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Foster Care

by Steven D. Blatt, MD

Foster care is care provided for children whose families are temporarily unable to care for them. Guided by federal (national) laws, local government determines the process of arranging foster care. Foster care is surprisingly common in the United States—about 750,000 children are in the foster care system each year.

Foster parents

Foster parents assume day-to-day care for the child but in most instances do not have legal authority to authorize medical treatment. Although the details vary by state, in general, birth parents retain some decision-making responsibilities and consent-granting abilities for their children until a court states otherwise. The local agency for social services, in many communities called the Department of Social Services, often has the legal ability to authorize medical treatment for and make legal decisions for children in their care.

Foster children

Most children in foster care come from families that have struggled to provide safe, nurturing, and loving home environments. They come from families that are often poor, have under-educated, single parents, and parents who have substance abuse problems or mental illness. The home life is often chaotic, and medical and dental needs are often unmet.

About 70% of the children in foster care are put there by Child Protective Services because the child has been abused or neglected (see Overview of Child Neglect and Abuse). Most of the remaining 30% are adolescents placed in care by the juvenile justice system. Very few children are placed voluntarily by their parents. Many children who might otherwise be placed into foster care are placed with extended family or friends, which is called "kinship care" and is usually not supervised by social service agencies. Adolescents may live in group homes or residential treatment facilities.

Did You Know...

  • Over half of children in foster care return to their birth families.

Removal from their family is enormously painful to children. In foster care, children may have frequent visits with their families or only limited, supervised visits.

Children in foster care often leave behind their neighborhoods, communities, schools, and most of their belongings. Many children and adolescents in foster care feel anxious, uncertain, and helpless to control their lives. Many feel angry, rejected, and pained by the separation, or they develop a profound sense of loss. Some feel guilty, believing that they caused the disruption of their birth family. Peers often tease children about being in foster care, reinforcing perceptions that they are somehow different or unworthy.

Children in foster care have more chronic health problems and behavioral, emotional, and developmental problems than do other children. They are also less likely to receive appropriate medical or mental care for their problems. Yet, most children in foster care adjust well as long as the placement is stable and the foster family is skilled in nurturing the child's emotional needs. Many children in foster care benefit from counseling.

Over half of the children eventually return to their birth families. About 20% of children in foster care are eventually adopted, most often by their foster family. Other children return to a relative or become too old for foster care. A small number of children are later transferred to another foster care agency if a placement does not work out or if the foster family is relocating to another area. Tragically, 18% of youth in foster care eventually age out of the system without a sense of belonging in any family.

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