Specifically, an estimated 12 percent of the children received no routine health care, and 34 percent received no immunizations in the three locations reviewed. Many of these children may need health-related services and treatment beyond those needed by the average child. Although young foster children received a wide variety of services from health care providers, many children had identified health-related needs that were not met. HIV-Infected Children Need to Be Identified Early, but Risk Assessments Often Did Not Take Place

One particularly critical health need of young foster children is HIV risk assessment because most young children in the locations reviewed are at risk for the infection as a result of parental drug abuse. The Number of HIV-Infected Children Is Largely Unknown as Few Children Are Tested

Foster care agencies in the locations reviewed do not know the full extent of their caseloads that is at high risk for HIV since no mechanism exists to ensure that all young foster children are assessed for HIV risk. Few data are available on the number of foster children infected with HIV. Children Placed With Relatives in Los Angeles County and New York City Were Less Likely to Receive Health-Related Services

Young children placed exclusively with relatives—known as kinship care—were less likely to receive health-related services than children placed exclusively with nonrelatives—known as traditional foster care.Specifically, children placed in kinship care were nearly three times as likely as those placed in traditional foster care to have received no routine health care. Studies indicate that caseworkers generally provide less monitoring and assistance to kinship care placements. Other efforts by this agency have focused on establishing medical clinics for foster children. ACF also audits states to certify states’ compliance with the safeguards for foster children specified in the Social Security Act. It questioned whether inadequate caseworker recordkeeping provided an incomplete depiction of the health-related services received by young foster children. “Guidelines for Human Immunodeficiency Virus (HIV)-Infected Children and Their Foster Families.” Pediatrics, Vol. 4 (Apr. 1 (Spring 1991). U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. 1 (1994).
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on the health-related services needed and received by young children in foster care, focusing on: (1) the relationship between the receipt of health-related services and foster care placements with relatives versus placements with nonrelatives; and (2) how responsible agencies are ensuring that foster children are receiving needed health-related services.

What GAO Found

GAO found that: (1) despite foster care agency regulations requiring comprehensive routine health care, an estimated 12 percent of young foster children receive no routine health care, 34 percent receive no immunizations, and 32 percent have some identified health needs that are not met; (2) an estimated 78 percent of young foster children are at high risk for human immunodeficiency virus (HIV) as a result of parental drug abuse, yet only about 9 percent of foster children are tested for HIV; (3) young foster children placed with relatives receive fewer health-related services than children placed with nonrelative foster parents, possibly since relative caregivers receive less monitoring and assistance from caseworkers; (4) the number of young children placed with relatives increased 379 percent between 1986 and 1991, which resulted in the lower likelihood of these children receiving services associated with kinship care; and (5) the Department of Health and Human Services has not designated any technical assistance to assist states with health-related programs for foster children and does not audit states' compliance with health-related safeguards for foster children.