RELATIONSHIP BETWEEN REASON FOR PLACEMENT AND MEDICAL FINDINGS AMONG CHILDREN IN FOSTER-CARE

Objective. To determine the reasons for placement of children in foste r care, the prevalence of medical findings during initial placement, a nd the relationship between reason for placement and medical findings. The association between placement reasons and parental substance abus e also was explored. Methods. Population-based analysis of medical rec ords of 749 children examined at the Child Protection Center in San Fr ancisco from October 1, 1991, to December 31, 1992, Health evaluations consisted of a clearance examination of children during entry into fo ster care and a comprehensive examination 3 weeks later. Reasons for f oster placement included abandonment, neglect, no available caretaker, physical abuse, sexual abuse, and failed placement. Results. Nearly 5 0% of children in our study were <6 years of age. Neglect (30%), physi cal abuse (25%), and no available caretaker (24%) were the most freque nt placement reasons, followed by abandonment (9%), failed placement ( 7%), and sexual abuse (5%). Substance abuse was documented in 30% of p arents, 51% when the placement reason was neglect. Medical findings we re identified in 60% of children. Among 0 to 6-year-olds, 27% had uppe r respiratory illnesses, 23% had developmental delay, and 21% had skin conditions; for children 7 to 12 years of age, 32% failed vision scre ening, 12% had dental caries, and 11% had upper respiratory illnesses; and among 13- to 18-year-olds, 31% failed vision screening and 12% ha d positive tuberculin skin tests. For younger children, skin condition s were associated with neglect, no available care taker, and failed pl acement, and developmental delay with neglect and abandonment. For ado lescents, history of psychiatric illness was associated with neglect a nd failed placement. Marks of abuse for all age groups were limited to children who had been physically abused. Three or more diagnoses were identified for similar to 20% of children who had been neglected or a bandoned or had failed placement, compared with 10% of children who ha d been either physically or sexually abused. Conclusions. Specific med ical findings associated with reasons for placement provide health pro fessionals with additional information to assess more accurately the h ealth care needs of children entering foster care. As important, scree ning tests revealed high rates of vision problems and exposures to tub erculosis, warranting earlier and more comprehensive screening. Finall y, children who have endured variations of neglect or failed placement may have more health problems than anticipated previously.