TABLE 1

Child Medical and Placement Characteristics

CharacteristicChildren, % (n)CharacteristicChildren, % (n)
SexDevelopmental factors and therapiesa
 Male53.3 (8) Developmental delay or disability86.7 (13)
 Female46.7 (7) Visual or hearing impairment46.7 (7)
Age category Physical therapy93.3 (14)
 <2 y old33.3 (5) Occupational therapy86.7 (13)
 2–5 y old40 (6) Speech therapy53.3 (8)
 6–11 y old26.7 (4)Medical devices and equipmenta
Complex chronic condition categoriesa,b Feeding tube86.7 (13)
 Technology dependence86.7 (13) Hardwarec53.3 (8)
 Gastrointestinal66.7 (10) Adaptive equipmentd53.3 (8)
 Other congenital or genetic defect60 (9) Respiratory supporte40 (6)
 Respiratory46.7 (7)Entered foster care from
 Neurologic and neuromuscular46.7 (7) Hospital73.3 (11)
 Cardiovascular33.3 (5) Home26.7 (4)
 Premature and neonatal33.3 (5)Reason for entering carea
 Hematologic or immunologic20 (3) Medical neglect86.7 (13)
 Renal and urologic13.3 (2) Inadequate housing46.7 (7)
 Transplant6.7 (1) Parental substance use disorder46.7 (7)
 Metabolic6.7 (1) Physical abuse20 (3)
 No. categories per child, median (range)4 (1–9) Voluntary6.7 (1)
SpecialistsaPermanency plan
 Gastroenterology or nutrition93.3 (14) Reunification46.7 (7)
 Ophthalmology66.7 (10) Concurrent reunification and adoption26.7 (4)
 Developmental pediatrics60 (9) Adoption or guardianship26.7 (4)
 Neurology53.3 (8)Parental rights
 Pulmonology46.7 (7) Intact93.3 (14)
 Genetics40 (6) Terminated6.7 (1)
 Cardiology33.3 (5)Placement continuityf
 Orthopedic surgery33.3 (5) No53.3 (8)
 ENT33.3 (5) Yes46.7 (7)
 Audiology26.7 (4)Length in care
 Neurosurgery26.7 (4) <1 y13.3 (2)
 Behavioral health20 (3) 1–2 y40 (6)
 Endocrinology20 (3) >2 y46.7 (7)
 Hematology or oncology13.3 (2)Barriers to permanencya
 Nephrology13.3 (2) Parental disengagement60 (9)
 Pediatric surgery13.3 (2) Parental incarceration33.3 (5)
 Transplant team13.3 (2) Lack of adoptive parents33.3 (5)
 Immunology6.7 (1) Parental inability to comprehend medical needs26.7 (4)
 Urology6.7 (1) Parental housing instability20 (3)
 Plastic surgery or wound care6.7 (1) Court or legal system barriers20 (3)
 Dermatology6.7 (1) Parental physical or mental health20 (3)
 No. specialists per child, median (range)5 (2–12) Parental substance use disorder13.3 (2)
  • ENT, ear, nose, throat.

  • a Percentages sum to >100% because multiple responses per child were permitted.

  • b Complex chronic condition categories are modified from Feudtner et al23; malignancy was not included because it was not reported by any participants.

  • c Hardware includes ventriculoperitoneal shunt; cardiac shunt; orthopedic rods, pins, or screws; and central line.

  • d Adaptive equipment includes orthotics, wheelchair, ramp, Hoyer lift, hospital bed, gait trainer, stander, and walker.

  • e Respiratory support includes tracheostomy, ventilator, continuous positive airway pressure, and/or supplemental oxygen.

  • f Placement continuity is defined as a child in the same placement since initial entry into child welfare system.