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Foster Care excerpt from Wikipedia

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Category: Foster Care
Created: Sunday, 18 April 2010 20:39
Written by Alecomm
This article is about the modern child welfare system of placing children in state custody in the homes of temporary caregivers. For the social practice of children being raised by families not their own, see Fosterage.

Foster care is the term used for a system in which a minor who has been made a ward is placed in the private home of a state certified caregiver referred to as a "foster parent".

The state via the family court and child protection 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 said minor. The foster parent is remunerated by the state for their services.

Foster care is intended to be a short term situation until a permanent placement can be made:[1]

  • Reunification with the biological parent(s)
  • When it is deemed in the child's best interest.
  • Adoption
  • Permanent transfer of guardianship

Contents

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[edit] Foster care placement

Children may enter foster care via voluntary or involuntary means. Voluntary placement may occur when a biological parent or lawful guardian is unable or unwilling 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.

[edit] Policy

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.

[edit] United States

[edit] Regulation, administration, and oversight

In the United States, foster home licensing requirements vary from state to state but are generally overseen by each state's Department of Social Services or Human Services. In some states, counties have this responsibility. Each state's services are monitored by the federal Department of Health and Human Services through reviews such as Child and Family Services Reviews, Title IV-E Foster Care Eligibility Reviews, Adoption and Foster Care Analysis and Reporting System and Statewide Automated Child Welfare Information System Assessment Reviews.[2]

Children found to be unable to function in a foster home may be placed in Residential Treatment Centers (RTCs) or other such group homes. In theory, the focus of treatment in such facilities is to prepare the child for a return to a foster home, to an adoptive home, or to the birth parents when applicable. But two major reviews of the scholarly literature have questioned these facilities' effectiveness.[3]

[edit] Funding and system incentives

A law passed by Congress in 1961 allowed AFDC (welfare) payments to pay for foster care which was previously made only to children in their own homes. This made aided funding foster care for states and localities, facilitating rapid growth. In some cases, the state of Texas paid mental treatment centers as much as $101,105 a year per child. Observers of the growth trend note that a county will only continue to receive funding while it keeps the child in its care. This may create a "perverse financial incentive" to place and retain children in foster care rather than leave them with their parents, and incentives are sometimes set up for maximum intervention. A National Coalition for Child Protection Reform issue paper states "children often are removed from their families `prematurely or unnecessarily' because federal aid formulas give states `a strong financial incentive' to do so rather than provide services to keep families together."[4]

Findings of a grand jury investigation in Santa Clara, California;

"The Grand Jury heard from staff members of the DFCS and others outside the department that the department puts too much money into "back-end services," i.e., therapists and attorneys, and not enough money into "front-end" or basic services. The county does not receive as much in federal funds for "front-end" services, which could help solve the problems causing family inadequacies, as it receives for out-of-home placements or foster care services. In other words, the Agency benefits, financially, from placing children in foster homes.[5]

There are some children in foster care who are difficult to place in permanent homes through the normal adoption process. These children are often said to require “special-needs adoption.” In this context, "special needs" can include situations where children have specific chronic medical problems, mental health issues, behavioral problems, and learning disabilities. Governments offer a variety of incentives and services to facilitate this class of adoptions.[6]

[edit] Recent United States foster care legislation

Average length of stay in foster care in the U.S.

In 1997, President Bill Clinton signed a new foster care law, the Adoption and Safe Families Act (ASFA),[7]) which reduced the time children are allowed to remain in foster care before being available for adoption. The new law requires state child welfare agencies to identify cases where "aggravated circumstances" make permanent separation of child from the birth family the best option for the safety and well-being of the child. One of the main components of ASFA is the imposition of stricter time limits on reunification efforts. Proponents of ASFA claimed that before the law was passed, the lack of such legislation was the reason it was common for children to languish in care for years with no permanent living situation identified. They often were moved from placement to placement with no real plan for a permanent home.

Opponents of ASFA argued that the real reason children languished in foster care was that too many were taken needlessly from their parents in the first place. Since ASFA did not address this, opponents said, it would not accomplish its goals, and would only slow a decline in the foster care population that should have occurred anyway because of a decline in reported child abuse.[8]

Ten years after ASFA became law, the number of children in foster care on any given day is only about 7,000 fewer than when ASFA was passed[9]

The Foster Care Independence Act of 1999, helps foster youth who are aging out of care to achieve self-sufficiency. The U.S. government has also funded the Education and Training Voucher Program in recent years in order to help youth who age out of care to obtain college or vocational training at a free or reduced cost. Chafee and ETV money is administered by each state as they see fit.

The Fostering Connection to Success and Increasing Adoptions Act of 2008 is the most recent piece of major federal legislation addressing the foster care system. This bill extended various benefits and funding for foster children between the age of 18 and 21 and for Indian children in tribal areas. The legislation also strengthens requirements for states in their treatment of siblings and introduces mechanisms to provide financial incentives for guardianship and adoption.[10][11]

[edit] Australia

Home-based care, which includes foster care, is provided to children who are in need of care and protection. Children and young people are provided with alternative accommodation while they are unable to live with their parents. As well as foster care, this can include placements with relatives or kin, and residential care. In most cases, children in home-based care are also on a care and protection order.[12]

In some cases children are placed in home-based care following a child protection substantiation and where they are found to be in need of a safer and more stable environment. In other situations parents may be incapable of providing adequate care for the child, or accommodation may be needed during times of family conflict or crisis.[12] In the significant number of cases substance abuse is a major contributing factor.

Respite care is a type of foster care that is used to provide short-term (and often regular) accommodation for children whose parents are ill or unable to care for them on a temporary basis.[12] It is also used to provide a break for the parent or primary carer to hopefully decrease the chances of the situation escalating to one which would lead to the removal of the child(ren).

As with the majority of child protection services, states and territories are responsible for funding home-based care. Non-government organizations are widely used, however, to provide these services.[12]

[edit] Current policy

There is strong emphasis in current Australian policy and practice to keep children with their families wherever possible. In the event that children are placed in home-based care, every effort is made to reunite children with their families wherever possible.[12]

In the case of Aboriginal and Torres Strait Islander children in particular, but not exclusively, placing the child within the wider family or community is preferred[12] This is consistent with the Aboriginal Child Placement Principle.[13]

[edit] The negative effects of foster care

Individuals who were in foster care experience higher rates of physical and psychiatric morbidity that the general population.[14] In a study of adults who were in foster care 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 Post Traumatic 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, and deficits in executive functioning, anxiety as well other developmental problems.[15][16][17][18] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Recent studies in the U.S., suggests that, foster care placements are more detrimental to children than remaining in a troubled home.[19][20][21]

[edit] Neurodevelopment

Negative environmental influences affect various aspects of neurodevelopment, such the formation of neurons and dendrites.

Foster care has been shown in various studies, to have deleterious consequences on the physical health and mental wellbeing of those who were in foster care. Many children enter foster care at a very young age. The human brain doesn't fully develop until approximately the age of twenty, one of the most critical periods of brain development occurs in the first 3–4 years.

The processes that govern the development of personality traits, stress response and cognitive skills are formed during this period. The developing brain is directly influenced by negative environmental factors including lack of stimulation due to emotional neglect, poor nutrition, exposure to violence in the home environment and child abuse.

Negative environmental influences have a direct effect on all areas of neurodevelopment, neurogenesis (creation of new neurons), apoptosis (death and reabsorption of neurons), migration (of neurons to different regions of the brain), synaptogenesis (creation of synapses), synaptic sculpturing (determining the make-up of the synapse), arborization (the growth of dendritic connections , myelinzation (protective covering of neurons), an enlargement of the brain's ventricles and can cause cortical atrophy. Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. 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).[22] Negative environmental influences during this critical period of brain development can have lifelong consequences.[23][24][25][26]

[edit] Epigenetic effects of environmental stress

epigentic mechanisms

Epigenetics is the effect environmental factors have on gene expression. Negative environmental influences such as maternal deprivation, child abuse and stress[27][28] have been shown to have a profound effect on gene expression including transgenerational epigenetic effects in which physiological and behavioral (intellectual) transfer of information across generations not yet conceived is effected. In the Överkalix study in Sweden the effects of epigentic inheritance were shown to have a direct correlation to the environmental influences faced by the parents and grandparents. [29] Many physiological and behavioral characteristics ascribed to Mendelian inheritance is due in fact to transgenerational epigenetic inheritance. The implications in terms of foster care and the cost to society as a whole is that the stress, deprivation and other negative environmetal factors many foster children are subjected to has a detrimental effect not only their physical, emotional and cognitive well-being but the damage can transcend generations.[30][31][32]

In studies of the adult offspring of Holocaust survivors, parental PTSD was risk factor for the development of PTSD in adult offspring in comparison to those whose parents went through the Holocaust without developing PTSD. The offspring of survivors with PTSD had lower levels urinary cortisol excretion, salivary cortisol and enhanced plasma cortisol suppression in response to low dose dexamethasone administration than offspring of survivors without PTSD. Low cortisol levels are associated with parental, particularly maternal, PTSD. This is in contrast to the normal stress response in which cortisol levels are elevated after exposure to a stressor. The results of the study point to the involvement of epigenetic mechanisms.[33][34]

Epigenetic Effects of Abuse;

"In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. (Neighh GN et al. 2009)[35]

It has been suggested in various studies that the deleterious epigentic effects may be somewhat ameliorated through pharmacological manipulations in adulthood via the administration of nerve growth factor-inducible protein A,[36] and through the inhibition of a class of enzymes known as the histone deacetylases (HDACs). "HDAC inhibitors (HDACIs) such as Trichostatin A (TSA); "TSA can be used to alter gene expression by interfering with the removal of acetyl groups from histones", and L-methionine an essential amino acid, have been developed for the treatment of a variety of malignancies and neurodegenerative disorders. Drug combination approaches have also shown promise for the treatment of mood disorders including bipolar disorder, anxiety and depression."[37][38]

[edit] Post Traumatic Stress Disorder

Regions of the brain associated with stress and post traumatic stress disorder[39]

Children in foster care have a higher incidence of Post traumatic stress disorder (PTSD).In one study (Dubner and Motta, 1999)[40] 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".[41][42]

[edit] Eating disorders

Foster children are at increased risk for a variety of eating disorders, in comparison to the general population.

Obesity children in foster care are more prone to becoming overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.[43]

Hyperphagic Short Stature syndrome (HSS) is a condition characterized by short stature due to insufficient growth hormone production , an excessive appetite (hyperphagia) and mild learning disabilities. While it is believed to have genetic component, HSS is triggered by being exposed to an environment of high psychosocial stress, it is not uncommon in children in foster homes or other stressful environments. HSS improves upon removal from the stressful environment.[44][45][46]

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". (Tarren-Sweeney M. 2006). 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.[47]

Bulimia Nervosa is seven times more prevalent among former foster children than in the general population. [48]

[edit] Disorganized attachment

A study by Dante Cicchetti found that 80% of abused and maltreated infants in his study exhibited symptoms of disorganized attachment.[49][50] Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing psychiatric problems.[51][52][53][54] These children may be described as experiencing trauma as the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment.[53][55][56] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[57] as well as depressive, anxiety, and acting-out symptoms.[58][59]

[edit] Child abuse

Children in foster care experience high rates of child abuse, emotional 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".[60]

[edit] Poverty and homelessness

New York street children; Jacob Riis, 1890

Nearly half of foster kids in the U.S. become homeless when they turn 18.[61][62] Most foster care children should be placed in adoptive homes. "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.[63][64]

Three out of ten of the United States homeless are former foster children.[65] 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.[66] Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others were "unofficial" placements in the homes of family or friends. Individuals with a history foster care tend to become homeless at an earlier age than those who were not in foster care and Caucasians who become homeless are more likely to have a history of foster care than Hispanics or African Americans. The length of time a person remains homeless is prolonged in indiviuals who were in foster care.[67]

[edit] Suicide rate

Children in foster care are at a geater risk of suicide,[68] the increased risk of suicide is still prevalent after leaving foster care. Those who spent time in foster care have a higher incidence of suicide than the general populatiion. In a study of Texas youths who aged out of the system 23 percent had a history of suicide attempts.[69]

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;
"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."[70]

[edit] Death rate

Children in foster care have an overall higher mortality rate than children in the general population.[71] 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.[72]

[edit] Poor academic prospects

Foster care has been proven in innumerable studies to not be conducive to academic performance. In a study conducted in Philadelphia by John Hopkins University it was found that; among high school students who are in foster care, have been abused and neglected, or receive out of home placement by the courts, the probability of dropping out of school is greater than 75%.[73]

Educational outcomes of ex-foster children in the Northwest Alumni Study;
  • 56% completed high school compared to 82% of the general population, although an additional 29% of former foster children received a G.E.D. and an additional 5% of the general population.
  • 42.7% completed some education beyond high school.
  • 20.6% completed any degree or certificate beyond high school
  • 16.1% completed a vocational degree; 21.9% for those over 25.
  • 1.8% complete a bachelors degree , 2.7% for over 25, the completion rate for the general population in the same age group is 24%, a sizable difference.

[edit] State abuses

[edit] Drug testing

Throughout the 1990s, experimental HIV drugs were tested on HIV-positive foster children at Incarnation Children’s Center in Harlem. The agency has also been accused of racism, some comparing the trials to the Tuskegee syphilis experiment, as 98 percent of children in foster care in New York City belong to ethnic minorities.[74]

[edit] Unnecessary/Over Medication

Studies"[75] 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 of (September 2003 to August 2004),Among 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%).

Psychiatrists prescribed 93% of the psychotropic medication, and it was noted in the review of these cases that 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.[76]

Medicating Foster Kids For Profit
CONCLUSIONS. "Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety".[75]

[edit] The lost children

Children victimized by the United Kingdom's Childrens Migrant Programme

An estimated 150,000 British children were sent to overseas colonies and countries in the commonwealth such as Australia. This practice was in effect from the beginning of the nineteenth century until 1967. Many of these children were sent to orphanages, foster homes and religious institutions, where they were used as a free source of labor and many were severely abused and neglected. These children were classified as orphans although most were not. In the period after World War II the policy was dubbed the "Child Migrants Programme". The prime consideration was money as it was cheaper to care for children in commonwealth countries than it was in the United Kingdom. This program was carried out with the complicity of the Methodist Church, the Catholic Church and the Salvation Army among others. At least 10,000 children some as young as 3 were shipped to Australia after the war,[77][78], most to join the ranks of the "Forgotten Australians", the term given for those who experienced care in foster homes and institutions in the 20th century. Among these Forgotten Australians were members of the "Stolen Generation", the children of Australian Aborigines, forcibly removed from their homes and raised in white institutions. In 2009 Australian Prime Minister, Kevin Rudd apologised to the approximately 500,000 "forgotten Australians" and in 2010 British Prime Minister Gordon Brown issued a similar apology to those who were victimised by the Child Migrants Programme.[79][80][81]

[edit] Therapeutic Intervention

The negative physical, psychological, cognitive and epigenetic effects of foster care have been established in innumerable studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study into various aspects of the psychosocial effects of foster care noted that 80% of ex-foster children are doing "poorly".

[edit] Neuroplasticity

The human brain however has been shown to have a fair degree of neuroplasticity.[82][83][84] Adult Neurogenesis, has been shown to be an ongoing process.[85]

"... all those experiences are of much significance which show how the judgment of the senses may be modified by experience and by training derived under various circumstances, and may be adapted to the new conditions..." - Hermann von Helmholtz, 1866

While 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 such as ADHD,[86] and PTSD[87][88] it may also serve to obfuscate the true cause of any underlying issues, there should be no automatic assumptions, it may have nothing to do with, or may be exacerbated by having a history of foster care and the attendant abuses.

[edit] See also

[edit] References

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  2. ^ Children's Bureau Website - Child Welfare Monitoring
  3. ^ Richard Barth, Institutions vs. Foster Homes, the Empirical Base for a Century of Action (University of North Carolina, Jordan Institute for Families, February 17, 2002; U.S. Department of Health and Human Services, Report of the Surgeon General's Conference on children's mental health: A national action agenda. Washington, D.C: Government Printing Office, 2000.USGPO
  4. ^ Child Abuse is Child Protection is Mental Health Treatment is Drugging Children
  5. ^ 1992-93 Santa Clara County Grand Jury, Final Report, Investigation: Department Of Family And Children's Services, 1993.
  6. ^ http://www.jstor.org/pss/1602402 Judith K. McKenzie Adoption of Children with Special Needs, Brookings Institution: The Future of Children, Vol. 3, No. 1, Adoption (Spring, 1993), pp. 62-76
  7. ^ Children's Bureau Express Online Digest:
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  9. ^ As of March, 1998, four months after ASFA became law, there were 520,000 children in foster care, (U.S. Department of Health and Human Services, AFCARS Report #1, http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report1/ar0199.htm). It took until September 30, 2005, for the number to fall to 513,000 (U.S. Department of Health and Human Services, Trends in Foster Care and Adoption, http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm.
  10. ^ Children's Defense Fund, Fostering Connection to Success and Increasing Adoptions Act: Overview, http://www.childrensdefense.org/helping-americas-children/child-welfare/fostering-connection-success-increasing-adoptions-act-overview.html.
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[edit] Further reading

  • Hurley, Kendra (2002). "Almost Home" Retrieved Jun. 27, 2006.
  • Carlson, E.A. (1998). A prospective longitudinal study of disorganized/disoriented attachment. Child Development 69, 1107–1128
  • Knowlton, Paul E. (2001). "The Original Foster Care Survival Guide"; A first person account directed to successfully aging out of the foster care.

[edit] External links

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