Young Children and Foster Care

Susan Conwell
September 13, 1999

Whether you are a pediatrician, social worker, therapist or foster parent working with young children, Young Children and Foster Care has a challenge for you. How will you take the "best practices" of this multidisciplinary team of authors and put it to work on behalf of infants and preschool aged children in your community?

This is a serious charge. The number of children between the ages of birth to five in foster care has increased dramatically in recent years, with as many as 44 percent of the children who entered foster care between 1990 and 1994 being between the ages of birth to three. The need for specialized assessment and care for these children has increased at the same time. A report by the U.S. General Accounting Office notes that, "As a group, (foster children) are sicker than homeless children and children living in the poorest sections of inner cities." Rates of developmental delay among children in foster care are four to five times the rates of developmental delay among children in the general population.

Young Children and Foster Care counters what the editors describe as the tendency of "professionals (to) function independently and, far too often, at cross purposes" by sharing the expertise of a variety of professionals in a straightforward and accessible manner. The book is organized into five sections: Developmental and Emotional Concerns; Medical Concerns; Advocating for Children; Prevention and Early Intervention; and Training. Each section includes contributions by several experts in the field and includes descriptions of innovative programs and collaborative models. Each chapter has helpful references and comprehensive endnotes. The descriptions of the model programs will both inspire and remind the reader of the complex nature of improving our child welfare systems.

The first two sections of the book relating to developmental, emotional and medical concerns of young children are particularly powerful. Recent dramatic advances in our understanding of brain development during a child's early years and our understanding of the importance of child/caregiver attachment provide the backdrop for these chapters. The complex interrelationship of developmental disabilities and abuse is a frequent and well-developed theme. Many of the authors discuss how a failure to diagnose a child's disability may compound earlier abuse or at least frustrate attempts at remediation. For example, children with undiagnosed speech and language difficulties may not follow requests because they do not understand them. Without a diagnosis, they may be labeled "naughty" or "difficult" children, their caregivers may find it more difficult to attach to them, and the child may be at risk for multiple placements. With an appropriate diagnosis and training for the caregiver, the child is much more likely to receive appropriate speech therapy and experience a more stable, supportive placement.

Dr. Barbara Amster's chapter on speech and language development of young children in the child welfare system should be required reading for educators and all professionals in the child welfare system. Amster's study of 289 children younger than 31 months of age in the Starting Young Program in Philadelphia found that 57 percent of the children had language delays. This incidence of speech-language difficulty contrasts to a 2-3 percent rate of language disorders among the general population of preschoolers.

Although I gained a great deal of understanding about the problem, I found myself wanting more. How many of the children who received speech/language therapy caught up with their peers in time for kindergarten? Are there differences in treating speech/language disorders that are related to abuse and neglect rather than biological or other environmental factors? What is the relationship between speech and language difficulties and the poor academic performance of many foster children? Like Dr. Amster, many of the authors leave the reader asking questions and seeking to make connections among the various disciplines. This is one of the book's contributions—as we are left with questions and we will have to keep pursuing the answers on behalf of the children in our care.

All of the authors provide solid descriptions of specific health problems common to foster children. Many contributors point out the need for a comprehensive initial assessment of children entering foster care so that their health, mental health and developmental needs may be addressed. However, the contributors also acknowledge how far we are from achieving that goal. Why this is so is less clear. Several contributors point to the difficulties of working with multiple funding streams and multiple systems. Many authors emphasize the need for collaboration. However, they shy from discussing how we will hold each other accountable. The slim section on training and the even slimmer section on advocating for foster children illustrate additional problems. Few of the adults in the lives of foster children and even fewer members of the broader community are aware of the sad state of health of America's young foster children. Given the profound impact that their early health care will have on their later development, this is a sad state indeed. Where are the advocates for foster children? Hopefully, Young Children and Foster Care will help to put us on the right track.

I strongly recommend this book to anyone who works with foster children—whether as a foster parent, doctor, lawyer, social worker or advocate. Although the book is subtitled, "A Guide for Professionals," I think the information is important for everyone who cares for or about foster children. If the going gets tough, my advice is to stick with it and get the information you need. Foster parents, mentors, teachers, social workers and advocates—use the information in this book to support your requests for help with the children in your care. It isn't your imagination—Johnny is having a hard time communicating, and Annie really is getting rigid when you attempt to hug her. The rewards will be yours when Johnny can tell you what he wants with a smile instead of an angry fist, and Annie can enjoy positive, caring relationships.


Young Children and Foster Care: A Guide for Professionals, edited by Judith A. Silver, Barbara J. Amster and Trude Haecker. Published by Paul H. Brookes Publishing Co., Copyright 1999, $39.95 (includes shipping and handling). ISBN 1-55766-381-5.


Susan Conwell and her husband Vincent Vukelich are foster parents to twin boys who had significant speech/language delays. Susan is a 1986 graduate cum laude of Princeton University and a 1992 graduate of Harvard Law School. She is a founder of "Best Interests," a Milwaukee, Wisconsin advocacy group for children in out-of-home care.