Foster care

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Children of the United Kingdom's Child Migration Programme - many of whom were placed in foster care in Australia Childrens migrant programme.jpg
Children of the United Kingdom's Child Migration Programme – many of whom were placed in foster care in Australia

Foster care is a system in which a minor has been placed into a ward, group home (residential child care community, treatment center, etc.), or private home of a state-certified caregiver, referred to as a "foster parent" or with a family member approved by the state. The placement of the child is normally arranged through the government or a social service agency. The institution, group home or foster parent is compensated for expenses unless with a family member. [1]

In law, a ward is someone placed under the protection of a legal guardian.

A group home is a private residence model of medical care for those with complex health needs. Traditionally, the model has been used for children or young people who cannot live with their families, people with chronic disabilities who may be adults or seniors, or people with dementia and related aged illnesses. Typically, there are no more than six residents, and there is at least one trained caregiver there 24 hours a day. In some early "model programs", a house manager, night manager, weekend activity coordinator, and 4 part-time skill teachers were reported. Originally, the term group home referred to homes of 8 to 16 individuals, which was a state-mandated size during deinstitutionalization. Residential nursing facilities, also included in this article, may be as large in 2015 as 100 individuals, which is no longer the case in field such as intellectual and developmental disabilities. Depending on the severity of the condition requiring one to need to live in a group home, some clients are able to attend day programs and most clients are able to live normal lifestyles.

Contents

The State, via the family court and child protective services agency, stand in loco parentis to the minor, making all legal decisions while the foster parent is responsible for the day-to-day care of the minor.

Family court is a court of Equity convened to decide matters and make orders in relation to family law, such as custody of children. In common-law jurisdictions "family courts" are statutory creations primarily dealing with equitable matters devolved from a court of inherent jurisdiction, such as a superior court. Family courts were first established in the United States in 1910, when they were called domestic relations courts although the idea itself is much older.

The term in loco parentis, Latin for "in the place of a parent" refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent. Originally derived from English common law, it is applied in two separate areas of the law.

Most kinship care is done informally, without the involvement of a court or public organization. However, in the U.S., formal kinship care is increasingly common. In 2012, a quarter of all children in formal foster care were placed with relatives instead of being placed into the system. [2]

By country

Australia

In Australia foster care was known as "boarding-out". Foster care had its early stages in South Australia in 1866 and stretched to the second half of the 19th century. It is said that the system was mostly run by women until the early 20th century. Then the control was centered in many state children's departments. "Although boarding-out was also implemented by nongovernment[al] child rescue organizations, many large institutions remained. These institutions assumed an increasing importance from the late 1920s when the system went into decline." The system was re-energized in the postwar era, and in the 1970s. The system is still the main structure for "out-of-home care." The system took care of both local and foreign children. "The first adoption legislation was passed in Western Australia in 1896, but the remaining states did not act until the 1920s, introducing the beginnings of the closed adoption that reached it peak in the period 1940–1975. New baby adoption dropped dramatically from the mid-1970s, with the greater tolerance of and support for single mothers". [3]

South Australia State of Australia

South Australia is a state in the southern central part of Australia. It covers some of the most arid parts of the country. With a total land area of 983,482 square kilometres (379,725 sq mi), it is the fourth-largest of Australia's states and territories by area, and fifth largest by population. It has a total of 1.7 million people, and its population is the second most highly centralised in Australia, after Western Australia, with more than 77 percent of South Australians living in the capital, Adelaide, or its environs. Other population centres in the state are relatively small; Mount Gambier, the second largest centre, has a population of 28,684.

Western Australia State in Australia

Western Australia is a state occupying the entire western third of Australia. It is bounded by the Indian Ocean to the north and west, and the Southern Ocean to the south, the Northern Territory to the north-east, and South Australia to the south-east. Western Australia is Australia's largest state, with a total land area of 2,529,875 square kilometres, and the second-largest country subdivision in the world, surpassed only by Russia's Sakha Republic. The state has about 2.6 million inhabitants – around 11 percent of the national total – of whom the vast majority live in the south-west corner, 79 per cent of the population living in the Perth area, leaving the remainder of the state sparsely populated.

Cambodia

Foster care in Cambodia is relatively new as an official practice within the government. However, despite a later start, the practice is currently making great strides within the country. Left with a large number of official and unofficial orphanages from the 1990s, the Cambodian government conducted several research projects in 2006 and 2008, pointing to the overuse of orphanages as a solution for caring for vulnerable children within the country. Most notably, the studies found that the percentage of children within orphanages that had parents approached 80%. At the same time, local NGOs like Children In Families [ permanent dead link ] began offering limited foster care services within the country. In the subsequent years, the Cambodian government began implementing policies that required the closure of some orphanages and the implementation of minimum standards for residential care institutions. These actions lead to an increase in the number of NGOs providing foster care placements and helped to set the course for care reform around the country. As of 2015, the Cambodian government is working with UNICEF, USAID, several governments, and many local NGOs in continuing to build the capacity for child protection and foster care within the Kingdom.

Canada

Foster children in Canada are known as permanent wards, (crown wards in Ontario). [4] A ward is someone, in this case a child, placed under protection of a legal guardian and are the legal responsibility of the government. Census data from 2011 counted children in foster care for the first time, counting 47,885 children in care. The majority of foster children – 29,590, or about 62 per cent – were aged 14 and under. [5] The wards remain under the care of the government until they "age out of care." All ties are severed from the government and there is no longer any legal responsibility toward the youth. This age is different depending on the province.

A legal guardian is a person who has the legal authority to care for the personal and property interests of another person, called a ward. Guardians are typically used in three situations: guardianship for an incapacitated senior, guardianship for a minor, and guardianship for developmentally disabled adults.

Israel

In December 2013, the Israeli Knesset approved a bill co-drafted by the Israel National Council for the Child to regulate the rights and obligations of participants in the foster care system in Israel. [6]

Japan

In Japan, foster care started around 1948, leading to the passing of the Child Welfare Law. [7] The idea of foster care or taking in abandoned children actually came about around 1392-1490s in Japan. The foster care system in Japan is similar to the Orphan Trains because Brace thought the children would be better off on farms. The people in Japan thought the children would do better on farms rather than living in the "dusty city." The families would often send their children to a farm family outside the village and only keep their oldest son. The farm families served as the foster parents and they were financially rewarded for taking in the younger siblings. "It was considered an honor to be chosen as foster parents, and selection greatly depended on the family's reputation and status within the village". [8] Around 1895 the foster care program became more like the system used in the United States because the Tokyo Metropolitan Police sent children to a hospital where they would be "settled". [9] Problems emerged in this system, such as child abuse, so the government started phasing it out and "began increasing institutional facilities". In 1948 the Child Welfare Law was passed, increasing official oversight, and creating better conditions for the children to grow up in. [10] [11]

United Kingdom

In the United Kingdom, foster care and adoption has always been an option, "in the sense of taking other people's children into their homes and looking after them on a permanent or temporary basis." Although, nothing about it had a legal foundation, until the 20th century. The UK had "wardship," the family taking in the child had custody by the Chancery Court. Wardship was not used very often because it did not give the guardian "parental rights." In the 19th century came a "series of baby farming scandals." At the end of the 19th century they started calling it "boarding-out" like they did in Australia. They started placing the children in orphanages and workhouses as well. "The First World War saw an increase in organized adoption through adoption societies and child rescue organizations, and pressure grew for adoption to be given legal status." The first laws based on adoption and foster care were passed in 1926. "The peak number of adoptions was in 1968, since when there has been an enormous decline in adoption in the United Kingdom. The main reasons for children being adopted in the United Kingdom had been unmarried mothers giving up their children for adoption and stepparents adopting their new partner's children". [12]

United States

In the United States, foster care started as a result of the efforts of Charles Loring Brace. "In the mid 19th Century, some 30,000 homeless or neglected children lived in the New York City streets and slums." [13] Brace took these children off the streets and placed them with families in most states in the country. Brace believed the children would do best with a Christian farm family. He did this to save them from "a lifetime of suffering" [14] He sent these children to families by train, which gave the name The Orphan Train Movement. "[This] lasted from 1853 to the early 1890s [1929?] and transported more than 120,000 [250,000?] children to new lives." [15] When Brace died in 1890, his sons took over his work of the Children's Aid Society until they retired. [14] The Children's Aid Society created "a foster care approach that became the basis for the federal Adoption and Safe Families Act of 1997" called Concurrent Planning. This greatly impacted the foster care system. Children's Aid works with the biological and foster parents to "achieve permanency". [13] "From the mid-1800s to the eve of the Great Depression, orphan train children were placed with families who pre-selected them with an order form, specifying age, gender, hair and eye color. In other cases, trainloads of children were assembled on stages, train platforms or town halls and examined by prospective parents. "Conjuring the image of picking the best apple from the bin. Sometimes a child would be separated from his or her brothers and sisters, or would end up in a family that only wanted them to work. Most of the time the children were chosen by a loving or childless family". [16]

Placement

Family-based foster care is generally preferred to other forms of out of home care. [17] Foster care is intended to be a short term solution until a permanent placement can be made. [18] In most states, the primary objective is to reconcile children with the biological parent(s). However, if the parent(s) is unable or unwilling to care for the child, then the first choice of adoptive parents is a relative such as an aunt, uncle or grandparent, known as kinship care. If no related family member is willing or able to adopt, the next preference is for the child to be adopted by the foster parents or by someone else involved in the child's life (such as a teacher or coach). This is to maintain continuity in the child's life. If neither above option are available, the child may be adopted by someone who is a stranger to the child.

If none of these options are viable the plan for the minor may be to enter OPPLA (Other Planned Permanent Living Arrangement). This option allows the child to stay in custody of the state and the child can stay placed in a foster home, with a relative or a long term care facility, such as a residential child care community or, for children with development disabilities, physical disabilities or mental disabilities, a treatment center.

671,000 children were served by the foster care system in the United States in 2015. [19] "After declining more than 20 percent between FY 2006 and FY 2012 to a low of 397,000, the number of children in foster care on the last day of the fiscal year increased to 428,000 in FY 2015, with a slightly higher percent change from 2014 to 2015 (3.3%) than observed from 2013 to 2014 (3.2%)." [20] In 2015, there were about 112,000 children ready for adoptive families in the nation's foster care systems. [21]

The median amount of time a child spent in foster care in the U.S. in 2015 was 13.5 months. [22] That year, 74% of children spent less than two years in foster care, while 13% were in care for three or more years. [23] Of the estimated 427,910 children in foster care on September 30, 2015: 43 percent were White, 24 percent were African-American, 21 percent were Hispanic (of any race), 10 percent were other races or multiracial, and 2 percent were unknown or unable to be determined. [23]

Children may enter foster care voluntarily or involuntarily. Voluntary placement may occur when a biological parent or lawful guardian is unable to care for a child. Involuntary placement occurs when a child is removed from their biological parent or lawful guardian due to the risk or actual occurrence of physical or psychological harm. In the US, most children enter foster care due to neglect. [24] If a biological parent or legal guardian is unwilling to care for a child, the child is deemed to be dependent and is placed under the care of the child protection agency. The policies regarding foster care as well as the criteria to be met in order to become a foster parent vary according to legal jurisdiction.

Especially egregious failures of child protective services often serve as a catalyst for increased removal of children from the homes of biological parents. An example is the brutal torture and murder of 17-month-old Peter Connelly, a British toddler who died in London Borough of Haringey, North London after suffering more than 50 severe injuries over an eight-month period, including eight broken ribs and a broken back. Throughout the period of time in which he was being tortured, he was repeatedly seen by Haringey Children's services and NHS health professionals. [25] Haringey Children's services already failed ten years earlier in the case of Victoria Climbié. [26] In the time since his death, in 2007, cases have reached a record rate in England surpassing 10,000 in the reporting year ending in March 2012.

Abuse and negligence

From 1993 through 2002 there were 107 recorded deaths[ clarification needed ][ who? ]; there are approximately 400,000 children in out-of-home care, in the United States. Almost 10% of children in foster care have stayed in foster care for five or more years. Nearly half of all children in foster care have chronic medical problems. 8% of all children in foster care have serious emotional problems, 11% of children exiting foster care aged out of the system, in 2011. [27] [ not in citation given ] Children in foster care experience high rates of child abuse, emotional deprivation, and physical neglect. In one study in the United Kingdom "foster children were 7–8 times, and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population". [28] A study of foster children in Oregon and Washington State found that nearly one third reported being abused by a foster parent or another adult in a foster home. [29]

Medical and psychiatric disorders

A higher prevalence of physical, psychological, cognitive and epigenetic disorders for children in foster care has been established in studies in various countries. The Casey Family Programs Northwest Foster Care Alumni Study was a fairly extensive study of various aspects of children who had been in foster care. It noted that 80% of ex-foster children are doing "poorly".[ citation needed ]

Individuals who were in foster care experience higher rates of physical and psychiatric morbidity than the general population and suffer from not being able to trust and that can lead to placements breaking down. [30] In the Casey study of foster children in Oregon and Washington state, they were found to have double the incidence of depression, 20% as compared to 10% and were found to have a higher rate of posttraumatic stress disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having attention deficit hyperactivity disorder (ADHD), and deficits in executive functioning, anxiety as well as other developmental problems. [31] [32] [33] [34] These children experience higher degrees of incarceration, poverty, homelessness, and suicide. Studies in the U.S. have suggested that some foster care placements may be more detrimental to children than remaining in a troubled home, [35] but a more recent study suggested that these findings may have been affected by selection bias, and that foster care has little effect on behavioral problems. [36]

Neurodevelopment

Foster children have elevated levels of cortisol, a stress hormone, in comparison to children raised by their biological parents. Elevated cortisol levels can compromise the immune system. (Harden BJ, 2004). [37] Most of the processes involved in healthy neurodevelopment are predicated upon the establishment of close nurturing relationships and environmental stimulation. Negative environmental influences during this critical period of brain development can have lifelong consequences. [38] [39] [40] [41]

Post traumatic stress disorder

Regions of the brain associated with stress and posttraumatic stress disorder PTSD stress brain.gif
Regions of the brain associated with stress and posttraumatic stress disorder

Children in foster care have a higher incidence of posttraumatic stress disorder (PTSD). In one study, [43] 60% of children in foster care who had experienced sexual abuse had PTSD, and 42% of those who had been physically abused met the PTSD criteria. PTSD was also found in 18% of the children who were not abused. These children may have developed PTSD due to witnessing violence in the home. (Marsenich, 2002).

In a study conducted in Oregon and Washington state, the rate of PTSD in adults who were in foster care for one year between the ages of 14–18 was found to be higher than that of combat veterans, with 25 percent of those in the study meeting the diagnostic criteria as compared to 12–13 percent of Iraq war veterans and 15 percent of Vietnam war veterans, and a rate of 4% in the general population. The recovery rate for foster home alumni was 28.2% as opposed to 47% in the general population.

"More than half the study participants reported clinical levels of mental illness, compared to less than a quarter of the general population". [44] [45]

Eating disorders

Foster children are at increased risk for a variety of eating disorders in comparison to the general population. In a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care. [46] Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care. It is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity"; it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to, it was prevalent amongst 25 percent of the study group in New Zealand. [32] Bulimia nervosa is seven times more prevalent among former foster children than in the general population. [47]

Poverty and homelessness

New York street children in 1890 Riischildren.jpg
New York street children in 1890

Nearly half of foster children in the U.S. become homeless when they turn 18. [48] "One of every 10 foster children stays in foster care longer than seven years, and each year about 15,000 reach the age of majority and leave foster care without a permanent family—many to join the ranks of the homeless or to commit crimes and be imprisoned. [49] [50]

Three out of 10 of the United States homeless are former foster children. [51] According to the results of the Casey Family Study of Foster Care Alumni, up to 80 percent are doing poorly—with a quarter to a third of former foster children at or below the poverty line, three times the national poverty rate. [52] Very frequently, people who are homeless had multiple placements as children: some were in foster care, but others experienced "unofficial" placements in the homes of family or friends.

Individuals with a history of foster care tend to become homeless at an earlier age than those who were not in foster care.[ citation needed ] The length of time a person remains homeless is longer in individuals who were in foster care. [53]

Suicide-death rate

Children in foster care are at a greater risk of suicide. [54] The increased risk of suicide is still prevalent after leaving foster care. In a small study of twenty-two Texan youths who aged out of the system, 23 percent had a history of suicide attempts. [55]

A Swedish study utilizing the data of almost one million people including 22,305 former foster children who had been in care prior to their teens, concluded:

Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts....Individuals who had been in long-term foster care tended to have the most dismal outcome...former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. [56]

Death rate

Children in foster care have an overall higher mortality rate than children in the general population. [57] A study conducted in Finland among current and former foster children up to age 24 found a higher mortality rate due to substance abuse, accidents, suicide and illness. The deaths due to illness were attributed to an increased incidence of acute and chronic medical conditions and developmental delays among children in foster care. [58]

Georgia Senator Nancy Schaefer published a report "The Corrupt Business of Child Protective Services" [59] stating:

"The National Center on Child Abuse and Neglect in 1998 reported that six times as many children died in foster care than in the general public and that once removed to official "safety", these children are far more likely to suffer abuse, including sexual molestation than in the general population". [59]

Academic prospects

Educational outcomes of ex-foster children in the Northwest Alumni Study: [60]

The study reviewed case records for 659 foster care alumni in Northwest USA, and interviewed 479 of them between September 2000 and January 2002. [60]

Higher Education

Approximately 10% of foster youth make it to college and of those 10%, only about 3% actually graduate and obtain a 4-year degree. [61] Although the number of foster youth who are starting at a 4-year university after high school has increased over the years, the number of youth who graduate from college continues to remain stable. A study of 712 youth in California, the results revealed that foster care youth are fives times less likely to attend college than youth who do not go through foster care. [62] There are different resources that offer both financial and emotional support for foster youth to continue their education. Simultaneously, there are also many barriers that make getting to a college or university difficult.

Borton describes some of the barriers youth face in her article, Barriers to Post-Secondary Enrollment for Former Foster Youth. A few of those barriers include financial hurdles, navigating through the application process with little to no support, and lack of housing. [63]

Many studies have shown that there are a few factors that have seemingly played a role in the success of foster youth making it to and graduating from a college or university.  While having financial resources for foster youth is a huge help, there are other components to look at. Beginning with having support for these youth at the high school level. In order for foster youth to obtain a college degree, they must enroll at a university first.

Out of the different factors that play in increasing college enrollment such as youth participating in extended foster care, reading ability, etc., youth who received assistance or had supportive relationships from adults, were more likely than youth who did not have supportive relationships, to enroll at a university. [62]

At colleges across the nation, there are programs that are specifically put in place to help youth who have aged out of the foster care system and continued into higher education. These programs often help youth financially by giving them supplemental funds and providing support through peer mentor programs or academic counseling services. While funding is an important key in helping get through college, it hasn't been found as the only crucial component in aiding a youth's success.  

A study done by Jay and colleagues provides insight on what youth view as important in helping them thrive on a college campus. The study, which had a sample of 51 foster youth, used Conceptual Mapping to break down the different components of support that may be important for youth to receive on a college campus. [64] It is important to take in the different factors that can be helpful for youth at a university and to look beyond providing financial support.

Psychotropic medication use

Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate that was 3 times higher than that of Medicaid-insured youth who qualify by low family income. In a review (September 2003 to August 2004) of the medical records of 32,135 Texas foster care 0–19 years old, 12,189 were prescribed psychotropic medication, resulting in an annual prevalence of 37.9% of these children being prescribed medication. 41.3% received 3 different classes of these drugs during July 2004, and 15.9% received 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The study also showed that youth in foster care are frequently treated with concomitant psychotropic medication, for which sufficient evidence regarding safety and effectiveness is not available. [65]

The use of expensive, brand name, patent protected medication was prevalent. In the case of SSRIs the use of the most expensive medications was noted to be 74%; in the general market only 28% are for brand name SSRI's vs generics. The average out-of-pocket expense per prescription was $34.75 for generics and $90.17 for branded products, a $55.42, difference. [66]

Therapeutic intervention

Children in the child welfare system have often experienced significant and repeated traumas and having a background in foster homes—especially in instances of sexual abuse—can be the precipitating factor in a wide variety of psychological and cognitive deficits [67] it may also serve to obfuscate the true cause of underlying issues. The foster care experience may have nothing to do with the symptoms, or on the other hand, a disorder may be exacerbated by having a history of foster care and attendant abuses. The human brain however has been shown to have a fair degree of neuroplasticity. [68] [69] [70] and adult neurogenesis has been shown to be an ongoing process. [71]

Cross-cultural adoption policies

George Shanti, Nico Van Oudenhoven, and Ekha Wazir, co-authors of Foster Care Beyond the Crossroads: Lessons from an International Comparative Analysis, say that there are four types of Government foster care systems. The first one is that of developing countries. These countries do not have policies implemented to take care of the basic needs of these children and these children mostly receive assistance from relatives. The second system is that of former socialist governments. The historical context of these states has not allowed for the evolution of their foster care system. NGO's have urged them to evolve; however the traditional system of institutionalizing these children is still in place. Thirdly, liberal democracies do not have the support from its political system in order to take care of these children, even though they have the resources. Finally, social democracies are the most advanced governments in regards to their foster care system. These governments have a massive infrastructure, funding, and support system in order to help foster care children. [72]

Adoption

Foster care [73] adoption is a type of domestic adoption where the child is initially placed into a foster care system and is subsequently placed for adoption. Children may be placed into foster care for a variety of reasons; including, removal from the home by a governmental agency because of maltreatment. [74] In some jurisdictions, adoptive parents are licensed as and technically considered foster parents while the adoption is being finalized. [75] According to the U.S Department of Health and Human Services Children's Bureau, there were approximately 408,425 children in foster care in 2010. Of those children, twenty-five percent had a goal of adoption. In 2015, 243,060 children exited foster care and twenty-two percent were adopted. [76] Nationwide, there are more than one hundred thousand children in the U.S. foster care system waiting for permanent families. [77]

See also

Related Research Articles

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Foster children in Canada are known as permanent wards,. A ward is someone, in this case a child, placed under protection of a legal guardian and are the legal responsibility of the government. Census data from 2011 counted children in foster care for the first time, counting 47,885 children in care. The majority of foster children – 29,590, or about 62% – were aged 14 and under. The wards remain under the care of the government until they "age out of care." This age is different depending on the province.

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Childhood trauma is referred to in academic literature as adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma, these might include neglect, abandonment, childhood sexual abuse and physical abuse, parent or sibling is treated violently or there is a parent with a mental illness. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

Foster Care Independence Act

The Foster Care Independence Act of 1999 aims to assist youth aging out of foster care in the United States in obtaining and maintaining independent living skills. Youth aging out of foster care, or transitioning out of the formal foster care system, are one of the most vulnerable and disadvantaged populations. As youth age out of the foster care system at age 18, they are expected to become self-sufficient immediately, even though on average youth in the United States are not expected to reach self-sufficiency until age 26.

Transgender youth children and adolescents who identify as transgender

Transgender youth are children and adolescents who are transgender and/or transsexual. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, and because most doctors are reluctant to provide medical treatments to them, transgender youth face different challenges compared to adults. Transgender issues manifest at different times in life in different individuals. In most cases of gender dysphoria, the condition is often apparent in early childhood, when such a child may express behavior in-congruent with and dissatisfaction related to their assigned gender. However, many of these children experience rejection as a result of their differences and quickly attempt to repress them. Therefore, people who see these children regularly may be unaware that they are unhappy as members of their assigned gender.

Effects of domestic violence on children, result from witnessing domestic violence in a home where one of their parents are abusing the other parent, plays a tremendous role on the well-being and developmental growth of children witnessing the violence. In 2009 in the Philippines, it was estimated that as many as 7 to 14 million children were exposed to domestic violence with about 3.3 million children exposed to domestic violence in their homes every year.

Foster care in the United States

Foster care is the term used for a system in which a minor who has been made a ward is placed in an institution, group home, or private home of a state certified caregiver referred to as a "foster parent". The placement of the child is usually arranged through the government or a social-service agency. The institution, group home or foster parent is provided compensation for expenses.

Utah Foster Care (UFC), formerly "Utah Foster Care Foundation" is a non-profit organization that provides foster families for the State of Utah. Since their founding, UFC has played a role in caring for young children who have been subjected to abuse, neglect, and other hardships by their caretakers. As of 2013, at any given time in Utah, there are about 2,700 children experiencing crisis in the home who are in need of foster care. Nearly half of all cases involve substance abuse by biological parents. Given the difficult circumstances and special needs of these children, UFC's goal is to find and prepare foster parents to meet those needs. They accomplish this goal by finding, educating, and nurturing families willing to open their homes to children in foster care. The Utah Division of Child and Family Services (DCFS), the agency responsible for the placement of children in foster homes, contracts with UFC to recruit, train, and retain the families needed to care for these children in crisis. Thus, UFC is not a child placement agency, but works directly with DCFS to meet the needs of foster children in Utah. Below is described six general attributes of UFC. They include their mission and goals, history, organizational structure, program relationships, budget, and challenges.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. The goal of TF-CBT is to provide psychoeducation to both the child and the non-offending caregivers and help them to identify and cope with emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced traumatic events.

Out-of-home placements are an alternative form of care when children must be removed from their homes. Children who are placed out of the home differ in the types and severity of maltreatment experienced compared to children who remain in the home. One-half to two-thirds of youth have experienced a traumatic event leading to increased awareness and growing literature on the impact of trauma on youth. The most common reasons for out-of-home placements are due to physical or sexual abuse, violence, and neglect. Youth who are at risk in their own homes for abuse, neglect, or maltreatment, as well as youth with severe emotional and behavior issues, are placed out of the home with extended family and friends, foster care, or in residential facilities. Out-of-home placements aim to provide children with safety and stability. This temporary, safe environment allows youth to have their physical, mental, moral, and social needs met. However, these youth are in a vulnerable position for experiencing repeated abuse and neglect.

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Further reading