Foster care for child maltreatment: impact on delinquent behavior

Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.     

Foster care placement improves children's functioning.

OBJECTIVE: To examine changes in reported functioning over a 12-month follow-up period and predictors of those changes for a cohort of young children enrolled in foster care. DESIGN: Data came from a longitudinal follow-up of a cohort of young children entering foster care in one Connecticut region. These data were originally assembled to evaluate the effectiveness of a specialized set of services designed to provide a baseline multidisciplinary assessment and ongoing monitoring for young children entering foster care. SETTING AND PARTICIPANTS: From February 1, 1992, through July 31, 1993, all young children (N = 120) entering foster care in one Connecticut region were enrolled in this study. Children were assessed at entry into care and at 6 and 12 months after entry. Participation rates exceeded 90% at each follow-up period. MAIN OUTCOME MEASURES: The principal outcome of interest for these analyses is 12-month functioning as measured by the Vineland Adaptive Behavior Scale (VABS) scores completed by their foster mothers. RESULTS: At entry into foster care, children ranged in age from 11 to 76 months, were evenly divided by sex, and had a mean VABS score of 79.5 signifying functioning below the average range. At 6 months children gained an average of 7.87 points on their VABS score. By 12 months children showed an average change of 9.65 points, for a mean VABS score of 94.5, well within the nationally normed average range. The multivariate linear model predicting the 12-month VABS score showed that, controlling for the baseline VABS score, when children who were abused, older at placement, female, of African American ethnicity, spent more time in foster care, and had fewer recommended services while in care, they were more likely to show improvement on the foster mother-reported VABS evaluation. CONCLUSIONS: These results demonstrate that children's reported functioning improves over the course of placement in foster care and that sociodemographic characteristics, reason for placement, length of time in foster care, and fewer recommended services at entry into foster care identified children who were more likely to improve. These results argue for a careful examination of the foster care environment to better understand which aspects of the environment contribute to improved foster mother reported functioning. Such understanding will be critical for the care and development of maltreated children.     

The early intervention foster care program: permanent placement outcomes from a randomized trial

Preschool-aged foster children face multiple risks for poor long-term outcomes. These risks appear to increase with the number of placement changes experienced. The Early Intervention Foster Care Program (EIFC) targets the spectrum of challenges that preschool-aged foster children face via a team approach delivered in home and community settings. In this article, we report on permanent placement outcomes from the EIFC randomized clinical trial. Children in EIFC had significantly fewer failed permanent placements than children in the regular foster care comparison condition. The number of prior placements was positively associated with the risk of failed permanent placements for children in the comparison condition but not for children in EIFC. Type of prior maltreatment did not predict permanent placement outcomes. These results provide the foundation of an evidence base for the EIFC program as a preventive intervention to improve permanent placement outcomes for preschool-aged foster children.     

School functioning and disease severity in boys with hemophilia

There have been few recent studies investigating the scholastic progress of children with hemophilia. The advent of PL94-142, which ensures an appropriate educational program based on a child's specific learning disabilities, and home Factor VIII therapy, which increases the hemophiliac's school attendance and sense of freedom and control, might have had a positive impact on the academic performance of these patients. We investigated past and current educational functioning of 26 boys with hemophilia, using both parental and teacher reports. Twenty-two of these children were administered reading and math achievement tests. Results indicate that school absenteeism is a continuing problem for these children, with the average hemophiliac missing 18 school days in an academic year (median = 11 school days missed); one child had missed 77% of the year. Although these boys had normal intelligence and made average grades in school, six of the 22 tested performed more than two grade levels below expectations in reading and 10 performed greater than two grade levels below expectations in math. School underachievement did not necessarily correlate with disease severity (as indicated by serum factor level), school absenteeism, or grade point average. Although eight parents indicated that their children had past or current school problems, and teachers reported that greater than 50% of the group received special tutoring or classes for learning disabled students, six out of 22 (27%) performed below expectations in either math or reading and yet had no current individual educational remediation plan.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of placement type on the language developmental trajectories of maltreated children from infancy to early childhood

This study describes the developmental trajectories of language skills in infants with substantiated maltreatment histories over a 5-year period and evaluates the effect of three different custodial placements on their language trajectories over time: in-home (remaining in the care of the biological parent/parents), nonkin foster care, and nonparental kinship care. Participants included 963 infants reported to child protective services prior to their first birthday and whose maltreatment was substantiated. Results from covariate-controlled growth modeling revealed no significant placement effects. Across all groups, children's auditory and expressive communication scores decreased significantly from Wave 1 (intake) in the infants' first year to Wave 4, when children were about 3.5 years of age, then improved to baseline levels by Wave 5, when children were about 6 years old. Despite these fluctuations, children's average language scores in each placement group remained below the population mean at each wave of the study.     

Emergency department utilization by children in foster care.

OBJECTIVE: To examine emergency department (ED) utilization of children in foster care using nationally representative data. METHODS: Cross-sectional analysis of the National Survey of Child and Adolescent Well-Being, Wave 1, which provided data for children ages 1 to 14 years in foster care for 1 year between October 1999 and December 2000. We identified children as having used the ED based upon foster parent responses to the question, "In the last 12 months, has your child gone to an emergency room or urgent care center (UCC) for an illness or injury?" We examined child and family demographic variables that were associated with having used the ED. RESULTS: The sample included 559 children in foster care. Thirty-one percent (95% confidence interval = 26%, 36%) of foster children had visited the ED or UCC in the past 12 months. Multivariate logistic regression analysis revealed that out of all children in foster care, children who had a chronic condition, children of younger age, and children with younger foster caregivers were significantly more likely to have used the ED. CONCLUSION: A sizeable proportion of children in foster care use the ED, and subgroups of these children have particularly high rates of ED use. An important component of providing a medical home for children in foster care should involve coordination of care around ED visits for this vulnerable group of children.     

Foster and adoptive mothers' assessment of permanent family placements

OBJECTIVES: To obtain the new carers' evaluation of the success of permanent placement of children within their families and any special needs in the children, and to determine the adequacy of support after placement. DESIGN: A postal questionnaire was sent to the foster or adoptive mothers of a five year cohort of 234 children placed for permanence, three to eight years previously, by one local authority. SETTING: Newcastle upon Tyne Social Services Adoption and Fostering Unit. SUBJECTS: All 234 permanent family placements recommended by the family placement panel from 1 January 1986 to 31 December 1990. MAIN OUTCOME MEASURE: The adoptive or foster mothers' evaluation of the placement. RESULTS: There was a 54% response rate, but the respondents did not differ significantly from the non-respondents in the variables tested. Only 33% of the children were placed when less than 2 years old with no special needs. Twenty per cent of the school age children had statements of special educational needs at placement. Ninety seven per cent of infant placements were rated "very successful' for the child by the new mothers, as were 90% of 1-6 year olds, but only 31% of children who were placed when older than 6 years were rated in this way. A third of the adoptive and foster mothers had experienced major difficulties in the placement and six carers said that more medical/psychiatric input would have prevented breakdown. CONCLUSION: There is a role for health care professionals to provide ongoing support, especially for older children with special needs.     

Rehospitalization of children with asthma.

BACKGROUND: Although some children with asthma experience multiple admissions, asthma is considered a preventable cause of hospitalization. OBJECTIVE: To assess whether components of medical histories, ambulatory care prior to hospitalization, or ambulatory care after discharge are associated with repeated hospitalizations for children admitted with asthma. DESIGN: Nested case-control study of a cohort of children hospitalized for asthma, comparing those who were rehospitalized within 1 year with those not rehospitalized. SETTING: Urban pediatric primary care clinic. PARTICIPANTS AND METHODS: Subjects were 119 children, aged 0 to 14 years, who had an inpatient admission with a diagnosis of asthma between July 1, 1993, and June 30, 1995 (index hospitalization). Data sources included medical charts, computerized patient records, and administrative data. Use of health care services was compared among children who were rehospitalized within 1 year of the index admission and those who were not. MAIN OUTCOME MEASURE: Repeated hospitalizations. RESULTS: The proportions of children who received general pediatric, allergy, or pulmonary care in the year prior to the index hospitalization were 86%, 7%, and 8%, respectively. By report, half of all children did not receive prescribed therapies, more than half were exposed to cigarette smoke at home, and one fourth were not up-to-date with immunizations at the time of admission. Thirty-five of the 119 children hospitalized with asthma were subsequently readmitted with asthma within 1 year of the index hospitalization. Children readmitted did not differ from those with a single admission in terms of the above characteristics. However, significantly more children subsequently readmitted had a pulmonary consultation during the index admission (23% vs 4%; P = .001) or in the year following discharge (37% vs 12%; P = .002). In addition, children readmitted were more likely to have other chronic conditions (69% vs 49%; P= .048). CONCLUSION: Among low-income urban children, readmission for asthma is not associated with receipt of prescribed therapies or pediatric care.     

A sampling bias in identifying children in foster care using Medicaid data.

BACKGROUND: Prior research identified foster care children using Medicaid eligibility codes specific to foster care, but it is unknown whether these codes capture all foster care children. OBJECTIVES: To describe the sampling bias in relying on Medicaid eligibility codes to identify foster care children. METHODS: Using foster care administrative files linked to Medicaid data, we describe the proportion of children whose Medicaid eligibility was correctly encoded as foster child during a 1-year follow-up period following a new episode of foster care. Sampling bias is described by comparing claims in mental health, emergency department (ED), and other ambulatory settings among correctly and incorrectly classified foster care children. RESULTS: Twenty-eight percent of the 5683 sampled children were incorrectly classified in Medicaid eligibility files. In a multivariate logistic regression model, correct classification was associated with duration of foster care (>9 vs <2 months, odds ratio [OR] 7.67, 95% confidence interval [CI] 7.17-7.97), number of placements (>3 vs 1 placement, OR 4.20, 95% CI 3.14-5.64), and placement in a group home among adjudicated dependent children (OR 1.87, 95% CI 1.33-2.63). Compared with incorrectly classified children, correctly classified foster care children were 3 times more likely to use any services, 2 times more likely to visit the ED, 3 times more likely to make ambulatory visits, and 4 times more likely to use mental health care services (P < .001 for all comparisons). CONCLUSIONS: Identifying children in foster care using Medicaid eligibility files is prone to sampling bias that over-represents children in foster care who use more services.     

The impact of parental alcohol or drug removals on foster care placement experiences: a matched comparison group study

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.     

Risk of death among children reported for nonfatal maltreatment

This article presents analyses of longitudinal data to explore whether low-income children who survived a first incident of reported maltreatment were at higher risk of later childhood death compared to a matched comparison group of low-income children without reports of maltreatment (n = 7,433). Compared to the comparison group, children in the maltreatment group had about twice the risk of death before age 18 (0.51% vs. 0.27%). Among children with mal-treatment reports, median time from the first report to subsequent death was 9 months. The majority of deaths among children who were reported for maltreatment could be categorized as preventable (accidents or recurrent maltreatment) as compared to resulting from severe health conditions.     

Improving resources for foster care.

The number of foster children and their psychological and medical morbidity are growing. To gain insight into how to recruit and retain foster homes, characteristics of 64 foster families were determined by interview. Foster parents had low-to-moderate incomes, were approaching middle age, had underutilized home space, and wanted more children. Most enjoyed foster care and planned to continue. Twenty-three percent of the 64 had half of all foster children in the study in their homes at interview and had cared for seven times as many children in the past, including 66% of all the teens and 83% of all the handicapped children who had been in the 64 homes. These "high providers" functioned like group homes for mentally handicapped individuals. Adapting the group-home concept to foster homes could improve care, especially for children with special needs.     

Children of alcoholic mothers. Growth and motor performance compared to matched controls

Twenty-one children born 1970-76, selected from 103 children of 30 alcoholic women, were paired to controls matched for sex, age, birth weight and gestational age. The sample (10 girls, 11 boys) was representative of the whole group with regard to weight, length and head circumference at birth. At follow-up (mean age 70 months) the study group was significantly leaner, shorter and had smaller mean head circumference than the control group. The controls had significant catch-up growth from birth to follow-up of weight, height and head circumference to the mean for Swedish children. The study group had no catch-up growth. Compared to controls the study group had significantly lower fine and gross motor age test scores and inferior coordination. One child had cerebral palsy (spastic hemiplegia) and in 6 other children slight tremor and ataxia were observed. Malformations and/or other signs of the fetal alcohol syndrome (FAS) were found in 10 cases. Study group children with FAS had significantly slower growth of head circumference than others without FAS. Children placed in foster home care (n = 11) were found to have significantly (p less than 0.05) lower birth weight, birth length and head circumference than children raised at home (n = 10). There were no significant differences at follow up between study group children raised in foster homes or in homes of their biological mother.     

Reduced school dropout rates among adolescent mothers receiving school-based prenatal care

BACKGROUND: Adolescent pregnancy is associated with increased school dropout rates. Dropping out amplifies the probability of persistent social and economic disadvantage. Whether school-based health centers might help reduce school absenteeism and dropout rates in this group has not been well studied. OBJECTIVE: To examine the association of school-based prenatal services on school attendance and dropout rates. METHODS: In this retrospective cohort study, using school rosters from an alternative school, we identified adolescents aged 18 years or younger who delivered a baby between July 1, 1995, and August 30, 1997, in Baltimore, Md. We linked school records spanning 3 years with medical records and birth certificates. School variables such as attendance and dropout rates were examined in relation to the teen's year of pregnancy and prenatal care setting (school-based vs non-school-based). Hierarchical logistic regression was used to examine effects of school-based prenatal care on dropout and promotion or graduation rates, with adjustment for baseline group differences. RESULTS: We identified 431 predominantly African American, low-income adolescents who attended the alternative school in their pregnancy school year. In the year prior to pregnancy, most performed poorly in school and had significant absenteeism. During their pregnancy school year, teens receiving school-based prenatal care were absent 12 fewer days, as compared with those receiving non-school-based care (P =.001), and their dropout rate was half that of those receiving non-school-based care (6% vs 15%; P =.02). Hierarchical logistic regression analyses, with adjustment for baseline prepregnancy differences, demonstrated that teens receiving school-based prenatal care were less likely to drop out of school during the pregnancy year (adjusted odds ratio, 0.39; 95% confidence interval, 0.15-0.99; P =.048). CONCLUSIONS: Absenteeism and dropout rates were reduced for pregnant adolescents receiving prenatal care at a school-based health center in an urban alternative school. Findings underscore the importance of funding and evaluating school-based health centers and other interventions that may ameliorate negative outcomes among childbearing adolescents.     

The cost of assistive devices for children with mobility limitation.

This study evaluated the costs of assistive devices for children with motor limitations at home, in day care, and in school, and the effect of diagnosis and severity of disabilities on costs. 201 children (mean age 7.4 years) who used 1274 various assistive devices (85.7% at home, 6.1% in day care, and 8.2% in school) were studied. The cost per device varied from $8.14 to $8138 with an average value of $539 per device. The distribution of costs per capita was unequal: 52.2% of children used 15.6% of total costs and 4.5% of children used 20.8% of total costs. The severity of motor impairment and the age of the child were the most important indicators associated with the need and cost of assistive devices. Assistive devices for basic needs, such as sitting, mobility, and personal hygiene, had a relatively low effect on costs in comparison with the high-technology devices, like powered wheelchairs and computers. Better cooperation with day care and school professionals, better assessment of needs, follow-up and recirculation of assistive devices are ways to promote rehabilitation services and partly solve the discrepancies between the costs of available technology and the resources to pay for it.     

The medical home: relationships with family functioning for children with and without special health care needs

ObjectiveIn this study we tested the association of the medical home with family functioning for children without and with special health care needs (CSHCN).MethodsWe used data from the 2007 National Survey of Children’s Health to run multivariate logistic regressions to test the association between having a medical home and family functioning (difficulty with parental coping, parental aggravation, childcare/work issues, and missed school days). We further assessed interactions of CSHCN status with having a medical home.ResultsIn adjusted analysis, parents of children with a medical home were less likely to report difficulty with parental coping (odds ratio [OR] 0.26 [0.19–0.36]), parental aggravation (OR 0.54 [0.45–0.65]), childcare/work issues (OR 0.72 [0.61–0.84]), and missed school days (OR 0.87[0.78–0.97]) for their children than those without a medical home. Using interaction terms, we found that for most outcomes, the medical home had a greater association for CSHCN compared with healthy peers, with odds ratios ranging 0.40 (CI 0.22–0.56) for parental aggravation to 0.67 (CI0.52–0.86) for missed school days.ConclusionsWe show that the medical home is associated with better family functioning. All children may benefit from receiving care in a medical home, but CSHCN, who have greater needs, may particularly benefit from this enhanced model of care.     

The physical, developmental, and mental health needs of young children in child welfare by initial placement type

The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%). Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a developmental evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation.     

Longitudinal analysis of repeated child abuse reporting and victimization: multistate analysis of associated factors

Most child subjects of maltreatment reports to child protective services (CPS) are involved just once, whereas other children experience repeated investigations and victimizations. This study examines individual, maltreatment, and service-related factors associated with maltreatment rereporting and substantiated rereporting in a multistate context. Case-level National Child Abuse and Neglect Data System data (505,621 children) were analyzed. Within 24 months, 22% of children were rereported, and 7% were rereported with substantiation. Younger and White and mixed race children, those with disabilities, and those whose caregivers abused alcohol were more likely to be rereported and rereported and substantiated. Service provision, including foster care placement, was associated with increased likelihood of subsequent events. When CPS agency performance is assessed using measures of reentry, separate measures may be necessary for children who receive services, so that improvements in safety can be appropriately recognized. Reentry into CPS is a complex interaction of risks to children and systemic factors tied to the intervention they receive.     

The outcome of childhood suicidal behaviour.

A group of children under 16 years of age who were admitted to hospital after episodes of deliberate self-poisoning, were followed up after one year. Ninety of the original sample of 100 were traced, and interviewed. Almost half of the subjects were improved after one year but the remaining children continued disturbed. Improvement was most marked in relation to "school problems" and "running away from home". There was significant improvement for some children in their family relationships. Ten per cent of children had been involved in further self-poisoning during the follow-up period. Extended follow-up some seven years later traced 41 of the original subjects. The repetition rate for self-poisoning was 20% although the majority of these episode occurred within a year of the original self-poisoning. Overall, the situation of subjects was judged as improved by them and their families although significant psycho-social difficulties remained for some.