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 thinking about caring for a foster child, there are ways you can start to prepare yourself and your home. By doing your research and preparing yourself ahead of time, you can make a mindful decision, easily manage the application and assessment process, and be ready to provide a safe and stable home for your foster child.

Understanding Foster Care for Children with Special Needs

Foster care is in desperate need of good parents across the country, but there is a particular need for foster homes for children with special needs. Many of the children in foster care live with emotional or physical health care needs, or a history of abuse or neglect. Foster care is meant to be temporary, but sometimes children stay in foster care for a long time because they are older, or because they are in foster care with their siblings. These children may have or be at risk of:

  • serious medical conditions
  • emotional disturbance
  • behavioral issues
  • 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 must be willing to advocate for the child's needs, which includes learning about medical needs and treatment, going to meetings and therapies, and working with the school system. There is often necessary involvement with the child's biological family. Foster parents can greatly benefit from having a support system of family, friends and community resources.

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 them to provide shelter and care for children who are removed from their homes. 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 sometimes end up adopting the children they care for, but many times the situation is temporary.

Foster parents may receive a monthly tax-free maintenance payment to help offset the costs of clothing, food, school supplies and other needs. 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 the 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 important team member, communicating with and between the child, their 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 special health care needs 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, generally over 7 years old.

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, start by thinking about your current family setting, and what will work for you. Talk with the whole family about what this means to them. When asked to foster 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 functional needs. Will your house work for this child, and if not, can you make the needed changes to it? For example, sometimes a child with a physical 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 enough 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
  • Fill out 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 check, reference checks, credit check, and medical examination report from your doctor)
  • 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 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” for the child. A life book is basically a scrapbook, and a very valuable resource that foster parents can create for their foster child. The life book will stay with the child through new foster placement, reunification, or adoption.

  • It can include anything:
    • medical records
    • school pictures, special artwork
    • awards and photographs
    • keepsakes

Advocate for your Foster Child

As a foster parent for a child with special needs, you will be become his advocate. This new responsibility means that you learn about your foster child’s condition or special health care needs by going to meetings, choosing and talking with his doctor(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 ad-litem (GAL).
  • Understanding and coordinating Medicaid services. Children entering the foster care system are entitled to Medicaid and EPSDT (Early Periodic Screening, Diagnosis, and Treatment). States have different ways of managing this care.
  • Choosing a primary care doctor for your child. Make sure they accept Medicaid and are available and willing to help advocate for the child.
  • Participating in medical appointments, which may include primary medical care, medical subspecialties, dental, mental health care and occupational, physical, and speech therapies.
  • Maintaining the foster placement packet and record keeping. Obtain as much information as possible on medical, dental, developmental, immunization, and mental health records, as well as the records from the child's former foster homes.
  • Working with the school system, meeting with teachers and therapists, going to IEP (Individual Education Plan) meetings, and special education meetings.

Saying Goodbye to a Child

The purpose of foster care is family preservation, 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 her and you. 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
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.

A national network for youth in foster care with excellent resources, 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: December 2020
Current Authors and Reviewers:
Author: Shena McAuliffe, MFA
Reviewer: Tina Persels