Research Article| Volume 66, P30-35, September 2022

Placement disruption of children with disabilities in foster care


      • Children with disabilities experience higher levels of placement disruption in foster care.
      • Children with disabilities spend more time in foster care than peers.
      • Children with disabilities experience more restrictive placement settings.



      To investigate and describe available data on children with disabilities in the United States foster care system and examine placement disruptions.


      This quantitative descriptive study was a secondary data analysis of the Adoption and Foster Care Analysis and Reporting System (AFCARS) and included 680,611 children.


      Descriptive and regression analyses were conducted.


      Of 680,611 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis, requiring additional or specialized care. Children with disabilities in foster care (CDFC) had a mean of 4.0 disruptions—significantly higher than the mean 2.37 disruptions among those without a disability (p < .001, d = 0.51). CDFC spent an average of 915 days in foster care compared to 514 days for children without a disability (p < .001, d = 0.59). Predictive risk factors for disruptions were increased child age, race (American Indian or Black), and increased foster parent age. Protective factors against disruptions included married foster parents and a child being placed outside of the child's initial state of residence.


      CDFC have significantly more disruptions and longer stays in foster care. While risk and protective factors affect all foster children similarly, they have significantly greater effect on foster children with disabilities.

      Practice implications

      Increased disruptions compound the vulnerability of CDFC as relationships and support systems are broken. Understanding the extent to which childhood disabilities play a role allows school nurses, healthcare providers, and child advocates to better design interventions to improve lifelong health outcomes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Arter S.J.
        • Tyler B.
        • McAllister J.
        • Kiel E.
        • Güler A.
        • Cameron Hay M.
        Longitudinal outcomes of children exposed to opioids in-utero: A systematic review.
        Journal of Nursing Scholarship. 2021; 53: 55-64
        • Austin A.
        • Craig S.L.
        • Matarese M.
        • Greeno E.J.
        • Weeks A.
        • Betsinger S.A.
        Preliminary effectiveness of an LGBTQ+ affirmative parenting intervention with foster parents.
        Children and Youth Services Review. 2021; 127106107
        • Blakeslee J.E.
        • Del Quest A.
        • Powers J.
        • Powers L.E.
        • Geenen S.
        • Nelson M.
        • McHugh E.
        Reaching everyone: Promoting the inclusion of youth with disabilities in evaluating foster care outcomes.
        Children and Youth Services Review. 2013; 35: 1801-1808
        • Brown J.D.
        • Rodger S.
        Children with disabilities: Problems faced by foster parents.
        Children and Youth Services Review. 2009; 31: 40-46
        • Bruskas D.
        Children in foster care: A vulnerable population at risk.
        Journal of Child and Adolescent Psychiatric Nursing. 2008; 21: 70-77
        • Centers for Disease Control and Prevention
        Introduction: CDC health disparities and inequalities report.
        in: Morbidity and mortality weekly report. Surveillance summaries. 62. 2013: 3-5
        • Children'’s Bureau
        The AFCARS report.
        • Collins J.L.
        Integrative review: Delivery of healthcare services to adolescents and young adults during and after foster care.
        Journal of Pediatric Nursing. 2016; 31: 653-666
        • Flink P.
        Person-first & identity-first language: Supporting students with disabilities on campus.
        Community College Journal of Research and Practice. 2021; 45: 79-85
        • Font S.A.
        Is higher placement stability in kinship foster care by virtue or design?.
        Child Abuse & Neglect. 2015; 42: 99-111
        • Font S.A.
        • Sattler K.M.P.
        • Gershoff E.T.
        Measurement and correlates of foster care placement moves.
        Children and Youth Services Review. 2018; 91: 248-258
        • Font Sarah A
        • Gershoff Elizabeth T
        Foster care and the best interests of the child: Integrating research, policy, and practice. Springer Cham, 2020
        • Grabovschi C.
        • Loignon C.
        • Fortin M.
        Mapping the concept of vulnerability related to health care disparities: A scoping review.
        BMC Health Services Research. 2013; 13: 94
        • Gypen L.
        • Vanderfaeillie J.
        • De Maeyer S.
        • Belenger L.
        • Van Holen F.
        Outcomes of children who grew up in foster care: Systematic-review.
        Children and Youth Services Review. 2017; 76: 74-83
        • Jedwab M.
        • Xu Y.
        • Keyser D.
        • Shaw T.V.
        Children and youth in out-of-home care: What can predict an initial change in placement?.
        Child Abuse & Neglect. 2019; 93: 55-65
        • Joo J.Y.
        • Liu M.F.
        Effectiveness of nurse-led case management in cancer care: Systematic review.
        Clinical Nursing Research. 2019; 28: 968-991
        • Koh E.
        • Rolock N.
        • Cross T.P.
        • Eblen-Manning J.
        What explains instability in foster care? Comparison of a matched sample of children with stable and unstable placements.
        Children and Youth Services Review. 2014; 37: 36-45
        • Konijn Carolien
        • Admiraal Sabine
        • Baart Josefiene
        • van Rooij Floor
        • Stams Geert-Jan
        • Colonnesi Cristina
        • Assink Mark
        Foster care placement instability: a meta-analytic review.
        Child and Youth Services Review. 2019; 96: 483-499
        • Kraus L.
        • Lauer E.
        • Coleman R.
        • Houtenville A.
        2017 disability statistics annual report.
        University of New Hampshire, Durham, NH2018
        • Leathers Sonya J
        • Spielfogel Jill E
        • Gleeson James P
        • Rolock Nancy
        Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?.
        Child and Youth Services Review. 2012; 34: 891-899
        • Lovett N.
        • Xue Y.
        Family first or the kindness of strangers? Foster care placements and adult outcomes.
        Labour Economics. 2020; 65
        • McClanahan R.
        • Weismuller P.C.
        School nurses and care coordination for children with complex needs: An integrative review.
        The Journal of School Nursing. 2015; 31: 34-43
        • Meleis A.
        • Sawyer L.
        • Im E.
        • Hilfinger Messias D.
        • Schumacher K.
        Experiencing transitions: An emerging middle-range theory.
        Advances in Nursing Science. 2000; 23: 12-28
        • Meleis A.I.
        Transitions theory. Middle-range and situation-specific theories in nursing research and practice.
        Springer Pub, New York2010
        • Mires C.B.
        • Lee D.L.
        • McNaughton D.
        “Every child that is a foster child is marked from the beginning”: The home-school communication experiences of foster parents of children with disabilities.
        Child Abuse & Neglect. 2018; 75: 61-72
        • Pufpaff L.A.
        • McIntosh C.E.
        • Thomas C.
        • Elam M.
        • Irwin M.K.
        Meeting the healthcare needs of students with severe disabilties in the school setting: Collaboration between school nurses and special education teachers.
        Psychology in the Schools. 2015; 52: 683-701
        • Ross E.J.
        • Graham D.L.
        • Money K.M.
        • Stanwood G.D.
        Developmental consequences of fetal exposure to drugs: What we know and what we still must learn.
        Neuropsychopharmacology. 2015; 40: 61-87
        • Sankaran V.S.
        Out of state and out of luck: The treatment of non-custodial parents under the interstate compact on the placement of children.
        Yale Law & Policy Review. 2006; 25: 63-94
        • Sattler K.M.P.
        • Font S.A.
        • Gershoff E.T.
        Age-specific risk factors associated with placement instability among foster children.
        Child Abuse & Neglect. 2018; 84: 157-169
        • Schlossberg N.K.
        A model for analyzing human adaptation to transition.
        The Counseling Psychologist. 1981; 9: 2-18
        • Slayter E.M.
        Foster care outcomes for children with intellectual disability.
        Intellectual and Developmental Disabilities. 2016; 54: 299-315
        • Taussig H.
        • Harpin S.
        • Betts W.
        • Melnicoe L.
        • Russo G.
        Youth in foster care.
        in: Neinstein’s adolescent and young adult health care: A practical guide. 6 ed. Wolters Kluwer Health, Philadelphia2016
        • Turney K.
        • Wildeman C.
        Mental and physical health of children in foster care.
        Pediatrics. 2016; 138
        • Vanderfaeillie J.
        • Van Holen F.
        • Carlier E.
        • Fransen H.
        Breakdown of foster care placements in Flanders: Incidence and associated factors.
        European Child & Adolescent Psychiatry. 2018; 27: 209-220
        • Vasileva M.
        • Petermann F.
        Attachment, development, and mental health in abused and neglected preschool children in foster care: A meta-analysis.
        Trauma Violence Abuse. 2018; 19: 443-458
        • Vreeland A.
        • Ebert J.S.
        • Kuhn T.M.
        • Gracey K.A.
        • Shaffer A.M.
        • Watson K.H.
        • Compas B.E.
        Predictors of placement disruptions in foster care.
        Child Abuse & Neglect. 2020; 99
        • Winter K.
        Understanding and supporting young children's transitions into state care: Schlossberg's transition framework and child-centred practice.
        British Journal of Social Work. 2014; 44: 401
        • Zinn A.
        Foster family characteristics, kinship, and permanence.
        The Social Service Review. 2009; 83: 185-219