Improving the Odds for the Healthy Development of Young Children in Foster Care

Executive Summary

Very young children are the fastest growing segment of the child welfare population. Over the past decade, the number of children under age five has increased by 110 percent in contrast to a 50 percent increase for all children. Over 30 percent of all children in foster care are under age five. Infants comprise the largest cohort of the young child foster care population, accounting for one in five admissions, and they remain in care twice as long as older children. Ensuring healthy development and permanency for these young children, given the range of risks they face, is a complex challenge that requires a unique mix of resources and strategies.

Yet, there has been relatively little attention focused on linking child welfare practice with health care, early intervention, and other strategies that could effectively address the risks that these young children face and strengthen their families. This policy paper is intended to be a wake-up call—to challenge communities all over the country to attend to the needs of children in or at risk of foster care placement. It is about what child welfare agencies, courts, and other partners can do to improve the physical, developmental, and emotional health of young children in foster care. It highlights the special risks these children face and identifies strategies that service providers, courts, policymakers, and advocates can use to enhance the healthy development of young children in foster care and promote their prospects for permanency—whether that means reunification with their families or adoption.

Key Findings From Research: Young Children in Foster Care are Among the Most Vulnerable Children in the Country

• Nearly 80 percent of these young children are at-risk for a wide range of medical and developmental problems related to prenatal exposure to maternal substance abuse.
• More than 40 percent of them are born low birth-weight and/or premature, two factors which increase their likelihood of medical problems and developmental delay.
• More than half suffer from serious physical health problems.
• Over half experience developmental delays, which is four to five times the rate found among children in the general population.
• Despite their vulnerability, a significant percentage of these young children do not receive basic health care such as immunizations, and specialized needs resulting from developmental delays and emotional and behavioral conditions are even less likely to be addressed.

Promising Strategies to Promote the Healthy Development of Young Children in Foster Care

• Provide developmentally appropriate health care to young children in the context of comprehensive health care for all children in foster care.
• Design and implement specialized developmental and mental health assessments and services for young children in foster care.
• Create monitoring and tracking mechanisms to ensure that needed health, developmental, and mental health services are provided.
• Ensure that young children in foster care have access to quality early care and learning experiences.
• Use the oversight authority of the courts to ensure that children in foster care receive needed health, developmental, and mental health services as a part of permanency planning.

Action Steps and Key Recommendations

• Use federal laws, programs, and dollars provided under the Adoption and Safe Families Act, Medicaid, Early and Periodic Screening, Diagnosis and Treatment, the Early Intervention Program (Part C of the Individuals with Disabilities Education Act), and Temporary Assistance for Needy Families to develop specialized attention to young children in foster care.
• Harness the power of the courts, which review the placement of all children in foster care, to enhance their healthy development.
• Build collaborative partnerships between the courts and child welfare, health care, early intervention, and early childhood agencies to enhance developmental outcomes for young children in foster care.
• Ensure that court personnel, child welfare workers, biological and foster parents, and other caregivers have the training and information that they need to help young children in foster care.
• Develop explicit state and community-based strategies to ensure that young children in foster care have access to developmental health services, high-quality child care including Early Head Start, and preschool and family support programs.
• Develop formal mechanisms to track and monitor the delivery of health, mental health, and related services to children in foster care.
• Use professional and state best-practice standards and relevant federal guidelines that call for the delivery of comprehensive, coordinated, continuous, and family supportive care as a framework to develop improved approaches to promote healthy early development for young children in foster care.
• Weave together multiple approaches to enhance the well-being of young children in foster care, building on community strengths.
• Pay special attention to young children at risk of placement in foster care and those being discharged from the child welfare system. These children need access to all the benefits to which they are entitled (such as continuation of Medicaid) as well as access to comprehensive and multidisciplinary services that can both enhance their healthy development and their prospects for permanency.
• Promote a federal agenda that provides incentives to states and communities to build partnerships with health care and early childhood agencies to enhance the healthy development of young children in or at risk of foster care placement.