Child abuse and neglect are common problems across the world that result in negative consequences for children, families and communities. Children who have been abused or neglected are often removed from the home and placed in residential care or with other families, including foster families. Foster care was traditionally provided by people that social workers recruited from the community specifically to provide care for children whose parents could not look after them. Typically they were not related to the children placed with them, and did not know them before the placement was arranged. In recent years many societies have introduced policies that favour placing children who cannot live at home with other members of their family or with friends of the family. This is known as 'kinship care' or 'families and friends care'. This review was designed to help find out if research studies could tell us which kind of placement is best. Sixty two studies met the methodological standards the authors considered acceptable. Wherever possible the authors combined the data from studies looking at the same outcome for children, in order to be more confident about what the research was telling us. Current best evidence suggests that children in kinship care may do better than children in traditional foster care in terms of their behavioral development, mental health functioning, and placement stability. Children in traditional foster care placements may do better with regard to achieving some permanency outcomes and accessing services they may need. Implications for practice and future research are discussed.

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Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND. Investigators from several states have reported that children entering foster care are at risk for medical and mental health conditions. Additional information based on data from a larger statewide population of children in foster care would assist in the development of appropriate strategies of care for these children. OBJECTIVES. The purpose of this work was to describe the prevalence of medical and mental health conditions, the number of referrals for specialty care, the use of medications and to compare the prevalence of these conditions across age groups of children entering foster care in Utah. METHODS. We conducted an analysis of a statewide database containing abstracted medical and mental health information from the initial medical and mental health assessments of all children entering foster care between January 1, 2001, and December 16, 2004. RESULTS. Of the 6177 children who entered foster care during the study period, 83% were white and 24% were Hispanic. One or more acute or chronic medical conditions were present in 54%, and 44% had ≥1 mental health condition. The most prevalent medical conditions in all of the children were overweight or obesity (35%), 30% had a referral for specialty care. The most prevalent mental health conditions were oppositional defiant disorder or conduct disorder (18%), reactive attachment and adjustment disorders (17%), and mood disorders (15%). The frequency of psychotropic medication use increased with age. Of the 2747 children of all ages with a diagnosed mental health condition, 35% were receiving psychotropic medications. CONCLUSIONS. This study of a statewide cohort of children entering foster care supports and strengthens previous evidence that children in foster care are more likely to have more health care needs compared with the general pediatric population. Focused strategies are needed that address prevalent conditions, the need for continuity of care, ongoing mental health services, and medication management.

Medical and Mental Health of Children Entering the Utah Foster Care System

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being. However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

https://onlinelibrary.wiley.com/doi/pdf/10.4073/csr.2014.2

Kinship Care for the Safety, Permanency, and Well-Being of Children Removed from the Home for Maltreatment: A Systematic Review

Background: Children living in out-of-home care have high and frequently unidentified health needs. The Child Protection Unit at Sydney Children’s Hospital offers comprehensive health screening to children in care.



Aims:  To report the experience of the health screening clinic and the rates of identified health problems of children in care in this sample, and to compare these rates with the general child population and children in care overseas.



Methods:  Comprehensive multidisciplinary health screens were offered to children in out-of-home care.



Results:  High rates of physical, developmental and emotional health problems were identified. The rates of poor health were greater than the average child population of New South Wales, but similar to the rates of poor health reported in children in care overseas.



Conclusions:  Children in care are a vulnerable group of the child population who experience unacceptable levels of poor health. Comprehensive health screens can help identify previously undetected health problems.

Health needs of Australian children living in out-of-home care.

Objective
To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6–17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6–17 years living in the community in Australia.

The health-related quality of life of children and adolescents in home-based foster care.

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.

Fatema Lakhani Mawjee

Papers

Comparing the health status of low-income children in and out of foster care.