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Code Blue: Health Services for Children in Foster Care

1998 | Download

As of March 1997, more than 100,000 of California’s children are in foster care. Removed from their homes because of neglect or abuse, about 40-72 percent of foster children require ongoing medical treatment and 50-60 percent have moderate to severe mental health problems. As wards of the state, children in foster care depend on government services for medical treatment. But how well equipped is California to deal with the health needs of foster children? 

This is the question debated by the members of the California Foster Children’s Health Task Force. Their diagnosis of the problem is disturbing: Foster children are not routinely assessed for medical, psychological or developmental conditions. Only a small pool of health care providers is willing to serve them, and Medi-Cal red tape and paperwork cause delays in treatment. As children are bounced from placement to placement, their medical records are poorly maintained or non-existent, placing them at considerable risk for over-immunization or misdiagnosis.

The report outlines the recommendations from a task force of more than 30 of the state's top experts on California's foster care system on how to improve the delivery of health services to children in foster care.

Download the report.

Why are health care services inadequate for foster children? The task force determined that there is no system of health care for foster children, but rather an unplanned, often uncoordinated set of services. The task force strongly recommends that the Legislature and the Governor launch a multi-year planning process to create a planned, statewide system of health care for foster children. This system of care should be designed to adhere to a set of “guiding principles” that the task force presents in this report.

There are also immediate steps that should be taken to improve the availability and adequacy of health care for foster children. Devising a system of health care for children in foster care is a daunting assignment. It involves the combined expertise of professionals in child protective services, mental health, medicine, dentistry, the criminal justice system, social work and more. It requires providers at both the local and state levels to work together—putting the needs of the child above competition for resources and jurisdictional disputes.

But good ideas, collaboration and dedication will go for naught if there is not the political will to respond to the needs of foster children, particularly when what is needed is system reform. There could not be a greater need for action—the health system for foster children is code blue—in dire need of reviving. We hope that the analyses and recommendations in this report assist policymakers to take decisive action—and to work collaboratively to improve health services for children who have only the state to turn to for care.


Through the California Foster Children’s Health Project, more than 30 leaders in child welfare and health care met over a period of six months in 1997-98 to analyze issues and develop recommendations to improve health services for children in foster care. The Project was sponsored by the Institute for Research on Women and Families, an affiliate of the Center for California Studies. The Project was funded in part by a grant from The California Wellness Foundation and through support from The David and Lucile Packard Foundation. Kate Karpilow, Ph.D., former Executive Director of PHI's California Center for Research on Women and Families (CCRWF) served as the Project Director.