This West Is OUR West

For first time, national data reveal just how hard foster care is on children's health

By Ryan White

We’ve all heard or read the gut-wrenching stories of children in foster care who’ve had to endure abusive treatment or squalid conditions, and of social workers and child welfare systems failing to carry out their most basic mission. The prevalence of such stories compounds their awfulness.

But beyond the horrific anecdotes and well-documented systemic dysfunction, what do we know about how the mental and physical health of children placed in foster care compares with that of other kids? While the available data hasn’t allowed such direct comparisons in the past, a new analysis from sociologists Kristin Turney of UC Irvine and Christopher Wildeman of Cornell University shows for the first time how the health of U.S. foster children differs from their peers. The data, drawn from 2011-12 National Survey of Children’s Health, show that kids placed in foster care are two to three times more likely to suffer from a host of conditions ranging from learning disabilities, anxiety and behavioral problems to asthma, obesity and vision problems.

“Children placed in foster care were in poor mental and physical health relative to children in virtually every other type of family situation and in children in economically disadvantaged families,” write Turney and Wildeman.

Kids placed in foster care were twice as likely as other children to have a learning disability (14.7 percent vs. 7.6 percent); three times more likely to have ADD or ADHD (21.8 vs. 7.4 percent); six times more likely to have behavioral problems (17.5 vs. 2.9 percent); and seven times more likely to suffer from depression (14.2 vs. 2 percent). As these numbers suggest, the disparities are especially pronounced for mental health problems. And these disparities remained even after the researchers adjusted for child characteristics, socioeconomic status and household conditions.

The study wasn’t designed to explain what aspects of foster care are key drivers of such health problems, but early childhood trauma has been shown to have serious, lifelong health consequences.

The data did reveal one counter-intuitive finding: “(C)hildren adopted from foster care had worse health than their counterparts placed in foster care.” The authors speculate this could be because of higher subsidies offered by some states for kids with more health problems, or because foster children can’t be adopted until the parents’ rights are terminated and children in such cases are more likely to experience trauma and abuse.

Too often, the misery deepens. In cases of foster children already struggling from mental and behavioral problems, the treatment can be worse than the cure. That fact was made powerfully clear by reporter Karen de Sá’s investigative series “Drugging Our Kids” in the San Jose Mercury News. De Sá found that nearly one in four children in California’s foster care system were given antipsychotic drugs to control their behavior:

“With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children,” de Sá wrote in her lead story in 2014. Such drugs, she noted, can have scary side effects: “rapid-onset obesity, diabetes and a lethargy so profound that foster kids describe dozing through school and much of their young lives. Long-term effects, particularly on children, have received little study, but for some psychotropics there is evidence of persistent tics, increased risk of suicide, even brain shrinkage.”

The Mercury’s in-depth reporting on the use of psychotropics on foster kids prompted a state audit and culminated in new legislation signed several weeks ago by California Gov. Jerry Brown that mandates annual monitoring of high-prescribing physicians and gives the state medical board new authority to investigate doctors in such cases.

But such legislation won’t eliminate the disparities in mental and physical health identified in this week’s study. It’ll just make it harder for guardians and doctors in California to dole out seemingly easy fixes to deeper problems. With 19 states facing monitoring and lawsuits over allegations of abuse, neglect and home shortages in their child welfare system as of the start of this year, it would seem our collective readiness to address the mental and physical wounds that often come with the experience of being a foster child is still deeply inadequate.


[Photo by Alyssa L. Miller via Flickr.]