Children in Foster Care With Disabilities Face Significant Challenges

Research on children in foster care with disabilities found profound impacts, including lower likelihood of permanent placement and higher risk of death

ORLANDO, Fla.— Children with disabilities in foster care are extremely vulnerable, facing risks of maltreatment and removal from their homes and greater need for healthcare services. New research suggests that children with specific disabilities in foster care are less likely to find a permanent home and have a higher risk of mortality while in care compared to those without disabilities.

This research, “The Effect of Initial Disability on Permanency Outcomes of Children in Foster Care,” presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1, found that children in foster care with specific disabilities were far less likely to achieve a positive outcome like adoption, guardianship, or reunion with family. Furthermore, children in foster care with intellectual disability, physical disability, and emotional disturbance had a significantly higher risk of death compared to those without disabilities. 

“In undertaking this study, we expected to find differential outcomes for children with disabilities,” said senior author Jill D McLeigh, PhD. “We were, however, surprised by the degree to which risk levels for failing to achieve permanency were higher for children with disabilities – across several disability types – and for dying while in care for physical disability, emotional disturbance and other medical conditions.”

Researchers analyzed national data from the federal Adoption and Foster Care Reporting System from fiscal year 2005 to 2019 for about 3.24 million children, ages 16 and younger, with disabilities in foster care. Results showed surprising challenges for these children. Children with intellectual disability, visual/hearing impairment, or emotional disturbance were less likely to achieve a positive outcome, such as reunification with family, adoption or permanent custody with another individual, and were more likely to leave foster care by running away, through emancipation or by being transferred to other agencies. 

“Given that children in foster care have higher rates of disability, it is very important that the child welfare and healthcare systems work to address the needs of this highly vulnerable population and to provide support to their caregivers,” said presenting author Gunjan Singh, MD, FAAP.  

Study author Dr. Singh is scheduled to present the research, which is below, from 2:25- 2:35 p.m. Sunday, Sept. 29, 2024, at the Council on Foster Care, Adoption, and Kinship Care program at the Orange County Convention Center.

To request an interview with the authors, contact Children’s Dallas Public Relations at mediarelations@childrens.com, 214-456-5310, or the UT Southwestern Public Relations, remekca.owens@utsouthwestern.edu.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.  

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Abstract

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Council on Foster Care, Adoption, and Kinship Care

Abstract Title: The Effect of Initial Disability on Permanency Outcomes of Children in Foster Care

Children with disabilities in foster care (FC) are an exceptionally vulnerable group. In addition to significant physical, mental, and/or developmental health challenges, they also face risk factors related to maltreatment and removal from their homes and greater need for healthcare services. The few studies that have explored disability and FC status have shown that having a disability is a barrier to permanency and associated with other poor outcomes. These studies, however, have been limited by single-state or small samples, exclusive focus on older youth, and/or cross-sectional data.

To address this gap, this study merged data from the federal Adoption and Foster Care Reporting System (AFCARS) from fiscal year (FY) 2005 to 2019 to provide longitudinal data on children with disabilities, and by disability type, in foster care and comparison data for children without disabilities in FC. The state ID and record number were used to find 3.24 million unique participants aged 0 to 16 when they first entered FC and link records among different FY data. The participants who first entered FC were selected based on their first removal date and excluded if seen in previous FY data (Table 1). They were divided into disability groups pre-defined by the AFCARS Code Book. Participants' longitudinal outcomes were collected from the time when they first entered FC to FY 2021. Any participants, if they stayed in FC, had at least 2-year follow-up time since they first entered FC. The study estimated the relative risk of different discharge types from FC for participants with various disabilities, using participants without disability as the reference (Figure 1).

Findings show that children in FC with disabilities are associated with greater risk for negative outcomes and that risk profiles vary by disability type. Participants with disabilities, except those with other medical conditions, were less likely to get permanence discharge (RR< 1, p< 0.0001). Participants with intellectual disability, visual/hearing impairment, or emotional disturbance were more likely to get a non-permanence discharge (RR=1.79, 1.72, 3.01 respectively, p< 0.0001). Participants with physical disability had a surprisingly high risk of death in the follow-up period (RR=9.07, p< 0.0001) as compared to participants without disability. Participants with intellectual disability or other medical conditions also had a significantly high risk of death (RR=3.12, 3.31, respectively, p< 0.0001).

This study showed that children in FC with different disabilities had different risk characteristics for non-permanence discharge or death. Given that children in FC have higher rates of disability than children not in care, specialized effort is needed from the child welfare and healthcare systems to recognize and address the health-related needs of this population and to support their caregivers.

Table 1: Data Management 

Figure 1: Discharge Type at the End of Follow-up by Participant Disability Type on Entry into Foster Care