Timely Medical Exams for Children in Foster Care
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- Definition: Number of children ages 0-17 in foster care on March 31 receiving medical exams in accordance with Child Health and Disability Prevention Program periodicity schedules effective July 1, 2016 (e.g., among California children in foster care on March 31, 2019, 31,242 received timely medical exams).Percentage of children ages 0-17 in foster care on March 31 receiving medical exams in accordance with Child Health and Disability Prevention Program periodicity schedules effective July 1, 2016 (e.g., among California children in foster care on March 31, 2019, 73.3% received timely medical exams).
- Data Source: Webster, D., et al. California Child Welfare Indicators Project Reports. UC Berkeley Center for Social Services Research (Jul. 2019).
- Footnote: Child Health and Disability Prevention Program periodicity schedules require medical and dental exams by the end of specific age periods; children are out of compliance if they leave an age period without a required exam. Periodicity schedules adopted July 1, 2016—which increased the frequency of examinations for children in most age groups—are used to measure compliance for all time periods; as a result, data for 2016 and earlier may be lower than performance measured against prevailing standards of the time. Data are based on unduplicated counts of children under the supervision of county welfare departments and exclude cases under the supervision of county probation departments, out-of-state agencies, state adoptions district offices, and Indian child welfare departments. Data are excluded for children in out-of-home placements shorter than 31 days. The notation S refers to data that have been suppressed because there were fewer than 20 children who had been in foster care for at least 31 days on March 31.
Learn More About Foster Care
- Measures of Foster Care on Kidsdata.org
Kidsdata.org provides the following indicators of children and youth involved in the foster care system:
Other measures related to foster care include:
- Children ages 0-17 entering foster care for the first time, by age group, race/ethnicity, reason for removal from home, and type of foster care placement
- Children and youth ages 0-20 in foster care on July 1st, by age group, race/ethnicity, and type of placement
- The number of foster youth enrolled in public schools on the first Wednesday in October, along with the percentage of foster youth in the total student population
- The percentage of children in foster care who receive timely medical exams and timely dental exams
- Among children in care longer than eight days, the median number of months in foster care
- For children in foster care at least 12 months, the number of placements and placement distance from home after one year in care
- Exit status (the number and percentage of foster children who are reunified with their parents, adopted, discharged to guardianship, emancipated from care (age out), and still in care) one year and four years after first entry
- Among foster children who are reunified with their parents, the percentage who re-renter care within a year, and among children who are adopted, the length of time from latest entry to adoption
- Foster Care
- First Entries into Foster Care
- Children in Foster Care
- Foster Youth in Public Schools
- Timely Medical Exams for Children in Foster Care
- Timely Dental Exams for Children in Foster Care
- Median Number of Months in Foster Care
- Number of Placements After One Year in Foster Care
- Placement Distance from Home After One Year in Foster Care
- Exit Status One Year After Entry into Foster Care
- Exit Status Four Years After Entry into Foster Care
- Re-Entries into Foster Care
- Length of Time from Foster Care to Adoption
- Child Abuse and Neglect
- Childhood Adversity and Resilience
- Prevalence of Childhood Hardships (Maternal Retrospective)
- Foster Care Placement (Maternal Retrospective)
- Prevalence of Adverse Childhood Experiences (Adult Retrospective; CA Only)
- Why This Topic Is Important
Foster care is intended to provide temporary, safe living arrangements and therapeutic services for children and youth who cannot remain safely at home because of risk for maltreatment or inadequate care. The U.S. foster care system aims to safely reunify children with their parents or secure another permanent home, e.g., through adoption. Often this goal is not achieved, however, especially for older children and those with disabilities (1). Instead, many children spend years in foster family homes or group homes, often moving many times (1).
Young people in foster care are at increased risk for a range of emotional, physical, behavioral, academic, and employment problems, with outcomes generally worse for those in group homes (2, 3). Recognizing this, leaders and policymakers have made efforts to safely reduce the number of children living in foster care, particularly in group settings (4, 5). While the number of children in foster care has decreased since the 2000s, statewide and nationally, California continues to have the largest number of children entering the system each year (6). Further, American Indian/Alaska Native, black, and Latino children continue to be overrepresented in the foster care system; in California, for example, African American/black children represent 19% of foster children but only 5% of the general child population (2, 7). Research has shown that children of color, those with disabilities, and LGBTQ+ youth are at increased risk for poorer outcomes compared with the general foster care population (1, 2, 3).Among California children and youth exiting foster care in 2020, more than one in eight aged out of the system without being reunited with their families or connected with another permanent family (7). Recognizing the need to support these youth in the transition to adulthood, California and many other states now extend foster care services to age 21, and the Affordable Care Act ensures that health coverage continues until age 26 (3). However, aging out of the system still creates challenges, as these young adults face increased risks for homelessness, inadequate housing, low educational and career attainment, early parenthood, physical and mental health problems, and involvement with the criminal justice system, among other negative outcomes (2, 3). Additional efforts are needed to ensure these young people have the support and resources to successfully navigate the critical transition to adulthood (2, 3).
For more information, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. U.S. Department of Health and Human Services, Children's Bureau. (2021). Child welfare outcomes 2018: Report to Congress. Retrieved from: https://cwoutcomes.acf.hhs.gov/cwodatasite
2. Lantos, H., et al. (2022). Integrating positive youth development and racial equity, inclusion, and belonging approaches across the child welfare and justice systems. Child Trends. Retrieved from: https://www.childtrends.org/publications/integrating-positive-youth-development-and-racial-equity-inclusion-and-belonging-approaches-across-the-child-welfare-and-justice-systems
3. Courtney, M. E., et al. (2020). Findings from the California Youth Transitions to Adulthood Study (CalYOUTH): Conditions of youth at age 23. Chapin Hall. Retrieved from: https://www.chapinhall.org/research/calyouth-wave4-report
4. National Conference of State Legislatures. (2022). Family First Prevention Services Act. Retrieved from: https://www.ncsl.org/research/human-services/family-first-prevention-services-act-ffpsa.aspx
5. California Department of Social Services. (n.d.). Continuum of care reform. Retrieved from: https://www.cdss.ca.gov/inforesources/Continuum-of-Care-Reform
6. KIDS COUNT Data Center. (2022). Children in foster care in California; Children entering foster care in the United States. Annie E. Casey Foundation.
7. Child Trends. (2022). State-level data for understanding child welfare in the United States: California foster care. Retrieved from: https://www.childtrends.org/cta-uploads/child-welfare-fy2020/pdf/state_profiles_mar8/foster/California.pdf
- How Children Are Faring
In 2018, 2.4 per 1,000 California children ages 0-17 entered foster care for the first time, a drop of more than 30% compared with twenty years earlier. Across time periods, infants consistently have higher rates of first entry into care than older children. Statewide, the rate of children under age 1 entering foster care for the first time in 2016-2018 (12.2 per 1,000) was more than three times the rate for children ages 1-2, nearly five times that for ages 3-5, and more than 6 times the rates for older groups. Among all children entering foster care for the first time in 2016-2018, 87% were removed from their families due to neglect, 7% due to physical abuse, and 2% due to sexual abuse.
The number of California children and youth ages 0-20 living in foster care on July 1, 2018 was 59,172—a rate of 5.3 per 1,000. Of these, 19,111 were placed in kinship care, 13,229 with foster family agencies, 7,452 in foster homes, and 6,147 in guardianship. At the county level, rates of youth in care ranged from 1.2 per 1,000 (Marin) to 18.8 per 1,000 (Trinity) among regions with data. In-care rates for African American/black and American Indian/Alaska Native youth statewide are substantially higher than rates for their peers in other groups—more than 20 youth in care per 1,000 in 2018, compared with 5.3 per 1,000 (Hispanic/Latino), 4.4 per 1,000 (white), and 1 per 1,000 (Asian/Pacific Islander).
Among California children under age 18 in foster care on March 31, 2019, 73% had received timely medical exams and 67% timely dental exams. Across counties with data, percentages ranged from 42% to 98% for timely medical exams and from 7% to 95% for timely dental exams.Statewide, the median length of stay for children entering foster care in 2017 was 17.4 months. After declining from 17.2 in 2001 to a low of 13.2 in 2009, the median number of months in foster care increased in seven of the eight years that followed. For children entering care for the first time in 2017, 34% were reunified with their families and 64% were still in foster care one year after entry.
- Policy Implications
Children and youth in foster care interact with a range of public and private systems that are meant to provide protection and support, facilitate healing, and secure permanent, safe homes. Unfortunately, many children who are removed from their family homes spend years in the system, often in multiple foster placements, which can traumatize them further (1, 2). Foster children tend to fare worse on measures of mental and physical health, education, justice system involvement, employment in adulthood, and other outcomes when compared with the general child population (3, 4).
Policymakers have an important role to play in preventing children from entering foster care, ensuring the well being of those in care, and facilitating supportive connections and opportunities to enable youth aging out of foster care to thrive as adults. This is particularly critical for children of color and LGBTQ+ youth, who are overrepresented in the child welfare system and are at increased risk for adverse life outcomes (3, 5, 6). Foster children with disabilities also are vulnerable, as they face additional challenges compared with other foster children and are less likely to find permanent family homes upon leaving care (1). While California has been a leader in foster care policy and systems change, systemic inequities and substantial unmet needs remain, requiring additional work and investments (2, 4, 5, 7).
Policy and program options that could help prevent children from entering foster care and improve outcomes for those in care include:
For more information, see kidsdata.org’s Research & Links section or visit the Child Welfare Information Gateway and California Evidence-Based Clearinghouse for Child Welfare.
- Ensuring that implementation of the Family First Prevention Services Act is effective in achieving its aim of preventing children from entering foster care, and that resources are maximized to meet the needs of families of color and LGBTQ+ youth (5, 6)
- Supporting and strengthening reforms—such as the Continuum of Care Reform and the California Advancing and Innovating Medi-Cal (CalAIM) Initiative—that prioritize placing children in foster family homes over group care settings and that advance integrated, comprehensive services to meet the unique needs of foster children, including those with complex health needs (2, 5, 8)
- Promoting efforts to recruit, strengthen, and support foster family homes, especially those provided by relatives of children in care and those where harder-to-place children, older youth, and sibling groups can be placed (7, 8)
- Continuing to address family separation issues related to immigration enforcement and strengthening child welfare agencies’ ability to meet the specific needs of immigrant children (7, 9)
- Supporting ongoing efforts to reduce the overrepresentation of, and improve outcomes for, children of color—particularly African American/black and American Indian/Alaska Native children—and LGBTQ+ youth in the system or at risk of entering it (3, 5, 6, 7)
- Raising public awareness about the commercial sexual exploitation of children and youth in California, recognizing that many victims have been in the foster care system, and working collaboratively with survivors and across sectors to implement policy and practice solutions (7, 10)
- Supporting the educational success of foster children through improved Local Control Funding Formula oversight and data monitoring, enhanced strategies to reengage students who are disconnected from school, and reduced barriers to specialized services; also, ensuring that foster youth have the support and resources to pursue postsecondary education and workforce opportunities (2, 5, 11)
- Strengthening and expanding existing laws, programs, and strategies that support foster youth in the transition to adulthood, build on lessons learned from implementation of the California Fostering Connections to Success Act, and improve the capacity of child welfare agencies to serve young adults (4, 12)
- Engaging foster care youth as partners in decision-making and increasing collaboration across sectors (e.g., child welfare, education, health care, juvenile justice, housing, etc.) to better serve the needs of diverse groups, including, among others, youth with disabilities, LGBTQ+ youth, youth of color, parenting youth, and youth facing homelessness (3, 6, 7, 8)
Sources for this narrative:
1. U.S. Department of Health and Human Services, Children's Bureau. (2021). Child welfare outcomes 2018: Report to Congress. Retrieved from: https://cwoutcomes.acf.hhs.gov/cwodatasite
2. Children Now. (2022). 2022 California children's report card: A survey of kids' well-being and roadmap for the future. Retrieved from: https://www.childrennow.org/portfolio-posts/2022-california-childrens-report-card
3. Lantos, H., et al. (2022). Integrating positive youth development and racial equity, inclusion, and belonging approaches across the child welfare and justice systems. Child Trends. Retrieved from: https://www.childtrends.org/publications/integrating-positive-youth-development-and-racial-equity-inclusion-and-belonging-approaches-across-the-child-welfare-and-justice-systems
4. Courtney, M. E., et al. (2020). Findings from the California Youth Transitions to Adulthood Study (CalYOUTH): Conditions of youth at age 23. Chapin Hall. Retrieved from: https://www.chapinhall.org/research/calyouth-wave4-report
5. Short, A. (2022). The 2022-23 budget: Analysis of child welfare proposals and program implementation updates. Legislative Analyst's Office. Retrieved from: https://lao.ca.gov/Publications/Report/4558
6. Raimon, M. L. (2021). The opportunity is now: Five ways to better serve adolescents and young adults through the Family First Prevention Services Act (FFPSA). Center for the Study of Social Policy. Retrieved from: https://cssp.org/resource/the-opportunity-is-now-five-ways-better-serve-adolescents-ffpsa
7. California Department of Social Services. (2019). Child and family services plan 2020-2024. Retrieved from: https://www.cdss.ca.gov/inforesources/child-welfare-program-improvement/child-and-family-services-plan
8. California Department of Social Services. (n.d.). Continuum of care reform. Retrieved from: https://www.cdss.ca.gov/inforesources/Continuum-of-Care-Reform
9. Prandini, R., et al. (2019). Strengthening child welfare practice for immigrant children and families: A toolkit for child welfare professionals in California. National Center For Youth Law & Immigrant Legal Resource Center. Retrieved from: https://youthlaw.org/resources/strengthening-child-welfare-practice-immigrant-children-families-toolkit-child-welfare-0
10. Walker Brown, K., et al. (2021). Strategies to end commercial sexual exploitation of youth: A toolkit for collaborative action. National Center for Youth Law. Retrieved from: https://youthlaw.org/resources/strategies-end-commercial-sexual-exploitation-youth-toolkit-collaborative-action
11. Alliance for Children's Rights. (2021). Best practices guide for developing a district system to improve education outcomes for youth in foster care. Retrieved from: https://allianceforchildrensrights.org/resources/best-practices-guide
12. McDaniel, M., et al. (2019). Specialized case management for young adults in extended federal foster care. Urban Institute & U.S. Department of Health and Human Services. Retrieved from: https://www.urban.org/research/publication/specialized-case-management-young-adults-extended-federal-foster-care
- Research & Links
- Websites with Related Information
- Administration for Children and Families: Abuse, Neglect, Adoption and Foster Care. U.S. Dept. of Health and Human Services.
- American Academy of Pediatrics: Foster Care
- Annie E. Casey Foundation: Child Welfare
- California Dept. of Social Services: Foster Care
- California Evidence-Based Clearinghouse for Child Welfare
- Center for the Study of Social Policy: Child Welfare
- Chapin Hall: Child Welfare. University of Chicago.
- Child Trends: Child Welfare
- Child Welfare Information Gateway. U.S. Dept. of Health and Human Services, Children’s Bureau.
- Child Welfare League of America
- Children Need Amazing Parents (CHAMPS)
- Children's Data Network. USC School of Social Work.
- Continuum of Care Reform. California Dept. of Social Services.
- Juvenile Law Center: Extended Foster Care
- National Center for Youth Law: Foster Care
- Represent: The Voice of Youth in Care. Youth Communication.
- Key Reports and Research
- 2022 California Children's Report Card. Children Now.
- Advancing Healthy Outcomes: Eight Ways to Promote the Health and Well-Being of LGBTQ+ Youth Involved with Child Welfare through FFPSA. (2019). Center for the Study of Social Policy. Citrin, A., & Martin, M.
- Best Practices Guide for Developing a District System to Improve Education Outcomes for Youth in Foster Care. (2021). Alliance for Children’s Rights.
- Breaking the Stigma and Changing the Narrative: Strategies for Supporting Expectant and Parenting Youth Involved in Systems of Care. (2022). Center for the Study of Social Policy & National Council of Juvenile and Family Court Judges.
- California Youth Transitions to Adulthood Study (CalYOUTH) (2021). Chapin Hall. Courtney, M. E., et al.
- Children Living Apart from Their Parents: Highlights from the National Survey of Children in Nonparental Care. (2016). U.S. Dept. of Health and Human Services. Radel, L., et al.
- Embracing a “Youth Welfare” System: A Guide to Capacity Building. (2018). Capacity Building Center for States.
- Entangled Roots: The Role of Race in Policies that Separate Families. (2018). Center for the Study of Social Policy. Minoff, E.
- Family First Prevention Services Act. (2022). National Conference of State Legislatures.
- How Can Child Protection Agencies Support Families and Children Who Lack Lawful Immigration Status? (2020). Casey Family Programs.
- How the Child Welfare System Works. (2020). Child Welfare Information Gateway.
- Integrating Positive Youth Development and Racial Equity, Inclusion, and Belonging Approaches Across the Child Welfare and Justice Systems. (2022). Child Trends. Lantos, H., et al.
- LGBTQ Youth in the Foster Care System. Human Rights Campaign.
- Mental and Physical Health of Children in Foster Care. (2016). Pediatrics. Turney, K., & Wildeman, C.
- Recommendations to Improve Out-of-Home Care from Youth Who Have Experienced Commercial Sexual Exploitation. (2020). Children and Youth Services Review. Dierkhising, C. B., et al.
- Strengthening Child Welfare Practice for Immigrant Children and Families: A Toolkit for Child Welfare Professionals in California. (2019). National Center for Youth Law & Immigrant Legal Resource Center. Prandini, R., et al.
- Systemically Neglected: How Racism Structures Public Systems to Produce Child Neglect. (2022). Center for the Study of Social Policy. Minoff, E., & Citrin, A.
- The Opportunity is Now: Five Ways to Better Serve Adolescents and Young Adults through the Family First Prevention Services Act (FFPSA) (2021). Center for the Study of Social Policy. Raimon, M. L.
- The Path to Racial Equity in Child Welfare: Valuing Family and Community. (2021). Alliance for Children’s Rights.
- County/Regional Reports
- 2023 California County Scorecard of Children's Well-Being. Children Now.
- Annual Report on the Conditions of Children in Orange County. Orange County Children's Partnership.
- Commercially Sexually Exploited Girls and Young Women Involved in Child Welfare and Juvenile Justice in Los Angeles County. (2018). National Center for Youth Law & California State University, Los Angeles. Dierkhising, C. B., et al.
- Dually-Involved Youth: Investigating Intersections Between the Child Welfare and Juvenile Justice Systems in Los Angeles County. Children’s Data Network.
- Important Facts About Kern’s Children. Kern County Network for Children.
- Live Well San Diego Report Card on Children, Families, and Community. The Children’s Initiative.
- Pathway to Progress: Indicators of Young Child Well-Being in Los Angeles County. First 5 LA.
- Santa Clara County Children's Data Book. Santa Clara County Office of Education, et al.
- Santa Monica Youth Wellbeing Report Card. Santa Monica Cradle to Career.
- Sexual and Gender Minority Youth in Foster Care: Assessing Disproportionality and Disparities in Los Angeles. (2014). Williams Institute, et al. Wilson, B. D. M., et al.
- More Data Sources For Foster Care
- California Child Welfare Indicators Project. University of California at Berkeley & California Dept. of Social Services.
- Children’s Bureau: Data and Research. U.S. Dept. of Health and Human Services.
- DataQuest. California Dept. of Education.
- KIDS COUNT Data Center. Annie E. Casey Foundation.
- National Data Archive on Child Abuse and Neglect
- National Survey of Child and Adolescent Well-Being. U.S. Dept. of Health and Human Services.
- National Survey of Children in Nonparental Care. Centers for Disease Control and Prevention.
- State-Level Data for Understanding Child Welfare in the United States. Child Trends.
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