7. Well being of Children Who Experience Out of Home Placement
Child well-being is a complex achievement that requires adequate nutrition, health care, and shelter; multiple supportive relationships with adults and peers; challenging and engaging activities and learning experiences; meaningful opportunities for involvement and membership; and physical and emotional safety. [i] For children who are involved with the child welfare system and especially those in foster care, well-being is a hard-won goal. Compared to their peers, they face much greater risks and poorer outcomes, including higher rates of physical disabilities and developmental delays, poor academic engagement and performance, serious emotional and behavioral problems, and fewer social skills. About 60 percent of children in foster care have a chronic medical condition, while 25 percent have three or more chronic problems. Fifty to 80 percent of children in foster care have moderate to severe mental health and behavioral problems, and up to 60 percent have at least one psychiatric disorder. About 60 percent of preschool age children in foster care have developmental delay. [ii]
By definition, children involved with the child welfare system are likely to have experienced trauma. The majority have experienced neglect, which may be associated with poor prenatal care, malnutrition, under-treated illnesses, immunization delays, the effects of parental depression or stress, and lack of access to needed social and educational services. At least one-third of children in the child welfare system are victims of sexual, psychological or physical abuse, often at the hands of a parent or caregiver, and for these children the emotional wounds can be severe and the impact devastating. [iii] The majority of children in foster care are under age five, and for them the impact of trauma on healthy development is especially acute. [iv]
In addition to the negative effects of the experiences that brought them into the child welfare system, these vulnerable children often experience further harm caused by separation from family, frequent placement moves, inappropriate placements, and lack of access to needed services and supports. Because multiple factors can negatively impact a child’s development, it is essential that all children in foster care have access to comprehensive assessment, ongoing monitoring, and an array of services to meet their needs. Policies to help ensure effective assessment, monitoring, and individualized case planning for children involved with the child welfare system are addressed in another section of this report. (See Policy 10.1, Individualized and comprehensive assessments and planning.) This section suggests policies that can improve access to services that research documents improve child well-being.
Specific state policy options are presented for each of the following areas:
7.1
Access to quality care and education
7.2
Educational advocates
7.3
Medical coverage
7.4 Evidence-based mental health and trauma treatment
7.5
Medical and educational records (passports)
[i]
Connell, James P., Gambone, Michelle Alberti, & Smith, Thomas J. Youth Development in Community Settings: Challenges to Our Field and Our Approach, Youth Development: Issues, Challenges and Directions, Community Action for Youth Project (A cooperative project of Gambone & Associates/ Institute for Research and Reform in Education)
[ii]
American Academy of Pediatrics, Committee on Early Childhood, Adoption and Dependent Care. 2002. Health Care of Young Children in Foster Care . Pediatrics 103 (3): 536-541. Shonk, S. and Cicchetti, D. 2001. Maltreatment, Competency Deficits, and Risk for Academic and Behavioral Maladjustment. Developmental Psychology, 37(1), 3-17.
[iii]
Putnam, F. W. 2006. The Impact of Trauma on Child Development. Juvenile and Family Court Journal, 57(1), pp. 1-11; U.S. Department of Health and Human Services. Administration on Children Youth, and Families. 2007. Child Maltreatment 2005. Washington, DC: U.S. Government Printing Office as cited by Cooper, J.L., Masi, R., Dababnah, S., Aratani, Y., Knitzer, J. 2007. Strengthening Policies to Support Children, Youth, and Families Who Experience Trauma. New York: National Center for Children in Poverty, Columbia University, Mailman School of Public Health.
[iv]
Cloitre, M., Cohen, L. R., & Koenen, K. C. 2006. Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life . New York, NY: Guilford Press as cited by Cooper, J.L., Masi, R., Dababnah, S., Aratani, Y., Knitzer, J.