A Literary Perspective on Foster Care in the United States

Abstract

One thing I appreciate about psychiatry is the field’s consideration of a patient as a person with a life outside of the doctor’s office. Yet, as medical school drew to an end, I knew little about one particular patient population I anticipated serving as a future child psychiatrist: children in foster care. According to the US Children’s Bureau, the number of children in foster care served nationally decreased almost 19% (from 797,000 to 646,000 children) between 2005 and 2012, but now is on the rise again with 653,000 served in 2014.1 Approximately 50% of children who enter the foster care system are returned to their parents, but 20-30% of those children will reenter the system within one year.1 In most states, children age out of the system at age 18 with no support and no one to turn to in a crisis; between 11% and 36% of those who age out become homeless, and only 40% find employment.2 A recent study in Pediatrics showed that former foster children are 2.3 times more likely to report poor general health than economically secure young adults.3 This is congruent with chronic stress research, which shows that exposure to chronic stressors can lead to adverse health outcomes. Studies show that 80% of children in foster care have significant emotional and behavioral problems.4 Tragically, behavioral health service use drops by 60% within a month of discharge from foster care, and 90% of young adults with externalizing disorders who were formerly in foster care are arrested within 1 year of aging out.2 What is the US foster care system that produces these sobering outcomes? To begin to answer this question, I started from a historical perspective to learn how the system developed and how it currently functions.