The medical and psychosocial needs of children entering foster care

The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population, require significant amounts of medical sub-specialty care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.     

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

Child sexual abuse: who goes home?

The purpose of this study was to ascertain the factors which influence custody change in cases of children who have been sexually abused. Of 180 children admitted to La Rabida Children's Hospital and Research center with a suspicion of having been sexually abused, 138 met the state's criteria for proven sexual abuse, and 30% of those children had a sexually transmitted disease. One-third of the children with proven abuse were under 4 years of age. Of the children with proven abuse, ultimately 40% had a custody change. Only an initial outcry of abuse was associated with an increased probability of a change in custody. A change in custody was not found to be related to the patient's age, sex, the perpetrator's relation to the child or access to the home, the presence of sexually transmitted disease, whether the child was also physically abused, or whether the child had had developmental delay. These data suggest an absence of any discernible guidelines in the juvenile court's decision concerning custody change of a sexually abused child.     

Do chronic conditions increase young children's risk of being maltreated?

OBJECTIVE: To examine whether and to what extent specific chronic health conditions place young children at risk of maltreatment. METHODS: The study used a sample of Illinois children (born between January 1990 and March 1996) who were through age 3 continuously enrolled in Medicaid, a public health insurance program for low-income families. The study used "paid claims" data and ICD-9-CM health codes to identify children with one or more of three chronic conditions: chronic physical illness, developmental delay/mental retardation (dd/mr), and behavior/mental health conditions (b/mh). The analysis used Cox proportional hazard models to estimate the risk of substantiated child maltreatment that each of these health conditions confer on children under age 6. RESULTS: Among children under age 6, 24.1% had chronic physical health conditions, 6.1% had b/mh conditions, and 4.2% had dd/mr. Among the children, 11.7% were maltreated (abused or neglected). Children with b/mh conditions were 1.95 times more likely than children without such conditions to be victims of child abuse or neglect. Children with chronic physical health conditions were 1.1 time more likely to be maltreated (p相似文献