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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 134-142

Comprehensive Assessments for Children Entering Foster Care: A National Perspective

Laurel K. Leslie, MD*,{ddagger},§, Michael S. Hurlburt, PhD{ddagger},§, John Landsverk, PhD{ddagger},§, Jennifer A. Rolls, MPH§, Patricia A. Wood, MA, MPH§ and Kelly J. Kelleher, MD, MPH

* University of California San Diego, San Diego, California
{ddagger} San Diego State University, San Diego, California
§ Child and Adolescent Services Research Center, San Diego, California
Columbus Children’s Hospital, Columbus, Ohio

Objectives. To 1) investigate the status of policies for comprehensive health assessments of children entering out-of-home care, 2) develop a profile for each primary sampling unit (PSU) regarding the comprehensiveness of its assessment policies with respect to physical, mental, and developmental health, and 3) examine the relationship between inclusiveness and the estimated percentage of children assessed, primary assessment location, and principal assessment provider type.

Method. In collaboration with the National Survey of Child and Adolescent Well-Being, a national probability sample of 92 PSUs was identified. Detailed telephone survey data, addressing policies for the assessment of physical, mental, and developmental needs of children on entry into out-of-home care, were collected from child welfare key informants. Descriptive statistics were used for analyses, and were weighted to account for the sampling strategy.

Results. Over 94% of PSUs surveyed assessed all children for physical health problems. The percentage of PSUs with inclusive policies regarding mental health and developmental assessment was much lower (47.8% and 57.8%, respectively). Only 42.6% of PSUs provided comprehensive physical, mental health, and developmental examinations inclusive of all children entering out-of-home care. Community locations and primary care providers were most often used to conduct assessments for physical and developmental problems.

Conclusions. Despite the publication of national guidelines regarding assessment, many PSUs do not have comprehensive policies or routine practices that address all children entering out-of-home care. Given the high use of primary care providers, these providers must be educated regarding the prevalence and types of problems experienced by children entering foster care.

Key Words: foster care • health care • mental health services • developmental delay • child health

Abbreviations: CWLA, Child Welfare League of America • AAP, American Academy of Pediatrics • PSU, primary sampling unit • CCCW, Caring for Children in Child Welfare • NSCAW, National Survey of Child and Adolescent Well-Being • CI, confidence interval • CASRC, Child and Adolescent Services Research Group

Received for publication Oct 17, 2002; Accepted Feb 4, 2003.




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