a decade.[19] [edit] Negative effects The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing "poorly". Individuals who were in foster care experience higher rates of physical and psychiatric morbidity than the general population and suffer from not being able to trust and that can lead to placements breaking down.[20] In the Casey study of foster children in Oregon and Washington state, they were found to have double the incidence of depression, 20% as compared to 10% and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having Attention Deficit Hyperactivity Disorder, and deficits in executive functioning, anxiety as well as other developmental problems.[21][22][23][24] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Recent studies in the U.S. suggest that foster care placements are more detrimental to children than remaining in a troubled home.[25][26][27] The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing "poorly". [edit] Neurodevelopment Foster care has been shown in various studies to have deleterious consequences on the physical health and mental wellbeing of those who were in foster care. Many children enter foster care at a very young age, a period where the development of mental and psychological processes are at one of their critical peaks. The human brain doesn't fully develop until approximately the age of 25,[28] and one of the most critical periods of brain development occurs in the first 3–4 years. The processes that govern the development of personality traits, stress response and cognitive skills are formed during this period. The developing brain is directly influenced by negative environmental factors including lack of stimulation due to emotional neglect, poor nutrition, exposure to violence in the home environment and child abuse.[29] Negative environmental influences have a direct effect on all areas of neurodevelopment: neurogenesis (creation of new neurons), apoptosis (death and reabsorption of neurons), migration (of neurons to different regions of the brain), synaptogenesis (creation of synapses), synaptic sculpturing (determining the make-up of the synapse), arborization (the growth of dendritic connections), myelinzation (protective covering of neurons), and an enlargement of the brain's ventricles, which can cause cortical atrophy.[30][31] Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Foster children have elevated levels of cortisol, a stress hormone in comparison to children raised by their biological parents. Elevated cortisol levels can compromise the immune system. (Harden BJ, 2004).[32] Negative environmental influences during this critical period of brain development can have lifelong consequences.[33][34][35][36] [edit] Epigenetic effects of environment Gene expression can be affected by the environment through epigenetic mechanisms. Negative environmental influences, such as maternal deprivation, child abuse and stress[37][38] have been shown to have a profound effect on gene expression, including transgenerational epigenetic effects in which physiological and behavioral (intellectual) transfer of information across generations-not-yet-conceived is effected. In the Överkalix study in Sweden, the effects of epigentic inheritance were shown to have a direct correlation to the environmental influences faced by the parents and grandparents.[39] Many physiological and behavioral characteristics ascribed to Mendelian inheritance are due in fact to transgenerational epigenetic inheritance. The implications in terms of foster care and the cost to society as a whole is that the stress, deprivation and other negative environmental factors many foster children are subjected to has a detrimental effect not only their physical, emotional and cognitive well-being, but that the damage can transcend generations.[40][41][42] In studies of the adult offspring of Holocaust survivors, parental PTSD was a risk factor for the development of PTSD in adult offspring in comparison to those whose parents went through the Holocaust without developing PTSD. The offspring of survivors with PTSD had lower levels of urinary cortisol excretion, salivary cortisol and enhanced plasma cortisol suppression in response to low dose dexamethasone administration than offspring of survivors without PTSD. Low cortisol levels are associated with parental, particularly maternal, PTSD. This is in contrast to the normal stress response in which cortisol levels are elevated after exposure to a stressor. The results of the study point to the involvement of epigenetic mechanisms.[43][44] Epigenetic Effects of Abuse "In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. (Neighh GN et al. 2009)[45] It has been suggested in various studies that the deleterious epigentic effects may be somewhat ameliorated through pharmacological manipulations in adulthood via the administration of nerve growth factor-inducible protein A,[46] and through the inhibition of a class of enzymes known as the histone deacetylases (HDACs). "HDAC inhibitors (HDACIs) such as Trichostatin A (TSA); "TSA can be used to alter gene expression by interfering with the removal of acetyl groups from histones", and L-methionine an essential amino acid, have been developed for the treatment of a variety of malignancies and neurodegenerative disorders. Drug combination approaches have also shown promise for the treatment of mood disorders including bipolar disorder, anxiety and depression."[47][48] [edit] Post traumatic stress disorder Regions of the brain associated with stress and posttraumatic stress disorder[49] Children in foster care have a higher incidence of posttraumatic stress disorder (PTSD). In one study,[50] 60% of children in foster care who had experienced sexual abuse had PTSD, and 42% of those who had been physically abused fulfilled the PTSD criteria. PTSD was also found in 18% of the children who were not abused. These children may have developed PTSD due to witnessing violence in the home. (Marsenich, 2002). In a study conducted in Oregon and Washington state, the rate of PTSD in adults who were in foster care for one year between the ages of 14–18 was found to be higher than that of combat veterans, with 25 percent of those in the study meeting the diagnostic criteria as compared to 12–13 percent of Iraq war veterans and 15 percent of Vietnam war veterans, and a rate of 4% in the general population. The recovery rate for foster home alumni was 28.2% as opposed to 47% in the general population. "More than half the study participants reported clinical levels of mental illness, compared to less than a quarter of the general population".[51][52] [edit] Eating disorders Foster children are at increased risk for a variety of eating disorders, in comparison to the general population. Obesity: Children in foster care are more prone to becoming overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.[53] Hyperphagic Short Stature syndrome (HSS) is a condition characterized by short stature due to insufficient growth hormone production, an excessive appetite (hyperphagia) and mild learning disabilities. While it is believed to have genetic component, HSS is triggered by being exposed to an environment of high psychosocial stress; it is not uncommon in children in foster homes or other stressful environments. HSS improves upon removal from the stressful environment.[54][55][56] Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care. It is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity"; it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to, it was prevalent amongst 25 percent of the study group in New Zealand.[22] Bulimia Nervosa is seven times more prevalent among former foster children than in the general population.[57] [edit] Disorganized attachment A study by Dante Cicchetti found that 80% of abused and maltreated infants in his study exhibited symptoms of disorganized attachment.[58][59] Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing psychiatric problems.[60][61][62][63] These children may be described as experiencing trauma as the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment.[62][64][65] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[66] as well as depressive, anxiety, and acting-out symptoms.[67][68] [edit] Poverty and homelessness New York street children; 1890 Nearly half of foster kids in the U.S. become homeless when they turn 18.[69][70] "One of every 10 foster children stays in foster care longer than seven years, and each year about 15,000 reach the age of majority and leave foster care without a permanent family—many to join the ranks of the homeless or to commit crimes and be imprisoned.[71][72] Three out of 10 of the United States homeless are former foster children.[73] According to the results of the Casey Family Study of Foster Care Alumni, up to 80 percent are doing poorly—with a quarter to a third of former foster children at or below the poverty line, three times the national poverty rate.[74] Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others experienced "unofficial" placements in the homes of family or friends. Individuals with a history of foster care tend to become homeless at an earlier age than those who were not in foster care.[citation needed] The length of time a person remains homeless is longer in individuals who were in foster care.[75] [edit] Suicide-death rate Children in foster care are at a greater risk of suicide,[76] the increased risk of suicide is still prevalent after leaving foster care and occurs at a higher rate than the general population. In a small study of twenty-two Texan youths who aged out of the system, 23 percent had a history of suicide attempts.[77] A Swedish study utilizing the data of almost one million people including 22,305 former foster children who had been in care prior to their teens, concluded: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts....Individuals who had been in long-term foster care tended to have the most dismal outcome...former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity.[78] Death rate Children in foster care have an overall higher mortality rate than children in the general population.[79] A study conducted in Finland among current and former foster children up to age 24 found a higher mortality rate due to substance abuse, accidents, suicide and illness. The deaths due to illness were attributed to an increased incidence of acute and chronic medical conditions and developmental delays among children in foster care.[80] Georgia Senator Nancy Schaefer published a report "The Corrupt Business of Child Protective Services"[81] stating: "The National Center on Child Abuse and Neglect in 1998 reported that six times as many children died in foster care than in the general public and that once removed to official “safety”, these children are far more likely to suffer abuse, including sexual molestation than in the general population".[81] [edit] Poor academic prospects Educational outcomes of ex-foster children in the Northwest Alumni Study*[82] 56% completed high school compared to 82% of the general population, although an additional 29% of former foster children received a G.E.D. compared to an additional 5% of the general population. 42.7% completed some education beyond high school. 20.6% completed any degree or certificate beyond high school 16.1% completed a vocational degree; 21.9% for those over 25. 1.8% complete a bachelors degree, 2.7% for over 25, the completion rate for the general population in the same age group is 24%, a sizable difference. *The study reviewed case records for 659 foster care alumni in Northwest USA, and interviewed 479 of them between September 2000 and January 2002.[82] Several studies have indicated that foster care children tend to underachieve academically with many never completing Foster care is the term used for a system in which a minor who has been made a ward is placed in an institution, group home, or private home of a state-certified caregiver referred to as a "foster parent". The placement of the child is usually arranged through the government or a social-service agency. The institution, group home or foster parent is compensated for expenses.[1] The state via the family court and child protection agency stand in loco parentis to the minor, making all legal decisions while the foster parent is responsible for the day-to-day care of said minor. The foster parent is remunerated by the state for their services. Contents 1 History 2 Foster care placement 3 State abuses 3.1 Drug testing 3.2 Unnecessary/over medication 3.3 Abuse and negligence 4 Negative effects 4.1 Neurodevelopment 4.2 Epigenetic effects of environment 4.3 Post traumatic stress disorder 4.4 Eating disorders 4.5 Disorganized attachment 4.6 Poverty and homelessness 4.7 Suicide-death rate 4.8 Poor academic prospects 5 Therapeutic intervention 6 Foster care in popular culture 7 See also 8 External links 9 References 10 Further reading 11 External links [edit] History [icon] This section requires expansion. (September 2012) Flyer seeking foster families for children on an Orphan Train. The foster care system in the modern sense had its beginnings in 1853 in both the United Kingdom and the United States. In the U.K. the Reverend John Armistead removed children from a workhouse in Cheshire, and placed them with foster families. The local council was legally responsible for the children and paid the foster parents for their maintenance. In the U.S. the Children's Aid Society founded by Charles Loring Brace started the Orphan Train Movement to help get orphaned, abused and neglected children off the streets of New York City, and afterwards other overcrowded cities on the East Coast of the United States, and sent via train to foster homes across the United States.[2] [edit] Foster care placement Foster care is intended to be a short term solution until a permanent placement can be made:[3] Generally the first choice of foster parents is a family member who is a relative such as an aunt, uncle or grandparent. If no related family member is willing or able to adopt, the next preference is for the child to be adopted by the foster parents or by someone else involved in the child's life (such as a teacher or coach). This is to maintain continuity in the child's life. If neither above option are available, the child may be adopted by someone who is a stranger to the child. If none of these options are viable the plan for the minor may be to enter OPPLA (Other Planned Permanent Living Arrangement). This option allows the child to stay in custody of the state and the child can stay placed in a foster home, with a relative or a long term care facility (for children with development disabilities, physical disabilities or mental disabilities). 547,415 children were in publicly supported foster care in the United States in September 2000.[4] In 2009, there were 423,773 children in foster care, a drop of about 20% in a decade.[5] In 2009, there were about 123,000 children ready for adoptive families in the nation's foster care systems.[6] African American children represented 41% of children in foster care, white children represented 40% and Hispanic children represented 15% in 2000.[4] Children may enter foster care via voluntary or involuntary means. Voluntary placement may occur when a biological parent or lawful guardian is unable to care for a child. Involuntary placement occurs when a child is removed from their biological parent or lawful guardian due to the risk or actual occurrence of physical or psychological harm. In the US, most children enter foster care due to neglect.[7] If a biological parent or lawful guardian is unwilling to care for a child, the child is deemed to be dependent and is placed under the care of the child protection agency. The policies regarding foster care as well as the criteria to be met in order to become a foster parent vary according to legal jurisdiction. Especially egregious failures of child protective services often serve as a catalyst for increased removal of children from the homes of biological parents. An example is the brutal torture and murder of 17-month-old Peter Connelly, a British toddler who died in London Borough of Haringey, North London after suffering more than 50 severe injuries over an eight-month period, including eight broken ribs and a broken back. Throughout the period of time in which he was being tortured he was repeatedly seen by Haringey Children's services and NHS health professionals.[8] Haringey Children's services already failed ten years earlier in the case of Victoria Climbié.[9]In the time since his death in 2007 cases have reached a record rate in England surpassing 10,000 in the reporting year ending in March 2012.[10] [edit] State abuses [edit] Drug testing Throughout the 1990s, experimental HIV drugs were tested on HIV-positive foster children at Incarnation Children’s Center in Harlem. The agency has also been accused of racism, some comparing the trials to the Tuskegee syphilis experiment, as 98 percent of children in foster care in New York City belong to ethnic minorities.[11] [edit] Unnecessary/over medication Studies[12] have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate that was 3 times higher than that of Medicaid-insured youth who qualify by low family income. In a review (September 2003 to August 2004) of the medical records of 32,135 Texas foster care 0–19 years-old, 12,189 were prescribed psychotropic medication, resulting in an annual prevalence of 37.9% of these children being prescribed medication. 41.3% received 3 different classes of these drugs during July 2004, and 15.9% received 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). "Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety".[12] — Psychotropic medication patterns among youth in foster care., Pediatrics 2008 Psychiatrists prescribed 93% of the psychotropic medication, and it was noted in the review of these cases that the use of expensive, brand name, patent protected medication was prevalent. In the case of SSRIs the use of the most expensive medications was noted to be 74%, in the general market only 28% are for brand name SSRI's vs generics. The average out-of-pocket expense per prescription was $34.75 for generics and $90.17 for branded products, a $55.42, difference.[13] [edit] Abuse and negligence Only known photograph of five-year-old Georgia resident Terrell Peterson while alive, taken shortly before his murder at the hands of his foster parent. The case was covered up by the Georgia Department of Children and Family Services. Children in foster care experience high rates of child abuse, emotional deprivation, and physical neglect. In one study in the United Kingdom "foster children were 7–8 times, and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population".[14] One study by Johns Hopkins University found that the rate of sexual abuse within the foster-care system is more than four times as high as in the general population; in group homes, the rate of sexual abuse is more than 28 times that of the general population.[15][16] An Indiana study found three times more physical abuse and twice the rate of sexual abuse in foster homes than in the general population.[16] A study of foster children in Oregon and Washington State found that nearly one third reported being abused by a foster parent or another adult in a foster home.[17] These statistics do not speak to the situation these children are coming from, but it does show the very large problem of child-on-child sexual abuse within the system. In the United Kingdom a convicted pedophile was allowed to become a foster parent despite having served three years in prison for sexually abusing a Boy Scout. The convicted pedophile – David Mason – was allowed to have a foster child placed with him because the Kent County Council did not have his identity checked. Mason is currently incarcerated for numerous charges including rape.[18] In Nottinghamshire County in the UK an ex-foster father was convicted in 2010 of raping and sexually abusing vulnerable boys for more than a decade.[19] [edit] Negative effects The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing "poorly". Individuals who were in foster care experience higher rates of physical and psychiatric morbidity than the general population and suffer from not being able to trust and that can lead to placements breaking down.[20] In the Casey study of foster children in Oregon and Washington state, they were found to have double the incidence of depression, 20% as compared to 10% and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having Attention Deficit Hyperactivity Disorder, and deficits in executive functioning, anxiety as well as other developmental problems.[21][22][23][24] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Recent studies in the U.S. suggest that foster care placements are more detrimental to children than remaining in a troubled home.[25][26][27] The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing "poorly". [edit] Neurodevelopment Foster care has been shown in various studies to have deleterious consequences on the physical health and mental wellbeing of those who were in foster care. Many children enter foster care at a very young age, a period where the development of mental and psychological processes are at one of their critical peaks. The human brain doesn't fully develop until approximately the age of 25,[28] and one of the most critical periods of brain development occurs in the first 3–4 years. The processes that govern the development of personality traits, stress response and cognitive skills are formed during this period. The developing brain is directly influenced by negative environmental factors including lack of stimulation due to emotional neglect, poor nutrition, exposure to violence in the home environment and child abuse.[29] Negative environmental influences have a direct effect on all areas of neurodevelopment: neurogenesis (creation of new neurons), apoptosis (death and reabsorption of neurons), migration (of neurons to different regions of the brain), synaptogenesis (creation of synapses), synaptic sculpturing (determining the make-up of the synapse), arborization (the growth of dendritic connections), myelinzation (protective covering of neurons), and an enlargement of the brain's ventricles, which can cause cortical atrophy.[30][31] Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Foster children have elevated levels of cortisol, a stress hormone in comparison to children raised by their biological parents. Elevated cortisol levels can compromise the immune system. (Harden BJ, 2004).[32] Negative environmental influences during this critical period of brain development can have lifelong consequences.[33][34][35][36] [edit] Epigenetic effects of environment Gene expression can be affected by the environment through epigenetic mechanisms. Negative environmental influences, such as maternal deprivation, child abuse and stress[37][38] have been shown to have a profound effect on gene expression, including transgenerational epigenetic effects in which physiological and behavioral (intellectual) transfer of information across generations-not-yet-conceived is effected. In the Överkalix study in Sweden, the effects of epigentic inheritance were shown to have a direct correlation to the environmental influences faced by the parents and grandparents.[39] Many physiological and behavioral characteristics ascribed to Mendelian inheritance are due in fact to transgenerational epigenetic inheritance. The implications in terms of foster care and the cost to society as a whole is that the stress, deprivation and other negative environmental factors many foster children are subjected to has a detrimental effect not only their physical, emotional and cognitive well-being, but that the damage can transcend generations.[40][41][42] In studies of the adult offspring of Holocaust survivors, parental PTSD was a risk factor for the development of PTSD in adult offspring in comparison to those whose parents went through the Holocaust without developing PTSD. The offspring of survivors with PTSD had lower levels of urinary cortisol excretion, salivary cortisol and enhanced plasma cortisol suppression in response to low dose dexamethasone administration than offspring of survivors without PTSD. Low cortisol levels are associated with parental, particularly maternal, PTSD. This is in contrast to the normal stress response in which cortisol levels are elevated after exposure to a stressor. The results of the study point to the involvement of epigenetic mechanisms.[43][44] Epigenetic Effects of Abuse "In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. (Neighh GN et al. 2009)[45] It has been suggested in various studies that the deleterious epigentic effects may be somewhat ameliorated through pharmacological manipulations in adulthood via the administration of nerve growth factor-inducible protein A,[46] and through the inhibition of a class of enzymes known as the histone deacetylases (HDACs). "HDAC inhibitors (HDACIs) such as Trichostatin A (TSA); "TSA can be used to alter gene expression by interfering with the removal of acetyl groups from histones", and L-methionine an essential amino acid, have been developed for the treatment of a variety of malignancies and neurodegenerative disorders. Drug combination approaches have also shown promise for the treatment of mood disorders including bipolar disorder, anxiety and depression."[47][48] [edit] Post traumatic stress disorder Regions of the brain associated with stress and posttraumatic stress disorder[49] Children in foster care have a higher incidence of posttraumatic stress disorder (PTSD). In one study,[50] 60% of children in foster care who had experienced sexual abuse had PTSD, and 42% of those who had been physically abused fulfilled the PTSD criteria. PTSD was also found in 18% of the children who were not abused. These children may have developed PTSD due to witnessing violence in the home. (Marsenich, 2002). In a study conducted in Oregon and Washington state, the rate of PTSD in adults who were in foster care for one year between the ages of 14–18 was found to be higher than that of combat veterans, with 25 percent of those in the study meeting the diagnostic criteria as compared to 12–13 percent of Iraq war veterans and 15 percent of Vietnam war veterans, and a rate of 4% in the general population. The recovery rate for foster home alumni was 28.2% as opposed to 47% in the general population. "More than half the study participants reported clinical levels of mental illness, compared to less than a quarter of the general population".[51][52] [edit] Eating disorders Foster children are at increased risk for a variety of eating disorders, in comparison to the general population. Obesity: Children in foster care are more prone to becoming overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.[53] Hyperphagic Short Stature syndrome (HSS) is a condition characterized by short stature due to insufficient growth hormone production, an excessive appetite (hyperphagia) and mild learning disabilities. While it is believed to have genetic component, HSS is triggered by being exposed to an environment of high psychosocial stress; it is not uncommon in children in foster homes or other stressful environments. HSS improves upon removal from the stressful environment.[54][55][56] Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care. It is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity"; it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to, it was prevalent amongst 25 percent of the study group in New Zealand.[22] Bulimia Nervosa is seven times more prevalent among former foster children than in the general population.[57] [edit] Disorganized attachment A study by Dante Cicchetti found that 80% of abused and maltreated infants in his study exhibited symptoms of disorganized attachment.[58][59] Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing psychiatric problems.[60][61][62][63] These children may be described as experiencing trauma as the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment.[62][64][65] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[66] as well as depressive, anxiety, and acting-out symptoms.[67][68] [edit] Poverty and homelessness New York street children; 1890 Nearly half of foster kids in the U.S. become homeless when they turn 18.[69][70] "One of every 10 foster children stays in foster care longer than seven years, and each year about 15,000 reach the age of majority and leave foster care without a permanent family—many to join the ranks of the homeless or to commit crimes and be imprisoned.[71][72] Three out of 10 of the United States homeless are former foster children.[73] According to the results of the Casey Family Study of Foster Care Alumni, up to 80 percent are doing poorly—with a quarter to a third of former foster children at or below the poverty line, three times the national poverty rate.[74] Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others experienced "unofficial" placements in the homes of family or friends. Individuals with a history of foster care tend to become homeless at an earlier age than those who were not in foster care.[citation needed] The length of time a person remains homeless is longer in individuals who were in foster care.[75] [edit] Suicide-death rate Children in foster care are at a greater risk of suicide,[76] the increased risk of suicide is still prevalent after leaving foster care and occurs at a higher rate than the general population. In a small study of twenty-two Texan youths who aged out of the system, 23 percent had a history of suicide attempts.[77] A Swedish study utilizing the data of almost one million people including 22,305 former foster children who had been in care prior to their teens, concluded: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts....Individuals who had been in long-term foster care tended to have the most dismal outcome...former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity.[78] Death rate Children in foster care have an overall higher mortality rate than children in the general population.[79] A study conducted in Finland among current and former foster children up to age 24 found a higher mortality rate due to substance abuse, accidents, suicide and illness. The deaths due to illness were attributed to an increased incidence of acute and chronic medical conditions and developmental delays among children in foster care.[80] Georgia Senator Nancy Schaefer published a report "The Corrupt Business of Child Protective Services"[81] stating: "The National Center on Child Abuse and Neglect in 1998 reported that six times as many children died in foster care than in the general public and that once removed to official “safety”, these children are far more likely to suffer abuse, including sexual molestation than in the general population".[81] [edit] Poor academic prospects Educational outcomes of ex-foster children in the Northwest Alumni Study*[82] 56% completed high school compared to 82% of the general population, although an additional 29% of former foster children received a G.E.D. compared to an additional 5% of the general population. 42.7% completed some education beyond high school. 20.6% completed any degree or certificate beyond high school 16.1% completed a vocational degree; 21.9% for those over 25. 1.8% complete a bachelors degree, 2.7% for over 25, the completion rate for the general population in the same age group is 24%, a sizable difference. *The study reviewed case records for 659 foster care alumni in Northwest USA, and interviewed 479 of them between September 2000 and January 2002.[82] Several studies have indicated that foster care children tend to underachieve academically with many never completing high school. In a study conducted in Philadelphia by Johns Hopkins University it was found that; among high school students who are in foster care, have been abused and neglected, or receive out of home placement by the courts, the probability of dropping out of school is greater than 75%.[83] It is important to be clear that these high rates of dropping out of school do not necessarily mean that contact with these social service systems caused these students to drop out, nor does it imply that pregnancy, birth, or juvenile justice placements preceded dropping out of school. But the data do highlight the magnitude of the challenge facing the city’s social service agencies as they attempt to support students through adolescence to earn their high school diploma. The educational supports provided to the adolescents involved with the City of Philadelphia’s social service agencies are currently insufficient to stem the tide of agency-involved youth who embark on adult life without a high school diploma.[83] [edit] Therapeutic intervention Children in the child welfare system have often experienced significant and repeated traumas and having a background in foster homes—especially in instances of sexual abuse—can be the precipitating factor in a wide variety of psychological and cognitive deficits[84] it may also serve to obfuscate the true cause of underlying issues. The foster care experience may have nothing to do with the symptoms, or on the other hand, a disorder may be exacerbated by having a history of foster care and attendant abuses. The human brain however has been shown to have a fair degree of neuroplasticity.[85][86][87]and adult neurogenesis has been shown to be an ongoing process.[88] Dyadic Developmental Psychotherapy is one of the approaches that has been used to treat the resulting trauma and attachment difficulties caused by chronic early maltreatment within a care-giving relationship.[89][90][91] [edit] Foster care in popular culture Fictional characters who have been in foster care have been represented in a variety of mass entertainment media throughout the years including the following television shows: Bones.[92] Secret Life of the American Teenager'[93] Leverage'.[94][95] The Great Gilly Hopkins Money Train Hustle (TV series) Life Unexpected Roswell (TV series) The Story of Tracy Beaker The Lying Game Coronation Street Foster's Home for Imaginary Friends Famous former foster children: Allison Anders Alonzo Mourning Babe Ruth Eddie Murphy Eriq La Salle Esai Morales Marilyn Monroe Victoria Rowell[96] Wayne Dyer Leland Chapman [edit] See also Foster care in Australia Foster care in the United Kingdom Foster care in the United States Foster care in Canada Foster care adoption Grandfamily Residential education Attachment theory Complex post-traumatic stress disorder Reactive attachment disorder [edit] External links The impact of foster care on development[3] Effects of early psychosocial deprivation on the development of memory and executive function[4] Enduring neurobehavioral effects of early life trauma mediated through learning and corticosterone suppression[5] [edit] References ^ "Foster care". 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(1990) Parents’ Unresolved Traumatic Experiences are related to infant disorganized attachment status. In M.T. Greenberg, D. Ciccehetti, & E. M. Cummings (Eds), Attachment in the Preschool Years: Theory, Research, and Intervention (pp161-184). Chicago: University of Chicago Press ^ Carlson, E. A. (1988). "A prospective longitudinal study of disorganized/disoriented attachment". Child Development 69 (4): 1107–1128. PMID 9768489. ^ Lyons-Ruth, K. (1996). "Attachment relationships among children with aggressive behavior problems: The role of disorganized early attachment patterns". Journal of Consulting and Clinical Psychology 64 (1): 64–73. doi:10.1037/0022-006X.64.1.64. PMID 8907085. ^ Lyons-Ruth, K.; Alpern, L.; Repacholi, B. (1993). "Disorganized infant attachment classification and maternal psychosocial problems as predictors of hostile-aggressive behavior in the preschool classroom". Child Development 64 (2): 572–585. doi:10.2307/1131270. JSTOR 1131270. PMID 8477635. ^ "Throwaway kids". Pasadena Weekly. 2006-06-22. Retrieved 2011-11-01. ^ "Saving foster kids from the streets / As the nation faces a new wave of homeless children, Larkin youth center helps provide a transition to adulthood". Sfgate.com. 2004-04-11. Retrieved 2011-11-01. ^ Current Controversies: Issues in Adoption. Ed. William Dudley. Publisher: Greenhaven Press; 1 edition (December 19, 2003) Language: English ISBN 0-7377-1626-6 ISBN 978-0-7377-1626-9 ^ Lopez, P; Allen, PJ (2007). "Addressing the health needs of adolescents transitioning out of foster care". Pediatric nursing 33 (4): 345–55. PMID 17907736. ^ V.Roman, N.P. & Wolfe, N. (1995). Web of failure: The relationship between foster care and homelessness. Washington, DC: National Alliance to End Homelessness. ^ "80 Percent Failure A Brief Analysis of the Casey Family Programs Northwest Foster Care Alumni Study". Nccpr.info. 2005-04-07. Retrieved 2011-11-01. ^ Web of Failure: The Relationship Between Foster Care and Homelessness, Nan P. Roman, Phyllis Wolfe, National Alliance to End Homelessness ^ Charles, G; Matheson, J (1991). "Suicide prevention and intervention with young people in foster care in Canada". Child welfare 70 (2): 185–91. PMID 2036873. ^ "Improving Outcomes for Older Youth" (PDF). Retrieved 2011-11-01. ^ Vinnerljung, B; Hjern, A; Lindblad, F (2006). "Suicide attempts and severe psychiatric morbidity among former child welfare clients—a national cohort study". Journal of child psychology and psychiatry, and allied disciplines 47 (7): 723–33. doi:10.1111/j.1469-7610.2005.01530.x. PMID 16790007. ^ Barth, R; Blackwell, Debra L. (1998). "Death rates among California's foster care and former foster care populations". Children and Youth Services Review 20 (7): 577–604. doi:10.1016/S0190-7409(98)00027-9. ^ Kalland, M; Pensola, TH; Meriläinen, J; Sinkkonen, J (2001). "Mortality in children registered in the Finnish child welfare registry: population based study". BMJ (Clinical research ed.) 323 (7306): 207–8. doi:10.1136/bmj.323.7306.207. PMC 35273. PMID 11473912. ^ a b "The Corrupt Business of Child Protective Services – report by Senator Nancy Schaefer, September 25, 2008". ^ a b "Findings from the Northwest Foster Care Alumni Study". ^ a b *Unfulfilled Promise: The Dimensions and Characteristics of Philadelphia's Dropout Crisis, 2000–05,"JHU.edu ^ Racusin R, Maerlender AC Jr, Sengupta A, et al. Psychosocial treatment of children in foster care: a review. Community Ment Health J. 2005 Apr;41(2):199-221. PMID 15974499 ^ Johansen-Berg, H (2007). "Structural plasticity: rewiring the brain". Current biology : CB 17 (4): R141–4. doi:10.1016/j.cub.2006.12.022. PMID 17307051. ^ Duffau, H (2006). "Brain plasticity: from pathophysiological mechanisms to therapeutic applications". Journal of Clinical Neuroscience 13 (9): 885–97. doi:10.1016/j.jocn.2005.11.045. PMID 17049865. ^ Holtmaat, A; Svoboda, K (2009). "Experience-dependent structural synaptic plasticity in the mammalian brain". Nature reviews. Neuroscience 10 (9): 647–58. doi:10.1038/nrn2699. PMID 19693029. ^ Ge, S; Sailor, KA; Ming, GL; Song, H (2008). "Synaptic integration and plasticity of new neurons in the adult hippocampus". The Journal of physiology 586 (16): 3759–65. doi:10.1113/jphysiol.2008.155655. PMC 2538931. PMID 18499723. ^ Becker-Weidman, A., & Shell, D., (Eds.) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes, 2005/2009/2011 ^ Becker-Weidman, A., Dyadic Developmental Psychotherapy: Essential Methods & Practices, Jason Aronson, Lanham, MD, 2010 ^ Hughes, D., Attachment Focused Family Therapy, Norton: NY, 2009 ^ Bones Season 4 TOP 10 Most Shocking Moments[dead link] ^ Secret Life Of The American Teenager Margaret[dead link] ^ "The Leverage Team – Parker's Biography". Tnt.tv. Retrieved 2011-11-01. ^ "The Leverage Team – Alec Hardison's Biography". Tnt.tv. Retrieved 2011-11-01. ^ "Foster to Famous". Fosterclub.com. Retrieved 2011-11-01. [edit] Further reading Hurley, Kendra (2002). "Almost Home" Retrieved June 27, 2006. Carlson, E.A. (1998). "A prospective longitudinal study of disorganized/disoriented attachment". Child Development 69 (4): 1107–1128. PMID 9768489. Knowlton, Paul E. (2001). "The Original Foster Care Survival Guide"; A first person account directed to successfully aging out of foster care. McCutcheon, James, 2010. "Historical Analysis and Contemporary Assessment of Foster Care in Texas: Perceptions of Social Workers in a Private, Non-Profit Foster Care Agency". Applied Research Projects. Texas State University Paper 332.