Research has demonstrated that abuse, neglect, in-utero exposure to drugs and alcohol, and multiple placements in foster care all have damaging effects on children and youth, and that special services are often required to ensure the healthy development of children and youth who have spent time in foster care. Children and youth in foster care have been found to have disproportionately higher rates of physical, developmental, and mental health problems.

NACAC believes that the public child welfare system has primary responsibility to properly assess and address the cognitive, social, emotional, physical, developmental, and educational needs of children and youth who are or who have been in the foster care system. The child welfare system must partner with family and community to do a thorough assessment and must provide services and support that meet the child’s or youth’s full range of needs. Both assessment and service provision are necessary to ensure the best possible outcomes for every child and youth in care.

Practice Recommendations

  • Within 30 days of a child’s or youth’s entry into foster care, the child’s or youth’s agency should be responsible for the completion of a comprehensive, racially and culturally competent assessment of the child’s or youth’s physical health (including dental health), mental health, and developmental and educational needs. The age-appropriate and developmentally tailored assessment should be anticipatory and preventive, focusing on early identification and interventions. The assessment should include the child’s or youth’s strengths, motor skills, cognition, speech and language function, emotional well-being (including interests, family connections, ability to form personal relationships), educational level and achievement, and behaviors. To ensure accurate background information and accurate identification of issues following the child’s or youth’s entry into care, each assessment should include:
    • a process—such as a family group conference meeting—for obtaining input from the child’s or youth’s family and community members who knew the child or youth before removal
    • conversations with the child or youth to determine who he/she is, what is important to him/her, and what he/she needs
    • detailed information about the child’s or youth’s entire family—including siblings, birth parents, and other family members.

The assessment should be updated at least every six months for the first year a child or youth is in care, and then annually thereafter. In some cases, based on the individual needs of the child or youth, updated assessments should be done more frequently.

  • The child or youth must be given the opportunity to be a full participant in a meaningful and respectful assessment, and be given proper support to ensure an open, honest, and inclusive process. This support should include accommodations of age or ability or other special circumstances, the opportunity to participate by videotape rather than in person, and the chance to speak with the person of the child’s or youth’s choice (a birth parent or other relative, friend, foster parent, CASA, teacher, counselor, etc.) before the assessment and to bring that person to any meetings conducted as a part of the assessment.
  • Courts should require and child welfare agencies must undertake the responsibility for identifying a community-based multi-disciplinary team to conduct a single, coordinated assessment. The team should include physicians, mental health providers, caregivers, birth and foster parents, educators, community resource providers, guardians/attorneys ad litem, court-appointed special advocates, the child’s or youth’s social worker, etc., and should use standardized instruments and assessment tools that accurately assess the child’s or youth’s developmental stage, attachment, physical health, mental health, and educational achievement and needs. The assessment must consider the child’s or youth’s history of abuse, neglect, and foster placement and how this has affected the child or youth. Practitioners conducting the assessments must be properly trained, and have experience, in these areas. After the assessments are completed, the team must develop a single written assessment report.
  • To ensure the training of practitioners, schools of social work—in conjunction with child welfare experts—should develop BSW and MSW courses as well as post-certification programs that educate students and service providers on the effects of abuse, neglect, and foster care placement on a child’s or youth’s development as well as physical and mental health. Similarly, schools that prepare professionals who serve children in foster care (including schools of education, law schools, medical schools, nursing programs) should develop curricula materials and classes that highlight the effect of abuse, neglect, and foster care on a child’s or youth’s development as well as physical and mental health.
  • Each assessment report should identify the services the child or youth needs (including educational supports such as tutoring), establish an effective plan for funding and delivering those services and supports, and identify a process for ensuring that services and support are actually provided. The agency should send the assessment report to all members of the assessment team, the judge, social workers, guardians/attorneys ad litem, and birth and foster parents. Teachers and others involved in caring for the child or youth should receive those portions of the assessment report that relate to the services they are providing to the child or youth. The agency should be held accountable for using the assessment in making the best placement decision for the child or youth, and determining whether, with appropriate services and support, the family of origin can meet the child’s or youth’s needs. When children are reunified with their family of origin, the agency should be held accountable for putting in place a plan to ensure that the needed services are available and accessible and ensure that those supports build on the family’s strengths. If reunification is not possible, the agency must use the assessment to make a placement decision with a caregiver(s) who can meet the child’s or youth’s needs and to assure that the appropriate subsidies and services are provided in the new permanent family. The agency must report to the court on the provision of services and supports, and the court should make a finding on whether the plan is being effectively implemented.
  • The initial assessment should be considered a baseline to which subsequent assessments are compared to determine whether the supportive services are meeting the child’s or youth’s needs and enhancing the child’s or youth’s strengths. If the assessment identifies that the child’s or youth’s situation warrants, the supportive services should be changed to ensure the best possible outcomes. When services are successfully helping the child or youth, however, those services should remain in place.
  • After a child is in a permanent family (whether through reunification, adoption, or guardianship), the family should have the option for an annual re-assessment of the child or youth’s needs and a plan for the provision of needed services. The plan should include a determination of how the services will be provided to the child or youth. When necessary, the services should be provided by the state or province/territory, so that financial issues do not prevent the child or youth from getting the help he/she needs. (In the long-term the provision of services is likely to be cost-effective since it can prevent the return of the child or youth to the foster care system.)

Policy Recommendations

To make services more accessible to families, the government should:

  1. Require private and public medical insurance entities to cover mental health services at the same level of coverage as physical health services
  2. Review Medicaid reimbursement rules and increase reimbursements and streamline the reimbursement process so that more providers are willing to accept Medicaid
  3. Require HMOs to hire and retain qualified, competent service providers, and when those providers are not available, to make referrals to and fully fund treatment received out of network
  4. Fully support the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program through which foster and adopted children can receive assessments and services through Medicaid.

To ensure educational continuity for foster children and youth, the government should pass legislation that:

  1. Allows foster children to remain in their school of origin for the duration of the school year, in spite of placement moves, when it is in their best interests
  2. Requires placing agencies to consider school stability as a factor during placement decisions
  3. When school moves are necessary, requires the placing agency to request, and the schools to comply with, immediate transfer of the child’s or youth’s records to the new school, and requires the new school to immediately use the records to facilitate the implementation of needed academic support services and appropriate class placement
  4. Allows a foster child to be immediately enrolled in school even if all typical requirements (records, immunizations, uniforms, etc.) are not available
  5. Requires districts to calculate and accept credit for full or partial coursework satisfactorily completed by the student and earned while attending a public school, juvenile court school, or nonpublic, nonsectarian school
  6. Ensures that foster youth will not be penalized for absences due to placement changes, court appearances, or related court-ordered activities.

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The North American Council on Adoptable Children (NACAC) supports, educates, inspires, and advocates so adoptive families thrive and every child in foster care has a permanent, safe, loving family.


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