Foster Care of Children with Special Needs

close-up of adult and child's clasped hands
Choosing to become a foster parent for a child with special needs is a life-changing decision. If you’re considering taking a child into your life, there are many ways you can begin to prepare yourself and your home. By doing your research and preparing yourself ahead of time, you can make a more informed decision, easily navigate the application and assessment process, and be ready to provide a stable, loving and supportive home for your foster child.

Understanding Foster Care for Children with Special Needs

Foster care is desperately needed across the country, but there is a particular need for foster homes for children with special needs. Many of the children in foster care suffer from emotional or physical disorders, or a history of abuse or neglect. Many are part of a cultural or racial minority group. Foster care is intended to be temporary, but sometimes children remain in foster care for a long time due to being older than the average age for adoption, or because they are in foster care with their siblings. These children may be at risk of serious medical conditions, emotional and behavioral disorders, and medical or genetic risk due to parental substance abuse or mental illness. The amount of commitment needed to care for these children may be much greater than what is required for a healthier, typically developing child. Foster parents need to be willing to advocate for the child's needs, which includes learning about the child's medical needs and treatment, attending frequent meetings and therapies, and working with the school system. There is often necessary involvement with the child's biological family. No matter the situation, foster families need a support system of family, friends, and community.

A Few Key Terms for New or Potential Foster Parents

Foster parents or resource families are a key resource for child welfare agencies which recruit, train, assess, and license foster parents to provide shelter and care for children who are removed from their homes. Foster parents sometimes end up adopting the children they care for, but many times the situation is temporary. The goal of foster care is often to reunify a child with his biological family on condition that the family can take the necessary steps to provide a stable, caring home for the child. In other situations, the goal is to find a permanent, adoptive family for the child. Foster parents may receive a monthly maintenance payment to help offset the costs of caring for the children. Resource families may include foster parents, foster/adoptive parents, and relatives or kinship caregivers. All of these caregivers provide safe shelter, care, nurturing, and support for children who have been removed from their homes. In family-centered foster care practice, foster parents are treated as members of a team working to achieve permanency for children and support birth families in their efforts to reunite with their children.
Case managers are social workers who provide support and services to foster parents to help them care for the children. They are an essential liaison for the foster children, communicating with and between the child, her biological parents, foster parents, schools, courts, and medical service providers.
With foster care, the term "special needs" is defined broadly and may vary by state. Special needs may mean that the child:
  • Has disabilities that may include mental, physical, or behavioral challenges.
  • Is at risk for developing learning, emotional, behavioral, or physical disabilities in the future.
  • Was prenatally exposed to drugs or alcohol.
  • Is older than the average age for adoption.
The American Academy of Pediatrics further defines children with special health care needs as "those who have or are at risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally."

Basic Considerations for Foster Families

As you explore becoming a foster parent, begin by considering your current family dynamics, and what your family can handle. Have a discussion with the whole family about what this means to them. Once you are considering fostering a specific child in your home, make sure you are aware of the child's needs–are you able to meet these needs? Beyond the emotional challenges, consider the child’s practical or logistical needs. Will your house work for this child, and if not, can you make the necessary modifications? For example, sometimes a disability may require wheelchair accessibility, or behavioral needs may require door alarms.

General Guidelines for Foster Parents

Although each state has different guidelines, in general, to be a foster parent you should:
  • Be at least 21 years of age.
  • Have sufficient income to meet the basic needs of your household.
  • Be in good physical, emotional, and mental health.
  • Have no criminal record for violent crimes, sexual crimes, or crimes against children.
  • Attend pre-service training and meet the continuing education requirements.

Steps to Become a Foster Parent

The steps to become a licensed foster parent include:
  • Contact a local foster care agency.
  • Complete an application to become a licensed foster parent.
  • Attend the required amount of pre-service training. Additional medical or behavioral training may be needed for children with special needs.
  • Complete a criminal background check. (You and any adult members of your household will be fingerprinted for a national criminal background check.)
  • Participate in a home study. (This will include interviews of all your household members, fire inspection, home safety audit, reference checks, credit check, and medical examination.)
  • Receive a state-issued foster parent license.
  • A child is placed in your home.

Welcoming a Child Into Your Home

When welcoming a child into your home, first remember that all children go through a transition and adjustment period when their environment changes, regardless of underlying emotional or physical issues. Children in foster care may also struggle with additional emotional, behavioral, and developmental issues due to their prior circumstances and family separation. It’s also common for foster children to have few coping or social skills.
You can help a child to adjust to your home more easily by encouraging her to think of your home as her own, and by welcoming her as an equal part of your family. You might put her photo on the mantle, for example, and include her in your regular family activities. A few other ways to welcome a child include:
  • Allow the child age-appropriate space and his own belongings.
  • Give the child a choice about what to call you. Generally, calling you by your first name is fine, but sometimes a child will want to call you "mom" or "dad." The general rule here is to let the child choose what is comfortable.
  • It is important for a foster child to understand the role of a parent as protective and nurturing. Let her know that you are the parent of your household, and that is your role.
  • Be aware of racial and cultural differences, and try to incorporate the child's culture into your own.
  • Create a life book with or for the child. A life book is basically a scrapbook, and a very valuable resource that foster parents can create for their foster child. It may become very important to a child, and can include anything from medical records, to school pictures, to awards and photographs. The life book will stay with the child through new foster placement, reunification, or adoption.

Advocate for your Foster Child

As a foster parent for a child with special needs, you will be become his advocate. This new responsibility demands that you learn about your foster child’s condition or special needs by attending meetings, choosing and talking with the child’s physician(s) and therapist(s), and doing additional research to learn more about your child. Advocating for a child with special needs includes:
  • Working closely with the caseworker and knowing their supervisor. Make sure they assist you in working with the birth family.
  • Knowing your child's court-appointed guardian.
  • Understanding and coordinating Medicaid services. Children entering the foster care system are entitled to Medicaid and an initial or periodic EPSDT (Early Periodic Screening, Diagnosis, and Treatment). States have a variety of approaches to fulfilling this obligation.
  • Choosing a primary care provider for your child. Make sure they accept Medicaid and are available and willing to advocate for the child.
  • Participating in medical appointments, which may include primary medical care, medical subspecialties, dental, mental health and therapies–occupational, physical, and speech.
  • Maintaining the placement packet and record keeping. Obtain as much information as possible on medical, dental, developmental, immunization, and mental health records, as well as the child's former foster homes.
  • Working with the school system, meeting with teachers and therapists, attending IEP (Individual Education Plan) meetings, and special education meetings.

Saying Goodbye to a Child

Foster care is intended to be temporary, meaning that the child will return to her birth family or be adopted. When your foster child moves on to the next stage in her life, it will mean another transition for your family and for the child. While you want the child to feel safe and stable in your home, a time will come when it is important to help her understand the role of foster care. Talk about court plans with the child, and give her time to adjust to the idea of leaving your home. Encourage your foster child or other children to talk about their concerns, worries, or hopes for the future. Finally, be prepared to give your foster child something to take along with her into the next part of her life (a blanket, toy, or a life book). And of course, you, too, will need to rely on your family and support network through it all.


Information & Support

For Parents and Patients

National Foster Care & Adoption Directory Search
Has a database of adoption and post-adoption resources that is searchable by state and region.

Healthy Foster Care America (AAP)
Resources for children and teens in foster care and foster parents; American Academy of Pediatrics.

FosterClub is a national network for youth in foster care. This site has excellent resources for youth in foster care, including: entering foster care; message board; topical information about things like foster families, court, your caseworker and the agency, school, friends and relationships, health, and leaving foster care; and state-by-state information and resources.

Trauma-Informed Patient Education (Children's Hospital of Philadelphia)
Downloadable patient education to help: parents help their children cope, children and teens cope with injury and pain or dealing with traumatic stress reminders, and siblings cope with their brother's or sister's hospitalization, illness, injury, and recovery. Also includes workbooks for coping with hospitalization.

What is Child Traumatic Stress? (NCTSN)
Education and questions and answers about child traumatic stress; National Child Traumatic Stress Network.

The Adverse Childhood Experiences Study (CDC)
One of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being; Centers for Disease Control and Prevention.

Services for Patients & Families Nationwide (NW)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: February 2013; last update/revision: May 2016
Current Authors and Reviewers:
Author: Shena McAuliffe, MFA