1. Children in foster care had more mental and physical health problems when compared to the general population of U.S. children.
2. Children in foster care had poorer mental and physical health outcomes than children across different family types as well as children in economically disadvantaged families.
Evidence Rating Level: (2) Good
Study Rundown: Children who have been raised in the foster care system are subject to many unfortunate circumstances that predispose them to complications downstream. It is estimated that at least 6% of U.S. children have been placed in foster care at least once between their birth and the age of 18. To date, little data exists to address the physical and mental health of these children compared to the general population of children not placed in foster care. The goal of this study was to document the differences in physical and mental health between children placed in foster care and children not placed in foster care, children adopted from foster care, children across specific family types, and children in economically disadvantaged families. Results indicated that children in foster care had more mental and physical health problems compared to children who are not in foster care. In addition, children placed in foster care had poorer mental and physical health outcomes than virtually all children in other family situations. One limitation of this study is its cross-sectional design; as a result, causality cannot be established. Another limitation is the fact that certain data was excluded, namely children in foster care that were in group home or institutions. The last limitation was the self-reported nature of children’s mental and physical health outcomes. Nonetheless, this study further demonstrates the vulnerability of children in foster care. Providers caring for foster care children should be encouraged to pay special attention to this population’s physical and mental health needs.
In-Depth [cross-sectional study]: Data in this study was collected from the 2011-2012 National Survey of Children’s Health, a national sample of almost 100 000 non-institutionalized children in the U.S. Data was collected via interviews, surveys, and phone calls. Outcome variables included 2 general indicators of health: overall health (excellent, very good, good, fair or poor) and activity limitations (limitations due to medical, behavioral or other conditions). Children in foster care were more likely to be in fair or poor health compared to children who were not in foster care (4.2% vs 3.1%). They were also more likely to have activity limitations (9.8% vs. 4.8%). Children placed in foster care were twice as likely to have learning disabilities (14.7% vs. 7.6%), developmental delays (7.3% vs 3.4%), asthma (18.0% vs 8.7%), obesity (24.1% vs 15.7%), and speech problems (11.2% vs 4.7%). They were 3 times as likely to have ADD/ADHD (21.8% vs 7.4%), hearing problems (3.9% vs 1.2%), and vision problems (3.4% vs 1.3%); 5 times as likely to have anxiety (14.2% vs 3.1%); 6 times as likely to have behavioral problems (17.5% vs 2.9%); and 7 times as likely to have depression (14.2% vs 2.0%). When comparing children in foster care to children in all other types of household living arrangements (single parent, two parents, grandparents, etc) they had a greater likelihood of having mental health problems, including ADD/ADHD, depression, anxiety, and behavioral problems. When compared with children in families of lower socioeconomic status, children in foster care also had a greater likelihood of developing ADD/ADHD (OR = 3.13; 95% CI = 1.91–5.13), depression (OR = 4.78; 95% CI = 2.47–9.25), anxiety (OR = 3.67; 95% CI = 2.11–6.39), and behavioral or conduct problems (OR = 4.14; 95% CI = 2.44–7.03).
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