This clinical report and its accompanying policy statement review the developmental challenges of young children in foster care under the age of 5years, including recent research on prenatal and postnatal environmental influences on early brain development, and the effects of severe or chronic stress on child development secondary to neglect, physical and sexual abuse. This report also highlights the impact of family disruption and child-parent attachment that occurs with foster care placement, the effects of structural and interpersonal racism, multigenerational poverty, and the more pervasive societal effects that are especially common among children in foster care. The report ends with a brief review of how interventions support resilience in the face of these challenges to child development.

This policy statement updates a previous statement to reflect advances in our understanding of both prenatal and postnatal environmental influences on early brain development, including the effects of alcohol and substance exposures prior to birth and the effects of severe or chronic stress on child development secondary to neglect, physical and sexual abuse, family disruption, poverty, and racism. The accompanying clinical report provides a detailed examination of the developmental challenges faced by children in foster care younger than 5years.

Art therapists’ perceptions of the characteristics, impact, and applications of art therapy with children in foster care

The decline of congregate care in the United States foster care system, 2004-2022.

Since colonisation in Australia, dominant western narratives have continually undermined the identity of Aboriginal and Torres Strait Islander peoples. Through a lens of subaltern theory, this article explores how Aboriginal children, their families, and their communities are spoken for and about as members of subaltern communities by non-Indigenous foster carers. The findings reveal how the narratives of foster carers can continue to perpetuate colonial harms, undermining the cultural identity, connectedness, and wellbeing of Aboriginal children living away from their kin, families, and communities in out-of-home care. To stem this erosion of culture, and the continued silencing of Aboriginal voices, a true commitment to safeguarding children’s cultural connectedness and placing children in accordance with the Aboriginal and Torres Strait Islander Child Placement Principles must be prioritised.

Adverse childhood experiences (ACEs) are traumatic or adverse events in early life that can have lasting effects on behavioral, emotional, and psychological functioning. Prior research suggests ACEs relate to later psychiatric outcomes through threshold, cumulative, and individual-specific risk patterns. Few studies, however, have operationalized all three models to test ACE-specific associations with diagnosed psychiatric disorders in individuals who are adopted or with foster care histories. We conducted a cross-sectional retrospective study using electronic health record data from foster care and adopted patients aged 0-21 years old seen at the University of Minnesota Adoption Medicine Clinic (UMN-AMC) between 2014-2024. Extracted measures included ACE history, demographics, and psychiatric diagnoses. We used latent class analysis and logistic regression to identify clusters of adversity and estimate associations with psychiatric diagnosis domains, adjusting for Sex and Age at Initial Visit. ACEs showed a threshold pattern across psychiatric domains, with higher ACE counts associated with greater odds of psychiatric diagnoses. Individual risk modeling indicated that exposure to abuse or violence was associated with higher odds of psychiatric diagnoses. Across cumulative and individual risk approaches, Anxiety Disorders, Mood Disorders, and Behavioral or Emotional Disorders showed the greatest sensitivity to adversity. Current ACE models may not fully capture neurodevelopmental impacts reflected in diagnosed psychiatric disorders among adolescents, particularly in high-risk groups such as foster and adopted individuals. In a large clinic sample our findings support a nuanced association between ACEs and later psychiatric diagnoses and highlight the need for ACE-focused assessment, prevention, and treatment strategies tailored to foster care and adopted populations.

Screening, brief Intervention, and referral to treatment: Persistence of effects in adolescents at risk.

Children who spend time in foster care are at risk for adverse developmental outcomes, including sleep problems. Yet, research examining sleep and emotional memory has primarily focused on children with no history of foster care placement. Additionally, most accounts of sleep problems among children with a foster care history rely on caregiver-report rather than objective measures. This study examined emotional memory and sleep using both objective and subjective reports. Participants included 3- to 5-year-old children who were adopted from foster care in the U.S. (n = 32) and a community sample of children with no foster care history (n = 35). Sleep was assessed using actigraphy and questionnaires (Children's Sleep Habits Questionnaire [CSHQ] and the Parent-Child Sleep Interactions Scale [PSIS]). Caregivers also completed the Adverse Childhood Experiences questionnaire (ACEs). Emotional memory was assessed with an emotional story task in the evening before overnight sleep and the following morning. As predicted, the adopted sample had worse objectively measured sleep quality, with higher wake after sleep onset, lower sleep efficiency, and earlier waketimes. Additionally, adopted children scored higher on the CSHQ Parasomnias subscale which was associated with a greater number of ACEs. Adoptive parents also reported providing more frequent reassurance at bedtime and reinforcement of positive sleep behaviors, as measured by the PSIS, compared to the community sample. Performance on the emotional story task did not differ significantly between the groups. These results reinforce that children with a history of foster care placement have worse sleep and are more prone to parasomnias even after adoption. Trauma-informed sleep interventions may be most effective in resolving sleep problems in these children.

A family navigator model for foster parents to promote youth mental health wellness: Study development and protocol

Repeated admissions of children and adolescents after inpatient psychiatric treatment point to underrecognized issues in the post-discharge period. The family environment is a promising target for sustained recovery. However, recent systematic reviews on predictors of psychiatric readmission in children and adolescents were unable to synthesize most family-level factors due to conceptual and methodological differences. To address this, we conducted a scoping review following PRISMA-ScR guidelines to (a) synthesize literature on family-related structural and process variables associated with youth psychiatric readmission and (b) identify conceptual and methodological gaps. We included primary and secondary studies in English or German language examining family-related constructs in relation to inpatient readmission. Eighty-three reports retrieved via a multi-tiered search strategy (including PubMed, PsycInfo, Scopus, Web of Science, ProQuest Dissertations & Theses Global, and Google Scholar) were included (79 empirical studies, three study protocols, and one meta-analytic review). Empirical studies have increased in recent years, were primarily conducted in the United States, and largely relied on retrospective or record-based data. Evidence was concentrated on structural characteristics. Among the examined constructs, results linked readmission to indicators of structurally burdened or disrupted caregiving environments (e.g., institutional or foster care), family psychiatric problems (e.g., history of or current psychopathology), and treatment involvement. In contrast, research on specific family processes remains sparse despite their established significance in adult populations. Findings support the relevance of various family factors for youth psychiatric readmission but highlight gaps regarding complex associations, short-term risks, and prospective studies of family processes.

Many children who experience child maltreatment fatalities (CMF) or near fatalities (CMNF) are previously known to the child welfare system (CWS). Although in-home services and foster care (FC) are tools for preventing CMF/CMNF, relatively little research has examined how each is associated with subsequent CMF/CMNF. Using a nested case-control design and linked administrative data from Pennsylvania, this study examined how in-home services and FC following an initial CWS case were associated with the odds of future CMF and CMNFs (n = 171 cases and 777 controls). Relative to receiving no services, in-home services were not associated with reduced odds of CMF/CMNF (OR = 1.27, p = 0.201), whereas FC was associated with lower odds (OR = 0.54, p = 0.061), though this association did not reach statistical significance at p < .05. Relative to in-home services, FC was significantly associated with 58% lower odds of CMF/CMNF (OR = 0.42, p = 0.010). Although replication with larger samples is needed, findings suggest that FC, but not in-home services, is associated with reductions in CMF/CMNFs in the years following CWS involvement.

Sleep plays a foundational role in early childhood development. Yet, children exposed to early adversity, such as those in foster care, are at elevated risk for sleep disturbances that may contribute to later emotional and behavioral difficulties. This longitudinal study investigated the association between early sleep disturbances and subsequent internalizing and externalizing symptoms in young children in foster care. A sample of 133 caregiver-child dyads participated in assessments at two time points: when children were approximately 25months and 48months old. Sleep was assessed through caregiver-reported measures across three days and two nights, and child mental health symptoms were measured using the Child Behavior Checklist (CBCL). Cross-lagged panel modeling revealed a significant association between early sleep disturbances and later mental health symptoms, both internalizing and externalizing. These findings underscore the potential lasting impact of early sleep disturbances on emotional development in children in foster care and highlight the need for early identification and intervention to promote healthy developmental outcomes among children facing early adversity.

Cumulative risks of foster care placement for U.S. children: Evidence from birth cohort and synthetic cohort approaches.

Sleep health of children and adolescents in foster and kinship care: A systematic review.

Sleep in children in foster care: A scoping review.

Improving foster care and juvenile justice services: A community-based participatory mixed-methods study in Iowa and Illinois.

Supporting a child with maltreatment associated psychiatric problems (MAPP): Exploration of parent and professional experiences using multi-perspectival Interpretative Phenomenological Analysis.

Validating a Predictive Risk Model for Child Abuse and Neglect With Adolescent Outcomes.

ABSTRACT The author’s long psychoanalytic journey has focused on community-oriented service, research, and innovation. Reflecting on a life shaped by transgenerational trauma and personal adversities, his early challenges inspired groundbreaking psychoanalytic applications, including Reflective Network Therapy (RNT), which merges classroom-based interventions with individualized psychoanalysis. His work on IQ rises among RNT treated traumatized or autistic children and the application of psychoanalysis in trauma recovery illustrates operationally measurable outcomes rarely achieved in the field. The author recounts his involvement in systemic change through litigation, promotion of resilience in children facing catastrophes, and advancing theories of PTSD and autism. Notably, he emphasizes the measurable role of psychoanalytic methods in reducing foster care transfers and the roles of quantity and frequency of sessions in improving cognitive and emotional development. Gilbert Kliman’s enduring passion for quantifiable outcomes, criteria for judging the existence of a psychoanalytic process, and the integration of psychoanalysis in both education and social justice are parts of the transformative potential of his work. His personal narrative serves as an inspiration for utilizing personal trauma to innovate and address societal challenges, advocating for psychoanalysts to expand their practice into community and systemic arenas. Despite physical challenges, at age 95 Kliman remains a beacon of resilience, research, and advocacy for operationalizable and quantitative research in psychoanalysis.

Rural/urban and racial disparities in receipt of family preservation services: An intersectional examination.