Children and Youth with Special Health Care Needs in Foster Care

Research BriefHealthDec 8 2020

In this brief, Child Trends examines the prevalence of children and youth with special health care needs (CYSHCN) in the foster care system. CYSHCN have—or are at increased risk for—chronic physical, developmental, or behavioral/emotional conditions.[i] This brief provides an overview of the literature on CYSHCN and their experiences in the foster care system, a detailed explanation of the methodology used for the current brief, an explanation of our findings, and a brief discussion of practice and policy implications.

Our findings suggest that children and youth’s reasons for entering foster care, their experiences while in care, and their reasons for leaving care vary depending on whether they have an SHCN. The findings presented below represent the national data; additional information on all 50 states and the District of Columbia (DC) is available in Appendix A.

For our analysis, we utilized the Adoption and Foster Care Analysis and Reporting System (AFCARS) Foster Care File, which provides data on the characteristics and foster care experiences of children and youth who have spent at least one day in foster care during a given fiscal year. Although AFCARS does not identify children who have a special health care need (SHCN), per se, it does indicate whether children have physical, developmental, or emotional/behavioral disabilities; we used this information as a proxy for SHCN.[1]

Key findings

  • Children and youth with special healthcare needs (CYSHCN) comprise at least 24 percent of the foster care population and may require unique services and resources during their time in foster care.
  • The proportion of children and youth in care identified as having a special health care need (SHCN) varies by state. Differences in states’ policies and practices related to assessing children in foster care for SHCN and tracking this information in administrative data systems likely result in substantial underidentification of SHCN among children in foster care in some states.
  • CYSHCN tend to enter foster care for different reasons than their peers without an SHCN. These include the following:
    • Caretaker inability to cope
    • Physical abuse
    • Child behavior problems
    • Abandonment or relinquishment
    • Child disability
    • Sexual abuse
    • Drug or alcohol abuse by the child
    • Parent death
  • CYSHCN in foster care are more likely to:
    • Have experienced an adoption disruption
    • Have more than one removal episode
    • Experience greater placement instability
    • Spend significantly more time in care
  • In addition, CYSHCN are less likely to achieve permanency (i.e., reunification with their family, adoption, guardianship, or living with a relative).



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