[Children and adolescents in foster care: health problems and guidelines for their health care]

[Maltreated gypsy children: social and health risk factors and high-priority health care needs]

OBJECTIVES

To determine the prevalence of maltreated gypsy children admitted to centers of protection, as well as their demographic characteristics, type of maltreatment, frequency of associated social and health risk factors, frequent health problems and whether there are differences between these children and the general population of maltreated children.

PATIENTS AND METHODS

We performed a retrospective cross-sectional cohort study over an 8-year period (1995-2002). The social and health reports of the maltreated children admitted to protection centers were reviewed and those belonging to the gypsy ethnic group were included. Information collection, definition of concepts and health assessments were performed according to nationwide methodologies, studies and directives. A descriptive and comparative statistical study was performed.

RESULTS

During the study period, 873 children were admitted, of whom 74 were from the gypsy ethnic group (a prevalence of 8.5 %, 1.7 times higher than that expected). Demography: mean age: 6.9 years (5.7 SDU); age group 0-5 years age: 56.7 %; females: 51.3 %. No significant demographic differences were observed in gypsy children compared with the general population of maltreated children. However, factors that were significantly more frequent in gypsy children were the prevalence of passive maltreatment (p = 0.0133; odds ratio [OR]: 2.4; 95 % confidence interval [CI]: 1.2-4.9), belonging to families with more than one social and health risk factor (p = 0.0000; OR: 30.5; 95 % CI: 9.4-99.1) with problems of delinquency (p = 0.0000; OR: 11.7; 95 % CI: 6.3-21.7) and with a history drug/alcohol abuse (p = 0.0000; OR: 3.4; 95 % CI: 1.9-6), presenting at least one health problem (p = 0.0000; OR: 6.9; 95 % CI: 2.7-17.3), absent or incomplete immunizations (p = 0.0000; OR: 4.9; 95 % CI: 3-8.1), disabilities (p = 0.0012; OR: 2.9; 95 % CI: 1.5-5.9) especially of neurological origin (p = 0.0000; OR: 4.8; 95 % CI: 2-11.4), psychomotor developmental delay in children younger than 6 years (p = 0.0330; OR: 2.4; 95 % CI: 1-5.3) and behavioral disorders in adolescents (p = 0.0005; OR: 4.7; 95 % CI: 1.8-12.1).

CONCLUSIONS

There is a significant association between maltreatment of gypsy children and the presence in their family of social and health risk factors such as delinquency and mental health problems related to drug addiction/alcoholism. The health status of these children is significantly different from that observed in maltreated children from the general population, with a greater incidence of neurological disabilities and problems and diseases related to chronic neglect and/or abandonment of the child's health, socio-educational and psycho-emotional needs. These children are admitted to centers of protection more frequently than their theoretical risk would predict.

[Foreign minors in the protection system of the Autonomous Community of Aragón (Spain)]

OBJECTIVES

To determine the prevalence of foreign minors in protection centers, their demographic characteristics, and reasons for entry, as well as the relation with geographic area, family, social and health risk factors, and high-priority health needs.

PATIENTS AND METHODS

We performed a retrospective cross-sectional study over an 11-year period (1992-2002). The health and socio-familial reports of 1,619 minors who were admitted to protection centers were reviewed and those from a foreign country were included. Compilation of information, definition of concepts, and health assessments were performed according to standard protocols.

RESULTS

Two hundred forty-one foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years (adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study period. The prevalence was 4.6 times higher than that expected. Origin: Africa 68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east 9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and relation with geographic area were as follows: 1. Being an abandoned illegal immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2. Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7 %, no difference by geographic area); 3. Temporary incapacity for their care 18.7 % (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa 18.1 %, Europe 17.5 %); 4. Other causes 7 %.

RISK FACTORS

at least one (78.4 %) and more than one (33.6 %); housing problems and especially living in a single parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %); main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %), growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %).

CONCLUSIONS

Being a minor immigrant in a foreign country with problems of documentation, housing or family regrouping and especially if there are language, cultural or racial (ethnic minorities) barriers is a major risk factor for living in a situation of vulnerability, risk or neglect/abandonment that requires social protection measures. Continuous follow-up by the social services of the adoptive community is required for the prevention and early detection of children in need of protection.

Comparación entre los niños de etnia gitana e inmigrantes extranjeros ingresados en centros de protección por maltrato

OBJECTIVES

To determine whether there are differences between Spanish gypsy and foreign immigrant children admitted to protection centers in the characteristics of the maltreatment, social and familial factors linked to maltreatment, and health status.

METHODS

The social and health reports of 83 Spanish gypsy and 105 foreign immigrant children admitted to protection centers of the Aragonese Institute for Social Services (Instituto Aragones de Servicios Sociales [IASS]) because of maltreatment from January 1994 to December 2003 were reviewed. Maltreatment, its types, and warning signs were defined and assessed according to the guidelines drawn up by the IASS. The social and familial risk factors associated with maltreatment were determined according to national studies. Health status was assessed following protocols used by the IASS. A descriptive and comparative statistical study was performed.

RESULTS

The Spanish gypsy children were mostly in the age group of 0-5 years, while foreign immigrants were mostly in the age group of 12-17 years. Spanish gypsy children showed a greater frequency of physical and emotional neglect and/or abandonment (p < 0.001) and were more likely to have families with problems of crime (odds ratio [OR] = 16.5; 95% confidence interval [95%CI], 6.7-40.7), drug/alcohol abuse (OR = 8.8; 95%CI, 3.7-21) and families with more than one social and health risk factor (OR = 9.3; 95%CI, 3.8-22.8). Spanish gypsy children showed a greater frequency of neurological disorders, disabling diseases, absent or incomplete immunizations, and dermatologic diseases. Foreign immigrant children showed a greater frequency of physical and psychological and/or sexual abuse (p < 0.001) and were more likely to live in a single parent family (OR = 7.9; 95%CI, 2.2-27.7).

CONCLUSIONS

Identifying the differences between these two groups of maltreated children could be useful for professionals working in the community social services in charge of developing intervention strategies for the prevention and early detection of maltreatment, as well as for professionals in charge of the health of these children during their stay in a protection center.