In recent years, America's present means of providing for unwanted children, the foster care system, has come under severe criticism from many child-serving professional groups. The Committee on Adoption and Dependent Children of the American Academy of Pediatrics notes that children in foster care are not likely to receive routine health care, such as immunizations and screening for hypertension, dental caries, or vision or hearing problems.1 Yet these vulnerable children frequently have significant health problems, and they may require more medical attention than the average child. In Massachusetts, 33% of the children in foster care have emotional handicaps, 13% suffer from serious physical illnesses, 19% are mentally retarded, and 15% have multiple handicaps.2 Children in foster care often lack a single health provider and they have few health advocates. Despite criticism from pediatricians about the sorry state of health care provided to these children, pediatricians frequently find themselves in the uneasy position of recommending foster care placement to social service workers in intransigent cases of child abuse and neglect.
Child psychiatrists, such as Anna Freud and Albert Solnit, have joined pediatricians in criticizing foster care. They point out that a child cannot develop emotionally in a rotating system of foster homes. With each move, the foster child becomes less open, attachments less intense. As a result, children emerge from foster care with significant emotional handicaps.3
Social workers, those professionals who work most closely with unwanted children, have added to the chorus of concern over foster care. They point to the difficulty of early identification of the family in trouble and then successful intervention.