The State of America's Children® 2020

For years, Samantha sought treatment for her addiction to opioids but, in her rural community in northern Maine, was never able to access the intensive services that would help her recover.¹ Her daughter, Sarah, was removed from her care and placed in foster care shortly after being born with neonatal abstinence syndrome but Samantha was not provided addiction support. That didn’t stop her from working to be the safe, stable parent her daughter needed her to be. She worked with a doctor at her local community clinic to lessen her dependence. Every week they called the only rehab center that would treat Samantha without insurance to see if they had space for her. After two long years separated from her daughter, Samantha secured a place in rehab and received the help she so desperately needed. She has been drug-free ever since, has a job helping others in her community find housing and is training to be a drug counselor so she can support people facing similar struggles. But Sarah, like so many children of the opioid crisis, is still being raised in the foster care system instead of with her mother who just needed a little help.

The historic passage of the Family First Prevention Services (Family First) Act in 2018 offers hope for families like Sarah’s, allowing federal funds to be used for certain prevention services and programs to help strengthen families and prevent children from needing foster care. As more states and tribes implement these prevention services the paradigm may shift, but today 36 percent of children in foster care are drawn into the system in part due to parental drug abuse.² In 2017, an estimated 325,000 children were removed from their homes due to opioid use, with 75,000 entering foster care and the rest being raised by family outside the supports of the child welfare system.³

A child is abused or neglected every 47 seconds in America—1,844 each day. In 2018, more than 673,000 children were victims of abuse or neglect (see Table 27). More than half of all child maltreatment cases involved children who were six years old or younger.⁴ Infants were disproportionately victimized, with 15.3 percent of cases involving children under 1. Nearly 40 percent of victims received no post-investigation services and many more received far fewer services than they needed.⁵

It is critical that communities seize the opportunities in the Family First to build systems of prevention and early intervention so every child can have a safe start in a permanent nurturing family and community. Children who have been abused and neglected, removed from their families and placed in foster care are among the most vulnerable children in America. There were 435,052 children in care in 2018 (see Table 28), and while intended to be temporary, the average length of stay was nearly 20 months.⁶ Although more than 90 percent of children exit foster care to a permanent family—either by returning home to their family, being adopted, placed into guardianship or otherwise living with relatives—nearly 18,000 young people “aged out” of foster care without being connected to a permanent family in 2018 (see Table 31).

• Black children are overrepresented in foster care. In 20 states, the percent of the foster care population that is Black is two or more times the percent of the overall child population that is Black (see Table 29).
• In 2018, 125,422 children in foster care were waiting to be adopted.⁷ Children under 6 comprised more than 41 percent of all children in foster care and more than 44 percent of all children in foster care waiting to be adopted. Twenty-six percent of children waiting to be adopted entered foster care before they were one year old.⁸
• Federal law requires children in foster care be placed in the most appropriate family-like settings, but far too often children are inappropriately placed in non-family settings. Nationally, 12 percent of children in foster care are in congregate care such as group homes or institutions; in certain states, up to 28 percent of children are in congregate care. Due to positive state reforms, however, the percent of children in congregate care has declined by 33 percent since 2005 (see Table 30).
• In 2018, the number of children in foster care decreased for the first time since 2012. There were 435,052 children in care in 2018, down from 436,532 in 2017.

With so many children in foster care, grandparents and other relatives have increasingly stepped in to care for them. Sometimes these arrangements are informal or private, and other times they are made with the involvement of the child welfare agency. For example, relatives may serve as foster parents and/or legal guardians.

• Large numbers of children are diverted from the child welfare system by agency staff or judges to live with grandparents or other relatives. Many receive no help in caring for the child.
• In 2019, more than 2.6 million children lived in households headed by grandparents or other relatives without their parents present.⁹ The vast majority of these kinship placements are outside of the child welfare system.
• About a third of all children in foster care (32 percent) are placed with a relative—approximately 139,000 children in total.¹⁰

Children exposed to the trauma of abuse or neglect can suffer profound lifelong consequences. Research has directly linked childhood trauma to depression, anxiety, impulse control issues, greater likelihood of substance use and risky behaviors, increased susceptibility to heart disease and cancer and more. Trauma can also impact children on a biological level, delaying neural development, hindering the ability to manage stress and even altering their DNA.

One important measure of trauma exposure comes from the landmark Adverse Childhood Experiences (ACEs) studies, which track ten key experiences and their risk of negative outcomes. As of 2017-2018, more than 40 percent of children had suffered at least one ACE and nearly one in five had suffered two or more ACEs (see Table 32). Children of color disproportionately experience ACEs; more than 60 percent of Black children have suffered at least one ACE compared with less than 40 percent of white children.¹¹

It is clear that more resources are needed to ensure the fundamental promise of the child welfare system: that every child deserves the opportunity to grow up in a safe, stable and loving family. Investing in prevention and early intervention can protect children from the trauma of abuse, neglect and separation from family. Specialized treatment services for the children and families already in foster care can help move children quickly and safely out of care and into permanent families. By providing post-permanency services after a child leaves foster care, communities can ensure those families are strong, safe and stable.