Listen to thisChildren in foster care face a challenging journey through childhood. In addition to the troubling family circumstances that bring them into state care, they face additional difficulties within the child welfare system that may further compromise their healthy development. This article discusses the importance of safety and stability to healthy child development and reviews the research on the risks associated with maltreatment and the foster care experience. It finds:
Family stability is best viewed as a process of caregiving practices that, when present, can greatly facilitate healthy child development.
Children in foster care, as a result of exposure to risk factors such as poverty, maltreatment, and the foster care experience, face multiple threats to their healthy development, including poor physical health, attachment disorders, compromised brain functioning, inadequate social skills, and mental health difficulties.
Providing stable and nurturing families can bolster the resilience of children in care and ameliorate negative impacts on their developmental outcomes.
The author concludes that developmentally sensitive child welfare policies and practices designed to promote the well-being of the whole child, such as ongoing screening and assessment and coordinated systems of care, are needed to facilitate the healthy development of children in foster care.
Introduction
Protecting and nurturing the young is a universal goal across human
cultures. An abundance of research from multiple fields confirms the
importance of the family unit as the provider of safe, stable, and
nurturing environments for children. Unquestionably, children who are
reared in safe and stable environments have better short- and long-term
adjustment than children who are exposed to harmful experiences.
Moreover, research demonstrates that children exposed to violent,
dangerous, and/or highly unstable environments are more likely to
experience developmental difficulties.1 Children exposed to
violence within their homes experience the most deleterious outcomes.
For example, children exposed to physical maltreatment often experience
impairments in their physical health, cognitive development, academic
achievement, interpersonal relationships, and mental health.2
Erratic, insecure home environments and a lack of continuity and
constancy in caregiving are also associated with poor developmental
outcomes.
Children in foster care are particularly vulnerable to detrimental outcomes, as they often come into state care due to their exposure to maltreatment, family instability, and a number of other risk factors that compromise their healthy development. Foster children may be witnesses to and victims of family violence, or may not have been supervised or provided for in an appropriate manner. They may have been subjected to the inadequate and impaired caregiving that results from a variety of parental difficulties, such as substance abuse, mental illness, and developmental disabilities. Moreover, these children are predominantly from impoverished backgrounds, a situation that exacerbates the risk factors they experience.
This article examines the research on the importance of safety and stability in the lives of children and in the lives of foster children in particular. Importantly, family stability is defined not as a specific family structure or condition, but rather as a family environment in which caregiving practices provide children with the consistent, nurturing care they need to thrive. The article also discusses the factors in the family and child welfare systems that influence foster children's development. It concludes with recommendations for developing more developmentally-sensitive child welfare policies and practices.
Family stability and healthy child
development
Child development can be understood as the physical, cognitive, social,
and emotional maturation of human beings from conception to adulthood, a
process that is influenced by interacting biological and environmental
processes. Of the environmental influences, the family arguably has the
most profound impact on child development.
Family stability has been defined in many ways in the empirical literature. Traditionally, many researchers defined family stability in terms of factors related to family structure (for example, single parenthood).3 Specifically addressing the experiences of foster children, other scholars have defined stability as limited movement from home to home.4 However, exploring the various family processes that pertain to stability may be a more useful means of understanding the specific characteristics of family stability that support healthy child development. For example, parental mental health, stable relationships among caregivers, and positive parenting are cited as markers of family stability.5 Characteristics of the home environment, such as warmth, emotional availability, stimulation, family cohesion, and day-to-day activities, have also been implicated in the notion of family stability.6 Children who experience family stability have caregivers who remain constant, consistent, and connected to them over time; caregivers who are mentally healthy and engage in appropriate parenting practices; a cohesive, supportive, and flexible family system; and a nurturing and stimulating home environment. This definition of family stability is not offered as a standard by which to evaluate families in the child welfare system, but rather as an essential goal of child welfare intervention with biological, foster, and adoptive families.
Children are more likely to have trusting relationships with caregivers who are consistent and nurturing, which leads to a number of positive developmental outcomes.7 Moreover, the research suggests that positive and consistent caregiving has the potential to compensate for factors that have a deleterious impact on children, such as poverty and its associated risk factors.8 In other words, children have much better outcomes if their family lives are stable, despite the overwhelming influence of poverty and associated risk factors. Research has also documented that stability in the family unit promotes positive outcomes for children within particular developmental periods.
Conversely, child maltreatment reflects an extreme form of family instability. Data from the National Survey of Child and Adolescent Well-Being (NSCAW), the only large-scale, nationally representative study of foster children, as well as data from other studies, indicate that the majority of children enter the foster care system due to neglect.9 The next largest group enters the system due to physical abuse, and a smaller number enter due to sexual abuse.10 Moreover, almost half of children who are maltreated experience more than one type of maltreatment. Thus, many scholars recommend examining the consequences of maltreatment in general, rather than specific types of maltreatment. Nevertheless, a large body of research documents that these forms of maltreatment are associated with adverse outcomes in physical health, brain development, cognitive and language skills, and social-emotional functioning.11 For example, neglect is associated with a variety of developmental difficulties in childhood, including cognitive, language, and academic delays, poor peer relations, and internalizing (anxiety, depression) and externalizing (aggression, impulsivity) behavioral problems.12 Physical abuse, in addition to its physical health consequences, has been linked to cognitive delays, aggressive behavior, peer difficulties, posttraumatic stress disorder, and other externalizing and internalizing behavioral problems.13 Documented consequences of sexual abuse include low academic performance, depression, dissociation, inappropriate sexual behavior, and other high-risk behaviors in later childhood.14 Emotional maltreatment, which is implicated in all other forms of maltreatment, leads to declines in cognitive and academic functioning, as well as a variety of behavioral problems.15 The diagnosis of “failure to thrive” is a particularly illuminating health outcome of a problematic family environment. The experience of severe parental emotional unavailability leads to serious growth delays as well as psychological difficulties in young children.16
Specific areas of child development research are particularly relevant to a consideration of the impact of family instability on foster children, and on child welfare policy and practice in general. Although the following paragraphs are by no means exhaustive, the research on attachment, brain development, and resilience seems particularly germane to an understanding of the development of foster children.
Attachment
The capacity of maltreated children to attach to caregivers has been a
key concern and has been widely studied among child welfare experts.
Attachment can be defined as the enduring emotional bond that exists
between a child and a primary caregiver, who could be a biological
parent or an unrelated caregiver. Most children are securely attached to
their caregivers: They look to their caregivers for comfort when
distressed and are able to explore their environment because of the
security they feel in their relationships with their caregivers.
Alternatively, due to the uncertainty they feel in their relationships
with their caregivers, insecurely attached children may not be
adequately consoled by their caregivers or able to explore their
environments.
Children reared by caregivers who are inconsistent or demonstrate inadequate parenting practices are much more likely to be insecurely attached, or to have a disordered attachment.17
Attachment disorders, which lead to the most problematic outcomes for children, include those in which children have disrupted attachments to their caregivers, display overly vigilant or overly compliant behaviors, show indiscriminate connection to every adult, or do not demonstrate attachment behaviors to any adult. Children with insecure, “disordered” or “disorganized” attachments may also have many other adverse outcomes that persist throughout childhood, such as poor peer relationships, behavioral problems, or other mental health difficulties.18
Maltreated children are often exposed to inconsistent and inadequate parenting and, as a result, may experience difficulty in forming healthy attachments. Some studies suggest that upwards of three-quarters of maltreated children have disordered attachments, but that the proportion may diminish with age.19 The limited empirical work on attachment in foster children suggests that they are more likely than non-foster children to have insecure and disorganized attachments. However, the psychological and environmental characteristics of their foster families can influence the type of attachments they have to their caregivers. In addition, research on the impact of institutionalization (that is, placement in orphanages or large-group foster care settings) on children suggests that children with multiple caregivers are more likely to display insecure attachments and indiscriminate friendliness.20
Brain development
With the advent of less-invasive and less-expensive techniques for
examining brain structure and function, contemporary developmental
researchers have begun to investigate developmental processes at the
level of the brain. A major conclusion derived from this research is
that although children's experiences during the first three years of
life are critical to brain development, the brain remains plastic even
after infancy.
Although the existing research suggests diverse outcomes, scholars have documented that young children exposed to trauma (for example, maltreatment and other forms of violence) are more likely than children who have not been exposed to trauma to experience physiologic changes at the neurotransmitter and hormonal levels (and perhaps even at the level of brain structure) that render them susceptible to heightened arousal and an incapacity to adapt emotions to an appropriate level.21 This emotional state increases their sensitivity to subsequent experiences of trauma and impairs their capacity to focus, remember, learn, and engage in self-control.22
In addition, the research on institutionalized children indicates that institutionalization and other adverse early experiences (for example, having multiple caregivers and being held and stimulated less) may affect brain structure and activity.23 Findings from these studies suggest that the timing and duration of institutionalization are important. Better outcomes were noted in children who were adopted from institutions prior to their second birthdays.24
One study directly assessed the brain functioning of children in foster care using the popular method of examining levels of cortisol, the hormone produced in response to stress in humans.25,26 Children who are exposed to high levels of stress show unusual patterns of cortisol production.27 Foster children exhibited unusually decreased or elevated levels of cortisol compared to children reared by their biological parents.28 Such findings are consistent with the literature, which points to the importance of the parent-child relationship in buffering the stress responses of children.
Resilience
The work on resilience is particularly relevant for foster children
because it examines the factors that allow some children faced with
severe adversities to “overcome the odds” and become successful at a
variety of developmental and life-adjustment tasks.29 Several
characteristics of children and their environments may compensate for
the high-risk situations with which they must contend, leading to more
positive outcomes. These protective factors include child IQ,
temperament, and health, as well as a warm parental relationship,
engagement with school, and support outside the family (such as a
mentor). Although the research on resilience in foster children
specifically is sorely lacking, studies of maltreated children suggest
that maltreated children who exhibit resilience have high cognitive
competence, self-esteem, and ego control (including flexibility,
planfulness, persistence, and reflection).30 Thus, foster
children, who have an increased likelihood of experiencing multiple risk
factors such as poverty, maltreatment, and separation from family of
origin, may have more positive outcomes if they are fortunate enough to
also experience protective factors.
In summary, children in stable family environments are likely to experience positive, engaged parenting and to have positive developmental outcomes. By contrast, children in foster care have often experienced family instability and other types of maltreatment that compromise their healthy development. However, providing safe, stable, and nurturing homes for these children may lessen the harmful effects of their experiences by exposing them to protective factors that can promote resilience.
Developmental outcomes of children in foster
care
Overall, the existing research suggests that children in foster care
have more compromised developmental outcomes than children who do not
experience placement in foster care.31 However, there is
considerable variability in the functioning of foster children, and it
is difficult to disentangle the multiple preplacement influences on
foster children from those that result from the foster care experience
itself. Children in foster care are biologically vulnerable to many poor
developmental outcomes, due to genetic factors, prenatal substance
exposure, and other physical health issues. Many of these children
experienced trauma prior to foster care entry, which has been documented
to have a major impact on children's outcomes across developmental
domains.
Additionally, many scholars argue that the risk factor leading to negative outcomes is not foster care per se but the maltreatment that children experience beforehand. For example, in the NSCAW study, foster children with experiences of severe maltreatment exhibited more compromised outcomes.32 Other scholars suggest that foster care may even be a protective factor against the negative consequences of maltreatment.33 Similarly, it has been suggested that foster care results in more positive outcomes for children than does reunification with biological families.34 Further, some studies suggest that the psychosocial vulnerability of the child and family is more predictive of outcome than any other factor.35 Despite these caveats, the evidence suggests that foster care placement and the foster care experience more generally are associated with poorer developmental outcomes for children.
The foster care experience and developmental
outcomes
Many studies have pointed to the deleterious impact of foster care on
children's physical health, cognitive and academic functioning, and
social-emotional wellbeing. In the area of physical health, pediatric
and public health scholars have documented that foster children have a
higher level of morbidity throughout childhood than do children not
involved in the foster care system. First, foster children are more
likely to have perinatal experiences that compromise their physical
health and overall development. For example, there has been a dramatic
increase in the number of children entering foster care due to prenatal
substance exposure.36 The negative effects of substance
exposure on the fetus and developing child have been extensively
documented, although scholars emphasize the variability in outcomes as
well as the contribution of multiple ecological factors to outcome.37
Foster children are also more likely to have growth abnormalities and untreated health problems.38 Despite the trend in these data, some scholars have suggested that the negative health outcomes attributed to foster children are not distinct from those found among children living with their impoverished biological families. Although scholars have highlighted the fragmented system of health care for foster children, they also acknowledge an increased sensitivity to foster children's medical issues on the part of health care providers.39
In the area of cognitive and academic functioning, NSCAW documented that the majority of foster children scored in the normal range on cognitive and academic measures, although a higher proportion than would be expected in the general population were found to have delayed cognitive development and compromised academic functioning. For example, findings from NSCAW indicate that more than one-third of infants and toddlers in the One-Year Foster Care Sample and one-half in the Child Protection Sample scored in the delayed range on a developmental screener. In both samples, 7% of school-age children scored in the clinical range on a cognitive test, and 13% scored in the delayed range on a language test.40 These data corroborate findings from smaller studies that point to developmental and cognitive delays in this population of children.41 However, foster children scored in the same ranges as similarly high-risk children who were not in out-of-home placement (for example, children in poverty).
Regarding academic achievement, some studies have found that foster children perform more poorly on academic achievement tests, have poorer grades, and have higher rates of grade retention and special education placement.42 The poorer academic functioning of foster children may not be attributable to their foster care experiences per se but to their pre–foster care experiences such as poverty and maltreatment. Additionally, lower school attendance of foster children due to placement instability may be a contributor to their poor school functioning.
On social-emotional measures, foster children in the NSCAW study tended to have more compromised functioning than would be expected from a high-risk sample.43 Moreover, as indicated in the previous section, research suggests that foster children are more likely than nonfoster care children to have insecure or disordered attachments, and the adverse long-term outcomes associated with such attachments.44 Many studies of foster children postulate that a majority have mental health difficulties.45 They have higher rates of depression, poorer social skills, lower adaptive functioning, and more externalizing behavioral problems, such as aggression and impulsivity.46Additionally, research has documented high levels of mental health service utilization among foster children47 due to both greater mental health needs and greater access to services. Some scholars suggest that the poor mental health outcomes found in foster children are due to a variety of factors beyond their foster care experiences. These children may be biologically predisposed to mental illness and may have experienced traumas that have set them on a path of mental health difficulty.48
Placement characteristics and developmental
outcomes
The type of placement and the stability of that placement influence
child outcomes. Research has shown that the majority of foster children
are placed in foster families. A rapidly growing trend is the kinship
placement of children. For example, in the NSCAW study, 58% of children
who had been in foster care for one year were placed in nonrelative
foster care, and 32% were placed in kinship care. The existing research
on the effects of kinship care on child developmental outcomes are
mixed. Some studies have documented that children in kinship care tend
to have higher functioning than those in unrelated foster homes, but
this may be a function of their being better off prior to placement with
kinship care providers.49Another study, however, found that
adults who had longer durations of kinship care as children had poorer
outcomes than those who were in unrelated foster care.50
A much smaller proportion of children in the NSCAW study (9%) were placed in group homes or residential care. Such placements are more often used for adolescents and children with serious mental or physical health difficulties.51 Overall, the evidence suggests that group home placement is deleterious to children.52 Children in group care in the NSCAW study had poorer developmental outcomes than their counterparts in family environments, but they also had more intense needs at placement entry.53 In a study comparing young children reared in foster family homes to those in group homes, children in group care exhibited more compromised mental development and adaptive skills but similar levels of behavioral problems.54
The research also suggests that placement instability is associated with negative developmental outcomes for foster children. Changes in placement or disruption rates are related to the length of the child's foster care stay,55 the age of the foster child, and the functioning of the foster child (for example, mental health).56 The quality of the parent-child relationship and the caseworker- foster parent relationship also influences placement stability. Most foster children experience only one to two placements. However, report data indicate that one-third to two-thirds of foster care placements are disrupted within the first two years.57
The type of placement also contributes to placement stability.58 Children in kinship care tend to experience more stability (that is, fewer placement disruptions),59 although high disruption rates are found in kinship situations with vulnerable children and/or families.60 Placement stability for children in group care varies depending on child age and needs. For example, adolescents in group care typically have more stable placements than younger children. In contrast, very young children in group care experience a higher number of moves due to attempts to secure less-restrictive placements for them.61
It is difficult to disentangle whether placement stability predicts developmental outcomes or if children with developmental difficulties are more likely to experience multiple placements. For example, one study suggests that children's developmental delays may lead to multiple placements and also may be a consequence of multiple placements.62 Further, most studies examining the effects of placement instability are not methodologically rigorous. Nevertheless, many studies suggest that placement instability leads to negative outcomes for children. Children in the NSCAW study with multiple placements had more compromised outcomes across domains than children who experienced greater placement stability.63 In another study of a large group of foster children, the number of placements children experienced predicted behavioral problems 17 months after placement entry.64 Other studies have reported that placement instability is linked to child behavioral and emotional problems, such as aggression, coping difficulties, poor home adjustment, and low self-concept.65 Relatedly, children's perceptions of the impermanency of their placements have also been linked to behavioral difficulties.66
A developmental-ecological approach
This brief review of the developmental literature suggests that the
development of children in foster care can be enhanced with more stable
environments in which to grow. “Ecological theory,” as advanced by
renowned developmental psychologist Urie Bronfenbrenner, emphasizes the
multiple, interdependent “ecologies,” or environmental systems, in which
children develop.67 In this theory, which has been tested and
confirmed by numerous studies, the most important ecologies for children
are the “microsystems–” those ecologies that contain the direct
relationships children have with caring adults. To ensure that children
in foster care experience greater stability and optimal developmental
outcomes, it is incumbent upon the child welfare system to provide them
with supportive microsystems. In other words, it is essential that the
child welfare system provide foster children with protective and
nurturing caregiving from substitute families when their biological
parents cannot provide the safety and stability they need.
Creating healthy family environments for
children in care
The research presented above argues compellingly for continuity,
constancy, and nurturance in the caregiving environments of children in
foster care. Children reared in a high-quality caregiving ecology are
set on a positive developmental path that has the potential to produce
long-term positive outcomes.68 Already vulnerable from the
experiences of maltreatment and other environmental risk factors (for
example, poverty and its associated stressors), the development of
foster children is further compromised if they experience more trauma
and instability while in care. Thus, substitute families best meet their
needs if they are able to nurture and commit to these children over the
long term. Unfortunately, research on foster care suggests that a
significant proportion of foster families have parenting difficulties,69
which may hinder their capacity to provide stable experiences for foster
children. Although the experience is not commonplace, foster children
are also maltreated by their foster parents.70 The
association between problematic parenting behaviors and the
social-emotional maladjustment of foster children has been documented in
several studies.71
An understanding of general child development and the child's individual developmental needs is crucial to understanding the type of caregiving foster children need. For example, the recognition that children in foster care often have achievement difficulties could promote the provision of more stimulating home environments. Some studies have examined the quality of the home environments of foster families, particularly their provision of stimulation and emotional responsiveness. One study found considerable variability in the quality of the home environments; higher-quality environments were found with families who had increased economic resources.72Another study also found variability in the home environments foster children experience and reported that unrelated foster parents had higher-quality home environments than kinship foster parents.73In this same vein, foster children need caregivers who can work with child welfare agencies to ensure that children's individual needs are met by the child welfare system and other social institutions charged with meeting these needs. Research has shown that foster parents who view themselves as part of an agency team with a goal of meeting the needs of children have more successful placements.74
Foster families also need to empathize with children's needs and experiences, such as early exposure to trauma and other risk factors. Empathy with maltreated children can play a major role in their social-emotional outcomes.75 Foster parents must acknowledge and respect the multiple family ties foster children have. Children often feel connected to former foster parents and biological parents, which may bear on their ability to connect to current caregivers. Kinship foster parents have been documented to be more accepting of these other attachment relationships and, as a result, report better relationships than nonrelated foster parents with the children in their care.76 Finally, an awareness and acceptance of one's racial or ethnic heritage is essential for developing a healthy sense of identity. Foster families must be sensitive to the need for children of different racial and ethnic backgrounds in their care to explore and celebrate their cultural heritage and traditions.
Creating developmentally-sensitive child
welfare agencies
Although ecological theory places primacy on the child's relationship
with the caregiver, the larger ecologies that children indirectly
experience contribute significantly to their outcomes. For foster
children, the child welfare system is probably the ecology beyond the
family with the greatest impact on their outcomes. The literature
presented in this article presents a compelling argument for a twofold
strategy to promote positive developmental outcomes in foster children:
policy and practice to promote family stability; and policy and practice
to specifically meet the developmental needs of children.
Despite the intuitive sensibility of such a twofold strategy, incorporating it into the child welfare service sector has many inherent challenges. First, the child welfare system has historically been concerned with shaping the experiences of children, not their functioning. Thus, the system focuses on outcomes relevant to safety and permanency, not to developmental outcomes. Services are established accordingly and are generally not designed to specifically promote the wellbeing of children. For example, the notion of prevention in child welfare refers to averting child placement within the foster care system, whereas prevention from a developmental perspective may have a goal of optimizing child functioning. These conceptual and service tensions reflect the vastly different perspectives of the child development and child welfare fields. An integration of the tenets of both fields is necessary to ensure that the needs of foster children are adequately addressed.
Child welfare policies
Shortening the time children spend in foster care by encouraging
permanent placement has been the primary thrust of policies designed to
ensure family stability for children in foster care. The Adoption and
Safe Families Act (ASFA) and the Adoptions Assistance and Child Welfare
Act (AACWA) have resulted in lower rates of foster care entry and
shorter stays in foster care (see the article by Allen and Bissell in
this journal issue for a more detailed discussion of these policies).
Practices such as expedited permanency hearings and concurrent planning
(that is, simultaneously working toward a child's return home and
placement in another permanent home) have also increased the numbers of
foster children who experience permanency. Permanency has also been
achieved by increasing the numbers of children who are placed in
adoptive homes, a trend that began in the years following AACWA and
continued with the passage of ASFA. Specialized recruitment efforts,
more frequent termination of parental rights, and incentives for
adoptive parents have served to increase the number of adoptive homes
for children. (See the article by Testa in this journal issue.)
Although the aforementioned legislation and policy emphasize the goal of family reunification as much as that of adoption, the number of children who are returned to their biological parents has not risen appreciably.77 Policy advocates assert that the lack of funding for intensive reunification efforts has been a major hindrance to this work. Others suggest that the permanency time limits imposed by ASFA are unrealistic when applied to families whose children are in the foster care system, given their chronic and complex needs. (See the articles by Stukes Chipungu and Bent-Goodley, and by Wulczyn in this journal issue.)
An increasing number of children are being returned to their extended family systems, either in guardianship or foster care status. Some jurisdictions are even making headway convincing relatives to adopt these children. (See the article by Testa in this journal issue.) The literature on these placements suggests that although kinship families are much more vulnerable than unrelated foster families, children living with relatives are more likely to remain in the same placement and to have longer durations in foster care.78 Given the large numbers of kinship placements occurring across the United States, it would behoove the child welfare system to provide supportive services to these vulnerable kinship families to enable them to provide quality care to the children in their care (see the article by Geen in this journal issue). All these policies should be implemented in the context of their impact on foster children's short- and long-term development.
Child welfare practices
As a result of ASFA, child well-being is now a performance measure by
which state and local child welfare systems will be assessed. However,
there is a lack of consensus and clarity on what outcomes demonstrate
achievement of the goal of promoting child well-being, to what extent
the child welfare system should be responsible for this goal, and what
strategies should be utilized to measure child well-being.79
Given the multiple needs of foster children, it is imperative that the
child welfare system move beyond a singular focus on safety and
permanency and that it promote the wellbeing of children in custodial
care.
Scholars who have documented the increased rates of health problems, developmental delays, and mental health difficulties in foster children call for universal, ongoing screening and assessment for the “whole” child.80 In other words, foster children should be assessed for physical, developmental, and mental health problems at foster care entry and then periodically while they are in care. Obviously, a follow-up goal of these assessments should be appropriate intervention for whatever health or developmental needs the children are found to have.81Some scholars assert that early intervention and school support for foster children should be routinely offered as a preventive measure.82
Given the high rates of mental health difficulties in foster children, appropriate mental health intervention is essential. Preventive approaches designed to promote social skills, self-regulation, and coping in high-risk children have been found to result in positive outcomes.83 Similarly, interventions to help foster parents support the emotional needs of their foster children have met with success.84 More targeted intervention services, such as group therapy for foster children with behavioral problems,85also have been found to be effective.
Research has documented that foster children are also major consumers of traditional mental health services (for example, individual play therapy and family therapy), much of which is paid for by child welfare dollars as opposed to mental health dollars.86 However, more evidence is needed regarding the quality of these services. For example, the mental health provider's experience with foster children may increase effectiveness. Additionally, the therapist's willingness and ability to address issues unique to foster children (for example, managing the loss and relationship complexity associated with multiple caregivers) are important factors.
Foster children also need support in negotiating the multiple transitions and family ties that they will experience in foster care. Systemic supports can be established to help children manage these issues. These supports include therapeutic visitation experiences with biological parents, siblings, and other family members; building connections between former and current caregivers; and providing children with “Lifebooks” and other concrete transitional items.87,88
Finally, the child welfare system has an obligation to ensure continuity between the various supports that foster children receive. This can be done through a coordinated system of care that is sufficiently flexible to address the individual needs of the child; is comprehensive so that the needs of the “whole” child can be met; places a priority on responding immediately to the vulnerable families of foster children; and ultimately avoids duplication of effort and funds. With the child welfare system at the helm, this type of service network will not only enhance the well-being of foster children and families but will enhance public service delivery in this arena as well.
Conclusion
Children in foster care traverse a challenging journey through
childhood, with many obstacles to their optimal development. Many have
experienced compromised prenatal environments, maltreatment prior to
foster care, or multiple moves while in foster care. The impact of these
experiences on their development can be devastating over the short and
long term. However, as with other children at environmental risk, a
stable, nurturing family environment can protect foster children against
the negative effects of these experiences.
The child welfare system, and its policymakers and practitioners, must ensure safe and stable family environments for children in foster care. Ensuring that each foster child receives a permanent home is a major step toward this goal, but it is not sufficient. The implementation of high-quality programs that document effectiveness in promoting positive family experiences for foster children is essential. In order to create “harm-free, effective environments” for foster children, child welfare systems must provide support and training to foster parents, establish a well-specified model of care to promote child well-being, focus on the positive behaviors of caregivers and children, and create consumer-oriented services that respond specifically to child and family needs.89
Although the field continues to debate the relative
merits of foster care for children, the fact remains that upwards of
half a million American children experience this social service at any
given time. As adults who are responsible for the protection and nurture
of the young of our species, we have an obligation to ensure that this
very vulnerable group of children has the needed opportunities for
developmental progress. This should be achieved through appropriate
child-centered interventions, as well as through support for the
families who care for foster children, whether they are biological
parents or relatives, or foster or adoptive caregivers. To paraphrase
the eloquent words of Bronfenbrenner, children's development is
dependent upon reciprocal activity with others with whom they have a
strong and enduring bond, and who are engaged in their developmental
progress.90 The system of child welfare can be engaged in no
better developmental enterprise than enhancing its support of these
strong, enduring relationships with the ultimate goal of optimizing the
development of both children and families in the foster care system.
Endnotes
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Cicchetti, D., and Toth, S., (Eds). (1997). Developmental perspectives on trauma: Theory, research, and intervention. Rochester, NY: University of Rochester Press.
Tolnay, S. and Crowder, K. (1999). Regional origin and family stability in northern cities: The role of context. American Sociological Review, 64(1). pp. 97–112.
Wulczyn, F., Hislop, K., and Jones Harden, B. (2002). The placement of infants in foster care. Infant Mental Health Journal, 23(5). pp.454–75.
Dickstein, S., Seifer, R., Hayden, L., et al. (1998). Levels of family assessment. II. Impact of maternal psychopathology on family functioning. Journal of Family Psychology, 12(1). pp.23–40; Ackerman, B., Kogos, J., Youngstrom, E., et al. (1999). Family instability and the problem behaviors of children from economically disadvantaged families. Developmental Psychology, 35(1). pp.258–68; and Azar, S. (2002). Parenting and child maltreatment. In M. Bornstein, (Ed). Handbook of parenting. Vol. 4, Social conditions and applied parenting. 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates. pp. 361–88.
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The caregiver fails to adequately provide for or supervise the child.
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Dozier, M., Levine, S., Stovall, K., and Eldreth, D. (2001). Atypical diurnal rhythms of cortisol production: Understanding foster children's neuroendocrine regulation. Unpublished manuscript.
Atypical cortisol production in young children can result in measurable changes in brain structure and decreased brain volume. See Teicher, M. (2000). Wounds that time won't heal: The neurobiology of child abuse. Cerebrum, 2(4). pp. 50–67.
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See note 1, Jones Harden and Koblinsky; Frank, D., Augustyn, M., Grant-Knight, W., et al. (2001). Growth, development, and behavior in early childhood following prenatal cocaine exposure: A systematic review. Journal of the American Medical Association, 285. pp. 1613–25; and Zuckerman, B., Frank, D., and Mayes, L. (2002). Cocaine-exposed infants and developmental outcomes: “Crack” kids revisited. Journal of the American Medical Association, 287(15). pp. 1990–91.
Halfon, N., Mendonca, A., and Berkowitz, G. (1995). Health status of children in foster care. Archives of Pediatric and Adolescent Medicine, 149. pp. 386–92.
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Leslie, L., Gordon, J., Ganger, W., and Gist, K. (2002). Developmental delay in young children in child welfare by initial placement type. Infant Mental Health Journal, 23(5). pp. 496–516.
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See note 10, DHHS; and Clausen, J.M., Landsverk, J., Ganger, W., et al. (1998). Mental health problems of children in foster care. Journal of Child and Family Studies, 7. pp. 283–96.
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See note 34, Taussig, et al.
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Berrick, J., Courtney, M., and Barth, R. (1993). Specialized foster care and group home care: Similarities and differences in the characteristics of children in care. Children and Youth Services Review, 15. pp. 453–74.
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Smith, D., Stormshak, E., Chamberlain, P., and Bridges, R. (2001). Placement disruption in treatment foster care. Journal of Emotional and Behavioral Disorders, 9(3). pp. 200–05; and Redding, R., Fried, C., and Bitner, P. (2000). Predictors of placement outcomes in treatment foster care: Implications for foster parent selection and service delivery. Journal of Child and Family Studies, 9(4). pp. 425–47.
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Horwitz, S., Simms, M., and Farrington, R. (1994). Impact of developmental problems on young children's exits from foster care. Developmental and Behavioral Pediatrics, 15. pp.105–10.
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See note 56, Smith, et al.; and note 55, Staff and Fein.
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See note 77, Wulczyn, et al.; and note 49, Wilson and Stukes Chipungu.
Altshuler, S., and Gleeson, J. (1999). Completing the evaluation triangle for the next century: Measuring child “well-being” in family foster care. Child Welfare, 78(1). pp.125–47.
Dale, G. (1999). Universal developmental screening. In P. Curtis, G. Dale, and J. Kendall, (Eds). The foster care crisis: Translating research into practice and policy. Lincoln, NE: University of Nebraska Press; and see note 39, Horwitz, et al.
Specialized health monitoring and intervention programs such as the Health Passport have been found to be effective for foster children. See Lindsay, S., Chadwick, J., Landsverk, J. and Pierce, E. (1993). A computerized health and education passport for children in out-of-home care: The San Diego model. Child Welfare, 72(6). pp. 581–94.
See note 41, Leslie, et al.; and Ayasse, R. (1995). Addressing the needs of foster care: The foster youth services program. Social Work in Education, 17(4). pp.207–16.
Webster-Stratton, C., and Herbert, M. (1994). Troubled families–problem children. New York: Wiley & Sons.
Chamberlain, P., Fisher, P., and Moore, K. (2002). Multidimensional treatment foster care: Applications of the OSLC intervention model to high-risk youth and their families. In J. Reid and G. Patterson, (Eds). Antisocial behavior in children and adolescents: A developmental analysis and model for intervention. Washington, DC: American Psychological Association, pp. 203–18.
Fisher, P., Gunnar, M., Chamberlain, P., and Reid, J. (2000). Preventive intervention for maltreated preschool children: Impact on children's behavior, neuroendocrine activity, and foster parent functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 39. pp. 1356–64.
Landsverk, J. Caring for children in child welfare. (2003). Paper presented at the biennial meeting of the Society for Research in Child Development. Tampa, FL. April 24–27, 2003; Leslie, L., Landsverk, J., Ezzet-Lofstrom, R., et al. (2000). Children in foster care: Factors influencing outpatient mental health service use. Child Abuse and Neglect, 24. pp. 465–76.
A “Lifebook” is a developmentally appropriate record and collection of mementos that document a child's life events and various caregivers and homes. Concrete transitional items would include favorite toys obtained from former placements.
Jones Harden, B. (2000). How do I help children adjust to out-of-homecare placement? In H. Dubowitz and D. DePanfilis, (Eds). Handbook for child protection practice. Thousand Oaks, CA: Sage Publications, pp. 420–24.
Daly, D., and Dowd, T. (1992). Characteristics of effective, harm-free environments for children in out-of-home care. Child Welfare, 71(6). pp. 487–96.
See note 67, Bronfenbrenner.
This feature: Harden, B.J. (2004). Safety and stability for foster children: A developmental perspective. Children, Families and Foster Care, 14, 1. Winter. From The Future of Children, a Collaboration of The Woodrow Wilson School of Public and International Affairs at Princeton University and The Brookings Institution.
