Health Needs of Young Children in Foster Care

Foster children are among the most vulnerable individuals in the welfare population. Of particular concern is the health of young foster children since conditions left untreated during the first 3 years of life can influence functioning into adulthood and impede a child's ability to become self-sufficient later in life. Yet, little comprehensive information is available about the provision of health-related services to meet the needs of young foster children. This report provides information on (1) the health-related services needed and received by young children in foster care, (2) the relationship between the receipt of health-related services and foster care placements with relatives versus placements with nonrelatives, and (3) what responsible agencies are doing to ensure that these children are receiving needed health-related services.

To develop this information, the General Accounting Office (GAO) reviewed foster care programs in California, New York, and Pennsylvania--the States with the largest average monthly foster care populations in 1991. In addition, random samples of case files from Los Angeles County, New York City, and Philadelphia County from a combined population of 22,755 young foster children were analyzed. These locations cared for a substantial portion of each State's young foster children. Findings reported here are based on cases from only these three locations.

Results indicated that a significant proportion of young foster children in Los Angeles County, New York City, and Philadelphia County did not receive critical health-related services. Despite State and county foster care agency regulations requiting comprehensive routine health care, an estimated 12 percent of young foster children received no routine health care, 34 percent received no immunizations, and 32 percent had at least some identified health needs that were not met. Furthermore, an estimated 78 percent of young foster children were at high risk for human immunodeficiency virus (HIV) as a result of parental drug abuse, yet only an estimated 9 percent of young foster children were tested for it.

Case files did not always reflect the exact nature or extent to which services were provided. Thus, children noted as having received routine medical care may have received as little care as one visit with a physician for treatment of a minor illness rather than comprehensive or ongoing medical care.

States must offer Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services to medicard-eligible children. EPSDT services are specific, comprehensive medical examinations and follow-up treatment; however, only an estimated 1 percent of the young foster children in the locations reviewed received them.

Children with no known health problems were less likely to receive routine care than children who were at risk for or had serious health problems. Of the children with no known serious health problems, an estimated 28 percent did not receive any health-related services.

By comparison, only 6 percent of children who were at high risk for serious health problems because of prenatal drug exposure and 2 percent of children with serious physical health problems did not receive any health-related services.

Although young foster children received a wide variety of services from health care providers, many children had identified health-related needs that were not met. GAO used information collected from case files to identify the health-related needs of each child and to match them with the services received. About one-third of the children had some identified needs that were not met. These unmet needs included pulmonary and speech therapy; psychotherapy; developmental assessments; infant stimulation services; cardiological, urological, and neurological examinations; and testing for sickle cell anemia, syphilis, and HIV.

Young foster children placed with relatives were less likely than children placed with nonrelatives to receive health-related services of all kinds. Also, children placed in kinship care were nearly three times as likely as those placed in traditional foster care to have received no routine health care. Since studies indicate that children in kinship care remain in foster care longer, and they receive a lower level of service, these children are likely to go without needed services for longer periods.

More and more, young foster children are being placed with relatives. In California and New York--the States where placement data were available--the number of young children placed with relatives increased by 379 percent between 1986 and 1991, while the number of young children placed with nonrelative foster parents increased by 54 percent. Consequently, whereas 20 percent of young foster children were placed with relatives in 1986, 43 percent of them were placed with relatives in 1991.

Young children placed in kinship care in Los Angeles County and New York City were three times more likely than those placed in traditional foster care to be at risk for future problems because of prenatal drug exposure. Furthermore, because drug-exposed children are more likely to be at risk for HIV and developmental delays, the need for health-related services for children in kinship care is even more critical. Yet, only 11 percent of children placed exclusively in kinship care received specialized examinations, such as developmental evaluations, compared with 42 percent of those placed exclusively in traditional foster care.

The Department of Health and Human Services (HHS) recently contracted for 10 National Resource Centers to assist its Administration for Children and Families (ACF) in responding to States' questions and in providing free technical assistance. None, however, is designated to assist States with health-related programs for foster children. Furthermore, while ACF audits States for compliance with federally mandated safeguards for foster children, these audits omit review of compliance with health-related safeguards. Therefore, when a State has passed its compliance audit, it is entitled to receive the full Federal child welfare funding available by law; because health-related safeguards are not included in the audit, States have no Federal financial incentive to comply with them.

Local foster care agencies continue to revise health-related policies, regulations, and programs in efforts to improve the delivery of health care to foster children. Given the importance of health care during the first 3 years of life, an improved response to the health needs of this vulnerable population is vital.

Source: U.S. General Accounting Office, 1995, Foster Care: Health Needs of Many Young Children Are Unknown and Unmet, Report to the Ranking Minority Member, Subcommittee on Human Resources, Committee on Ways and Means, House of Representatives, GAO/HEHS95-114.

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