Drug exposed children and the foster care system: In the best interests of the child?

Children born to substance abusing women face many risks that can impede optimal developmental outcome. These risks include both potential neurologic and organic sequelae of intrauterine substance exposure, as well as additional risk factors in their postnatal environment. Foster care placement is a common occurrence among this population. The current study was conducted to explore the developmental status of a group of drug exposed infants and toddlers in foster care. Twenty-seven children placed through a church-based foster care program were observed. All but one of the children were African-American and nearly half (48%) had been placed shortly after birth. The children ranged in age from 1 to 29 months. Home environment and caregiver-child interaction was assessed using the HOME Inventory and the NCAS Feeding and Teaching Scales. Children were also given physical, neurological, and developmental assessments (Mean age 11.7 months). While the majority of the children fell within normal limits on developmental testing, 28% were considered at risk for cognitive delay and over half exhibited suspect or abnormal neurological signs. Many were felt to be at further risk because of poor home environment and/or caregiving. Implications for intervention and policy changes are discussed.