Foster Care

Alexander Okun

doi:10.1542/pir.2016-0076

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Alexander Okun, MD, FAAP*

^*New Alternatives for Children, New York, NY

Suggested Reading

Child Maltreatment 2014. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2016). Available at: http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment. Accessed April 30, 2016
Foster Care and Healing from Complex Trauma. Forkey H, Szilagyi M. Pediatr Clin North Am. 2014;61(5):1059–1072.DOI: 10.1016/j.pcl.2014.06.015
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Kinship Care for the Safety, Permanency, and Well-Being of Children Removed from the Home for Maltreatment. Winokur M, Holtan A, Batchelder KE. Cochrane Database Syst Rev. 2014;1;CD006546. DOI: 10.1002/14651858.CD006546.pub3
Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. Szilagyi MA, Rosen DS, Rubin D, Zlotnik S; Council on Foster Care, Adoption and Kinship Care; Committee on Adolescence; Council on Early Childhood. Pediatrics. 2015;136(4):e1142–e1166. DOI: 10.1542/peds.2015-2656.(This technical report is accompanied by a policy statement; see Pediatrics. 2015;136(4): e1131–e1140. DOI: 10.1542/peds.2015-2655)
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Adoption & Foster Care. HealthyChildren.org. Available at: https://www.healthychildren.org/English/family-life/family-dynamics/adoption-and-foster-care/Pages/default.aspx. Accessed September 16, 2016
Healthy Foster Care America. American Academy of Pediatrics. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/default.aspx. Accessed September 16, 2016

AUTHOR DISCLOSURE
Dr Okun has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Every 4 minutes in the United States, a child is placed into foster care. In 70% of cases, placement follows investigation by child protective services into reports of suspected neglect, physical abuse, sexual abuse, or psychological maltreatment. Nearly all other cases represent adolescents ordered into care by the courts, mostly as a result of a juvenile justice issue. Fewer than 1% of children in foster care are placed voluntarily by their parents or other family caregivers. Most children entering foster care are able to live in the households of relatives or unrelated foster parents, but 1 in 7 is placed in a group home or residential treatment facility.

Fewer children are in foster care than in the past. There were 400,000 in 2014, a reduction of 20% compared to 10 years previously. Although racial disparities within the system have also diminished, children classified as African-American or multiracial still comprised 25% of those in foster care in 2014, a significant overrepresentation relative to the population distribution of the United States.

More than two-thirds of children enter foster care from an environment characterized by extreme poverty; mental illness or substance abuse in a caregiver; or exposure to …