Sunday, June 9, 2013

Foster Care

 

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"Foster child" redirects here. For the 1989 film, see Foster Child.

 

Children of the United Kingdom's Children's Migrant Programme, many of whom were placed in foster care in Australia.

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 receives a stipend from the state for expenses incurred.

Contents

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]

Foster care placement

Family-based foster care is generally preferred to other forms of out of home care.[3] Foster care is intended to be a short term solution until a permanent placement can be made.[4] Generally the first choice of adoptive parents 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.[5] In 2009, there were 423,773 children in foster care, a drop of about 20% in a decade.[6]

In 2013, there were about 104,000 children ready for adoptive families in the nation's foster care systems.[7] African American children represented 41% of children in foster care, white children represented 40% and Hispanic children represented 15% in 2000.[5]. Lesbian, Gay, Bisexual, Trans and Queer, LGBTQ youth represent a large percentage due to families of origin placing their children in foster care due to their sexuality or gender expression. Once in care, some "75% are physically harassed by staff or other youth'. After emancipation, LGBTQ foster youth represent a larger percentage of foster youth who end up homeless--'up to 40%'. America's Most Unwanted,

LGBTQ foster youth film. [8]

Children may only enter foster care voluntarily. 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.[9] 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.[10] Haringey Children's services already failed ten years earlier in the case of Victoria Climbié.[11] 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.[12]

There have been recorded neglects and deaths that occur in foster care; The State Department of Human Services reported 32 neglect or abuse deaths [13]

Abuse and negligence

From 1993 through 2002 there were 107 recorded deaths; there are approximately 400,000 children in out-of-home care, in the United States. Almost 10% of children in foster care have stayed in foster care for five or more years. Nearly half of all children in foster care have chronic medical problems. 8% of all children in foster care have serious emotional problems, 11% of children exiting foster care aged out of the system, in 2011.[14] 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".[15] 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.[16] 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.

Medical and psychiatric disorders

A higher prevalence of physical, psychological, cognitive and epigenetic disorders for children in foster care has been established in studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study of various aspects of children who had been in foster care. It 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.[17] 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.[18][19][20][21] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Studies in the U.S. have suggested that some foster care placements may be more detrimental to children than remaining in a troubled home,[22] but a more recent study suggested that these findings may have been affected by selection bias, and that foster care has little effect on behavioral problems.[23]

Neurodevelopment

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).[24] Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Negative environmental influences during this critical period of brain development can have lifelong consequences.[25][26][27][28]

Posttraumatic stress disorder

Regions of the brain associated with stress and posttraumatic stress disorder[29]

Children in foster care have a higher incidence of posttraumatic stress disorder (PTSD). In one study,[30] 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".[31][32]

Eating disorders

Foster children are at increased risk for a variety of eating disorders in comparison to the general population. In a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.[33] 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.[19] Bulimia nervosa is seven times more prevalent among former foster children than in the general population.[34]

Poverty and homelessness

New York street children; 1890

Nearly half of foster kids in the U.S. become homeless when they turn 18.[35][36] "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.[37][38]

Three out of 10 of the United States homeless are former foster children.[39] 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.[40] 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.[41]

Suicide-death rate

Children in foster care are at a greater risk of suicide,[42] 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.[43]

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.[44]

Death rate

Children in foster care have an overall higher mortality rate than children in the general population.[45] 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.[46]

Georgia Senator Nancy Schaefer published a report "The Corrupt Business of Child Protective Services"[47] 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".[47]

Academic prospects

Educational outcomes of ex-foster children in the Northwest Alumni Study:[48]

  • 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.[48]

Psychotropic medication use

Studies 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%). The study also showed that youth in foster care are frequently treated with concomitant psychotropic medication, for which sufficient evidence regarding safety and effectiveness is not available.[49]

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.[50]

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[51] 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.[52][53][54] and adult neurogenesis has been shown to be an ongoing process.[55]

Cross-Cultural Adoption Policies

George Shanti, Nico Van Oudenhoven, and Ekha Wazir, co-author's of Foster Care Beyond the Crossroads: Lessons from an International Comparative Analysis, say that there are four types of Government foster care systems. The first one is that of developing countries. These countries do not have policies implemented to take care of the basic needs of these children and these children mostly receive assistance from relatives. The second system is that of former socialist governments. The historical context of these states has not allowed for the evolution of their foster care system. NGO's have urged them to evolve; however the traditional system of institutionalizing these children is still in place. Thirdly, liberal democracies do not have the support from its political system in order to take care of these children, even though they have the resources. Finally, social democracies are the most advanced governments in regards to their foster care system. These governments have a massive infrastructure, funding, and support system in order to help foster care children.[59]

Foster care adoption

See also: Adoption

Foster care adoption is a type of domestic adoption where the child is initially placed into a foster care system and is subsequently placed for adoption. Children may be placed into foster care for a variety of reasons, including removal from the home by a governmental agency because of maltreatment.[60] In some jurisdictions, adoptive parents are licensed as and technically considered foster parents while the adoption is being finalized.[61] According to the U.S Department of Health and Human Services, Children's Bureau, there were approximately 408,425 children in foster care in 2010. Of those children, twenty-five percent had a goal of adoption. In 2010, 254,114 children exited foster care and twenty-one percent were adopted.[62] Nationwide, there are more than one hundred thousand children in the U.S. foster care system waiting for permanent families.[63]

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:

Famous former foster children:

See also

References

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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]

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.

External links