It is well documented that children enter foster care with special health and mental health needs and, while in care, those conditions are often exacerbated. However, less attention has been given to foster parents who have the most contact with these children. Results are presented from a national study on the developmental, health and mental health care needs of children in foster care that included foster parents' perspectives and observations. Their role in improving child well being is explained and recommendations for policy, practice and advocacy also are included.
Many children enter foster care suffering from insufficient prenatal and health care, poverty, homelessness, exposure to alcohol and other drugs, learning problems in school, and, of course, physical abuse, sexual abuse, and neglect (Blome, 1997; Downs, Moore, McFadden, & Costin, 2000; Half on, Mendoca, & Berkowitz, 1995; Kortenkamp and Ehrle, 2002; National Commission on Children in Need of Parents, 1978; National Commission on Family Foster Care, 1991; Pecora, Whittaker, Maluccio, Barth, & Plotnick, 2000). Children with these risk factors need a stable and therapeutic living arrangement, in which the effects of these traumas can be ameliorated if not healed (Duncan & Brooks-Gunn, 2000; Fein & Maluccio, 1991). This article first summarizes key research findings over the past 20 years on the health and mental health needs of children in foster care. These previous studies document that foster parents-although they are trusted with the daily care of children with complex needs-largely have been overlooked from research efforts and recommendations in this area. This article then details interventions that could address foster parents' concerns about accessing health and mental health services for children in their care. Advocacy for more inclusive research for the foster parents is the third objective of the article.
More than two decades have gone by since the passage of RL. 96-272, the Adoption Assistance and Child Welfare Act of 1980, which had the promise of significant reform for children and adolescents reported to be "drifting" in out-of-home care. But the 1980s saw the social safety net for many American families dismantled, the emergence of HTV/AIDS, increased reports of child abuse and neglect, caseworkers* overwhelmed by increasing caseloads and decreasing agency and community supports, and a dwindling supply of foster parents whose role in the delivery of foster care services continued to be ambiguous (National Commission on Family Foster Care, 1991; Pasztor & Wynne, 1995).
The need for developmental, health, dental, and mental health care for children in foster care was documented as early as 1982 (Schor), showing that while abused, neglected, and emotionally maltreated children had a range of health and mental health problems, the health care they subsequently received failed to address these issues. Although the role of caseworkers as part of the systems-wide problem was addressed, no specific recommendations were made for the role of foster parents.
Hochstadt, Jaudes, Zimo, and Schachte (1987) studied 200 children taken into care in Cook County, Illinois, during August 1984, finding that they were at "high risk for medical and psychosocial problems" (p. 53). As one of the first articles to specifically address the role of foster parents, the authors report that "foster parents are the critical element in the successful delivery of adequate health care services to foster children" (p. 61), recognizing many problems foster parents faced in obtaining adequate healthcare services.
In a study that included a potential role for foster parents relating to the mental health needs of children in care, the perspectives of foster parents were evaluated along with those of administrators, caseworkers, and healthcare providers in 14 counties in California (Halfon & Klee, 1987). …