Health status of children in foster care. The experience of the Center for the Vulnerable Child.

OBJECTIVES

To describe the health status and to illustrate the usefulness of an enhanced primary care model for children in foster care.

DESIGN

Cross-sectional analysis of a clinical cohort via chart review.

SETTING

Foster Care Program of the Center for the Vulnerable Child at the Children's Hospital, Oakland, Calif.

SUBJECTS

Two hundred thirteen children in foster care assessed between August 1988 and June 1991.

INTERVENTIONS

None.

METHODS

A multidisciplinary assessment protocol was used to collect health and social histories and to conduct developmental, emotional, and behavioral assessments and medical examinations. Cross-tabulations were used to compare distributions of conditions and characteristics of the population, including the reasons for, timing of, and number of placements.

RESULTS

The population was largely African-American (83.4%), with a mean age of approximately 3 years. At least 78% of children came from homes where drug use was a primary reason for placement. A history of maternal drug use was present in 94% of infants. The number of placements ranged from one to eight (mean, 2.0). Placement changes were common. Over 20% of children had growth abnormalities, 30% had neurologic abnormalities, and 16% had asthma. Fewer than 20% of children had no medical conditions, while 28.8% had three or more conditions. Over 80% of children had developmental, emotional, or behavioral problems. Emotional, relational, and behavioral problems were more common in children first placed after 2 years of age and in those with a greater number of placements (chi 2 = 12.6, P < .05).

CONCLUSION

This comprehensive assessment of children in foster care revealed higher rates of chronic multiple medical and mental health problems than previously reported.