Health Care Policies for Children in Out-of-Home Care

By Risley-Curtiss, Christina; Kronenfeld, Jennie Jacobs | Child Welfare, May/June 2001 | Go to article overview

Health Care Policies for Children in Out-of-Home Care


Risley-Curtiss, Christina, Kronenfeld, Jennie Jacobs, Child Welfare


Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care

Ensuring that the health care needs of children in out-of-- home care are met is a recognized responsibility of child welfare agencies [National Commission on Foster Family Care 1991; Halfon & Klee 1987; United Way 1987]. Although some health care services are provided by a number of substitute care agencies, in general, health care for children in out-of-home care has received low priority [Kavaler & Swire 1983; Schor 1988; Simms & Halfon 1994]. Standardizing the provision of health care services for children in care has been advocated by such professional organizations as the American Academy of Pediatrics [Committee on Early Childhood, Adoption and Dependent Care 1994] and the Child Welfare League of America [1988]. Nonetheless, the probability of the comprehensive health care needs of these children being served is often small, with medical and mental health care services to children in out-of-home care falling victim to duplication, inefficiency, and fragmentation (see e.g., Risley-- Curtiss et al. [1996]; Halfon & Klee [1987]; Moffatt et al. [1985]; U.S. General Accounting Office [1995]).

One obstacle to meeting the health care needs of children in out-of-home care has been the lack of uniform models, policies, and procedures to ensure that all children in care receive appropriate health care [Combs-Orme et al. 1991; Simms & Halfon 1994; Kendall et al. 1995; U.S. General Accounting Office 1995]. This study seeks to describe the extent of health care policies of public out-of-home care placement agencies, document such policies, and provide recommendations for how agencies can ensure that the health care needs of the children in their care are met.

Health Care Needs of and Utilization by Children in Out-of-Home Care

Many children, regardless of the type of out-of-home care in which they are placed, are not in good health. Studies of children entering care have found that 87% to 95% have at least one physical health problem, and that 50% to 60% have multiple physical abnormalities [Hochstadt et al. 1987; Chernoff et al. 1994]. Studies on the health status of children already in care provide additional evidence that these children continue to be at high risk for multiple health problems while in placement. In several studies, some kind of physical problem (e.g., skin problems, neurological abnormalities, elevated lead levels) has been almost uniformly identified for 86% to 90% of children in care [Dubowitz et al. 1992; Moffatt et al. 1985]. Abnormalities in growth (e.g., short stature), vision, and hearing are common [Chernoff et al. 1994; Hochstadt et al. 1987; Kavaler & Swire 1983; Moffat et al. 1985; Silver et al. 1999; Simms et al. 1989; White & Benedict 1985], as are chronic health problems such as anemia and asthma. The most prevalent problems have been psychological and behavioral [Blatt et al. 1997; Dubowitz et al. 1993; Halfon et al. 1994; Hochstadt et al. 1987; Schneiderman et al. 1998; Stein et al. 1994; Kavaler & Swire 1983; Thompson & Fuhr 1992].

The little research that exists on the sexual development needs of children in out-of-home care also suggests that these children are at high risk for early sexual activity, sexually transmitted diseases (STD), and pregnancy. …

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