Foster Care

Foster children are among the most vulnerable persons in the welfare population. As a group, they are sicker than homeless children and children living in the poorest sections of inner cities. Of particular concern is the health of young foster children because conditions left untreated during the first three years of life can have an impact into adulthood and impede a child's ability to become self-sufficient later in life. Understanding the ability of state child welfare agencies to meet the needs of foster children is critical as policymakers consider restructuring federal welfare policies and responsibilities. Federal money is now used to help states with the cost of foster care. Legislation now being considered by Congress would give states even greater responsibility for foster children through block grants. GAO examined foster care programs in California, New York, and Pennsylvania. GAO also analyzed random samples of case files from Los Angeles, New York City, and Philadelphia. This report discusses (1) the health services needed and received by young children in foster care, (2) the relationship between the receipt of health services and foster care placements with relatives versus placements with nonrelatives, and (3) agencies efforts to ensure that these children are receiving needed health services.

GAO found that: (1) despite foster care agency regulations requiring comprehensive routine health care, an estimated 12 percent of young foster children receive no routine health care, 34 percent receive no immunizations, and 32 percent have some identified health needs that are not met; (2) an estimated 78 percent of young foster children are at high risk for human immunodeficiency virus (HIV) as a result of parental drug abuse, yet only about 9 percent of foster children are tested for HIV; (3) young foster children placed with relatives receive fewer health-related services than children placed with nonrelative foster parents, possibly since relative caregivers receive less monitoring and assistance from caseworkers; (4) the number of young children placed with relatives increased 379 percent between 1986 and 1991, which resulted in the lower likelihood of these children receiving services associated with kinship care; and (5) the Department of Health and Human Services has not designated any technical assistance to assist states with health-related programs for foster children and does not audit states' compliance with health-related safeguards for foster children.