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Epidemiology of foster care placement and overview of the foster care system in the United States

Moira A Szilagyi, MD, PhD
Sandra H Jee, MD, MPH
Section Editors
Marilyn Augustyn, MD
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD


Children and adolescents who spend time in foster care have been exposed to multiple adverse childhood experiences and trauma. This is also true for other children whose families are involved with the child welfare system and children living away from their parents in informal placements with relatives.

An understanding of the structure, goals, and mandates of the foster care system, as well as the unique health, mental health, developmental, and educational problems of children and adolescents in foster care facilitates provision of appropriate comprehensive care to this vulnerable population [1,2]. In particular, health providers need to consider and be able to educate other professionals and caregivers about the impact of early childhood adversity and trauma on emotional, behavioral, and developmental health. (See "Comprehensive health care for children in foster care", section on 'Complex childhood trauma and toxic stress'.)

The epidemiology of foster care placement and an overview of the structure, goals, and mandates of the foster care system will be discussed here. The health, mental health, developmental, and educational needs of children in the foster care system are discussed separately. (See "Comprehensive health care for children in foster care".)


Children and adolescents are placed in foster care when their parents are unwilling or unable to safely care for them [1,3]. Children and adolescents who are placed in foster care have suffered childhood trauma or a variety of adverse childhood experiences. Placement in foster care is intended to be a temporary arrangement during which the health and safety of children are protected while the birth parents are provided with services that support reunification with their children.

Foster care is mandated to seek timely permanency for children in its care, either through reunification with family, placement with relatives, or adoption. If independent living is a realistic goal for an adolescent, foster care is mandated to provide services that nurture the adolescent toward independent adult living.

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Literature review current through: Sep 2017. | This topic last updated: Apr 07, 2016.
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