Raising a child outside the child’s biological family of origin, as in foster care or adoption, presents a unique set of psychosocial challenges involving an interplay between transition and adaptation. The child must contend with separation from and possible reunification with the birth parent, adjustments to 1 or more families, and changes in physical environment, social support, and care providers. The foster or adoptive parents are challenged with helping the child integrate into a new family, taking into account the child’s previous experiences, and facing the possibility of further transitions in the future. The child’s and family’s success in adapting to these changes in care are influenced by a complex interaction between innate, individual capabilities and external resources. Nowhere is the traditional role of the pediatric provider more important in providing continuity of care, family guidance, and support for the physical, neurodevelopmental, and emotional needs of the child and family.
EPIDEMIOLOGY AND DEFINITIONS
The primary purpose of a child entering foster care is to provide a “temporary haven” for those who have been neglected and/or abused and cannot remain safely with their birth parents or family. The goals then are to provide for child and adolescent well-being, safety, health, and permanence of care. Approximately 415,000 children were in foster care on any given day in 2014 with about 653,000 children being served by the foster care system in a year. To characterize this population further, 108,000 children were awaiting adoption in 2014 and just over 50,000 were actually adopted out of foster care. After a peak number of 800,000 children in 2006, the overall number of children in the foster care system has slowly declined due to an increased emphasis on permanency planning. The overall number of children in foster care has remained relatively stable for the past 4 years. Of those children living in foster care in 2014, 49% were living in a nonrelative foster home, 29% in a relative or kinship care foster home, and the remainder in various care arrangements including group homes, other institutions, and pre-adoptive homes.
The Adoption and Foster Care Analysis and Reporting System (AFCARS) estimates that the median age for entering foster care is just over 6 years old, with a trend toward younger age of entry into the system for the past decade. Fifty-two percent of the foster care population is male. This report further describes the ethnic/racial distribution as 42% white, 24% African American, 22% Hispanic, and the remainder multiracial or undetermined. The median length of stay for a child in foster care in 2014 was 13.3 months with 26% remaining in this system for longer than 2 years. Of youth in foster care, 50% experienced at least more than one foster care placement with 25% experiencing three or more.
In contrast to the early years of foster care when foster placement often resulted ...