Health Status of Children in Foster Care

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.