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For first time, national data reveal just how hard foster care is on children’s health

For first time, national data reveal just how hard foster care is on children’s health

Picture of Ryan White
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We’ve all heard or read the gut-wrenching stories of children in foster care who’ve had to endure abusive treatment or squalid conditions, and of social workers and child welfare systems failing to carry out their most basic mission. The prevalence of such stories compounds their awfulness.

But beyond the horrific anecdotes and well-documented systemic dysfunction, what do we know about how the mental and physical health of children placed in foster care compares with that of other kids? While the available data hasn’t allowed such direct comparisons in the past, a new analysis from sociologists Kristin Turney of UC Irvine and Christopher Wildeman of Cornell University shows for the first time how the health of U.S. foster children differs from their peers. The data, drawn from 2011-12 National Survey of Children’s Health, show that kids placed in foster care are two to three times more likely to suffer from a host of conditions ranging from learning disabilities, anxiety and behavioral problems to asthma, obesity and vision problems.

“Children placed in foster care were in poor mental and physical health relative to children in virtually every other type of family situation and in children in economically disadvantaged families,” write Turney and Wildeman.

Kids placed in foster care were twice as likely as other children to have a learning disability (14.7 percent vs. 7.6 percent); three times more likely to have ADD or ADHD (21.8 vs. 7.4 percent); six times more likely to have behavioral problems (17.5 vs. 2.9 percent); and seven times more likely to suffer from depression (14.2 vs. 2 percent). As these numbers suggest, the disparities are especially pronounced for mental health problems. And these disparities remained even after the researchers adjusted for child characteristics, socioeconomic status and household conditions.

The study wasn’t designed to explain what aspects of foster care are key drivers of such health problems, but early childhood trauma has been shown to have serious, lifelong health consequences.

The data did reveal one counter-intuitive finding: “(C)hildren adopted from foster care had worse health than their counterparts placed in foster care.” The authors speculate this could be because of higher subsidies offered by some states for kids with more health problems, or because foster children can’t be adopted until the parents’ rights are terminated and children in such cases are more likely to experience trauma and abuse.

Too often, the misery deepens. In cases of foster children already struggling from mental and behavioral problems, the treatment can be worse than the cure. That fact was made powerfully clear by reporter Karen de Sá’s investigative series “Drugging Our Kids” in the San Jose Mercury News. De Sá found that nearly one in four children in California’s foster care system were given antipsychotic drugs to control their behavior:

“With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children,” de Sá wrote in her lead story in 2014. Such drugs, she noted, can have scary side effects: “rapid-onset obesity, diabetes and a lethargy so profound that foster kids describe dozing through school and much of their young lives. Long-term effects, particularly on children, have received little study, but for some psychotropics there is evidence of persistent tics, increased risk of suicide, even brain shrinkage.”

The Mercury’s in-depth reporting on the use of psychotropics on foster kids prompted a state audit and culminated in new legislation signed several weeks ago by California Gov. Jerry Brown that mandates annual monitoring of high-prescribing physicians and gives the state medical board new authority to investigate doctors in such cases.

But such legislation won’t eliminate the disparities in mental and physical health identified in this week’s study. It’ll just make it harder for guardians and doctors in California to dole out seemingly easy fixes to deeper problems. With 19 states facing monitoring and lawsuits over allegations of abuse, neglect and home shortages in their child welfare system as of the start of this year, it would seem our collective readiness to address the mental and physical wounds that often come with the experience of being a foster child is still deeply inadequate.

[Photo by Alyssa L. Miller via Flickr.]


Picture of <span class="username">Guest (not verified)</span>

I just read the article written by Ryan White and I agree with his observations and as a foster and now adoptive parents I went through these same stages. I learned that foster/adoption mental health services are not really equipped to help the amount of loss these children endure with the biggest loss of being removed from their families. I found that the kids develop coping skills to live within their families situations and in foster care/adoption spend years trying to overcome the effects of being removed from their families this has had on their lives.

So now I say if you can't really help them then put impact services in the areas/schools where this is more prevelant so these kids can gravitate towards opportunities and healthy relationships vs removing them from their families and they can influence (empowerment) changes in their homes/communities.

One of the biggest factors is that most of my adoptive kids bio parents are developmentally delayed and so are the kids. So without opportunities for people in our society I have noticed that they all have turned to "survival" living.

Picture of <span class="username">Guest (not verified)</span>

Thank you for this. As the foster/adoptive parent of three, I love my children tremendously, but if I had a choice I'd rather that their biological families had the supports and opportunities to be healthy parents. Foster care is always a tragic choice.

Picture of <span class="username">Guest (not verified)</span>

Hi Shelley, Great to hear another foster parent I agree with! My facebook is mostly devoted to sharing CPS reform efforts (Stacy Youst Sillen). I've been to D.C. three times lately lobbying for passage of the Family First Act (FFA). Please friend me if you want to! peace, Stacy

Picture of <span class="username">Guest (not verified)</span>

Love your articles.

Picture of <span class="username">Guest (not verified)</span>


I would like to raise public awareness, that in some states the supervisors and directors of children's protective services and foster care services are not even licensed in mental health, nor do they have a Masters level mental health education and licensing, and they are the ones calling the shots, shooting down social workers trained in mental health that advocate for children and families. The social workers in the field are taking the hits because they are trying to do what is right but their supervisors block them, often having bachelors degrees, and not even in social work. At least, that is the case in our state. It is unbelievable to me that people not trained in mental health, are calling the shots for vulnerable children and families, and some of them just read vigilante style. And it is not the fault of the social workers. It is the fault of those who put in place lower qualifications for the supervisors, directors, and regional directors, that are required for the Masters level social worker to do the groundwork and care about children and families. When the licensed masters clinicians must bow to their supervisors and directors, who often have lower level of educations in a profession that is not even related to the caring professions, this creates a great deal of turnover, as corrections officers are acting in foster care supervisory positions, or former law-enforcement are acting directors of two counties in the state, not at all qualified to make clinical decisions but calling all the shots. These supervisors and directors don't even have to have a license, as the workers in the field do. These are the social workers, the caring individuals who are advocating their best for children, but bulldozed by those in authority who do not have the qualifications to be in their positions. And that causes a high-level of turnover, as corrections officers, undersheriffs, police officers, people who are not licensed in Masters level social work, or any Masters level mental health professional whatsoever are not clinically competent to make decisions of the field workers. And they have a completely different mindset, often a bully mindset rather than a Karen, listening, collaborating mindset. Social workers understand family systems, ecosystems, and the need for children to be able to know where they came from. There are about 40 states that do family placements better than the state that we live in. And it creates a great deal of trauma to children. And the directors and supervisors are not overseen well. Their jobs are to know the mandated laws, make sure the policies and procedures are followed, and yet some of the same individuals run amok, violating the mandated laws that social workers know are in their code of ethics, but are bullied into making decisions that are not in the best interest of families and children. Hence, the turnover is profound. It is not the fault of the dedicated social workers. It is the fault of legislature, and those who make the rules, allowing those are not qualified to make clinical decisions based on money rather than in the best interest of children and their families. And these mistakes are unacceptable. Because they are destroying children's lives, and these children grow up into adults who don't have secure attachments, join gangs, break the law, end up in prison, and it is the fault of our legislators. It is not the fault of the social workers. So, we all know that children services don't rank high on the list for our legislators, but when they are so broken that they have gone into hiding and no longer have a conscience it affects our society as a whole. This is why there need to be licensed Master's level mental health providers - from regional directors of children services, to directors of counties, to supervisors within the county agencies. Those in positions of authority and supervisory roles must have the education and the clinical skills, not just macro-level and business skills, We need to look out for the best interest of the children, who will become the adults in the next generation. So please do not blame the social workers. It is probably not a social worker who is calling the shots. In fact, they may being abused by their own supervisors and directors. So get the facts about what the regulations for The directors and supervisors of children's protective services and foster care services. Period. I am a palled at the individuals who breaks social workers, giving them a bad name, when it is not their fault. Because they are in the field advocating for the children and the families. Whilst of their bosses are on power trips send numbers people, not looking at each small individual child and the trauma the indoor at the hand of poor legislation.

Thank you.

Picture of <span class="username">Guest (not verified)</span>

Let me start by saying that I am a former foster child. I grew up in 40-50 different placements ranging from mental hospitals, lockdowns, group homes, foster homes, etc al. Every type of abuse you can put an adjective in front of I personally endured. When I aged out I had less than 1 year of High school. On my own I got a GED, and a BSW in Social Work.

I initially wanted to be a social worker so that I could utilize my unique background to help other kids who are in a similar predicament that I was in. One of the first things that I learned in University was that most of my classmates were totally indoctrinated in the progressive view point of glorifying the victim. The professors were completely out of touch with reality.

There were three people who turned my life around. Two of them were foster parents and the third was a social worker without "proper" training that you described. There are several tangibles that an advanced degree is unable to teach chiefly empathy and love. I went to my first foster mother when I was 9 years old having come from a group home where I was repeatedly raped by older residents. Not only that but the so call experts (the ones that you want to turn to) were forcing me to take medication that no 9 year old should take in huge dosages.

My foster mother only had a high school education. She had no special degree or no special training (this was back in 1988). when I arrived in her care I could not even read and could only sign my first two initials 'JL" The public schools did not want to work with me and the social workers constantly fought with my foster mother trying to take me away. She was able to keep me for nearly 3 years often fighting the system tooth and nail for my sake.

The social worker that I mentioned did not have a degree in social work when she became my worker. If I recall correctly she only had an education degree though later she was mandated to get a masters. What made her stand out though among the dozen of other social workers I had? She had a caring heart who could not stand injustice. She treated me as though I was one of her own children.

There are going to be bad social workers, supervisors, and even directors. Having a advanced degree as you advocated will not change that. I would even argue that having an advanced degree is oftentimes a detriment in this field. What needs to be done? Do away with children courts altogether (its unconstitutional) and forcing the state to make their allegations against the parent in a regular court of law. All parents have a right to be judged by their peers and not some judge! Also, stop incentivizing the state government through adoption grants. This amounts to modern day slavery when the federal government gets 80,000 dollar per year per child in the system and even more when they get adopted.

Picture of <span class="username">Guest (not verified)</span>

to see that people like yourself can still rise above circumstances of life ... that are beyond description of horrendous... these institutions are lifeless, because they are not established on the principle of LOVE... lifeless can not give life, loveless can not give LOVE...
I found it intriguing to learn that children's court is UNCONSTITUTIONAL... if Family Court also unconstitutional? the decision is being made by a judge and not by a jury of their peers... I am in a situation with my daughter... going to lots of anguish due to the father of the baby and that the judge whose only consideration is to follow policies that may work for some people but for the most part it does not see each case on its own merits and like a cookie cutter imparts cookie cutter "justice"... I am sure had a jury been part of the proceeding my daughter and I would be back home and the father a heroin addict facing the consequences of his choices...

Picture of <span class="username">Guest (not verified)</span>

This article puts the causation of these medical problems on the foster caretakers instead of the trauma or neglect the child experienced before entering the foster care system. Some of my foster children had never gone to a doctor before coming to live with me. It is inflammatory articles like this one that lead to the shortage of good foster homes.

Picture of <span class="username">Guest (not verified)</span>

Yes I agree! I've been a foster parent for over 6 years and have adopted 3. The trauma came from the biological parents ( drug abuse, abuse, neglect)
These parents were given opportunities to get help and chose not to. The system rescued them and I'm so thankful! They are now healthy, thriving and on the path to healing.

Picture of <span class="username">Guest (not verified)</span>

I have witnessed firsthand multiple kids be deliberately injured by the social workers that were supposed to be protecting them. Mind games, abrupt moves for no reason etc...
As bad as it was for these kids, it would have been a bigger mercy to leave them at home than to subject them to a corrupt broken system that allows people to deliberately abuse them as a full time job.
I am a foster father that has been doing fostering on and off for 12 years. We have done high needs foster-care and normal foster-care. The system is broken and it is not only the courts that need to be changed, case-workers need to face abuse charges for some of the deliberate actions they make that hurt children.
I would advocate that social workers should not be the degree path that is best at advocating for these children or seeing that they get what they need. Maybe a degree path that is focused on children would make more sense. Lets quit worrying about the parents and start worrying about the kids.

Picture of <span class="username">Guest (not verified)</span>

I am a result of foster care and late adoption. I will agree that we begin early on to just try to make it to the next day. All the while thinking we will go home soon. My thought in all of this is these children in particular need to be told the truth of the situation at the level of understanding per the age. The not knowing where we are going and just having role play for counseling does not help these children. They become lost and when that happens they become indifferent and for the most part really don't care where they end up because they feel no one else cares either. I really don't believe that someone who hasn't been there can really relate or truly help these children with this particular issue. What we need are souls with a similar road traveled who have dug their way out and learned to see past today and forgive yesterday. To guide and show these kids and young adults that we are worth the effort every step of the way. I do what I can but I still have a hard time with permanent situations and social anxiety and I'm now in my mid 40s. Trust and truth go hand in hand. Im rambling so I'll end here..for the most part the other side has great intentions but if you haven't had that lost feeling as we do its hard to pull us out of it. Just my thought on why it's so hard mentally and physically on these young ones. Much respect, Marie

Picture of <span class="username">Guest (not verified)</span>

Hi Marie, I'm in the facebook page Adoption Sucks because it's open, and I'm beginning to believe that you guys are the right bunch to lead this fight for reform. The rest of us are just basically disgusted bystanders. We are fighting, but it IS different. Peace, Stacy

Picture of <span class="username">Guest (not verified)</span>

The biggest fallacy that I see with your argument is that there are so few of us who have survived and living productive lives. Most foster kids end up in dead, in prison, or on drugs.

Picture of <span class="username">Guest (not verified)</span>

for people who have endured and survived the injustices served by heartless people... I have nothing but respect for you and Jeff... You are certainly a role model for all of the children caught in the web of institutions that even when they mean well, it still leaves them hopeless and injured...

Picture of <span class="username">Guest (not verified)</span>

this video outlines the true warehousing of children during cps investigations this more than indicates that the cure is more dangerous than the disease.....

Picture of <span class="username">Guest (not verified)</span>

There were 3 extensive MIT studies in the 2000's that supported much of what you stated. Basically, the conclusion was that children that have been through the foster system are 3 times more likely to have a bad outcome, ie high school dropout, no college, incarceration, early pregnancy. 60 percent of youth that get into trafficking or prostitution are former foster children. The 'easy' conclusion is that children in foster care came in damaged, but that is not always the case. These children are ripped from family and thrown into homes with strangers. I am not saying that all foster care is bad, but it is not looked upon as the tragic solution that it is. And children that are 'adopted' don't fare much better. For the most part they miss their family and will have a wound that will never heal.

So why does the government pour it's resources into foster care and adoption? It's a good question and one that needs to be asked. I do have some ideas, however..

- The general public is clueless about the reality of the situation. They think children are removed for horrible 'abuse' when that's true less than 20 percent of the time.
- Joe public does not realize the damage foster care does to children, and/or the damage adoption does.
- The Church fawns all over the foster and adoption systems and does little to help parents in crisis that do need help working through hard times.
- Foster care and adoption are BIG BUSINE$$.
- Joe Public does not realize how corrupt the system has become.

Our nation's children have become a commodity for federal money. It's is the biggest scandal, bigger than the VA.

Picture of <span class="username">Guest (not verified)</span>

I was one of those foster children.
One home to rules everytime.
Going to different schools, like a vagabond.
Being called into the principals office, social worker there, moving you to a new home, no explanation, your life in garbage bags.
Never seeing a doctor. Counselor. A dentist.
Being told by new fosters, that your pneumonia is a result of not praying enough.
Being pushed down stairs, by a foster mom, resulting in a two week stay at the hospital. No punishment for her. No one stood up for me. Having your stuff stolen by other kids. Never replaced. Being starved. Neglected. Knowing you are a paycheck.
The constant on guard. Looking behind your back. Its stressful. Never ever seeing your sisters or any family again. And all you long for is your grandma. Your aunt. Your sisters. Foster care was awful, and I suffered more in cps care, than at home.
It was safer on the streets than in States care .

Picture of <span class="username">Guest (not verified)</span>

Thank you Ryan for this important piece, judging by the quality of the responses here you have hit the nail on the head. But I can say having studied the topic for the last decade, you are only scratching the surface of a giant septic cesspit, where otherwise good people harm children in the belief they are "protecting" them. Despite their best intentions, the Outcomes for "Cared For" children are dismal, 80% have poor outcomes. When the State steps in and says you cant parent a child, we have to expect that the State will do a better job, and yet they fail spectacularly.

Rather than my usual long response, I will keep it brief. I feel here I would only be preaching to the converted which would be a waste of time. I wrote a book on the topic entitled "Secret Courts" in which I believe I have captured all the issues, I would like to send you a copy. I hope that your research continues on this issue, perhaps in reading my book you would find other subjects to pursue.

In this short video, the Director of Baltimore Children's Services nails it, its about satisfying the egos of those involved. Parents suspected of abuse or neglect are ranked lowed than pedophiles. By dehumanizing caregivers, it allows them to abuse both the child and the parents by placing the child with strangers. Having spent over 10 years helping families I can say that the vast majority of children don't need to be in "Care". If I had the resources I could prevent most children ending up in "Care". Molly McGrath Tierney sums it up better in a few minutes than I could in this post. Thanks again for this piece.

Picture of <span class="username">Guest (not verified)</span>

This article breaks my heart. I fought so hard to have my grandson. But the Courts and the State had a different agenda. My petition was ignored long enough for the foster parent to have in so they could petition the court to adopt my grandson. The the Judge denied my and allow them to adopt. I appealed and my case went all the way to the Supreme Court of Utah and they ruled that the Juvenile Court Judge Erred and reversed the adoption and ordered it to be redone. But by the time my case went through all of this too much time had passed. The new Judge determined even though I was a suitable home for my grandson he didnt want to take chance on my grandson not doing well with changing his life again. The Judge did "recommend and encourage" that my grandson be allowed to have a relationship with his biological family. Up to now that has never happened and the final ruling was in Nov 2014...

Picture of <span class="username">Guest (not verified)</span>

Hi, I started researching GAL and CPS performances approx. 18 months ago. I collected data from families, service providers and foster families and maybe took about 9 months off to focus on my kiddos. I had started my investigation again in June. As a former foster child who languished for 5 years in foster care, moved 21 times in 18 years, but still fortunate enough to chase higher education, I wanted to affect change in juvenile court and foster care reform. I also have the financing report for child welfare and that is cringe worthy as well. During my investigation, I learned my kiddos had been neglected while I was at work and they were with babysitters. Although my kids did not share with me what happened until a year later, I took them immediately to the ER, next day in therapy and then Project Harmony for specialized therapy. CPS did not investigate, did not ask for documentation, did not ask for phone records to illustrate my immediate response and made up a story that my kids did not have the proper babysitter/ separation mechanisms in place during the investigation. My kids were seized too. My kids now have this shared experience of being seized, zero communication and collaboration, but in foster care for 3.5 months with a dismissal coming due to lack of evidence to sustain a trial. Growing up, I did not have well check medical care, maybe dental care a handful of times at the age of 10, no mental healthcare. Now that my children are seized by the government, their mental healthcare, medical and no dental is neglected. Fortunately, I still have medical rights, so I can take my littles to their lifelong pediatrician when feeling ill. Over the past year, I had taken my children to our family therapist and their pediatrician for preventative, well checks & mental health care. It is nowhere the medical, dental & mental healthcare they were given in my care though and moreso their needs are neglected due to the power plays happening with social workers, kinship placements, bureaucratic tape. Juvenile Court & Foster Care Reform have been a very troubling and scary process, possibly causing some retaliation, but unconfirmed. The children at the center have zero voice, the GAL has only met one child once, but the other two have not met her. My research uncovered 8/10 cases of GAL's not meeting clients but collecting payments. CPS continues to seize many kids without interviews as reflected in my interviews. Although, our family has the education and resources to deal with what the State of Nebraska dishes to us, most live below poverty level, culture bias plays a role in removal too and a visitation worker indicated that parents she works with faced seizures of their kids for non-emergency removals. First families first makes sense with the proper services where there is transparency and collaboration to help not hurt. Preventative care makes better sense such as mental healthcare for people struggling to cope to fully address the foster care initiative to seize kids at such a high rate in Nebraska in my humble opinion.

Picture of <span class="username">Guest (not verified)</span>

After having 75 foster children go through my home and the adoption of seven(sibling group of 4 teens) I could certainly write a book. Also I was part of the foster/adoption life. It has been rewarding but tested our strength many times. Our 2 youngest have special needs, ages 11 & 13. Our oldest bio will soon be 50. Just keep a sense of humor!

Picture of <span class="username">Guest (not verified)</span>

I to had to rehabilitate children from egregious care administered from and by the cps system. attached please view the video tape... These children were removed due to false allegations and returned some 17 months later the habits learned in foster care were very difficult if not impossible to remove from their character. The family of origin had some success and some failures to enable the youths to enter society prepared for the rigors of normal life. Although the abuse was eradicated fro their lives the learned behaviors threatened to through the entire family off the rails at many junctures. The system when confronted with their harmful actions sought to only remove themselves from any accountability, and offered the children no care in overcoming the imposed damages. Clearly child advocacy is something lost in this society, and families are left high and dry to pursue normal lives after an intervention by cps. With the incredulous amounts of money spent on behalf of these children [an average of 171,000.00 dollars per year per child] the entire child advocacy program in this country has been highjacked as a job fair, and the mission to serve children and families has been lost.

Picture of <span class="username">Guest (not verified)</span>

Gilmer Texas corrupt. Please help. Cps fraud!

Picture of <span class="username">Guest (not verified)</span>

I diligently advocated for foster care child placed in a home with a woman who had her foster care license revoked. The caseworker had to take a medical leave because of this case. What I uncovered brought all the forces of hell and law enforcement against me and now I am hiding for my life. So there are those who love, care, who speak the truth, who try to protect, and the My stand alone. Not one person will help me stay safe. It went all the way to the top of state, which is when the harassment became so intolerable it destroyed my health. It destroyed my livelihood. And I have had to move several states away to stay alive, to protect my clients, to protect my family. And I am all alone now. Not one person to protect me. I was trying to protect a vulnerable child and uncovered a huge scandal accidentally. Nobody will help me. But in my heart, I know that I did everything for that child I could. I even tried to protect our whole County, which ranks worst in the state for investigation and substantiation of child abuse and neglect. When I had the reason dropped in my lap and reported it to the proper person at the top of the state children's services and foster care, that's when all of hell came against me. I have lost everything trying to protect a terrified, failure to thrive, psychotic, traumatized child removed from her homeless grandmother. If only someone would fight for me as I tried to protect her. But nobody will. I've lost it all. but when I stand before God I will say I did the best that I could.

Picture of <span class="username">Guest (not verified)</span>

I need to add that I tried to file a child abuse and neglect report against the foster care supervisor for medical abuse and collect, the same supervisor of foster care who was trying to suppress information this child had been placed with a license-revoked foster care parent. The centralized intake for the state would not take a report against their own.

Picture of <span class="username">Guest (not verified)</span>

In our case, the three children that we have adopted through the foster care system are healthy and thriving. The trauma was caused by the biological parents ( drug exposure, neglect and emotional abuse) not by them being placed in foster care. The system as we call it rescued them from people who were harming them. They are now loved and cared for. This is true for so many other foster children that I know.

Picture of <span class="username">Guest (not verified)</span>

Arkansas is the worst state to try and adopt or be a foster parent. They want people to take parenting classes and then they say they don't have enough people that want to be a foster parent so you have to wait. I gave known people who where all the way approved and never got a child. There a r e few foster parent specialist that say they don;t want children and do not like children, They just took the job because it is a paycheck. The cost for the classes is high and I don't feel you can tech anyone to be a parent by reading a book. I feel that all they need to do is the criminal backgrounds checks and then place the child if they pass the background check. The system is broken and there are too many children aging out of foster without being adopted. I would like to adopt a White, Male Child between 3 and 10 but to got thur DHS is a waste of time because they are too slow and the longer it takes the more money they get from the Federal Government. The DHS is more interested in keeping the funds coming in then getting children adopted and off the waiting child list. There is NO way to teach a person to become a parent. Teenage girls are having babies every day and no one has taught them how to be a good parent, Parenting classes look good on paper but is not a goal that can be obtained in the real world!

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