Highlights
- •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.
Abstract
Purpose
To investigate and describe available data on children with disabilities in the United
States foster care system and examine placement disruptions.
Design
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.
Methods
Descriptive and regression analyses were conducted.
Findings
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.
Conclusions
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.
Keywords
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References
- Longitudinal outcomes of children exposed to opioids in-utero: A systematic review.Journal of Nursing Scholarship. 2021; 53: 55-64
- Preliminary effectiveness of an LGBTQ+ affirmative parenting intervention with foster parents.Children and Youth Services Review. 2021; 127106107
- Reaching everyone: Promoting the inclusion of youth with disabilities in evaluating foster care outcomes.Children and Youth Services Review. 2013; 35: 1801-1808
- Children with disabilities: Problems faced by foster parents.Children and Youth Services Review. 2009; 31: 40-46
- Children in foster care: A vulnerable population at risk.Journal of Child and Adolescent Psychiatric Nursing. 2008; 21: 70-77
- Introduction: CDC health disparities and inequalities report.in: Morbidity and mortality weekly report. Surveillance summaries. 62. 2013: 3-5
- The AFCARS report.
- Integrative review: Delivery of healthcare services to adolescents and young adults during and after foster care.Journal of Pediatric Nursing. 2016; 31: 653-666
- Person-first & identity-first language: Supporting students with disabilities on campus.Community College Journal of Research and Practice. 2021; 45: 79-85
- Is higher placement stability in kinship foster care by virtue or design?.Child Abuse & Neglect. 2015; 42: 99-111
- Measurement and correlates of foster care placement moves.Children and Youth Services Review. 2018; 91: 248-258
- Foster care and the best interests of the child: Integrating research, policy, and practice. Springer Cham, 2020
- Mapping the concept of vulnerability related to health care disparities: A scoping review.BMC Health Services Research. 2013; 13: 94
- Outcomes of children who grew up in foster care: Systematic-review.Children and Youth Services Review. 2017; 76: 74-83
- Children and youth in out-of-home care: What can predict an initial change in placement?.Child Abuse & Neglect. 2019; 93: 55-65
- Effectiveness of nurse-led case management in cancer care: Systematic review.Clinical Nursing Research. 2019; 28: 968-991
- 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
- Foster care placement instability: a meta-analytic review.Child and Youth Services Review. 2019; 96: 483-499https://doi.org/10.1016/j.childyouth.2018.12.002
- 2017 disability statistics annual report.University of New Hampshire, Durham, NH2018
- Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?.Child and Youth Services Review. 2012; 34: 891-899https://doi.org/10.1016/j.childyouth.2012.01.017
- Family first or the kindness of strangers? Foster care placements and adult outcomes.Labour Economics. 2020; 65
- School nurses and care coordination for children with complex needs: An integrative review.The Journal of School Nursing. 2015; 31: 34-43
- Experiencing transitions: An emerging middle-range theory.Advances in Nursing Science. 2000; 23: 12-28
- Transitions theory. Middle-range and situation-specific theories in nursing research and practice.Springer Pub, New York2010
- “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
- 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
- Developmental consequences of fetal exposure to drugs: What we know and what we still must learn.Neuropsychopharmacology. 2015; 40: 61-87
- 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
- Age-specific risk factors associated with placement instability among foster children.Child Abuse & Neglect. 2018; 84: 157-169
- A model for analyzing human adaptation to transition.The Counseling Psychologist. 1981; 9: 2-18
- Foster care outcomes for children with intellectual disability.Intellectual and Developmental Disabilities. 2016; 54: 299-315
- Youth in foster care.in: Neinstein’s adolescent and young adult health care: A practical guide. 6 ed. Wolters Kluwer Health, Philadelphia2016
- Mental and physical health of children in foster care.Pediatrics. 2016; 138
- Breakdown of foster care placements in Flanders: Incidence and associated factors.European Child & Adolescent Psychiatry. 2018; 27: 209-220
- Attachment, development, and mental health in abused and neglected preschool children in foster care: A meta-analysis.Trauma Violence Abuse. 2018; 19: 443-458
- Predictors of placement disruptions in foster care.Child Abuse & Neglect. 2020; 99
- 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
- Foster family characteristics, kinship, and permanence.The Social Service Review. 2009; 83: 185-219
Article info
Publication history
Published online: May 20, 2022
Accepted:
May 5,
2022
Received in revised form:
May 3,
2022
Received:
June 7,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
