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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".)


Involvement with child welfare usually begins when a mandated reporter or other citizen makes a report to child protective services for concerns of child abuse or neglect. Of the 3.5 million families reported annually in the United States, approximately 60 percent are investigated for child maltreatment and approximately 21 percent of these families, involving approximately 675,000 children, have allegations of maltreatment founded [3]. Whether or not allegations are founded, most families remain intact and are referred to a variety of preventive services.

Removal of children occurs when child protective services affirms that the child is at imminent risk of harm if he/she remains in the home. Child welfare has to substantiate the reasons for removal to the court system within 72 hours to keep the child in placement. Annually, approximately 230,000 children are removed from their families and placed in foster care.

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Literature review current through: Nov 2017. | This topic last updated: Oct 27, 2017.
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