Child maltreatment occurs at significantly higher rates among those living in poverty. Children in foster care usually come to the attention of child welfare officials because they are neglected by parents who struggle with conditions associated with poverty: homelessness, history of incarceration, HIV seropositivity, and substance abuse. This article reports the disadvantages experienced by young children in foster care (aged 36 months and younger) via a study of records documenting the multiple risks to their health and development. Low birth weight, prenatal substance exposure, and prematurity were commonly encountered risks. Additionally, the child welfare agency had a low rate of documented screening for early intervention (11% of records surveyed) despite multiple risks and mandates for screening. Implications for nurses are offered.J Am Psychiatr Nurses Assoc, 2007; 13(5), 296-303. DOI: 10.1177/1078390307308421
Annie E. Casey Foundation. (2002). Children at risk: State trends 1990-2000. Baltimore, MD : Author.
2.
Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in SouthThames: The Special Needs and Autism Project (SNAP). Lancet, 368(9531), 210-215.
3.
Barnett, D., Manly, J., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. Toth (Eds.), Child abuse, child development, and social policy (pp. 7-73). Norwood, NJ: Ablex.
4.
Barth, R.P., Wildfire, J., & Green, R.L. (2006). Placement into foster care and the interplay of urbanicity, child behavior problems, and poverty. American Journal of Orthopsychiatry, 76(3), 358-366.
5.
Berger, L.M. (2004). Income, family structure, and child maltreatment risk. Children and Youth Services Review, 26(8), 725-748.
6.
Caley, L.M., Shipkey, N., Winkelman, T., Dunlap, C., & Rivera, S. (2006). Evidence-based review of nursing interventions to prevent secondary disabilities in fetal alcohol spectrum disorder. Pediatric Nursing, 32(2), 155-162.
7.
Center for Mental Health Services. (1997). Evaluation of the comprehensive community mental health services for children and their families program. Washington, DC: Center for Mental Health Services.
8.
Connell, C.M., Bergeron, N., Katz, K.H., Saunders, L., & Tebes, J.K. (2007). Re-referral to child protective services: The influence of child, family, and case characteristics on risk status. Child Abuse & Neglect, 31(5), 573-588.
9.
Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry,60(8), 837-844.
10.
Dalaker, J. (2001). Poverty in the United States. Washington, DC: U.S. Census Bureau.
11.
De Bellis, M.D. (2005). The psychobiology of neglect. Child Maltreatment, 10(2), 150-172.
12.
Denavas-Walt, C., Proctor, B., & Lee, C. (2005). Income, poverty, and health insurance coverage 2004. Washington, DC: U.S. Census Bureau.
13.
Doris, J.L., Meguid, V., Thomas, M., Blatt, S., & Eckenrode, J. (2006). Prenatal cocaine exposure and child welfare outcomes . Child Maltreatment, 11, 326-337.
14.
Drake, B., Jonson-Reid, M., Way, I., & Chung, S. (2002). Recurrence in child protective services among substantiated and unsubstantiated cases. Final report, DHHS Grant #90CA159101
15.
Drake, B., & Zuravin, S. (1998). Bias in child maltreatment reporting: Revisiting the myth of classlessness. American Journal of Orthopsychiatry , 68(2), 295-304.
16.
Floyd, R.L., O'Connor, M.J., Bertrand, J., & Sokol, R. (2006). Reducing adverse outcomes from prenatal alcohol exposure: A clinical plan of action. Alcoholism: Clinical and Experimental Research, 30(8), 1271-1275.
17.
General Accounting Office. (1995). Foster care: Health status of many young children is unknown or unmet. Washington, DC: Author.
18.
Gollan, J.K., & Pane, H. (2006). High rates of recurrence of depression in children and adolescents. Evidence BasedMental Health, 9(4), 95.
19.
Kruttschnitt, C., McLeod, J., & Dornfeld, L. (1994). The economic environment of child abuse. Social Problems, 41, 299-315.
20.
Kurita, H. (2006). Disorders of the autism spectrum. Lancet, 368(9531), 179-181.
21.
Leech, S.L., Richardson, G.A., Goldschmidt, L., & Day, N.L. (1999). Prenatal substance exposure: Effects on attention and impulsivity of 6-year-olds. Neurotoxicology andTeratology , 21(2), 109-118.
22.
Leslie, L., Gordon, J., Menedken, L., Premji, K., Michemore, K., & Ganger, W. (2005). The physical, developmental, and mental health needs of young children in child welfare by initial placement type. Journal of Developmental and Behavioral Pediatrics, 25(3), 177-185.
23.
Lester, B.M., LaGasse, L.L., & Seifer, R. (1998). Cocaine exposure and children: The meaning of subtle effects. Science, 282(5389), 633-634.
24.
Lindsey, D. (1991). Factors affecting the foster care placement decision: An analysis of national survey data. American Journal of Orthopsychiatry , 61(2), 272-281.
25.
Maughan, B., Iervolino, A.C., & Collishaw, S. (2005). Time trends in child and adolescent mental disorders. Current Opinion in Psychiatry, 18(4), 381-385.
26.
McKee, J., Storrs, J., & Humphrey, S. (2007). Creating a continuum of care for chronically underserved children. The Joint Commission Journal on Quality and Patient Safety, 33(4), 200-204.
27.
McSherry, D. (2007). Understanding and addressing the “neglect of neglect”: Why are we making a mole-hill out of a mountain? Child Abuse & Neglect. Electronic publication ahead of print, DOI: 10.1016/j.chiabu.2006.08.011.
28.
Merrick, J., Kandel, I., & Morad, M. (2004). Trends in autism. International Journal ofAdolescent Medicine and Health, 16(1), 75-78.
29.
Nair, P., Schuler, M.E., Black, M.M., Kettinger, L., & Harrington, D. (2003). Cumulative environmental risk in substance abusing women: Early intervention, parenting stress, child abuse potential and child development. Child Abuse & Neglect , 27(9), 997-1017.
30.
Olfson, M., Gameroff, M.J., Marcus, S.C., & Jensen, P.S. (2003). National trends in the treatment of attention deficit hyperactivity disorder. American Journal of Psychiatry,160(6), 1071-1077.
31.
Polansky, N., Chalmers, M., Buttenweiser, E., & Williams, D. (1981). Damaged parents: An anatomy of child neglect. Chicago: University of Chicago Press.
32.
Ramchandani, P. (2004). Prevalence of childhood psychiatric disorders may be underestimated. Evidence BasedMental Health, 7, 59.
33.
Rasmussen, C., Horne, K., & Witol, A. (2006). Neurobehavioral functioning in children with fetal alcohol spectrum disorder. Child Neuropsychology, 12(6), 453-468.
34.
Richardson, G.A., Conroy, M.L., & Day, N.L. (1996). Prenatal cocaine exposure: Effects on the development of school-age children. Neurotoxicology andTeratology, 18(6), 627-634.
35.
Rosenfeld, A.A., Pilowsky, D.J., Fine, P., Thorpe, M., Fein, E., Simms, M.D., et al. (1997). Foster care: An update. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 448-457.
36.
Rutter, M. (2003). Poverty and child mental health: Natural experiments and social causation. Journal of theAmerican Medical Association , 290(15), 2063-2064.
37.
Schiller, C., & Allen, P.J. (2005). Follow-up of infants prenatally exposed to cocaine . Pediatric Nursing, 31(5), 427-436.
38.
Schneiderman, J.U. (2006). Innovative pediatric nursing role: Public health nurses in child welfare. Pediatric Nursing, 32(4), 317-321.
39.
Sedlak, A.J., & Broadhurst, D.D. (1996). Executive summary of the Third National Incidence Study of Child Abuse and Neglect. Washington, DC: National Center on Child Abuse and Neglect, HHS.
40.
Silva, R.R., Bath, E., Beer, D., Minami, H., & Engel, L. (2007). Administrative issues in child psychiatry. Psychiatric Quarterly. E-publication ahead of print, March 31, 2007. Available at http://springerlink.metapress.com/content/104966/
41.
Slinning, K. (2004). Foster placed children prenatally exposed to poly-substances—Attention-related problems at ages 2 and 4 1/2. European Child & Adolescent Psychiatry, 13(1), 19-27.
42.
Smith, D.K., Johnson, A.B., Pears, K.C., Fisher, P.A., & DeGarmo, D.S. (2007). Child maltreatment and foster care: Unpacking the effects of prenatal and postnatal parental substance use. Child Maltreatment, 12(2), 150-160.
43.
Sokol, R.J., Janisse, J.J., Louis, J.M., Bailey, B.N., Ager, J., Jacobson, S.W., et al. (2007). Extreme prematurity: An alcohol-related birth effect. Alcoholism, Clinical and Experimental Research , 31(6), 1031-1037.
44.
Stahmer, A.C., Leslie, L.K., Hurlburt, M., Barth, R.P., Webb, M.B., Landsverk, J., et al. (2005). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics , 116(4), 891-900.
45.
Steinhausen, H.C., Mas, S.D., Ledermann, C., & Metzke, C.W. (2006). Risk factors for the development of emotional and behavioural problems in children born to drug-dependent mothers. European Child & Adolescent Psychiatry, 15(8), 460-466.
46.
Streissguth, A. (1997). Fetal alcohol syndrome: A guide for families and communities. Baltimore, MD: Brookes .
47.
Teicher, M.H., Tomoda, A., & Andersen, S.L. (2006). Neurobiological consequences of early stress and childhood maltreatment: Are results from human and animal studies comparable?Annals of the New York Academy of Sciences , 1071, 313-323.
48.
U.S. Department of Health and Human Services. ( 2003). Child maltreatment 2001. Washington, DC: U.S. Government Printing Office.
49.
Vaughn, T., Pumariega, A., & Klaehn, R. (2003). Systems of care under legal mandates. In A. Pumariega & N. Winters (Eds.), The handbook of child and adolescent systems of care (pp. 414-431). San Francisco, CA: Jossey-Bass.
Woolf, S.H., Johnson, R.E., & Geiger, H.J. (2006). The rising prevalence of severe poverty in America: A growing threat to public health. American Journal of PreventionMedicine, 31(4), 332-341.
52.
Wulczyn, F., Barth, R.P., Yuan, Y., Harden, B.J., & Landsverk, J. (2005). The epidemiology of child maltreatment. In F. Wulczyn, R. P. Barth, Y. Yuan, B. J. Harden, & J. Landsverk (Eds.), Beyond common sense: Child welfare, child well-being, and the evidence for policy reform (pp. 59-90). New Brunswick, NJ: Aldine.
