Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children
(Letter Report, 04/04/94, GAO/HEHS-94-89).

The 1991 population of young foster care children differs significantly
from the 1986 population in the three locations GAO
reviewed--California, New York, and Pennsylvania, the states with the
largest average foster care populations in 1991.  The 1991 population is
much larger, more of these children entered foster care due to some form
of neglect, these children have more health-related problems and are at
high risk for further problems due to prenatal drug exposure, and they
are more likely to be eligible for federal payments.  Both federal and
state expenditures have felt the impact of the rising number of young
foster children and the decline in their overall health.  Further, two
broad service needs overlap foster and health care programs.  First,
drug abuse treatment programs for biological mothers and pregnant women
are needed to reduce the risks associated with prenatal drug exposure
and the likelihood that children will be removed from their families.
Second, services to address the health and developmental needs of
drug-exposed children are needed to treat their problems. Although few
alternatives to foster care are now available to these families, meeting
these needs should increase the chances for family reunification.
However, drug abuse, to the extent that it persists, will remain a
hidden contributor to the costs of various federal programs.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-94-89
     TITLE:  Foster Care: Parental Drug Abuse Has Alarming Impact on 
             Young Children
      DATE:  04/04/94
   SUBJECT:  Foster children
             Public assistance programs
             Drug abuse
             Drug treatment
             Health care services
             Alcohol or drug abuse problems
             Health care costs
             Women
             Federal/state relations
             Parents
IDENTIFIER:  California
             New York
             Pennsylvania
             Los Angeles County (CA)
             New York (NY)
             Philadelphia (PA)
             Aid to Families with Dependent Children Program
             AFDC
             Medicaid Program
             
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Cover
================================================================ COVER


Report to the Chairman, Subcommittee on Human Resources, Committee on
Ways and Means
House of Representatives

April 1994

FOSTER CARE - PARENTAL DRUG ABUSE
HAS ALARMING IMPACT
ON YOUNG CHILDREN

GAO/HEHS-94-89

Young Foster Children


Abbreviations
=============================================================== ABBREV

  AIDS - acquired immune deficiency syndrome
  AFDC - Aid to Families with Dependent Children
  EPSDT - early and periodic screening, diagnosis, and treatment
  FAS - fetal alcohol syndrome
  HHS - Department of Health and Human Services
  HIV - human immunodeficiency virus
  LSD - lysergic acid diethylamide
  PCP - phencyclidine hydrochloride

Letter
=============================================================== LETTER


B-251314

April 4, 1994

The Honorable Harold E.  Ford
Chairman, Subcommittee on Human Resources
Committee on Ways and Means
House of Representatives

Dear Mr.  Chairman: 

As the nation's policymakers consider national health care and
welfare reforms, the information contained in this report should be
valuable in helping frame policies that can significantly impact one
of our most vulnerable population groups--young foster children--and
their families.  The average number of children in foster care
nationwide increased 53 percent in 5 years, from 280,000 in 1986 to
429,000 in 1991.  The three states we reviewed care for over 50
percent of the foster care population.  In those states, the number
of children in foster care increased about 66 percent during that
period and the number of young foster children--those 36 months of
age and younger--more than doubled.  Additionally, more young foster
children had health-related problems, including prenatal exposure to
drugs, in 1991 than in 1986. 

This report responds to the first of three issues in your request;
that we compare and contrast the population sizes and distinctive
characteristics of young foster children in 1986 and 1991.  As
agreed, we plan to report later on the two remaining issues:  (1) how
and to what extent the service needs of young foster children are
identified and met, and (2) the areas where federal assistance to
states could best serve the needs of young foster children and
increase their chances of becoming self-sufficient or, at a minimum,
less dependent on government assistance later in life. 

We reviewed foster care programs in California, New York, and
Pennsylvania, the states with the largest average foster care
populations in 1991.  We analyzed statewide foster care databases for
California and New York and reviewed random samples of case files for
1986\1 and 1991 from those of 32,123 young foster children in three
locations:  Los Angeles County, New York City, and Philadelphia
County.\2 These locations cared for a substantial portion of each
state's young foster children in 1991:  44 percent in California, 81
percent in New York, and 29 percent in Pennsylvania. 


--------------------
\1 For one location in the 1986 sample, program officials could not
locate about 40 percent of the requested case files.  Appendix I
describes the steps we took to ensure that comparisons between 1986
and 1991 case file review results were appropriate. 

\2 Pennsylvania does not have a statewide foster care database; to
review this state's foster care program we relied on summaries that
the state compiles from aggregate data submitted by its counties. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

The 1991 population of young foster children is significantly
different from the 1986 population in the locations reviewed in a
variety of ways:  the 1991 population size is much larger, more of
these children entered foster care due to some form of neglect, their
biological parents are more likely to abuse drugs, these children
have more health-related problems and are at high risk for further
problems due to prenatal drug exposure,\3 and they are more likely to
be eligible for federal maintenance payments. 

The number of young foster children increased at almost twice the
rate of the general foster care population.  Neglect and caretaker
absence prompted an estimated 68 percent of removals, up from 47
percent in 1986.  We estimate that families where at least one parent
was a drug abuser increased from 52 percent to 78 percent.  An
increasing percentage of children had serious health-related problems
in 1991 and most of them were prenatally exposed to drugs. 
Specifically, an estimated 58 percent of young foster children had
serious health-related problems in 1991 compared with 43 percent in
1986.  Those at high risk for problems due to prenatal drug exposure
increased from 29 percent to 62 percent over this period.  Cocaine
was the most prevalent drug children were prenatally exposed to in
both years; documented prenatal cocaine exposure increased from 17
percent to 55 percent between 1986 and 1991.  A larger percentage of
young foster children qualified for federal maintenance payments in
1991 than previously.  At the same time, the growing number of young
foster children increased overall maintenance expenditures,
compounding their financial impact on government.  Federal and state
governments in these three states alone spent over $2 billion in 1992
to maintain foster children of all ages. 

These changes have implications for federal foster care and health
care programs.  Both federal and state expenditures have felt the
impact of the growth in the number of young foster children and the
decline in their overall level of health.  Further, two broad service
needs overlap foster and health care programs.  First, drug abuse
treatment programs for biological mothers and pregnant women are
needed to reduce the risks associated with prenatal drug exposure and
the likelihood that children will be removed from their families. 
Second, services to address the health and developmental needs of
drug-exposed children are needed to treat their problems.  While few
alternatives to foster care currently exist for many of these
families, meeting both of these service needs should increase the
possibility that such families can be reunified and leave the foster
care system.  However, drug abuse, to the extent it continues to
occur, will remain a hidden contributor to the costs of various
federal programs. 


--------------------
\3 We included alcohol abuse in our definition of drug abuse. 
However, the documented incidence of alcohol use was low, about 6
percent in 1991 and 3 percent in 1986. 


   BACKGROUND
------------------------------------------------------------ Letter :2

While the federal, state, and county governments and foster parents
share responsibility for providing care and services to foster
children, the Department of Health and Human Services (HHS) is
responsible for the management and oversight of federal programs
benefiting foster children.  The programs are authorized primarily by
the Social Security Act.  The act, in part, authorizes expenditures
to (1) maintain foster children who are eligible under the Aid to
Families with Dependent Children (AFDC) program, (2) assist states in
providing child welfare services, and (3) provide medical care. 
Primarily, HHS establishes federal regulations and monitors states'
compliance with them for children placed in federally funded foster
care and other programs under the act and administers federal funding
for them. 

Federal expenditures for the administration and maintenance of
AFDC-eligible foster children are authorized under title IV-E of the
Social Security Act.  Those expenditures increased from about $637
million in 1986 to over $2.2 billion nationwide in 1992.  The federal
portion of foster care maintenance costs varies by state and is
linked to a state's Medicaid matching rate.  The federal portion
ranges from 50 percent to 83 percent of the maintenance cost for
AFDC-eligible foster children; states or counties are responsible for
the full cost of maintaining foster children who are not eligible for
AFDC benefits.  Thus, payments to foster parents for the care of an
AFDC-eligible foster child are comprised of federal, state, and in
some cases county monies. 

In addition to maintenance funds under title IV-E, federal funds
authorized in other titles of the Social Security Act may be used to
provide medical and other needed services to foster children.  States
may participate in programs such as title IV-B, federal matching
grants for various child welfare services; title XIX, Medicaid, for
medical services for foster children; and, title XX, block grants for
a wide array of social services for children.  Data were unavailable
to estimate the additional federal, state, and county expenditures
for these other services for foster children.  However, we previously
reported that median costs associated with newborn medical care for
infants known to be prenatally drug-exposed were approximately $1,100
to $4,100 higher (in 1989 dollars) than for other infants.  Further,
an HHS study provides an example of Medicaid costs in California from
1986 to 1988 for children from birth to 24 months of age.  HHS
reported a 2-year average Medicaid expenditure of $1,551 for children
who were not identified as being prenatally exposed to drugs compared
to $2,285 for those who were known to be exposed.\4 Further, medical
expenses for drug-exposed foster children from birth to 12 months of
age were 62 percent greater than the medical expenses for
drug-exposed children who were not in foster care. 


--------------------
\4 An Exploratory Analysis of the Medicaid Expenditures of Substance
Exposed Children Under 2 Years of Age in California, Office of the
Assistant Secretary for Planning and Evaluation and Health Care
Financing Administration, HHS (1993) (study prepared by SysteMetrics,
a division of MEDSTAT Systems, Inc., Cambridge, Mass.).  The average
was calculated for all children receiving Medicaid benefits in
California, not just foster children.  It also excluded costs for the
federally mandated Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) services and delivery services at birth.  However,
we believe that this is a reasonable minimum estimate of average
costs for foster children as well. 


   MORE YOUNG CHILDREN IN FOSTER
   CARE
------------------------------------------------------------ Letter :3

The foster care populations in the states reviewed increased
dramatically between 1986 and 1991, with the number of young foster
children increasing at a faster rate.  The total foster care
population in these states increased 66 percent while the number of
young foster children increased 110 percent.  During the same years,
the total number of young children in these states increased 19
percent, indicating that a greater percentage of all young children
in these states entered foster care in 1991 than entered previously. 
(See fig.  1 and tables II.1-II.4 in app.  II.)

   Figure 1:  Increase in Foster
   Care and Child Populations in
   Three States Between 1986 and
   1991

   (See figure in printed
   edition.)

Note:  Part of New York's increase in foster children is due to the
provisions of the New York Supreme Court case, Eugene F., which
required all foster children placed with relatives to be included in
foster care caseloads and eligible for services.

Pennsylvania's count of "Young Foster Children" consists of all
foster children under age 5, as its aggregate data did not break out
children under age 3.

California and New York foster children counts represent all children
in foster care at any time during the review year; Pennsylvania data
for foster children represent year-end counts, as comparable data
were not available. 

Sources:  California and New York--state databases;
Pennsylvania--aggregated state data; except "All Children and All
Young Children"--Bureau of the Census midyear estimates. 


   NEGLECTFUL OR ABSENT PARENTS
   TRIGGERED MOST REMOVALS FROM
   HOME
------------------------------------------------------------ Letter :4

Neglect and caretaker absence or incapacity were the primary reasons
why young children were removed from their families in both
California and New York, the states where data were available. 
Together, these reasons accounted for approximately 47 percent and 68
percent of the removals in 1986 and 1991, respectively.  No other
reasons for removals, such as physical abuse, accounted for a large
portion of the entries of young children into foster care in either
year.  For example, all types of abuse accounted for 11 percent of
the removals of young children in 1986 and 7 percent in 1991.  (See
fig.  2 and table II.6 in app.  II.)

   Figure 2:  Reasons for Removal
   of Young Children From Home in
   California and New York

   (See figure in printed
   edition.)

Note:  There were other reasons for removals that did not account for
significant portions of total removals.  In addition, some cases only
show broad service program categories, such as "court ordered
placement;" others are listed as unknown or error. 

\a Includes removals due to neglect, caretaker absence or incapacity,
relinquishment, and voluntary placements. 

\b Consists of physical, sexual, and emotional abuse. 

\c Consists of New York data only.  This state uses up to two reasons
for removal, thus, abuse and/or neglect can be cited.  Further, the
definitions of some reasons for removal, such as Health/Safety, refer
to abuse and/or neglect. 

Source:  State electronic databases. 


      DRUG ABUSE FURTHER IMPACTS
      TROUBLED FAMILIES
---------------------------------------------------------- Letter :4.1

To better describe the parents' situation around the time their
children were removed from home, we reviewed random samples of case
files for certain difficulties that families face in the three
locations reviewed.  Of these situations, estimated increases in the
number of parents who abused drugs or had other children in foster
care are significant between 1986 and 1991.  Fully 78 percent of the
young foster children reviewed had at least one parent who was
abusing drugs or alcohol in 1991 compared with 52 percent in 1986. 
Families with other children in foster care increased from 68 percent
to 79 percent.  Further, families with no other children decreased
from an estimated 18 percent to 11 percent during this time. 

Families in 1991 had additional serious problems in common with their
counterparts in 1986 in the three locations.  For example, the
percentage of young foster children who came from families with at
least one parent absent was high in both years, estimated at about 70
percent.  In addition, over 27 percent of the young foster children
in these years came from families where both parents were absent from
the home around the time of the child's removal, according to our
estimates.  (See fig.  3 and table II.7 in app.  II.)

   Figure 3:  Family Situation in
   Three Counties

   (See figure in printed
   edition.)

\a Differences are not statistically significant at the 95-percent
confidence level. 

Source:  Case file review. 

The urgent need for attention to the problems that these families
face is underscored by the facts that in 1991, about one-third of
these families were comprised of drug-abusing single mothers and most
had more than one child in foster care.  Without treatment programs
designed for pregnant women and mothers, women are likely to continue
using drugs, leaving few alternatives to foster care for these
families.  Yet, as we previously reported, access to treatment
programs for pregnant women is lacking.\5


--------------------
\5 ADMS Block Grant:  Women's Set-Aside Does Not Assure Drug
Treatment for Pregnant Women (GAO/HRD-91-80, May 6, 1991). 


   MORE CHILDREN ARE ILL OR AT
   HIGH RISK
------------------------------------------------------------ Letter :5

Young children in foster care have or are at high risk for a wide
range of health problems.  In the locations reviewed, young foster
children with serious physical health problems increased
significantly, to an estimated 58 percent; similarly, 62 percent of
them were at high risk for serious health problems due to prenatal
drug exposure in 1991.  The comparable estimates for 1986 were 43
percent and 29 percent, respectively.\6 (See fig.  4 and table II.8
in app.  II.)

   Figure 4:  Health Conditions of
   Young Foster Children in Three
   Counties

   (See figure in printed
   edition.)

\a Consists of prenatal drug exposure (including alcohol exposure)
and drug withdrawal or symptoms. 

\b Consists of fetal alcohol syndrome (FAS), low birth weight,
cardiac defects or heart problems, HIV positive or AIDS,
developmentally delayed, and other serious problems. 

\c Consists of psychologically disturbed and behavioral problems. 

\d Consists of physical, sexual, and emotional abuse. 

\e Differences are not statistically significant at the 95-percent
confidence level. 

\f Consists of children who did not have any of the above conditions. 
However, these children may have had minor illnesses. 

Source:  Case file review. 

Medical research suggests that the chronic illnesses these children
have or are at risk for, such as developmental delays, may have been
caused or compounded by prenatal exposure to drugs and alcohol. 
Supportive services and treatment beyond those needed by the average
child will be required for many of them. 

In addition, the number of drug-exposed children may be
underestimated.  We relied on mothers' self-reporting of drug use as
well as the more objective toxicology tests.  Yet, not all children
or mothers are tested at birth for drugs and, when tested, only
recent drug use can be confirmed.  In 1991 only 59 percent of young
foster children were known to have received a toxicology test at
birth to determine prenatal drug exposure in the days before
delivery.  We previously reported that hospitals differ in their
efforts to identify drug-exposed infants.\7 Further, while hospitals
serving primarily Medicaid patients are more likely to perform
toxicology tests than those serving primarily non-Medicaid patients,
drug use during pregnancy is as likely to occur among privately
insured women as among those relying on public assistance for their
health care. 


--------------------
\6 We considered a child to be prenatally drug-exposed if any of the
following conditions were documented in the child's foster care
records:  mother self-reported drug use during pregnancy, toxicology
test results for mother or infant were positive for drug use, or
infant was diagnosed as having drug-withdrawal symptoms. 

\7 Drug-Exposed Infants:  A Generation at Risk (GAO/HRD-90-138, June
28, 1990). 


      COCAINE USE ESCALATED
---------------------------------------------------------- Letter :5.1

Cocaine was the most prevalent drug that young foster children were
known to be prenatally exposed to in both years.  The percentage of
young foster children estimated to have been prenatally exposed to
cocaine increased significantly, from 17 percent in 1986 to 55
percent in 1991.  Because toxicology tests cannot identify the form
of cocaine used, we often could not determine whether crack or
another form of cocaine had been used; however, in some cases mothers
self-reported crack use.  Of the children who were prenatally
drug-exposed in 1991, 24 percent of their mothers used more than one
kind of drug during pregnancy.  (See fig.  5 and table II.9 in app. 
II.)

   Figure 5:  Prenatal Drug
   Exposure in Three Counties

   (See figure in printed
   edition.)

\a Includes crack and other cocaine derivatives. 

\b Includes heroin and methadone. 

\c Differences are not statistically significant at the 95-percent
confidence level. 

\d Includes methamphetamines. 

Source:  Case file review. 

The increased use of cocaine by the mothers of young foster children
adds additional urgency to the need for drug treatment programs if
the impact of drug abuse on foster care is to be alleviated.  Studies
have found that prenatal cocaine exposure can be addictive and can
result in withdrawal symptoms, direct injuries, and disabling effects
on developing fetuses.  When the crack derivative of cocaine is used,
the user can become addicted much more quickly and the effects of the
exposure on the fetus are more severe.  We previously reported that
researchers attribute crack's popularity among women to its low cost
and the users' perception that smoking a drug is more acceptable and
less intrusive than injecting one.\8 Further, we reported that a
study of prostitutes found that cocaine and crack users are as likely
as intravenous drug users to test positive for the human
immunodeficiency virus (HIV) that causes AIDS.  Other research has
found that mothers who abuse cocaine are likely to have three to five
children.  Thus, cocaine-abusing women may have a greater impact on
both the foster and health care systems than users of other drugs. 


--------------------
\8 Drug Abuse:  The Crack Cocaine Epidemic--Health Consequences and
Treatment (GAO/HRD-91-55FS, Jan.  30, 1991). 


   FOSTER CARE COSTS INCREASED
------------------------------------------------------------ Letter :6

A greater portion of foster care maintenance expenditures for young
children shifted to the federal government between 1986 and 1991,
compounding the impact of the increase in overall foster care
maintenance costs.  Much of the 110-percent growth in the population
of young foster children between 1986 and 1991 occurred among those
who were AFDC-eligible for federal matching funds, thereby placing
even greater financial responsibility on the federal level.  (See
fig.  6 and table II.10 in app.  II.)

   Figure 6:  Sources of Foster
   Care Maintenance Funding in
   California and New York

   (See figure in printed
   edition.)

Source:  State electronic databases. 

For the three states reviewed--California, New York, and
Pennsylvania--total foster care maintenance expenditures, including
both state and federal portions, increased from about $848 million in
1986 to over $2 billion in 1992.\9 In 1992, foster parents of young
children received a minimum monthly payment of $345 in California,
$353 in New York, and $330 in Pennsylvania.  However, foster parents
can receive much higher payments to care for children with special
needs.  For example, in New York City, foster parents caring for very
sick children can be paid as much as $1,281 per month for each child
in their care.  Further, if foster children require specialized care
in a group setting, maintenance payments could be even higher; for
example, the maximum monthly payment is $4,762 in Los Angeles County. 


--------------------
\9 No national data exist on total costs for foster care. 


---------------------------------------------------------- Letter :6.1

We conducted our work between November 1992 and November 1993 in
accordance with generally accepted government auditing standards. 
Our scope and methodology are discussed further in appendix I.  As
agreed with your office, we did not obtain written comments on this
report, but discussed its contents with state and county program
officials in California, New York, and Pennsylvania and officials
from HHS.  We incorporated their comments where appropriate. 

In addition, unless you publicly announce its contents earlier, we
plan no further distribution of this report until 21 days after its
issue date.  At that time, we will send copies to the Secretary of
Health and Human Services, the Attorney General, the Director of the
Office of National Drug Control Policy, program officials in the
states reviewed, and other interested parties.  We will also make
copies available to others upon request.  For additional information,
please call me on (202) 512-7215.  Major contributors to this report
are listed in appendix III. 

Sincerely yours,

Jane L.  Ross
Associate Director
Income Security Issues


SCOPE AND METHODOLOGY
=========================================================== Appendix I

To accomplish the objectives of our review, we obtained and analyzed
data on state foster care programs and the children in them from the
three states with the largest average monthly foster care populations
in 1991--California, New York, and Pennsylvania.  Over 50 percent of
the nations's foster children are under the jurisdiction of the three
states we reviewed. 

We used a variety of approaches to meet our objectives.  We analyzed
electronic state and county foster care databases; conducted a case
file review based on generalizable random samples; interviewed
Department of Health and Human Services, state, and county foster
care officials; conducted a telephone survey of child welfare
advocacy groups and other child welfare experts; conducted group
interviews with foster parents and case workers; reviewed foster care
and related literature; reviewed applicable portions of the Social
Security Act and other legislation; and reviewed foster care agency
regulations and other documents. 


   STATEWIDE DATA
--------------------------------------------------------- Appendix I:1

To determine the foster care population size, reasons for removal,
and funding eligibility of young foster children, we analyzed
electronic foster care databases for states where they were
available, California and New York.  State officials provided us with
automated records for all children who were in foster care at any
time during calendar years 1986 and 1991. 

We could not obtain comparable electronic records for Pennsylvania as
that state has not established an automated case record system. 
Instead we relied on aggregate data available in management reports
for 1986 and 1991 to determine the size of the state foster care
population.  Thus, we relied on end-of-year data, which undercounts
the total foster care population for that state. 

To determine the population size for all children in the three
states, we used 1986 and 1991 Bureau of the Census midyear estimates. 


   COUNTY CASE FILE DATA
--------------------------------------------------------- Appendix I:2

To determine additional characteristics of young foster children, we
reviewed statistically representative samples of foster care case
files for the county with the largest foster care population in 1991
for each of the states reviewed.  To identify those locations, we
again used the state foster care databases for California and New
York; for Pennsylvania, we relied on information provided by state
officials.  The counties identified are Los Angeles County, New York
City, and Philadelphia County, respectively.\1 To complete our
sampling, Philadelphia County officials provided us with an
electronic database of foster children in that county in 1986 and
1991.  Table I.1 shows the number of children in that county whose
electronic records were initially supplied to us by county officials
and the final number of children whose records remained after we
expunged records that did not meet our criteria because they were for
children who were in emergency homeless shelters, not foster care. 



                          Table I.1
           
            Initial and Final Population Sizes for
               Philadelphia County's Electronic
             Database of Children in Foster Care


                 Initial                 Initial
                    size  Final size        size  Final size
------------  ----------  ----------  ----------  ----------
Philadelphia       8,852       7,405       8,885       7,704
 County
 database
------------------------------------------------------------
Before drawing the sample, we narrowed the databases to include only
foster children whose third birthday occurred no later than December
31 in the year under review.  In addition, we stratified the foster
care records of the 32,123 young foster children in our population by
location and by year.  Our initial samples contained 932 children. 
The population and initial sample sizes are shown in table I.2. 



                          Table I.2
           
           Initial Population and Sample Sizes for
                   Children in Foster Care


                      Populati            Populati
                            on    Sample        on    Sample
--------------------  --------  --------  --------  --------
Los Angeles County       4,241       226     8,249       137
New York City            4,381       150    13,171       150
Philadelphia County        746       142     1,335       127
============================================================
Total\a                  9,368       518    22,755       414
------------------------------------------------------------
\a Sample size totals are provided to indicate the composition of the
initial samples.  When used in analyses, sample strata were weighted. 

We requested all foster care case files for each child in the
samples.  A few case files were dropped from the samples because the
child did not meet the criteria of being in foster care during the
review year or was not of the appropriate age.  In addition, other
case files were dropped because county officials could not locate
them.  In particular, for one county, many of the 1986 case files we
requested could not be found.  By comparing demographic data for
available and unavailable case files in that county, we determined
that the two groups had similar characteristics.  Further, state and
county program officials told us that they are unaware of differences
between the available and unavailable case files and believe that
they represent the same population.  We concluded that the dropped
case files were likely to be analogous to those we reviewed.  Thus,
we used them for comparisons with 1991. 

Our final sample size was 759 young foster children.  We used an
adjusted population size, inversely proportional to our dropout rate,
to project to the county level; however, the data cannot be projected
to these states as a whole or to the national population of foster
children.  Initial and final sample sizes, along with the percentages
of the initial samples used, are shown in table I.3. 



                          Table I.3
           
           Sample Sizes and Percentages of Initial
                         Samples Used

                                                  Percent of
                                                     initial
                             Initial       Final      sample
                              sample      sample        used
------------------------  ----------  ----------  ----------
1986
------------------------------------------------------------
Los Angeles County               226         132        58.4
New York City                    150         131        87.3
Philadelphia County              142         113        79.6
============================================================
Total\a                          518         376        73.6

1991
------------------------------------------------------------
Los Angeles County               137         122        89.1
New York City                    150         145        96.7
Philadelphia County              127         116        91.3
============================================================
Total\a                          414         383        93.6
------------------------------------------------------------
\a Percentage totals are weighted averages showing the percentage of
the total population covered by the final samples. 

We examined the foster care case files beginning at a child's first
entry into foster care until the end of the review year or until the
child was discharged from foster care, whichever occurred earlier. 
We used an automated data collection instrument to record information
from the case files.  The recorded information was reviewed for
accuracy by the individual preparing it before finalizing each
electronic record.  We also reviewed the case file data for
consistent coding among individuals; minor adjustments were made to
the coding as a result of that review. 

We analyzed the case file data using univariate analysis, a
descriptive statistical method.  We also used a t-test to determine
statistically significant differences between the 1986 and 1991 data. 
In addition, when combining the strata, we weighted them to adjust
for disproportionate sampling.  Finally, we found that results from
the three locations were similar; thus, the locations could be
combined for analysis. 

For data derived from the case file review, the percentage estimates
reported in the letter and the numerical estimates reported in
appendix II are point estimates.  The precision of these estimates
varies with the quantitative relationship of a number of attributes
in a population.  We are 95-percent confident that the point
estimates fall within the confidence intervals reported in appendix
II.  Conversely, there is a 5-percent chance that the confidence
intervals do not contain the actual population. 

We performed limited tests of the completeness of the case files. 
However, we did not independently verify the accuracy of the
electronic databases provided to us by state and county officials. 


--------------------
\1 New York City is comprised of five boroughs and is treated in the
state database as a county. 


DISTINCTIVE CHARACTERISTICS
ANALYSIS RESULTS
========================================================== Appendix II

This appendix presents the numerical values for the data discussed in
the body of this report.  Where appropriate, point estimates and
confidence intervals are provided.  The appendix includes statewide
data and case file review results for the review years of 1986 and
1991. 



                          Table II.1
           
             All Children in Foster Care in Three
                            States

                                                     Percent
                          1986           1991         change
---------------  -------------  -------------  -------------
California\a            70,240        109,804           56.3
New York\a,b            44,613         84,997           90.5
Pennsylvania\c          13,181         17,737           34.6
============================================================
Total                  128,034        212,538           66.0
------------------------------------------------------------
\a California and New York counts of foster children represent all
children who were in foster care at any time during the review year. 

\b Part of New York's increase in foster children is due to the
provisions of the New York Supreme Court case, Eugene F., which
required all foster children placed with relatives to be included in
foster care caseloads and eligible for services. 

\c Pennsylvania's count of foster children represents year-end
counts, as data on the total number of children in foster care at any
time during the year were not available. 

Sources:  California and New York--state databases;
Pennsylvania--aggregate state data. 



                          Table II.2
           
            Young Children in Foster Care in Three
                            States

                                                     Percent
                          1986           1991         change
---------------  -------------  -------------  -------------
California\a            10,039         18,786           87.1
New York\a,b             6,443         16,215          151.7
Pennsylvania\c           2,341          4,537           93.8
============================================================
Total                   18,823         39,538          110.1
------------------------------------------------------------
\a California and New York counts of foster children represent all
young children who were in foster care at any time during the review
year. 

\b Part of New York's increase in foster children is due to the
provisions of the New York Supreme Court case, Eugene F., which
required all foster children placed with relatives to be included in
foster care caseloads and eligible for services. 

\c Pennsylvania's count of young foster children represents year-end
counts, as data on the total number of young children in foster care
were not available.  Further, that count is for foster children under
the age of 5 years, as its aggregate data did not break out children
under age 3 years. 

Sources:  California and New York--state databases;
Pennsylvania--aggregate state data. 



                          Table II.3
           
                 All Children in Three States

                                                     Percent
                          1986           1991         change
---------------  -------------  -------------  -------------
California           7,044,750      8,172,768           16.0
New York             4,341,069      4,359,573            0.4
Pennsylvania         2,840,991      2,825,376           -0.5
============================================================
Total               14,226,810     15,357,717            7.9
------------------------------------------------------------
Source:  Bureau of the Census midyear estimates. 



                          Table II.4
           
                Young Children in Three States

                                                     Percent
                          1986           1991         change
---------------  -------------  -------------  -------------
California           1,320,377      1,671,335           26.6
New York               730,588        828,255           13.4
Pennsylvania           465,077        491,742            5.7
============================================================
Total                2,516,042      2,991,332           18.9
------------------------------------------------------------
Source:  Bureau of the Census midyear estimates. 



                                    Table II.5
                     
                     States' Young Children in Foster Care in
                                  Three Counties


                        Selected  Percent of                Selected  Percent of
               State      county       state       State      county       state
              foster      foster      foster      foster      foster      foster
                care        care        care        care        care        care
--------  ----------  ----------  ----------  ----------  ----------  ----------
Californ      10,039       4,241        42.2      18,786       8,249        43.9
 ia\a
New            6,443       4,381        68.0      16,215      13,171        81.2
 York\a
Pennsylv       2,341         746        31.9       4,537       1,335        29.4
 ania\b
================================================================================
Total         18,823       9,368        49.8      39,538      22,755        57.6
--------------------------------------------------------------------------------
\a California and New York counts of foster children represent all
young children who were in foster care at any time during the review
year. 

\b Pennsylvania's state count of young foster children represents
year-end counts, as data on the total number of young children in
foster care at any time during the year were not available.  Further,
that count is for foster children under the age of 5 years, as its
aggregate data did not break out children under age 3 years. 
However, the count for the selected county represents all children
under age 3 years who were in foster care at any time during the
year. 

Sources:  California and New York--state databases;
Pennsylvania--aggregate state data and county database. 



                          Table II.6
           
            Reasons for Removal of Young Children
             From Home in California and New York


                               Abuse                   Abuse
                                and/                    and/
                                  or                      or
              Neglec  Abuse\  neglec  Neglec          neglec
                 t\a       b     t\c       t   Abuse       t
------------  ------  ------  ------  ------  ------  ------
California     4,259   1,844      --  15,340   2,495      --
New York       3,524      14   1,028   8,497      17   1,522
============================================================
Total          7,783   1,858   1,028  23,837   2,512   1,522
------------------------------------------------------------
Note:  There were other reasons for removals that did not account for
significant portions of total removals.  In addition, some cases only
show broad service program categories, such as "court ordered
placement," and others are listed as unknown or error. 

\a Includes removals due to neglect, caretaker absence or incapacity,
relinquishment, and voluntary placements. 

\b Consists of physical, sexual, and emotional abuse. 

\c Consists of New York data only.  This state uses up to two reasons
for removal, thus, abuse and/or neglect can be cited.  In addition,
the definitions of some reasons for removal, such as Health/Safety,
refer to abuse and/or neglect. 

Sources:  State databases. 



                                    Table II.7
                     
                       Family Situation Around the Time of
                       Removal From Home in Three Counties



                                                      Upper  Lower  Upper  Lower
     Statistical    Point    Point    Point    Point  bound  bound  bound  bound
Sit  ly           estimat  estimat  estimat  estimat     s,     s,     s,     s,
uat  significant       e,       e,       e,       e,  perce  perce  perce  perce
ion  change\a      number  percent   number  percent     nt     nt     nt     nt
---  -----------  -------  -------  -------  -------  -----  -----  -----  -----
Social Problems
--------------------------------------------------------------------------------
Dru  yes            3,572     51.8   16,660     78.2   58.0   45.6   83.4   73.0
 g
 ab
 us
 e
Cri  no             1,132     16.4    3,604     16.9   20.7   12.7   20.7   13.5
 mi
 na
 l
 re
 co
 rd
Inc  no             1,037     15.0    2,587     12.1   19.0   11.0   15.7    8.6
 ar
 ce
 ra
 te
 d
Hom  no             2,305     33.4    6,809     32.0   39.0   27.9   37.4   26.5
 el
 es
 s\
 b
Dom  no               867     12.6    1,989      9.3   16.5    9.2   12.9    6.4
 es
 ti
 c
 vi
 ol
 en
 ce
Div  no                 0      0.0       60      0.3    1.8    0.0    2.2    0.0
 or
 ce
 d

Parents absent
--------------------------------------------------------------------------------
At   no             4,754     68.9   14,828     69.6   75.3   62.6   75.3   64.0
 le
 as
 t
 on
 e
 pa
 re
 nt
 ab
 se
 nt
Fat  no             4,512     65.4   14,353     67.4   71.8   59.1   73.1   61.7
 her
 ab
 se
 nt
Mot  no             2,125     30.8    6,454     30.3   36.3   25.4   35.6   25.0
 her
 ab
 se
 nt
Bot  no             1,883     27.3    5,978     28.1   32.5   22.1   33.3   22.9
 h
 pa
 re
 nt
 s
 ab
 se
 nt
Dec  no                96      1.4      570      2.7    3.8    0.5    5.4    1.3
 ea
 se
 d

Siblings
--------------------------------------------------------------------------------
Sib  yes            4,659     67.5   16,790     78.8   73.7   61.4   83.9   73.8
 li
 ng
 s
 in
 fo
 st
 er
 ca
 re
 in
 re
 vi
 ew
 ye
 ar
Sib  no               667      9.7    1,608      7.6   12.7    6.6   10.5    4.6
 li
 ng
 s
 no
 t
 in
 fo
 st
 er
 ca
 re
 in
 re
 vi
 ew
 ye
 ar
No   yes            1,242     18.0    2,357     11.1   22.4   13.7   14.7    7.5
 si
 bl
 in
 gs
--------------------------------------------------------------------------------
\a Statistically significant change between 1986 and 1991. 

\b Includes unstable residency. 

Source:  Case file review. 



                                    Table II.8
                     
                        Health Conditions of Young Foster
                            Children in Three Counties



Hea
lth                                                   Upper  Lower  Upper  Lower
con  Statistical    Point    Point    Point    Point  bound  bound  bound  bound
dit  ly           estimat  estimat  estimat  estimat     s,     s,     s,     s,
ion  significant       e,       e,       e,       e,  perce  perce  perce  perce
s    change\a      number  percent   number  percent     nt     nt     nt     nt
---  -----------  -------  -------  -------  -------  -----  -----  -----  -----
At   yes            1,996     28.9   13,290     62.4   34.2   23.7   68.2   56.6
 ri
 sk
 fo
 r
 se
 ri
 ou
 s
 he
 al
 th
 pr
 ob
 le
 ms
 \b
Dru  yes            1,799     26.1   13,202     62.0   31.1   21.1   67.8   56.2
 g-
 ex
 po
 se
 d
Dru  yes            1,746     25.3   12,786     60.0   30.3   20.4   65.9   54.2
 g-
 ex
 po
 se
 d
 (e
 xc
 lu
 de
 s
 al
 co
 ho
 l)
Alc  yes              176      2.6    1,198      5.6    5.1    1.3    8.7    3.2
 oh
 ol
 -
 ex
 po
 se
 d
 (e
 xc
 lu
 de
 s
 dr
 ug
 s)
Dru  yes            1,171     17.0    5,936     27.9   21.6   12.4   33.2   22.6
 g
 wi
 th
 dr
 aw
 al
Ser  yes            2,977     43.2   12,420     58.3   49.1   37.2   64.1   52.5
 io
 us
 he
 al
 th
 pr
 ob
 le
 ms
 \c
Fet  no                77      1.1      257      1.2    3.5    0.3    3.5    0.4
 al
 al
 co
 ho
 l
 sy
 nd
 ro
 me
Low  yes              985     14.3    5,084     23.9   18.3   10.2   28.9   18.9
 bi
 rt
 h
 we
 ig
 ht
Hea  no               409      5.9    1,786      8.4    9.2    3.8   12.0    5.0
 rt
 pr
 ob
 le
 ms
HIV  no                 0      0.0      383      1.8    1.8    0.0    4.3    0.6
 or
 AI
 DS
Dev  yes              546      7.9    3,753     17.6   11.0    4.9   22.0   13.2
 el
 op
 me
 nt
 al
 ly
 de
 la
 ye
 d
Oth  yes            2,352     34.1   10,119     47.5   39.7   28.5   53.3   41.7
 er
Abu  no               243      3.5      569      2.7    6.2    2.1    5.3    1.4
 se
 d\
 d
Phy  no               175      2.5      509      2.4    5.1    1.5    5.0    1.2
 si
 ca
 l
Sex  no                56      0.8       60      0.3    2.9    0.2    2.2    0.0
 ual
Emo  no                29      0.4        0      0.0    2.5    0.0    1.8    0.0
 ti
 on
 al
Psy  yes               11      0.2      833      3.9    2.0    0.0    6.9    2.1
 ch
 os
 oc
 ia
 l
 pr
 ob
 le
 ms
 \e
Psy  no                 0      0.0      236      1.1    1.8    0.0    3.4    0.3
 ch
 ol
 og
 ic
 al
 ly
 di
 st
 ur
 be
 d
Beh  yes               11      0.2      773      3.6    2.0    0.0    6.6    1.9
 av
 io
 ra
 l
 pr
 ob
 le
 ms
No   yes            2,543     36.9    4,162     19.5   42.5   31.2   24.1   15.0
 kn
 ow
 n
 se
 ri
 ou
 s
 he
 al
 th
 pr
 ob
 le
 ms
 \f
--------------------------------------------------------------------------------
\a Statistically significant change between 1986 and 1991. 

\b Consists of prenatal drug exposure (including alcohol exposure)
and drug withdrawal or symptoms. 

\c Consists or fetal alcohol syndrome (FAS), low birth weight,
cardiac defects or heart problems, HIV positive or AIDS,
developmentally delayed, and other serious problems. 

\d Consists of physical, sexual, and emotional abuse. 

\e Consists of psychologically disturbed and behavioral problems. 

\f Consists of children who did not have any of the above conditions. 
However, these children may have had minor illnesses. 

Source:  Case file review. 



                                    Table II.9
                     
                     Prenatal Drug Exposure in Three Counties



Pre
nat
al
dru                                                   Upper  Lower  Upper  Lower
g    Statistical    Point    Point    Point    Point  bound  bound  bound  bound
exp  ly           estimat  estimat  estimat  estimat     s,     s,     s,     s,
osu  significant       e,       e,       e,       e,  perce  perce  perce  perce
re   change\a      number  percent   number  percent     nt     nt     nt     nt
---  -----------  -------  -------  -------  -------  -----  -----  -----  -----
Coc  yes            1,185     17.2   11,642     54.7   21.8   12.6   60.8   48.5
 ai
 ne
 \b
Alc  yes              230      3.3    1,509      7.1    6.1    1.9   10.4    4.5
 oh
 ol
Mar  no               203      2.9    1,028      4.8    5.5    1.7    7.8    3.1
 ij
 ua
 na
Opi  no               496      7.2    1,551      7.3   10.5    5.0   10.7    4.9
 at
 es
 \c
Amp  no                96      1.4      361      1.7    3.5    0.6    4.0    0.7
 he
 ta
 mi
 ne
 s\
 d
PCP  no               225      3.3      301      1.4    5.7    1.9    3.6    0.5
Tob  no               152      2.2      181      0.8    4.8    1.1    3.0    0.2
 ac
 co
LSD  no                 0      0.0        0      0.0    1.8    0.0    1.8    0.0
Not  yes            4,363     63.3    7,289     34.2   69.4   57.1   39.7   28.8
 kn
 ow
 n
 to
 be
 pr
 en
 at
 al
 ly
 ex
 po
 se
 d
--------------------------------------------------------------------------------
\a Statistically significant change between 1986 and 1991. 

\b Includes crack and other cocaine derivatives. 

\c Includes heroin and methadone. 

\d Includes methamphetamines. 

Source:  Case file review. 



                         Table II.10
           
              Sources of Foster Care Maintenance
              Funding in California and New York



                 Federal  Nonfederal     Federal  Nonfederal
                 funding     funding     funding     funding
------------  ----------  ----------  ----------  ----------
California         5,496       2,572      10,487       3,245
New York           4,384         751      13,649         738
============================================================
Total              9,880       3,323      24,136       3,983
------------------------------------------------------------
Sources:  State databases. 


MAJOR CONTRIBUTORS TO THIS REPORT
========================================================= Appendix III

Robert L.  MacLafferty, Assistant Director
Kerry Gail Dunn, Evaluator-in-Charge
Helen Cregger
Lynne M.  Fender
Susan J.  Malone
Sheila E.  Murray
Tranchau T.  Nguyen
Terri M.  Paynter
Susan K.  Riggio
Ann T.  Walker
Cameo A.  Zola
