Meeting the Challenges of Contemporary Foster Care
Over the past two decades, the foster care
system experienced an unprecedented rise in
the number of children in out-of-home care,
significant changes in the policy framework
guiding foster care practice, and ongoing
organizational impediments that complicate
efforts to serve the children in foster care.
This article discusses the current status of
the foster care system and finds:
Agencies often have difficulty providing
adequate, accessible, and appropriate services
for the families in their care.
Children of color, particularly African-
American children, are disproportionately
represented in foster care, a situation
which raises questions about the equity of
the foster care system and threatens the
developmental progress of children of
Foster families can find the experience
overwhelming and frustrating, causing
many to leave foster parenting within their
Organizational problems such as large
caseloads, high staff turnover, and data
limitations compromise efforts to adequately
serve and monitor families.
The challenges before the foster care system
are numerous, however the authors believe
promising policies and practices aimed at
strengthening families, supporting case workers,
providing timely and adequate data, and
infusing cultural competency throughout the
system, can move the foster care system forward
in the coming years.
Sandra Stukes Chipungu, M.S.W., Ph.D., is associate
dean of academic affairs at the School of Social Work
at Howard University.
Tricia B. Bent-Goodley, Ph.D., L.I.C.S.W.-C., is an
associate professor of social work at Howard University.
Stukes Chipungu and Bent-Goodley
Volume 14, Number 1 76
The foster care system faces serious challenges
in the twenty-first century. Major societal
problems such as high rates of child and
family poverty, homelessness, unemployment,
substance abuse, HIV/AIDS, unequal education,
family and community violence, and racism have
a deleterious effect on families and directly impact child
well-being and the child welfare system. According to
the U.S. Department of Health and Human Services,
?These factors have contributed to the development of
large caseloads of families that have multiple and complex
needs. The child welfare system must respond to
these needs, while protecting the rights of children and
families and ensuring the safety of children.?1
The primary goal of foster care is to ensure the safety
and well-being of vulnerable children. In that spirit, the
principal provisions of the Adoption and Safe Families
Act (ASFA) were developed to decrease the time to
permanent placement, increase the incidence of adoption
and other permanency options, enhance states?
capacity for reaching these goals, and establish performance
outcome measures to increase accountability.
2 (See the article by Allen and Bissell in this journal
issue.) The foster care system is expected to meet these
goals while simultaneously facing a decrease in the
number of unrelated foster homes, long waiting lists
for substance abuse treatment, a lack of affordable
housing and child care, increased unemployment,
shortened time limits for public welfare assistance, and
heightened public scrutiny.
This article discusses the status of contemporary foster
care and the challenges currently faced by the child
welfare system. The article begins by discussing some
of the factors that lead to children being placed in foster
care and provides a demographic profile of foster
children. It also explores factors that contribute to the
disproportionate representation of children of color in
child welfare. The article then discusses the foster care
experience from both the child?s and the foster parents?
perspective, and it explores the institutional challenges
in meeting both children?s and parents? needs. The
article closes with policy and practice recommenda-
? Bob Gore/Corbis
Challenges of Contemporary Foster Care
77 The Future of Children
tions for improving foster care and the child welfare
system in the twenty-first century.
Major Challenges Facing the Child
The child welfare system faces multiple challenges in
serving and supporting the families and children in its
charge. Throughout the 1980s and 1990s, child welfare
caseloads grew substantially. Increasingly, the families
and children who come to the attention of child
welfare agencies present complex needs requiring the
provision of multiple services. However, child welfare
agencies do not have control over all the services needed,
thus they must develop interorganizational relations
with private for-profit agencies, private nonprofit
agencies, and other service systems to ensure access for
their clients. Children of color are disproportionately
represented and receive differential treatment in the
child welfare system. Moreover, these challenges must
be confronted in light of high staff turnover and difficulties
recruiting foster families. These challenges are
Expanding Caseloads with Complex Needs
Major increases in the number of children entering foster
care occurred in the 1980s and 1990s (see Figure
1). Reasons for the growing number of young children
in foster care include an increased number of births, a
growing number of incarcerated mothers, and an
increased exposure of children to substance abuse. In
the 1990s, the number of children entering care began
to decline, but as of September 2001, some 542,000
children3 were still in foster care (representing a
decrease of about 5% from 2000).4 (See Figure 1.)
As illustrated in Figure 2, various aspects of the foster
care population are noteworthy. In terms of race,
African American children comprise the largest proportion
of the foster care population, yet other children
of color are also disproportionately represented in
the foster care system. In terms of age, although the
average age of children in care is 10, increasingly
infants and children under age 5 are entering care.5
Well over one-quarter of all children in the foster care
system are under age five.6 In 2001, nearly one-third of
abused children were under age three; children
younger than six accounted for 85% of all child fatalities
due to child abuse; and approximately 40% of those
deaths were babies under age one.7 In terms of placement
type, most children are placed in nonrelative foster
homes, but substantial numbers are also placed with
relatives or in group homes or institutions. Finally, in
terms of those exiting care, most are reunited with
their birth parents or primary caretakers or are adopted
(see Figure 2).
Foster Care Population 1980?2001
Sources: U.S. House of Representatives. 2000 green book: Overview of entitlement programs. Washington, DC: Government Printing Office, 2000; U.S. Department of Health and
Human Services. AFCARS, Report #6. Washington, DC: DHHS, 2001; and U.S. Department of Health and Human Services. AFCARS, Report #7. Washington, DC: DHHS, 2002.
1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Volume 14, Number 1 78
Stukes Chipungu and Bent-Goodley
Families who come to the attention of the child welfare
system are vulnerable families with complex needs. The
parents experience multiple stressors that weaken their
ability to appropriately parent. According to the
National Child Abuse and Neglect Data System
(NCANDS), American Child Protective Services
(CPS) agencies received 3 million referrals concerning
the welfare of approximately 5 million children in
2001.8 Of these, approximately 903,000 children were
found to be victims of child maltreatment. Nationally,
it is estimated that more than 275,000 children were
placed in foster care as a result of child abuse investiga-
4% 1 to 5
6 to 10 11 to 15
16 to 18
19 and over Under 1
Note: Some totals may not equal 100 due to rounding.
Source: U.S. Department of Health and Human Services. The AFCARS report: Preliminary FY 2001 estimates as of March 2003. Washington, DC: DHHS, 2003. Available online at
Challenges of Contemporary Foster Care
79 The Future of Children
tions or assessments. The most common reason for
entering foster care is neglect.9 Maltreatment deaths
were associated with neglect (35%) more than any
other type of abuse.10
Almost two-thirds of child victims suffered from neglect,
thus a child is more likely to enter care due to neglect
than due to physical abuse, sexual abuse, and
psychological abuse combined.11 However, neglect is
often used as a catchall category, and the underlying
reasons that may lead to parental neglect are often not
accurately recorded. Children who come into state care
often live in fragile family systems experiencing multiple
stressors such as poverty, substance abuse, mental
illness, physical illness, and domestic violence. Societal
and familial problems such as parental incarceration
and HIV/AIDS can also lead to involvement with the
foster care system, yet our understanding of these connections
is limited (see Box 1). Moreover, these family
challenges tend to coexist and interact, presenting a
complex family dynamic and a complicated set of service
needs. Strengthening fragile families is a major challenge.
Any efforts to stem the flow of children coming
into foster care must provide comprehensive and coordinated
support to these families.
Securing the appropriate kind and level of resources for
children and families is an ongoing challenge for child
welfare agencies for several reasons, however. Often, there
is a mismatch between services offered and what families
actually need to resolve their difficulties. For example,
birth parents may be offered parent training classes
or counseling when concrete services such as housing
assistance or child care are needed more critically. Moreover,
the challenges birth families face are often overlapping,
complicated, and multifaceted, and public child
welfare agencies do not have control over the numerous
resources needed to serve these families. Often, agencies
must develop cooperative agreements and mutual
understandings with numerous public and private agencies
to provide needed services, making for a complicated
service-delivery network. Negotiating a fragmented
service-delivery system can be confusing and frustrating
for birth and foster families, as well as social workers.
Disproportionate Representation of Children of Color
Racial disproportion is a major challenge facing the
child welfare system. Although studies have documented
that ?there are no differences in the incidence of
child abuse and neglect according to racial group,?12
African American and Latino families are more likely
than white families under similar circumstances to be
reported for child abuse and neglect and to have children
removed from the home.13 High poverty rates
among children of color exacerbate this trend. As a
result, children of color, who comprise 33% of the child
population in the United States, constitute more than
55% of children in foster care placement. African American
children are most seriously affected by disproportionality,
composing only 15% of the child population
yet 38% of children in care. American Indian children
compose 2% of the foster care population, nearly double
their rate in the general population. According to
official data, Latino children are slightly overrepresented
in child welfare, with Latino children composing
12.5% of the child population and 17% of children in
care. However, there are indications that Latino children
are coming into care at faster rates than other children.
Equally disturbing, despite situational similarities, children
of color are treated differently at critical points in
the child welfare system. Once in care, children of
color receive fewer familial visits, fewer contacts with
caseworkers, fewer written case plans, and fewer developmental
or psychological assessments. They tend to
remain in foster care placement longer.15
Several key dimensions of the challenge of disproportional
representation?including reasons for differential
treatment, unique developmental needs of children
of color, and the important role of communities and
culturally competent workers in addressing these
needs?are explored below.
Factors That Contribute to Disproportionality
Poverty and poverty-related challenges, structural
inequality, and racially biased decision making are some
of the factors that have contributed to the disproportionate
representation of children of color in child welfare.
16 More than 40% of African American and Latino
children and 38% of American Indian children live
below the poverty line.17 African American children are
more likely to live in poverty longer than white children
and are three times as likely to come from families
with ?incomes too low to meet even the adults?
Volume 14, Number 1 80
Stukes Chipungu and Bent-Goodley
needs in the family.?18 Providing adequate care and
supervision for children while living within the constraints
associated with acute poverty is extremely difficult.
Even though most low-income parents do not
abuse their children, poor children are more likely to
enter the child welfare system, often for child neglect,
than are children from higher-income families.
Racially biased decision making and structural inequities,
such as a lack of community-based services, negatively
interact and lead to more children of color entering foster
care and fewer parents able to obtain the help they
need to get them back. For example, many more white
women than women of color, including pregnant
women and parents, use illicit drugs.19 However, studies
have shown that African American children prenatally
exposed to illicit drugs are much more likely than white
children to be reported to child protective services20 and
are more likely to be placed in foster care, even after taking
into account factors such as a family?s previous child
welfare involvement, the physical health of the child, and
other related factors.21 Despite the large numbers of children
of color in care due to parental substance abuse,
there are few treatment programs available to serve communities
of color. Limited substance-abuse and mental
health services in communities of color are examples of
structural inequalities that result in differential treatment
based on race. Moreover, the lack of appropriate and
accessible community-based services decreases the likelihood
of successful family reunification.
Factors That Affect Entry into the Foster Care System
Poverty remains the largest risk factor for poor health and wellbeing
outcomes for children, and for entry into the foster care system.
Poor children are twice as likely as nonpoor children to have
developmental delays and mental disabilities; three times as likely
to be hospitalized for chronic illness; five times more likely to
die from a physical illness,a and more likely to suffer from a lack
of resources, such as adequate housing and proper nutrition. Poor
children are also far more likely than middle-class children to be
reported for abuse and neglect. ?Children in families with incomes
below $15,000 are 45 times more likely to be victims of substantiated
neglect than children in families with incomes above
$30,000.?b Poor children are also at higher risk for physical and
sexual abuse than children from middle-class families.c
Due to inconsistencies in data collection, estimating the number
of children who come into care due to parental substance abuse
is difficult. However, evidence suggests that a high percentage of
children in foster care are there because of parental substance
abuse.d Child welfare agencies tend to focus their attention on
infants and very young children of substance abusers, particularly
children who have been prenatally exposed to illicit drugs. As a
result, children from families with substance abuse problems tend
to come into the system at a younger age and remain in care longer,
and they are more likely to be adopted than other children.e
Domestic violence and child welfare are inseparably connected. It
is estimated that domestic violence takes places in at least onethird
of homes where child abuse exists,f however, specific data
on the number of children in foster care due to domestic violence
are scant. Again, families experiencing domestic violence are
often experiencing other difficulties, such as substance abuse,
thus the removal may be subsumed under the general category of
child neglect, and the problem of domestic violence may not be
initially recognized. Notably, children of color appear to be
removed from the home at greater levels than white children
when domestic violence is involved.g
The number of parents in prison has doubled since 1986; 1.5 million
children have an incarcerated parent, and more than 7 million
children have a parent under some form of correctional supervision.
h However, it is unclear how many children in foster care are
there because of parental incarceration. In 1999 it was estimated
that 1.8% of men and 9.6% of women in state prisons had children
placed in foster care. However, the actual numbers are like-
Challenges of Contemporary Foster Care
81 The Future of Children
aBerrick, J.D., Needell, B., Barth, R.P., and Jonson-Reid, M. The tender years:
Toward developmentally sensitive child welfare services for very young children.
New York: Oxford University Press, 1998; Golden, R. Disposable children: America?s
child welfare system. Belmont, CA: Wadsworth, 1997; and Lewit, E.M., Terman,
D.L., and Behrman, R.E. Children and poverty: Analysis and
Recommendations. The Future of Children (1997) 7(2):2?24.
bLindsey, D., and Klein Martin, S. Deepening child poverty: The not so good news
about welfare reform. Child and Family Services Review (2003) 25(1?2):165?73.
cSee note b, Lindsey and Klein Martin.
dAlthough states have begun reporting numbers of children whose parental alcohol or
substance abuse is a factor in placement to the federal Adoption and Foster Care Analysis
and Reporting System (AFCARS), there is wide variation across states in recording
and reporting this data. Semidei, J., Feig Radel, L., and Nolan, C. Substance abuse and
child welfare: Clear linkages and promising responses. Child Welfare 80(2):109?28.
eU.S. Department of Health and Human Services. Blending perspectives and
building common ground: A report to Congress on substance abuse and child
protection. Washington, DC: U.S. Government Printing Office, 1999.
f Fleck-Henderson, A. Domestic violence in the child protection system: Seeing
double. Children and Youth Services Review (2000) 22(5):333?54.
gEdelman, M. Families in peril: An agenda for social change. Massachusetts: Harvard
University Press, 1989.
hBilchik, S., Seymour, C., and Kreisher, K. Parents in prison. Corrections Today
(2001) 63:108?12; and Mumola, C.J. Incarcerated parents and their children.
Washington, DC: Bureau of Justice Statistics, 2000.
i See note h, Mumola. Inmates are not always willing to give information about
their children; some inmates do not know they have fathered a child; and not all
correctional facilities collect information on the children of inmates.
jJohnson, E.I., and Waldfogel, J. Parental incarceration: Recent trends and implications
for child welfare. Social Service Review (2002) 76:460?79.
kCarter, A.J., and Fennoy, I. African American families and HIV/AIDS: Caring for
surviving children. Child Welfare (1997) 46:107?26; and Stein, T.J. The social
welfare of women and children with HIV and AIDS: Legal protections, policies
and programs. New York: Oxford University Press, 1998.
l Downs, S.W., Moore, E., McFadden, E.J., and Costin, L.B. Child welfare and family
services: Policies and practice. 6th ed. Boston: Allyn and Bacon, 2000.
mSee note a, Berrick, et al., p. 6.
ly higher.i Growth in the female inmate population portends a
growth in the number of children placed in foster care, as children
with incarcerated mothers are more likely to come into care than
those with incarcerated fathers.j
It is estimated that 125,000 to 150,000 children have lost mothers,
their primary caregivers, to AIDS. Yet the number of children in
foster care as a result of losing a parent to the AIDS epidemic is
not clear.k Approximately 28% of children from families in which a
parent has died of AIDS enter care, however, there is great variation
in rates from state to state.l ?Nearly 8 percent of all infants
who are abandoned in hospitals are reported to be HIV infected,?
and they eventually end up in foster care.m Although 43 of the 50
state child welfare agencies have policies on HIV/AIDS, this issue
is in dire need of empirical investigation and documentation.
Unique Developmental Needs
The disproportionate number of children of color in
foster care is particularly problematic because of the
unique developmental issues these children face. From
infancy through adolescence, culture and ethnicity play
a significant role in facilitating the healthy development
of children of color.22 For example, infants of color may
exhibit specific hereditary factors, such as advanced
psychomotor and sensorimotor skills, including coordination
skills and the ability to manipulate objects,
which caretakers must consider to be responsive to
children?s needs during this vulnerable stage of development.
23 Beginning as early as age two, children of
color are aware of differences in skin color and culture,
and racial and ethnic labeling.
As children progress through early and middle childhood,
they become increasingly aware that these differences
have social meaning. During the middle stages
of development, children often encounter their first
prejudicial experiences, become aware of social
inequities based on race, and are at risk of developing
a negative self-image or even self-hate. It is also during
the middle childhood years that differences in learning
styles start to emerge. Children of color whose learning
styles diverge from the mainstream may be labeled
?disinterested? or ?disobedient? and risk being inappropriately
placed in special education or left back a
grade.24 This situation is particularly problematic for
children of color in foster care, who face the additional
barrier of moving from school to school, often with-
Volume 14, Number 1 82
Stukes Chipungu and Bent-Goodley
out anyone assuring that their educational needs are
being met.25 As children move into adolescence, developing
a sense of self and positive identity becomes
paramount. Adolescents are acutely aware of social differences
and inequities. Faced with what can seem like
insurmountable racial barriers, adolescents of color
may experience feelings of anxiety, hopelessness, and
The Role of Culture and Communities
The impact of racism and discrimination, and the need
to develop skills for negotiating a sometimes hostile
social world, distinctly shape an individual and cannot
be discounted. For example, the ability to function
?biculturally??that is, within the larger society as well
as within a specific community?is an important survival
skill for children of color. Communities of color
teach children how to negotiate being bicultural in a
healthy and safe manner.27 The skill can be significantly
difficult to acquire outside the community.
Learning to live biculturally is particularly important
when cultural conflicts emerge. For example, many
communities of color place significant emphasis on
communalism, collective consciousness, and responsibility
to extended family. These traditions may conflict
with ?American? cultural values, which have traditionally
emphasized independence, self-reliance, and
autonomy.28 Consequently, although the foster care
system focuses on preparing children to become independent,
communities of color generally emphasize
the importance of social obligation and connections to
the family and larger community. This difference can
pose developmental confusion for children of color in
a foster care system whose objectives may conflict with
their cultural heritage.
A culturally sensitive environment can provide a nurturing
and protective foundation that children can
draw upon in times of distress. For example, an
engaged spiritual life is often an important characteristic
of people of color and may provide stability and cultural
continuity for children of color in care. Spiritually
focused family rituals such as naming ceremonies and
rites of passage emphasize principles such as communalism,
social responsibility, interdependence, and
racial pride, and place children within a family and
community system that connects them to a larger historical
and contemporary experience.29 Such connectedness
provides a stable force that can foster resilience
for a child during tough times.
The impacts of migration and immigration status on
family dynamics are also critical cultural factors for children
in either documented or undocumented families.
30 Migration can add stress to a family unit, such as
the frustration of not being able to understand or
accept one?s new culture.31 This situation can cause
intergenerational stress, as ?biculturality? may be easier
for children than for their parents. Without a family
and community that are sensitive to this dilemma and
able to facilitate a healthy transition, a child could
become confused about his or her identity. Immigration
status can also affect a family?s willingness to interact
with the child welfare system. Undocumented
immigrants may be wary of the child welfare system
? NonStock/George J. Kunze
Challenges of Contemporary Foster Care
83 The Future of Children
A culturally sensitive environment can provide a nurturing and
protective foundation that children can draw upon in times of
due to fear of deportation or arrest. Documented
immigrants may have similar concerns, particularly if
they are associated with someone who is undocumented.
Previous experiences with public officials in a country
of origin may discourage an immigrant?s willingness
to share information. This history colors a person?s
experience and can create justifiable anxiety, fear, and
mistrust of child welfare workers.32
High Staff Turnover
One of the most pressing concerns of child welfare
agencies is recruiting, training, and retaining competent
staff. Ninety percent of state child welfare agencies
report difficulty in recruiting and retaining workers.33
Exceedingly high numbers of caseloads, poor working
conditions, high turnover rates, and a poor public perception
of the child welfare system are widely recognized
as problems that contribute to the difficulty of
attracting high-quality, innovative, and committed
staff.34 Increasingly, the public is demanding better
results from beleaguered child welfare agencies, and
these demands are reflected in policy changes that
emphasize measuring outcomes and documenting
processes leading to reunification or adoption. As a
result, workers are spending an increasing amount of
time meeting paperwork requirements rather than providing
counseling, support, and encouragement to
clients. Recruiting the most skilled social workers to
work with the most vulnerable children and families is
difficult under these circumstances. Moreover, only
one-third of child welfare workers are trained social
workers.35 Providing adequate training, compensation,
and institutional support for social workers could
address some of these concerns.36
Difficulties Recruiting Foster Parents
Foster parenting is one of the most demanding jobs a
person can assume. Foster parents are expected to provide
for the day-to-day needs of children; respond to
their emotional and behavioral needs appropriately;
arrange and transport children to medical appointments,
mental health counseling sessions, and court
hearings; advocate on behalf of foster children with
schools; and arrange visits with birth parents and caseworkers.
Given these high demands, it is not surprising
that child welfare agencies often experience difficulty
recruiting and retaining foster parents. Moreover, once
recruited, foster parents face additional challenges as
they endeavor to care for children with complex needs.
A decline in the number of nonrelated foster families
has moved child welfare agencies to carefully consider
the motivations for becoming a foster parent and to
adopt innovative means of recruiting and retaining
potential families. Individuals are compelled to become
foster parents for a variety of reasons, most based on
altruism and social responsibility. Most individuals
become foster parents out of a sense of social obligation
and a desire to enhance the life chances of a child.
Other reasons cited are the desire to fulfill a societal
need, religious reasons, the need for supplemental
income, foster care as a step toward adoption,
increased family size, and substitution for a child lost
Commonly used recruitment tactics include advertisements
in mass media, personal contacts, flyers posted in
churches and civic organizations, and targeted recruitment
efforts. In a survey of foster parents, the majority
heard about foster parenting from other foster
parents, mass media, or other sources.38 Recruitment
through faith-based organizations and targeted recruitment
using race and residence as variables are most
effective.39 Targeted recruitment efforts identify specific
groups that may have an interest in foster parenting
and develop recruitment strategies rooted in an understanding
of the culture and customs of local communities,
as well as the groups themselves. Consequently,
there is an increase in the likelihood of securing participation.
Recently, there has also been an emphasis on
utilizing market research to identify prospective foster
families.40 As opposed to utilizing limited resources to
engage individuals known to be resistant and unwilling,
the market research approach capitalizes on
resources by focusing on those most willing or open to
the notion of becoming foster parents and then con-
Volume 14, Number 1 84
Stukes Chipungu and Bent-Goodley
nects them with children in need of foster parents. For
a profile of who becomes a foster parent, see Box 2.
Despite innovative efforts to recruit foster parents, the
number of non-kin foster homes continues to decline,
even as the placement of children in foster care is
increasing.41 In the 1970s and 1980s, non-kin families
provided care for most children in foster care; however,
by 1999, an estimated 142,000 licensed foster families
cared for less than half (48%) of the children in
care.42 Although the number of children in foster care
increased by 68% between 1984 and 1995, the number
of foster parents decreased by 4%.43 The poor public
image of the foster care system is one factor that
makes it difficult to recruit and retain non-kin foster
parents. Other considerations, such as the high cost of
housing, changing family structures, and increasing
numbers of women working outside the home, also
make it difficult to become a foster parent. For example,
potential foster parents, and particularly relative
providers, may find themselves unable to meet strict
housing requirements in their current homes and
unable to obtain new housing or needed
modifications. Consequently, these individuals may be
ruled out as foster parents, when in fact the core issue
is really poor housing options, not the quality or ability
of the person to parent. At the same time, available
families are underutilized by agencies: One-third of
licensed foster parents have no children in the home at
any given time.44
The challenges facing the child welfare system are
numerous. A growing caseload of children and families
with multifaceted needs tests the capacity of child welfare
agencies to secure and provide appropriate and
adequate services. The disproportionate representation
of children of color in the child welfare system is particularly
troubling given the history and contemporary
practice of systematic inequality. Additionally, most
child welfare agencies report difficulties in recruiting
and retaining staff and foster families. Recommendations
for addressing these challenges will be discussed
in the concluding sections of this article.
The Foster Care Experience
Living within the foster care system can be trying for
both children and foster parents. From a child?s perspective,
the foster care experience can be emotionally
traumatic, and it is associated with detrimental developmental
outcomes and lower educational achievement.
Foster parents are often expected to care for
children, many with special needs, with inadequate
financial support, minimal training, and limited access
to respite care. The foster care experience from the perspectives
of both children in care and foster parents is
The Child?s Perspective
Children who are removed from their homes and
placed in foster care often experience detrimental shortand
long-term effects. Researchers estimate that 30% to
80% of children in foster care exhibit emotional and/or
Who Becomes a Foster Parent?
More than three-quarters of non-kin foster parents are married
and white, and less than 20% of non-kin foster parents
are African American.
The average age of both foster mothers and fathers is
More than 50% of foster parents have incomes below
More than 30% of foster mothers and 80% of foster fathers
are employed full-time.
Nearly one-quarter of foster parents have a high school
diploma, and more than 30% have some professional training
or college education.
More than three-quarters of foster parents have at least one
birth child, and 30% have adopted at least one child.
Forty percent of foster parents live in suburbia, 36% live in
urban communities, and 24% live in rural neighborhoods.
On average, foster parents have 6.6 years of fostering experience.
Source: National Survey of Current and Former Foster Parents (NSCFFP). Conducted
in 1991, this is the only nationally representative sample of foster families.
Approximately 660 non-kin foster parents were surveyed. Cox, M.E.,
Orme, J.G., and Rhodes, K.W. Willingness to foster special needs children and
foster family utilization. Children and Youth Services Review (2002)
24:293?317; and Cuddeback, G.S., and Orme, J.G. Training and services for
kinship and nonkinship foster families. Child Welfare (2002) 51:879?909.
Challenges of Contemporary Foster Care
85 The Future of Children
behavioral problems, either from their experiences
before entering foster care or from the foster care experience
itself.45 Children entering foster care may experience
grief at the separation from or loss of relationship
with their natural parents. Children in care also face
emotional and psychological challenges as they try to
adjust to new and often changeable environments.
Within three months of placement, many children
exhibit signs of depression, aggression, or withdrawal.
Some children with severe attachment disorders may
exhibit signs of sleep disturbance, hoarding food, excessive
eating, self-stimulation, rocking, or failure to thrive.46
(See the article by Jones Harden in this journal issue.)
Children in foster care are also placed at greater risk
educationally. In New York City, 3,026 foster care
alumni were interviewed about their experiences in foster
care. More than 40% stated that they did not start
school immediately upon entering foster care, and
more than 75% stated that they did not remain in their
schools once placed in foster care. Nearly 65% reported
that they transferred in the middle of the school
year.47 More than half of the young people who
responded reported that they did not feel prepared to
support themselves after leaving foster care, and an
equal number were not satisfied with the quality of
education received while in foster care.
The perceptions of foster care alumni regarding the
inadequacy of their educational experiences are corroborated
by a study of private foster care agencies.48
Researchers in this study found that more than onethird
of children in care had written language skills
below grade level and that close to one-third had math
and reading skills below grade level. Thirty to forty percent
of youths in foster care are in special education.49
Due to placement changes, children in foster care are
often forced to change schools. This situation places
them at a great disadvantage. They often have difficulty
forming peer networks and support systems, feel stigmatized
due to their foster care status, and are forced to
resolve different curricula and varying educational expectations
without continuity of instruction or services.50
Retrospective studies examining the outcomes of
young adults who were in foster care as children provide
additional insights into the foster care experience.
For example, one study found that children who
remained in foster care appeared to have greater feelings
of insecurity than those who were adopted from
foster care.51 Moreover, many youths leaving foster
care end up in jail or on public assistance, or otherwise
represent an economic cost to the community.52 A
study of employment outcomes for youths aging out of
foster care found that many were underemployed and
progressing more slowly in the labor market than other
low-income youths, and only half had any earnings in
the two years after aging out of care.53 At the same
time, studies also find that providing support services
for youths transitioning out of foster care significantly
improved outcomes.54 (See the article by Massinga and
Pecora in this journal issue.)
In addition, some research indicates that foster care can
have a positive impact on children. One study of children
ages 11 to 14 found that, although placement
caused severe disruption because of the need to blend
into new neighborhoods, schools, and families and to
make new friends, the children described their lives and
The Foster Parents? Perspective
Once committed to the care of children, foster parents
are confronted with a number of challenges as they try
to attend to the complex needs of the children in their
care with limited support. Historically, foster parents
have been reimbursed at low rates and have been
expected to subsidize children?s care with their own
funds. In 2000, the average monthly foster care reimbursement
was $387 for a 2-year-old, $404 for a 9-
year-old, and $462 for a 16-year-old.56 Low rates of
compensation make it difficult for foster parents to
meet the needs of young people in their care while
simultaneously caring for the rest of the family.57 Inadequate
financial support can prove to be a disincentive
to the most willing and desirable foster parent.58 Moreover,
foster children have seven times the developmental
delays of similar children who are not in foster care
placement.59 As a result, foster parents are often
required to give extra care and attention to address foster
children?s needs, but without any extra resources,
support, access to respite care, or training.60
Recent efforts to incorporate foster parents? perspectives
into the planning and decision-making processes
for the children in their care create additional expecta-
Volume 14, Number 1 86
Stukes Chipungu and Bent-Goodley
tions on top of the already enormous demands placed
on foster parents. Historically, foster parents, preadoptive
parents, and relative caregivers have not been
viewed as active participants in these processes. Agencies
tended to focus on the temporary nature of foster
care, with little emphasis on the role that foster parents
and relatives could play as members of a team committed
to the safety, well-being, and permanence of children.
However, in the current practice environment,
caregivers are more often seen as playing multiple roles.
In addition to nurturing children and promoting their
healthy growth and development, they are expected to
advocate for children, mentor birth parents, and provide
members of the team (including social workers,
lawyers, and judges) with key information about the
well-being and permanency of children.61 Provisions in
ASFA underscore the greater formal role foster parents
are expected to play in caring for foster children by
specifying that foster parents, preadoptive parents, and
relatives who care for children in the custody of public
child welfare agencies are to receive timely notice of
permanency hearings and six-month periodic reviews,
and must be afforded an opportunity to be heard.
To meet these challenges, foster parents not only need
better financial support, they also need better case
management support.62 Foster parents report feeling
devalued by workers and stress the importance of
respecting foster parents.63 Lack of trust between
workers and foster parents can arise from poor service
integration, lack of service coordination, and the inaccessibility
of workers to support foster parents. Foster
parents find workers are often unavailable, even though
the expectations to meet children?s needs are rigorous.64
To manage the tensions of competing demands, foster
parents stress the need for workers to return their
phone calls, keep them informed, better articulate what
is expected of them, and be more readily available.65
In addition, further efforts are needed to ensure foster
parents? input is actively sought and valued in the decision-
making process. For example, despite provisions
in the federal law, focus groups in California indicated
that, in the previous two years, one-third of caregivers
had not received any written notices of court hearings
involving children in their care.66 When notified, caregivers
typically attended all court proceedings for the
children in their care. However, focus groups with
social workers, attorneys, and judges showed that they
were ambivalent or opposed to foster parents being
involved in court hearings and decision making regarding
the children in their care. Social workers who were
interviewed did not want caregivers involved in case
planning, nor were they enthusiastic about the idea of
having caregivers attend court hearings. Children?s
attorneys were open to the idea of caregivers attending
court proceedings. Attorneys representing other stakeholders
were not, however.67
Finally, making better training available to foster parents
is essential. Foster parents often complain about
receiving inadequate training; less than one-third
report being well prepared,68 and often there is no
reinforcement of what is learned in the training once
the child comes home.69 Effective foster parent training
models exist, but they are not used consistently across
local child welfare organizations.70 For many foster
parents, the fragmentation and irregularity of support
can be traumatic.
For these reasons, many certified foster families
become dissatisfied with their experiences as foster parents
and quit fostering within the first year of service.71
Although better training is not the sole solution, it is
one way to enhance the experience of foster parents
and to motivate them to continue to serve.72 When foster
parents receive quality training, they are more likely
to retain their licenses, have greater placement
lengths, and provide more favorable ratings of their
experiences as foster parents.73
Ensuring Safe, Stable, and Supportive
Homes for Children
Improving service operations to ensure the safety and
well-being of children in foster care, given the current
. . . less than one-third [of foster parents] report being well
prepared, and often there is no reinforcement of what is learned in
the training once the child comes home.
Challenges of Contemporary Foster Care
87 The Future of Children
policy constraints, requires multiple strategies and
significant creativity. A discussion of some of the measures
that can lead to a more responsive and responsible
child welfare system follows.
Responding to Children?s Developmental Needs
Child welfare systems and services must be designed
with the developmental needs of children at the forefront.
For example, infancy and early childhood are
acknowledged as the most fragile stages of development,
yet increasingly, more children in these age
groups are being placed in foster care. Some might
argue that the increase in out-of-home placements for
children in these age groups is warranted, given that
this is a fragile developmental stage and child abuse
rates for this age group are relatively high. However,
placing children outside the home during this stage can
be particularly harmful for their development. When
safety can be assured, every effort should be made to
either maintain children in their homes with the proper
supports or to place them in a kinship community
setting. The developmental literature tells us that
?placement with a relative has psychological advantages
for a child in terms of knowing his or her biologic
roots and family identity.74 When possible,
prioritizing and utilizing kinship care may provide
additional protective supports to the very young. (See
the article by Geen in this journal issue.)
Child welfare workers should also work to ensure the
positive developmental health of children. Developmentally
sensitive child welfare practices would include
conducting a comprehensive pediatric assessment within
30 days of placement; creating and coordinating
centralized medical files and creating ?health passports?
for children; identifying a medical home and a
health plan for each child; and creating standardized
measures for developmental and psychological screening.
75 Foster parents and child welfare workers need
training on the connections between developmental
delays, culture, and environmental influences, and how
to proactively identify possible difficulties. Additionally,
greater collaboration between professionals and the
creation of holistic developmental assessment tools,
including psychosocial connections, are equally important
to foster practices that encourage the healthy
development of children in care.
Finally, developmentally sensitive child welfare policies
must build on the existing strengths of children in foster
care and their families. These strengths must be acknowledged
when work with the child and birth
parents begins. Acknowledging children?s strengths and
building upon them through appropriate direct interventions,
administrative decisions, and public policies are
critical for children?s healthy development and well-being.
Addressing Disproportionality and
The disproportionate removal of children of color and
poor children from their homes should be acknowledged
as a crisis in child welfare warranting immediate
action. Discriminatory and differential treatment is evidenced
throughout the child welfare system. Advocates
for children should not dismiss these phenomena
as either coincidence or a consequence of increased
rates of abuse. Empirical studies have alerted child welfare
advocates to the realities of poor children and children
of color and their increased likelihood of being
removed from home. Addressing racism, discrimination,
and differential treatment is critical for better
serving and improving the experiences of families and
children of color. However eliminating race-based
decision making is also important for better serving
those white children who go without protection
because they are not properly assessed and removed
from abusive homes.
Diffusing Cultural Competence
Throughout the System
Cultural competence must be infused into the child
welfare system throughout the decision-making
process.76 This effort must go beyond hiring a bilingual
staff member, adding a music component to a program,
or hosting an international potluck dinner. As
one researcher explains, ?Cultural competence denotes
the ability to transform knowledge and cultural awareness
into health and/or psychosocial interventions that
support and sustain healthy client-system functioning
within the appropriate cultural context.?77 In child
welfare, cultural competence is demonstrated when
?an agency is aware of and accepts differences, promotes
cultural knowledge, [and] has the ability to
adapt practice skills to fit the cultural context of children,?
78 families, and communities. Cultural competence
includes administrative and managerial teams
Volume 14, Number 1 88
Stukes Chipungu and Bent-Goodley
that reflect the clients being served and that support
cultural adaptation of recruitment strategies, assessment
tools, interventions, and evaluative methods.
Appraisals and performance evaluations must include
assessments of workers? abilities to engage in cultural
competence. Supporting the development and substantiation
of culturally competent models is a direct
form of cultural competence, and establishing policies
and procedures that are culturally rooted is necessary
to guide practice on all levels.
Supporting and strengthening families is essential if we
are to protect and nurture this nation?s most vulnerable
children. Alleviating the effects of poverty on fragile
families can help reduce the numbers of children coming
into foster care. When placement is necessary, extending
the appropriate services and supports to birth
families can help them resolve their difficulties and
acquire the tools needed to get their children back. Moreover,
actively involving birth parents in developing
their own case plans can help them take ownership, and
this process has been shown to increase compliance.
Increasing supports for foster parents, through
enhanced communication with child welfare workers,
increased financial support, enriched ongoing training,
and respite care, can facilitate the retention of foster
parents. The poor support currently offered may
be a factor in the decreasing number of non-kin foster
homes and the difficulty in recruiting and retaining
foster parents. Emphasis must be placed on ensuring
that foster parents are provided with respite care.
When a prospective foster family resides in inadequate
housing, rather than being ruled out as ineligible,
efforts should be made to help the family secure
appropriate housing or to make housing improvements
in order to meet the specifications of the foster
care system. Finally, providing foster parents with relevant
training and a greater understanding of what to
anticipate will increase their ability to meet the needs
of foster children.
Ensuring Competent Staffing
Staff competence does not rest solely on the individual
but involves the entire child welfare organization. The
best and brightest social work schools have to offer are
unlikely to join the ranks of child welfare, despite
bonuses and pay increases, when conditions continue
to be poor and systems unresponsive to needed
changes. Developing systems that support workers
must be a priority, despite contemporary constraints.
Strong supervisors with both clinical and managerial
skills are critical for providing effective support to staff
and ensuring that less-seasoned workers receive the
direction they need.79 Skilled supervisors assigned to
manage a small number of staff will offer greater
opportunities to fully enhance the experience and competence
of child welfare workers.
Regular and ongoing trainings that provide continuing
education credits toward professional degrees can also
enhance staff and aid in retention. Training curricula
should be based on sound data that support the needs
of staff. Workers who do not see the connection
between what they do, how to improve practice, and
training curriculum will not be motivated to attend
trainings. Bringing in experts with practical experience
in the child welfare system will assist in shaping trainings
that are grounded in the needs of staff.
Improving Data Collection and Accountability
News reports of foster children being abused while in
care or ?lost? in the system are all too frequent. Protecting
children in care by developing structures and
measures for establishing agency accountability is a
paramount public concern. Again, adequately training
and supporting staff is a critical element for establishing
accountability, but careful analysis and utilization of
administrative data can also be a powerful tool for diagnosing
problems, identifying emerging issues, and
monitoring agency efforts.
Child welfare agencies regularly collect administrative
data on such variables as reason for removal, characteristics
of children in care, placement type and duration,
and exit outcome. Although there are limitations to
administrative data, federal funding incentives to develop
Statewide Automated Child Welfare Information
Systems (SACWIS) and the availability of computerized,
longitudinal administrative data give child welfare
agencies tools with which to assess agency performance.
Agencies can use this data to promote agency
accountability, as well as to reward improved performance
and to recognize workers and units that excel.
Further, this data can be used to complement other
Challenges of Contemporary Foster Care
89 The Future of Children
Innovative Foster Care Models
Family to Family
First introduced in Alabama, Maryland, New Mexico, Ohio, and
Pennsylvania, Family to Family is now operating or under consideration
in seven other states. In this model, recruitment efforts
target those communities where foster parents are needed most.
Foster parents are paid not only to care for children but also to
develop a mentoring relationship with birth parents. Ideally, foster
parents, birth parents, social workers, and community liaisons
work together to reunify families.a
Shared Family Care
The Shared Family Foster Care (SFFC) model involves the planned
provision of out-of-home care to parents and their children. In this
model, parents and host caregivers simultaneously share the care of
children and work toward independent, in-home care by parents.b
Typical shared family care arrangements include residential programs
for children that also offer residence and treatment for their
parents; drug and alcohol treatment programs for adults that also
offer treatment for children; drug treatment programs for mothers
and children; residential programs for pregnant and parenting
mothers; and foster family homes that offer care for parents and
children.c Monthly SFFC costs are generally higher than those of
basic family foster care placements, but because SFFC placements
are typically shorter in duration the program appears to be,
at a minimum, cost neutral. SFFC shows promise in protecting
children and preserving families. However, it is not appropriate for
everyone. Parents must demonstrate a real desire to care for their
children and a readiness to participate in a plan to improve their
parenting skills and life situations. Experience suggests that parents
who are actively using drugs, involved in illegal activity, violent, or
severely mentally ill (and not receiving appropriate treatment) are
unlikely to benefit from this program. Parents in recovery, those
with developmental disabilities, those who are socially isolated, and
those with poor parenting skills are good candidates for SFFC.
aMiller, C. Fostering community. Children?s Advocate (March/April 2000), p. 8. Available online at http://126.96.36.199/news/300ftf.htm.
bBarth, R.P, and Price, A. Shared family care: Providing services to parents and children placed together in out-of-home care. Child Welfare (1999) 78(1):88?108.
cBarth, R.P. Shared family care: Child protection and family preservation. Social Work (1994) 39(5):515?25.
measures to insure that the quality of work is at the
For administrative data to be an important diagnostic
and evaluation tool, however, improvements in state
and local data collection are urgently needed. Currently,
child neglect operates as a catchall category that
obscures the underlying reasons for placement. This
category needs to be further broken down so that reasons
for placement such as parental substance abuse,
mental illness, incarceration, or death can be properly
documented. More detailed and accurate data would
allow states to better plan programs for children in
their jurisdictions and would illuminate the root causes
of entry into foster care. States also need to stop
relying on data that documents only what is occurring
at a particular point in time and better utilize the data
in administrative databases for analyses and planning.
For example, administrative data can be used to identify
children placed with relatives or nonrelatives, or to analyze
the disproportionate representation of minorities
in care. This information can be further used to determine
where such phenomena exist, down to the county
or city level, and can provide the basis for better practice.
Finally, better data is needed on services provided.
Better data collection and ongoing analyses will allow
policymakers, planners, administrators, and workers to
do a better job serving children and families.
Experimenting with Innovative Models
Innovative models of family foster care that recognize
the relational nature and community context of foster
care hold promise for reinventing foster care. Two particularly
promising models, Family to Family and
Shared Family Foster Care, encourage social workers
and foster families to reach out to birth families with
the mentoring, community support, and services they
need to reunify with their children, while simultaneously
providing out-of-home care for children (see Box
There are also a number of culturally competent interracial
adoption programs that can serve as models for
cultural competence in foster care more generally.
These programs and organizations have worked successfully
with children, foster and adoptive parents, and
child welfare workers, and they provide an example of
how to use cultural competence in working with each
stakeholder in the foster care system (see Box 4).
The challenges facing the foster care system are daunting.
Yet there are promising practices and models for
addressing the needs of foster children. The system
must acknowledge the interconnection between the
multitude of factors that lead to children being placed
in foster care and must develop a comprehensive and
holistic array of services to serve fragile families. Providing
foster families with the incentives and supports
to facilitate their success is a primary issue for foster
care?s longevity as an option for children. Addressing
the underlying racism and discriminatory treatment of
poor people and people of color is both a social and a
Good child welfare practice depends on diligent and
dedicated social workers, innovative service systems,
effective policymaking, strong advocacy, and family
and community partnerships. Organizational reforms
that develop accurate and meaningful measures of performance
while ensuring that staff members receive
the support and training they need to optimize their
working environment and achieve their long-term
goals are critical to success. Although there are pressing
challenges in contemporary foster care, there are
also recognized solutions that, if honestly incorporated,
could make a difference for these fragile yet promising
Volume 14, Number 1 90
Stukes Chipungu and Bent-Goodley
Models for Infusing Cultural Competency
into Foster Care
Several successful cultural competency models utilized in the
adoption process hold lessons for infusing cultural competency
into the foster care system more generally. For example,
ROOTS, Inc., an African American adoption agency in Atlanta,
has a successful record of using culturally competent techniques
to recruit and retain adoptive families. Specializing in
placing hard-to-place children, ROOTS has been able to find
permanent homes for children of color with racially matched
families by using formal and informal networks. The Institute
for Black Parenting (IBP), the first licensed adoption agency of
color in the state of California, is another example of a culturally
competent child welfare organization. IBP has been able
to effectively recruit and retain families of color by training all
staff in cultural competence, working with communities and
churches, and maintaining flexible hours, along with other
techniques. These programs provide evidence that success
emanates from culturally competent practice.
Sources: Jackson-White, G., Dozier, C.D., Oliver, J.T., and Gardner, L.B. Why
African American adoption agencies succeed: A new perspective on self-help.
Child Welfare (1997) 46:239?54; McRoy, R.G., Oglesby, Z., and Grape, H.
Achieving same-race adoptive placements for African American children: Culturally
sensitive practice approaches. Child Welfare (1997) 46:85?106.
Challenges of Contemporary Foster Care
91 The Future of Children
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2. See note 1, U.S. Department of Health and Human Services.
3. Berrick, J.D., Needell, B., Barth, R.P., and Jonson-Reid, M. The
tender years: Toward developmentally sensitive child welfare services
for very young children. New York: Oxford University Press, 1998.
4. U.S. Department of Health and Human Services. Adoption and
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5. Simms, M.D., Dubowitz, H., and Szilagyi, M.A. Health care needs
of children in the foster care system. Pediatrics (2000)
6. Waldfogel, J. Child welfare research: How adequate are the data?
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7. U.S. Department of Health and Human Services, Administration
for Children, Youth and Families. Child maltreatment 2001. Washington,
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8. See note 7, U.S. Department of Health and Human Services.
9. Other reasons for entering foster care include medical neglect,
physical abuse, sexual abuse, and psychological maltreatment.
(Medical neglect occurs when a caregiver fails to provide adequate
health care for a child, despite either having or being provided the
financial means to do so, resulting in harm to the child?s health.
Prenatal exposure to drugs may be included.)
10. See note 7, U.S. Department of Health and Human Services.
11. See note 7, U.S. Department of Health and Human Services.
12. Green, M.Y. Minorities as majority: Disproportionality in child
welfare and juvenile justice. Children?s Voice (November?December
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delivery of child welfare services to African American clients.
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31. See note 28, Falicov; and note 30, Ogbu.
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40. See note 37, Baum, et al.
41. See note 37, Baum, et al.
42. See note 4, U.S. Department of Health and Human Services.
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46. See note 5, Simms, et al.
47. Festinger, T. New York City adoptions 2000. New York: Ehrenkranz
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48. See note 25, Yu, et al.
49. See note 25, Yu, et al.
50. See note 25, Yu, et al.
51. Of 44 young adults who had been adopted and 44 who had been
foster children, adoptees appeared more confident and secure,
whereas those who had remained foster children seemed insecure
and less grounded in their identities. See Triseliotis, J. Identity and
security in adoption and long-term care fosters. Early Childhood
Development and Care (1984) 15:149?70.
52. Westat, Inc. A national evaluation of Title IV-E foster care independent
living programs for youth, phase 2: Final report. Rockville,
MD: Westat, Inc., 1991.
53. U.S. Department of Health and Human Services. Employment outcomes
for youth aging out of foster care. Washington, DC: DHHS,
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54. Kerman, B., Wildfire, J., and Barth, R.P. Outcomes for young
adults who experienced foster care. Children and Youth Services
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55. Ruff, P., and Yoken, C. Family foster care placement: The child?s
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56. Based on data collected by the Child Welfare League National
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57. Fees, B.S., Stockdale, D.F., Crase, S.J., et al. Satisfaction with foster
parenting: Assessment one year after training. Children and
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58. See note 57, Fees, et al.
59. See note 37, Baum, et al.
60. See note 37, Baum, et al.
61. Barbell, K., and Freundlich, M. Foster care today. Washington, DC:
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62. Sisco, C. Private foundation helps Utah recruit, train, retain foster
parents. Policy and Practice of Public Human Services (2001)
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65. Foster parents also mention the need for workers to do better
when matching children with foster parents, and to use consultants
to assist when necessary. See Brown, J. and Calder, P. Conceptmapping
the challenges faced by foster parents. Children and
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66. See note 61, Barbell and Freundlich.
67. See note 61, Barbell and Freundlich.
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69. See note 68, Cuddeback and Orme; and note 22, Pecora, et al.
70. The NOVA university model is a common foster parent training
model. This model screens foster parents through a three-hour orientation
and then commences with six three-hour sessions. The
sessions emphasize group discussion and interaction; strong trainer
experience and ability; specific exercises to enhance the skill base
of foster parents; suggestions on how to negotiate working with
the biological family; and, finally, what to expect from a foster child
and how to respond. The ability to negotiate situations with biological
parents may be particularly relevant for relative providers, as
they may have more contact with biological parents and not know
how to address these relationships in light of the circumstances.
This model has been empirically tested and found to be reliable
among a diverse group of foster parents.
71. See note 38, Cox, et al.; and note 61, Barbell and Freundlich.
72. See note 57, Fees, et al.
73. Lee, J.H., and Holland, T.P. Evaluating the effectiveness of foster
parent training. Research on Social Work Practice (1991) 1:162?75.
74. American Academy of Pediatrics, Committee on Early Childhood
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children in foster care. Pediatrics (2000) 106:1145?50.
75. American Academy of Pediatrics, Committee on Early Childhood
Adoption and Dependent Care. Health care of young children in
foster care. Pediatrics (2002) 109:536?39. ?Health passports? are
documented medical records that can follow a child in different
placement settings. Consequently, information on the health status
of the child will not be lost, and the child can receive necessary care
with an acknowledgement of previous medical conditions. Psychosocial
connections are those social relationships, influences, and
ways of thinking and feeling that are important in the helping
process. See also note 5, Simms, et al.
76. See note 16, Pinderhughes.
77. See note 16, McPhatter, p. 261.
78. See note 22, Pecora, et al., p. 439.
79. See note 22, Pecora, et al.