Health Care Services for Children in Out-of-Home Care: Facts and Figures
The Health of Children in Out-of-Home Care
Compared with the U.S. population as a whole, children in the foster care system are more likely to be poor and in poor health. The abused and neglected children and troubled families in the child welfare system confront especially serious health care problems. Many of these children are likely to start their lives at low birthweight, prenatally exposed to illegal drugs or alcohol, or exposed to HIV/AIDS or other diseases. Abused or neglected children too often lack immunizations or have unaddressed developmental disabilities. As adolescents these vulnerable youths are among those most at risk to abuse alcohol or drugs, contract and transmit HIV infection, or become teen parents. Further, many of the troubled parents who come to the attention of the child welfare system have never received the physical care, mental health services, or substance abuse treatment they need.
Children in foster care increasingly have complex problems rooted in family, social, and environmental conditions, sometimes referred to as the "new morbidities." These conditions include poverty, child abuse, drug exposure, drug use, teenage pregnancies, school failure, family violence, and conduct disorders. But when children in foster care receive appropriate care, they can show significant improvement in physical, emotional, and intellectual development.
According to the 1997 CWLA Stat Book, in 1995, 715,743 children received out-of-home care services for some period of time. This means that these children live in family foster care, kinship care, or residential care because their parents are unable or unwilling to care for them. The gravity and extent of the health care problems facing abused and neglected children are truly alarming.
Physical health problems affect 30 to 40 percent of children in the child welfare system. These include delayed growth and development, HIV infection, neurological disabilities, malnutrition, and asthma. Vision, hearing, and dental problems are also especially prevalent among the children in the child welfare system. One study revealed that children in out-of-home care check into hospitals more frequently than other low-income children and stay for longer periods of time.
Mental health problems are particularly widespread. Experts estimate that between 30 and 85 percent of youngsters in out-of-home care have significant emotional disturbances. Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders than those living with their own families.
Developmental disabilities affect a high proportion of children who are abused or neglected. A recent nationwide study revealed that approximately 20 percent of children in out-of-home care have developmental disabilities, mental retardation, cerebral palsy, and learning disabilities, as well as speech, hearing, and sight impairments.
- Approximately 60 percent of all children in out-of-home care have moderate to severe mental health problems. A substantial number of these children have psychological problems so serious that they require residential placement. Despite this level of need, less than one-third of children in the child protective system are receiving mental health services.
Prenatal drug exposure contributes to the increasing number of children entering out-of-home care. Between 14 and 18 percent of all pregnancies involve fetal alcohol or drug exposure. Infants are entering the child welfare system in record numbers, at least partly as a result of the substance abuse epidemic.
- In 1988, nearly 30% of the Illinois school-age foster care caseload was in special education.
HIV/AIDS is impacting the child welfare system. Estimates suggest that the HIV epidemic alone will increase the number of children living in foster care and other types of out-of-home care by almost one-third before the end of the decade. It is estimated that between 72,000 and 125,000 children will be orphaned by AIDS by the year 2000.
- There are more than 5,000 cases of fetal alcohol syndrome (FAS) reported each year. The average cost of caring for a baby born with FAS to age 65 is estimated to be nearly $500,000.
- A 1993 report of the U.S. Department of Health and Human Services Children's Bureau cited 22,000 boarder babies (babies born exposed to alcohol or other drugs and left in hospitals) and other abandoned infants in the United States in 1991. Over three-fourths of these infants were drug exposed. None of these infants was expected to leave the hospital in the care of a biological parent. Fifty-four percent of the abandoned infants were expected to be placed in foster family care, and six percent were expected to move into adoptive placements.
- Of the 513 children born drug-exposed at one Chicago hospital between 1985 and 1990, by the end of 1991, 20 percent had been the subjects of substantiated child abuse and neglect reports.
- As many as 80 percent of drug exposed infants will come to the attention of the child welfare system before their first birthday.
Teen pregnancy rates in the United States continue to be higher than in other industrialized nations. Despite a decrease in the rate of teenage childbearing, the number of births to teens increased in 1994, reflecting an increase in the overall U.S. teenage population. Sexual abuse elevates the risk of adolescent pregnancy. Between 1986 and 1993, the estimated number of sexually abused children increased from 119,200 to 217,700. Each year almost one million teenagers become pregnant. Each year, one girl in 10 between the ages of 15 and 19 gives birth or has an abortion, compared with fewer than one in 20 in England, France, and Canada. Infants of unmarried teenage mothers are 1.5 times more likely to die in infancy and two times more likely to be born underweight than those born to women older than 20.
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