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The Experience of the Center for the Vulnerable Child

Neal Halfon, MD, MPH; Ana Mendonca, MPH; Gale Berkowitz, DrPH

Arch Pediatr Adolesc Med. 1995;149(4):386-392.

Abstract
Objectives
To describe the health status and to illustrate the usefulness of an enhanced primary care model for children in foster care.

Design
Cross-sectional analysis of a clinical cohort via chart review.

Setting
Foster Care Program of the Center for the Vulnerable Child at the Children's Hospital, Oakland, Calif.

Subjects
Two hundred thirteen children in foster care assessed between August 1988 and June 1991.

Interventions
None.

Methods
A multidisciplinary assessment protocol was used to collect health and social histories and to conduct developmental, emotional, and behavioral assessments and medical examinations. Cross-tabulations were used to compare distributions of conditions and characteristics of the population, including the reasons for, timing of, and number of placements.

Results
The population was largely African-American (83.4%), with a mean age of approximately 3 years. At least 78% of children came from homes where drug use was a primary reason for placement. A history of maternal drug use was present in 94% of infants. The number of placements ranged from one to eight (mean, 2.0). Placement changes were common. Over 20% of children had growth abnormalities, 30% had neurologic abnormalities, and 16% had asthma. Fewer than 20% of children had no medical conditions, while 28.8% had three or more conditions. Over 80% of children had developmental, emotional, or behavioral problems. Emotional, relational, and behavioral problems were more common in children first placed after 2 years of age and in those with a greater number of placements (²=12.6, P<.05).

Conclusion
This comprehensive assessment of children in foster care revealed higher rates of chronic multiple medical and mental health problems than previously reported.

(Arch Pediatr Adolesc Med. 1995;149:386-392)

Author Affiliations
From the Center for the Vulnerable Child, Children's Hospital, Oakland, Calif (Drs Halfon and Berkowitz and Ms Mendonca); the Department of Community Health Services, School of Public Health, University of California, Los Angeles (Dr Halfon); and the Department of Pediatrics, School of Medicine, University of California, Los Angeles (Dr Halfon).

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