American Judges Association


Date of this Version



Court Review - Volume 58


Used by permission.


Congress enacted the Adoption and Safe Families Act to improve outcomes concerning the permanency, safety, and wellbeing of children in the care of child welfare agencies. However, achieving its goals for the more than 700,000 children who spend time in the custody of child protective services (CPS) every year in the United States is made more difficult by their poorer health compared to the general population.1 Common health concerns among children in CPS custody include developmental delay (e.g., intellectual delay or disability, gross or fine motor delay, speech delay), infections diseases, mental and behavioral health concerns, and medical concerns. Higher levels of healthcare compared to other children who live in poverty are often required.2 While health concerns may have been identified before children entered CPS custody, connections to healthcare providers and services are disrupted when children are removed from their families of origin and placed in out-of-home care. Efforts to collect a child’s complete medical history upon entering care may be difficult, and incomplete histories negatively impact health and disease management. Moreover, disruptions in healthcare can continue even after children enter CPS custody and out-of-home care—for example, when children change placements or caseworkers—leading to additional challenges managing children’s health needs and increasing healthcare use.3