Foster care

Children of the United Kingdom's Child Migration Programme – many of whom were placed in foster care in Australia

Foster care is a system in which a minor has been placed into a ward, group home, or private home of a state-certified caregiver, referred to as a "foster parent". The placement of the child is normally arranged through the government or a social service agency. The institution, group home or foster parent is compensated for expenses.[1]

The State, via the family court and child protection services agency, stand in loco parentis to the minor, making all legal decisions while the foster parent is responsible for the day-to-day care of the minor.

The vast majority of children who would otherwise need foster care are in kinship care, that is, in the care of grandparents or other relatives.[2] Most kinship care is done informally, without the involvement of a court or public organization. However, in the U.S., formal kinship care is increasingly common. In 2012, a quarter of all children in formal foster care were placed with relatives.[3]

By Country

Australia

In Australia foster care was known as "boarding-out". Foster care had its early stages in South Australia in 1866 and stretched to the second half of the 19th century. It is said that the system was mostly run by women until the early 20th century. Then the control was centered in many state children's departments. "Although boarding-out was also implemented by nongovernment[al] child rescue organizations, many large institutions remained. These institutions assumed an increasing importance from the late 1920s when the system went into decline." The system was re-energized in the postwar era, and in the 1970s. The system is still the main structure for "out-of-home care." The system took care of both local and foreign children. "The first adoption legislation was passed in Western Australia in 1896, but the remaining states did not act until the 1920s, introducing the beginnings of the closed adoption that reached it peak in the period 1940–1975. New baby adoption dropped dramatically from the mid-1970s, with the greater tolerance of and support for single mothers".[4]

Cambodia

Foster care in Cambodia is relatively new as an official practice within the government. However, despite a later start, the practice is currently making great strides within the country. Left with a large number of official and unofficial orphanages from the 1990s the Cambodian government conducted several research projects in 2006, and 2008 pointing to the overuse of orphanages as a solution for caring for vulnerable children within the country. Most notably, the studies found that the percentage of children within orphanages that had parents approached 80%. At the same time, local NGOs like Children In Families began offering limited foster care services within the country. In the subsequent years, the Cambodian government began implementing policies that required the closure of some orphanages, and the implementation of minimum standards for residential care institutions. These actions lead to an increase in the number of NGOs providing foster care placements, and helped to set the course for care reform around the country. As of 2015, the Cambodian government is working with UNICEF, USAID, several governments, and many local NGOs in continuing to build the capacity for child protection and foster are within the Kingdom.

Canada

Foster children in Canada are known as permanent wards, (crown wards in Ontario).[5] A ward is someone, in this case a child, placed under protection of a legal guardian and are the legal responsibility of the government. Census data from 2011 counted children in foster care for the first time, counting 47,885 children in care. The majority of foster children – 29,590, or about 62 per cent – were aged 14 and under.[6] The wards remain under the care of the government until they "age out of care." All ties are severed from the government and there is no longer any legal responsibility toward the youth. This age is different depending on the province.

India

Foster care has had a long history in India, first initiated in the 1960s by the central government. The first non-institutional scheme was introduced in Maharashtra in 1972. The scheme was later revised in 2005 as the 'Bal Sangopal Scheme – Non Institutional Services'. In the late 1990s Karnataka implemented a foster care scheme focused on destitute children. Emergency schemes were operational even in Gujarat, after the 2001 earthquake where around 350 children were rehabilitated with their relatives and neighbours in the community. However, although the JJ Act presently provides for foster care, it is not being implemented effectively. Very few state governments have developed foster care programs. Foster care is still largely used as a pre-adoption procedure, which is limiting the potential of this method to provide family care to children. In the year 2016 the Ministry of Women and child Development published Model Guidelines on Foster Care. The Centre of Excellence in Alternative Care of Children established in December 2015 has started the work on foster care by creating awareness on foster care, by providing training to all agencies at all levels reading foster care and helping NGOs and other agencies in implementing foster care. In a very short amount of time they have trained more then 600 people in the country.

Israel

In December 2013, the Israeli Knesset approved a bill co-drafted by the Israel National Council for the Child to regulate the rights and obligations of participants in the foster care system in Israel.[7]

Japan

In Japan, foster care started around 1948, leading to the passing of the Child Welfare Law.[8] The idea of foster care or taking in abandoned children actually came about around 1392-1490s in Japan. The foster care system in Japan is similar to the Orphan Trains because Brace thought the children would be better off on farms. The people in Japan thought the children would do better on farms rather than living in the "dusty city." The families would often send their children to a farm family outside the village and only keep their oldest son. The farm families served as the foster parents and they were financially rewarded for taking in the younger siblings. "It was considered an honor to be chosen as foster parents, and selection greatly depended on the family's reputation and status within the village".[9] Around 1895 the foster care program became more like the system used in the United States because the Tokyo Metropolitan Police sent children to a hospital where they would be "settled".[10] Problems emerged in this system, such as child abuse, so the government started phasing it out and "began increasing institutional facilities". In 1948 the Child Welfare Law was passed, increasing official oversight, and creating better conditions for the children to grow up in.[11]

United Kingdom

In the United Kingdom, foster care and adoption has always been an option, "in the sense of taking other people's children into their homes and looking after them on a permanent or temporary basis." Although, nothing about it had a legal foundation, until the 20th century. The UK had "wardship," the family taking in the child had custody by the Chancery Court. Wardship was not used very often because it did not give the guardian "parental rights." In the 19th century came a "series of baby farming scandals." At the end of the 19th century they started calling it "boarding-out" like they did in Australia. They started placing the children in orphanages and workhouses as well. "The First World War saw an increase in organized adoption through adoption societies and child rescue organizations, and pressure grew for adoption to be given legal status." The first laws based on adoption and foster care were passed in 1926. "The peak number of adoptions was in 1968, since when there has been an enormous decline in adoption in the United Kingdom. The main reasons for children being adopted in the United Kingdom had been unmarried mothers giving up their children for adoption and stepparents adopting their new partner's children".[12]

United States

In the United States, foster care started as a result of the efforts of Charles Loring Brace. "In the mid 19th Century, some 30,000 homeless or neglected children lived in the New York City streets and slums."[13] Brace took these children off the streets and placed them with families in most states in the country. Brace believed the children would do best with a Christian farm family. He did this to save them from "a lifetime of suffering"[14] He sent these children to families by train, which gave the name The Orphan Train Movement. "[This] lasted from 1853 to the early 1890s [1929?] and transported more than 120,000 [250,000?] children to new lives."[15] When Brace died in 1890, his sons took over his work of the Children's Aid Society until they retired.[14] The Children's Aid Society created "a foster care approach that became the basis for the federal Adoption and Safe Families Act of 1997" called Concurrent Planning. This greatly impacted the foster care system. Children's Aid works with the biological and foster parents to "achieve permanency".[13] "From the mid-1800s to the eve of the Great Depression, orphan train children were placed with families who pre-selected them with an order form, specifying age, gender, hair and eye color. In other cases, trainloads of children were assembled on stages, train platforms or town halls and examined by prospective parents. "Conjuring the image of picking the best apple from the bin. Sometimes a child would be separated from his or her brothers and sisters, or would end up in a family that only wanted them to work. Most of the time the children were chosen by a loving or childless family".[16]

Placement

Family-based foster care is generally preferred to other forms of out of home care.[17] Foster care is intended to be a short term solution until a permanent placement can be made.[18] Generally, the first choice of adoptive parents is a relative such as an aunt, uncle or grandparent, known as kinship care. If no related family member is willing or able to adopt, the next preference is for the child to be adopted by the foster parents or by someone else involved in the child's life (such as a teacher or coach). This is to maintain continuity in the child's life. If neither above option are available, the child may be adopted by someone who is a stranger to the child.

If none of these options are viable the plan for the minor may be to enter OPPLA (Other Planned Permanent Living Arrangement). This option allows the child to stay in custody of the state and the child can stay placed in a foster home, with a relative or a long term care facility (for children with development disabilities, physical disabilities or mental disabilities).

671,000 children were served by the foster care system in the United States in 2015.[19] "After declining more than 20 percent between FY 2006 and FY 2012 to a low of 397,000, the number of children in foster care on the last day of the fiscal year increased to 428,000 in FY 2015, with a slightly higher percent change from 2014 to 2015 (3.3%) than observed from 2013 to 2014 (3.2%)."[20] In 2015, there were about 112,000 children ready for adoptive families in the nation's foster care systems.[21]

The median amount of time a child spent in foster care in the U.S. in 2015 was 13.5 months.[22] That year, 74% of children spent less than two years in foster care, while 13% were in care for three or more years.[23] Of the estimated 427,910 children in foster care on September 30, 2015: 43 percent were White, 24 percent were African-American, 21 percent were Hispanic (of any race), 10 percent were other races or multiracial, and 2 percent were unknown or unable to be determined.[24]

Children may enter foster care voluntarily or involuntarily. Voluntary placement may occur when a biological parent or lawful guardian is unable to care for a child. Involuntary placement occurs when a child is removed from their biological parent or lawful guardian due to the risk or actual occurrence of physical or psychological harm. In the US, most children enter foster care due to neglect.[25] If a biological parent or legal guardian is unwilling to care for a child, the child is deemed to be dependent and is placed under the care of the child protection agency. The policies regarding foster care as well as the criteria to be met in order to become a foster parent vary according to legal jurisdiction.

Especially egregious failures of child protective services often serve as a catalyst for increased removal of children from the homes of biological parents. An example is the brutal torture and murder of 17-month-old Peter Connelly, a British toddler who died in London Borough of Haringey, North London after suffering more than 50 severe injuries over an eight-month period, including eight broken ribs and a broken back. Throughout the period of time in which he was being tortured, he was repeatedly seen by Haringey Children's services and NHS health professionals.[26] Haringey Children's services already failed ten years earlier in the case of Victoria Climbié.[27] In the time since his death, in 2007, cases have reached a record rate in England surpassing 10,000 in the reporting year ending in March 2012.[28]

Abuse and negligence

From 1993 through 2002 there were 107 recorded deaths; there are approximately 400,000 children in out-of-home care, in the United States. Almost 10% of children in foster care have stayed in foster care for five or more years. Nearly half of all children in foster care have chronic medical problems. 8% of all children in foster care have serious emotional problems, 11% of children exiting foster care aged out of the system, in 2011.[29] Children in foster care experience high rates of child abuse, emotional deprivation, and physical neglect. In one study in the United Kingdom "foster children were 7–8 times, and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population".[30] A study of foster children in Oregon and Washington State found that nearly one third reported being abused by a foster parent or another adult in a foster home.[31]

Medical and psychiatric disorders

A higher prevalence of physical, psychological, cognitive and epigenetic disorders for children in foster care has been established in studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study of various aspects of children who had been in foster care. It noted that 80% of ex-foster children are doing "poorly".

Individuals who were in foster care experience higher rates of physical and psychiatric morbidity than the general population and suffer from not being able to trust and that can lead to placements breaking down.[32] In the Casey study of foster children in Oregon and Washington state, they were found to have double the incidence of depression, 20% as compared to 10% and were found to have a higher rate of posttraumatic stress disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having attention deficit hyperactivity disorder (ADHD), and deficits in executive functioning, anxiety as well as other developmental problems.[33][34][35][36] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Studies in the U.S. have suggested that some foster care placements may be more detrimental to children than remaining in a troubled home,[37] but a more recent study suggested that these findings may have been affected by selection bias, and that foster care has little effect on behavioral problems.[38]

Neurodevelopment

Foster children have elevated levels of cortisol, a stress hormone, in comparison to children raised by their biological parents. Elevated cortisol levels can compromise the immune system. (Harden BJ, 2004).[39] Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Negative environmental influences during this critical period of brain development can have lifelong consequences.[40][41][42][43]

Posttraumatic stress disorder

Regions of the brain associated with stress and posttraumatic stress disorder[44]

Children in foster care have a higher incidence of posttraumatic stress disorder (PTSD). In one study,[45] 60% of children in foster care who had experienced sexual abuse had PTSD, and 42% of those who had been physically abused fulfilled the PTSD criteria. PTSD was also found in 18% of the children who were not abused. These children may have developed PTSD due to witnessing violence in the home. (Marsenich, 2002).

In a study conducted in Oregon and Washington state, the rate of PTSD in adults who were in foster care for one year between the ages of 14–18 was found to be higher than that of combat veterans, with 25 percent of those in the study meeting the diagnostic criteria as compared to 12–13 percent of Iraq war veterans and 15 percent of Vietnam war veterans, and a rate of 4% in the general population. The recovery rate for foster home alumni was 28.2% as opposed to 47% in the general population.

"More than half the study participants reported clinical levels of mental illness, compared to less than a quarter of the general population".[46][47]

Eating disorders

Foster children are at increased risk for a variety of eating disorders in comparison to the general population. In a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.[48] Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care. It is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity"; it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to, it was prevalent amongst 25 percent of the study group in New Zealand.[34] Bulimia nervosa is seven times more prevalent among former foster children than in the general population.[49]

Poverty and homelessness

New York street children in 1890

Nearly half of foster children in the U.S. become homeless when they turn 18.[50] "One of every 10 foster children stays in foster care longer than seven years, and each year about 15,000 reach the age of majority and leave foster care without a permanent family—many to join the ranks of the homeless or to commit crimes and be imprisoned.[51][52]

Three out of 10 of the United States homeless are former foster children.[53] According to the results of the Casey Family Study of Foster Care Alumni, up to 80 percent are doing poorly—with a quarter to a third of former foster children at or below the poverty line, three times the national poverty rate.[54] Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others experienced "unofficial" placements in the homes of family or friends.

Individuals with a history of foster care tend to become homeless at an earlier age than those who were not in foster care. The length of time a person remains homeless is longer in individuals who were in foster care.[55]

Suicide-death rate

Children in foster care are at a greater risk of suicide,[56] the increased risk of suicide is still prevalent after leaving foster care and occurs at a higher rate than the general population. In a small study of twenty-two Texan youths who aged out of the system, 23 percent had a history of suicide attempts.[57]

A Swedish study utilizing the data of almost one million people including 22,305 former foster children who had been in care prior to their teens, concluded:

Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts....Individuals who had been in long-term foster care tended to have the most dismal outcome...former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity.[58]

Death rate

Children in foster care have an overall higher mortality rate than children in the general population.[59] A study conducted in Finland among current and former foster children up to age 24 found a higher mortality rate due to substance abuse, accidents, suicide and illness. The deaths due to illness were attributed to an increased incidence of acute and chronic medical conditions and developmental delays among children in foster care.[60]

Georgia Senator Nancy Schaefer published a report "The Corrupt Business of Child Protective Services"[61] stating:

"The National Center on Child Abuse and Neglect in 1998 reported that six times as many children died in foster care than in the general public and that once removed to official "safety", these children are far more likely to suffer abuse, including sexual molestation than in the general population".[61]

Academic prospects

Educational outcomes of ex-foster children in the Northwest Alumni Study:[62]

The study reviewed case records for 659 foster care alumni in Northwest USA, and interviewed 479 of them between September 2000 and January 2002.[62]

Psychotropic medication use

Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate that was 3 times higher than that of Medicaid-insured youth who qualify by low family income. In a review (September 2003 to August 2004) of the medical records of 32,135 Texas foster care 0–19 years old, 12,189 were prescribed psychotropic medication, resulting in an annual prevalence of 37.9% of these children being prescribed medication. 41.3% received 3 different classes of these drugs during July 2004, and 15.9% received 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The study also showed that youth in foster care are frequently treated with concomitant psychotropic medication, for which sufficient evidence regarding safety and effectiveness is not available.[63]

The use of expensive, brand name, patent protected medication was prevalent. In the case of SSRIs the use of the most expensive medications was noted to be 74%; in the general market only 28% are for brand name SSRI's vs generics. The average out-of-pocket expense per prescription was $34.75 for generics and $90.17 for branded products, a $55.42, difference.[64]

Therapeutic intervention

Children in the child welfare system have often experienced significant and repeated traumas and having a background in foster homes—especially in instances of sexual abuse—can be the precipitating factor in a wide variety of psychological and cognitive deficits[65] it may also serve to obfuscate the true cause of underlying issues. The foster care experience may have nothing to do with the symptoms, or on the other hand, a disorder may be exacerbated by having a history of foster care and attendant abuses. The human brain however has been shown to have a fair degree of neuroplasticity.[66][67][68] and adult neurogenesis has been shown to be an ongoing process.[69]

Cross-cultural adoption policies

George Shanti, Nico Van Oudenhoven, and Ekha Wazir, co-author's of Foster Care Beyond the Crossroads: Lessons from an International Comparative Analysis, say that there are four types of Government foster care systems. The first one is that of developing countries. These countries do not have policies implemented to take care of the basic needs of these children and these children mostly receive assistance from relatives. The second system is that of former socialist governments. The historical context of these states has not allowed for the evolution of their foster care system. NGO's have urged them to evolve; however the traditional system of institutionalizing these children is still in place. Thirdly, liberal democracies do not have the support from its political system in order to take care of these children, even though they have the resources. Finally, social democracies are the most advanced governments in regards to their foster care system. These governments have a massive infrastructure, funding, and support system in order to help foster care children.[70]

Adoption

Foster care[71] adoption is a type of domestic adoption where the child is initially placed into a foster care system and is subsequently placed for adoption. Children may be placed into foster care for a variety of reasons; including, removal from the home by a governmental agency because of maltreatment.[72] In some jurisdictions, adoptive parents are licensed as and technically considered foster parents while the adoption is being finalized.[73] According to the U.S Department of Health and Human Services Children's Bureau, there were approximately 408,425 children in foster care in 2010. Of those children, twenty-five percent had a goal of adoption. In 2015, 243,060 children exited foster care and twenty-two percent were adopted.[74] Nationwide, there are more than one hundred thousand children in the U.S. foster care system waiting for permanent families.[75]

See also

References

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  2. ↑ "Kinship Care, Save the Children UK" (PDF). 2007. Retrieved November 9, 2013.
  3. ↑ "Stepping Up for Kids, Annie E. Casey Foundation" (PDF). 2012. Retrieved November 9, 2013.
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  5. ↑ Anne Tweddle, "Youth Leaving Care Report", September 2005
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  7. ↑ Danielle Ziri (December 8, 2013). "Knesset passes bill regulating foster care system in Israel". The Jerusalem Post. Retrieved July 31, 2015.
  8. ↑ Kumasaka, Y, and H Aiba. "Foster Care in Japan: Past and Present." The Milbank Memorial Fund Quarterly. 46.2 (1968): 253. Print.
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  16. ↑ Chin, Richard. "'Orphan Train' Riders Share Common Bond: Until 1929, Children Abandoned on New York Streets were Sent West to Begin New Lives with New Families. Few Orphan Train Riders Survive, but for those Who do, their 'Bond is Forever.'." McClatchy – Tribune Business News: 0. Sep 19 2007. ProQuest. Web. 7 Oct. 2013.
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  24. ↑ Id.
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  57. ↑ "Improving Outcomes for Older Youth" (PDF). Retrieved 2011-11-01.
  58. ↑ Vinnerljung, B; Hjern, A; Lindblad, F (2006). "Suicide attempts and severe psychiatric morbidity among former child welfare clients—a national cohort study". Journal of child psychology and psychiatry, and allied disciplines. 47 (7): 723–33. PMID 16790007. doi:10.1111/j.1469-7610.2005.01530.x.
  59. ↑ Barth, R; Blackwell, Debra L. (1998). "Death rates among California's foster care and former foster care populations". Children and Youth Services Review. 20 (7): 577–604. doi:10.1016/S0190-7409(98)00027-9.
  60. ↑ Kalland, M; Pensola, TH; Meriläinen, J; Sinkkonen, J (2001). "Mortality in children registered in the Finnish child welfare registry: population based study". BMJ (Clinical research ed.). 323 (7306): 207–8. PMC 35273 Freely accessible. PMID 11473912. doi:10.1136/bmj.323.7306.207.
  61. 1 2 "The Corrupt Business of Child Protective Services – report by Senator Nancy Schaefer, September 25, 2008" (PDF).
  62. 1 2 "Findings from the Northwest Foster Care Alumni Study" (PDF).
  63. ↑ Zito, JM; Safer, DJ; Sai, D; Gardner, JF; Thomas, D; Coombes, P; Dubowski, M; Mendez-Lewis, M (2008). "Psychotropic medication patterns among youth in foster care". Pediatrics. 121 (1): e157–63. PMID 18166534. doi:10.1542/peds.2007-0212.
  64. ↑ Cascade, EF; Kalali, AH (2008). "Generic Penetration of the SSRI Market". Psychiatry (Edgmont (Pa. : Township)). 5 (4): 25–6. PMC 2719553 Freely accessible. PMID 19727306.
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  66. ↑ Johansen-Berg, H (2007). "Structural plasticity: rewiring the brain". Current Biology. 17 (4): R141–4. PMID 17307051. doi:10.1016/j.cub.2006.12.022.
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  70. ↑ George, S, N van Oudenhoven, and R Wazir. "Foster Care Beyond The Crossroads: Lessons From An International Comparative Analysis." Childhood 10.3 (2003): 343–361. CINAHL with Full Text. Web. 30 Apr. 2013.
  71. ↑ "The Current State of Foster Care in the U.S.". University of New England Master of Social Work Online. University of New England.
  72. ↑ http://www.hhs.gov/
  73. ↑ http://www.childwelfare.gov/adoption/foster/
  74. ↑ "Foster care statistics 2015" (PDF). U.S Department of Health and Human Services, Children's Bureau. Retrieved May 11, 2017.
  75. ↑ http://www.davethomasfoundation.org/

Further reading

  • Hurley, Kendra (2002). "Almost Home" Retrieved June 27, 2006.
  • Carlson, E.A. (1998). "A prospective longitudinal study of disorganized/disoriented attachment". Child Development. 69 (4): 1107–1128. JSTOR 1132365. PMID 9768489. doi:10.1111/j.1467-8624.1998.tb06163.x. 
  • Knowlton, Paul E. (2001). "The Original Foster Care Survival Guide"; A first person account directed to successfully aging out of foster care.
  • McCutcheon, James, 2010. "Historical Analysis and Contemporary Assessment of Foster Care in Texas: Perceptions of Social Workers in a Private, Non-Profit Foster Care Agency". Applied Research Projects. Texas State University Paper 332.
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