Developmental Impact of Foster Care

Foster Child Health and Development: Developmental Impact of Foster Care
Authors and Disclosures


Abstract and Introduction
Physical Health Status of Children in Foster Care
Mental Health Status
Developmental Impact of Foster Care
Implications for Primary Care
Developmental Impact of Foster Care

It has been estimated that up to 60% of children in foster care experience some type of developmental delay, including language delays (57%), cognitive problems (33%), gross motor difficulties (31%), and growth problems (10%) (Silver et al., 1999; Simms & Halfon, 1994). Children who enter care with developmental problems are more likely to remain in care long-term (Horowitz, Simms, & Farrington, 1994). Table 1 summarizes common developmental problems experienced by children in foster care at different developmental stages.

Due to the nature of the traumatic experiences that typically precede a child's foster care placement, such as family violence and instability, problems with attachment and developing trusting interpersonal relationships are quite common (Milan & Pinderhughes, 2000). These experiences, coupled with a trajectory of multiple placement transitions, serve to maintain attachment difficulties as the hallmark of a child's development in foster care. An early foundation of insecure attachments and developmental discontinuity in significant relationships has been shown to be related to increased time in care, further placement disruptions, and increased mental health problems in children in foster care (Marcus, 1991). With placement and relationship instability, a pattern of emotional detachment from foster caregivers often develops; the lack of emotional reciprocity between child and caregiver is often too emotionally challenging for foster parents to endure, thus perpetuating a cycle of placement failure (Simms et al., 2000). Adolescents in long-term foster care reported unwillingness to make continued attempts to form attachments with new caregivers. To shield themselves from interpersonal loss, they described self-protective strategies including keeping relationships superficial and maintaining interpersonal distance from others (Kools, 1997, 1999).

Instability and difficulties in interpersonal relationships extend from the foster home context to the peer network. Multiple placements make it logistically difficult for the young person to maintain friendships (Marcus, 1991). Adolescents also reported feeling stigmatized by peers for their diminished status of foster child, resulting in social isolation. Likewise, these experiences have an impact on the adolescent's identity development, with the young person at risk for internalizing the negative views of others (Kools, 1997).

For school-aged children and adolescents, school is a major context for growth and development. Within this important environment, the foundation is set for interpersonal and life skills that contribute to healthy functioning across the life span (Carnegie Council on Adolescent Development, 1995). Frequent school disruption and discontinuity in education are other consequences of multiple foster care placements. Moving from home to home often results in changing school settings. There may be a delay in school enrollment and educational records transmission after each move, resulting in a child's pattern of getting behind in school and increasing the risk for academic failure (Zima et al., 2000).

Finally, independent living skills training has been federally mandated for adolescents in foster care. However, those adolescents with the personal skills, emotional maturity, and financial stability to live independently after aging out of the system at age 18 are the rare exception (GAO, 1999). Premature launching into independent living generally occurs before the adolescent is developmentally ready for this system-imposed milestone (Kools, 1997). This is evidenced in former foster youths' failure to complete high school education and failure to secure affordable housing and stable employment at a living wage (Courtney & Piliavan, 1998). Many foster care "graduates" face serious problems such as homelessness, incarceration, victimization, and early pregnancy and parenting (GAO, 1999; Westat, 1991). In terms of health care, a recent study documented that young people discharged from foster care had extreme difficulty obtaining affordable health care. The majority had no health insurance. They were even less likely to receive mental health services despite clear evidence of ongoing psychological distress (Courtney & Piliavan, 1998).

http://www.medscape.com/viewarticle/449673_4