Differs between the US and Canada

Practical orientation for people fostering or adopting, and for anyone deciding whether they could. It covers the first weeks, trauma and attachment, school, health, contact with birth family, looking after yourself, and what happens to young people who leave care without a permanent family.

Where something is genuinely true everywhere, we say so. Where it depends on your state or province, which is more often than most resource pages admit, we say that instead of generalising.

Trauma and attachment

The science here is universal. What is available, funded and who may deliver it is not.

Trauma is an emotional response to an event that threatens or causes harm. For children who come into care the sources include abuse and neglect, separation from people they love, witnessing violence, unpredictable adult behaviour, and, importantly, being placed in the child welfare system itself.

The effects reach further than behaviour: a dysregulated stress response, difficulty with concentration, memory and mental flexibility, difficulty trusting, and trouble with impulse control.

Approaches with actual evidence behind them

Be careful with the word “evidence-based”, which is used loosely in this field. On the California Evidence-Based Clearinghouse scale, where 1 is well-supported and 5 is a concerning practice, no attachment intervention for children or adolescents currently rates better than 3, promising. That is not a reason to avoid them. It is a reason to be suspicious of anyone promising certainty.

  • Attachment and Biobehavioral Catch-up (ABC), rated Supported by the federal Title IV-E Prevention Services Clearinghouse. Ten weekly in-home sessions with a trained parent coach, for toddlers.
  • Trauma-Focused CBT, rated Promising. Twelve to sixteen weekly sessions delivered by a licensed mental health professional.
  • Trust-Based Relational Intervention (TBRI), rated Promising, high relevance to child welfare. Caregiver training delivered by certified practitioners.

The first weeks

Mostly universal, but the household rules you must follow are local.

What actually helps, according to AdoptUSKids and the American Academy of Pediatrics:

  • Routine before anything else. A predictable day gives a child a sense of control they have not had.
  • Physical contact offered, never required. Hugs, hair combing, reading side by side. Encourage eye contact gradually; do not demand it.
  • Their own things. Comfort items the child chooses, photographs of important people kept where they can reach them, and a say in how their room is set up.
  • Introduce people slowly. Daytime meetings in familiar places first, then day visits, then overnight. The same graduated approach works for extended family.
  • Give them a real job in the household. Being needed is part of belonging.

What the evidence says about placements breaking down

Around 10 to 25% of adoptions disrupt before finalisation; dissolution after finalisation is rarer, at roughly 1 to 10%. The identified risk factors are worth knowing because several are within reach:

  • Each additional placement move a child has already had raises the risk by about 15%
  • Unrealistic expectations going in
  • Inadequate information sharing about the child's history, so ask, and keep asking
  • Inadequate subsidy, and inadequate post-adoption support

Caregiver commitment is protective, and buffers behavioural difficulty. So is proper training and genuinely careful matching.

Ask your agency about the local rules on bedroom sharing, babysitting and overnight stays away, who may transport the child, travel out of the area, and photographs on social media. These are licensing conditions, they are set locally, and they catch new carers out.

School

Not universal. The US has a federal floor; Canada does not.

Educational disruption is one of the clearest harms of time in care. In the Northwest Foster Care Alumni Study, 65% of alumni had experienced seven or more school changes between elementary and high school. Those alumni were placed between 1988 and 1998, so treat it as evidence of a pattern rather than a current national statistic. More recently, US Department of Education guidance reports that 71% of students in foster care graduate high school by 21, against 88% of all young people.

In the United States, the Every Student Succeeds Act gives real, usable rights:

  • School of origin. The presumption is that a child stays at the same school when a placement changes, unless a formal best interest determination says otherwise.
  • Transport cost is not a permitted reason to move a child's school.
  • Immediate enrolment if a move is necessary, ideally within three business days, without the usual paperwork.
  • Every state education agency has a foster care point of contact, and so does each district once notified. Finding yours is the single most useful thing you can do here.

On special education, note that federal regulation defines “parent” to include a foster parent unless state law says otherwise, which is exactly why the answer to “can I sign the IEP?” depends on where you live. Where no parent can act, a surrogate parent must be appointed, normally within 30 days.

In Canada there is no equivalent to either ESSA or the federal special education framework. Ontario identifies exceptionality through an IPRC and requires an IEP within 30 school days of placement in a special education programme. British Columbia requires an IEP as soon as practical after identification, with defined exceptions. Other provinces use different terminology and different processes, ask your school board directly.

Health

US professional standards, not law. Consent and records rules vary everywhere.

The American Academy of Pediatrics sets out what a child entering care should receive: a health screening visit within 72 hours of placement, a comprehensive admission visit within 30 days covering mental health, development, education and dental, and a follow-up at 60 to 90 days.

For a newly adopted child, the AAP recommends an evaluation as soon as possible, including review of whatever medical background exists, a full physical, newborn screening panels, hearing, vision, dental and formal developmental and behavioural screening, and immunisation catch-up. Nutritional assessment matters too, iron, calcium and vitamin D deficiency occur in domestically adopted children, not only in children adopted from abroad.

Records worth asking for, in writing

  • Birth records and newborn screening results
  • The complete immunisation record
  • Prior primary care and specialist records
  • Hospital and emergency department history
  • Current medications, including any psychotropic medication, and who consented to it
  • Developmental and mental health assessments
  • Dental, hearing and vision records
  • Known family medical and genetic history

The AAP publishes consent forms for obtaining and releasing confidential records, which are worth having before you need them.

Who may consent to routine care, to mental health treatment and to psychotropic medication for a child in care is set by state or provincial law, as is what must be disclosed to prospective adoptive parents. Ask your agency for its own policy in writing.

Contact with birth family

The grief is universal. Whether an agreement is enforceable is not.

This is the area where adoptive parents' fears and the evidence most often point in opposite directions. Maintained contact with birth relatives is associated with reduced grief, stronger identity development, access to medical and genetic information, preservation of cultural heritage, and a better understanding of why the adoption happened, which reduces feelings of rejection. Extended contact with relatives is linked to more positive psychological adjustment in young adulthood.

Siblings deserve particular attention. They are among the most important relationships a child in care has.

Contact can be supervised, or mediated, where there was prior abuse or neglect, untreated mental health or substance use difficulties, or a likelihood of boundary violations. Wanting contact to be safe is not the same as wanting it to stop.

On enforceability: post-adoption contact agreements are enforceable in only around 29 US states, and generally only when written into a court order. Nowhere does a broken contact agreement undo an adoption.

If you are fostering with reunification as the plan: intense reactions after visits are normal and you should expect them. Visits tend to go better when they are informal and outside an agency office. And the loss you feel when a child goes home is real, successes in foster parenting routinely involve a loss for the foster family, and carers who are prepared for that do better than carers who are not.

Looking after yourself

Genuinely universal, apart from what respite is funded where you live.

Secondary traumatic stress is the emotional strain that comes from hearing about, and living alongside, someone else's trauma. Its symptoms mirror PTSD: hypervigilance, sleeplessness, chronic exhaustion, anger and cynicism, avoidance, guilt, physical complaints, and a creeping loss of the sense that you are any good at this.

Risk rises with direct work with traumatised children, high empathy, unresolved trauma of your own, and isolation. What protects: supervision, peer support, training, and actual rest.

We have deliberately not published a percentage here. The figures that circulate, 6 to 26%, and up to 50% at high risk, are for therapists and child welfare workers, not foster and adoptive parents, and we could not find a reliable figure for carers specifically. The definition and the symptoms transfer; the numbers do not.

Respite care is a short, planned break. It is associated with reduced stress and better family relationships. Funding varies: Medicaid waivers, state programmes, adoption assistance, or self-pay. The most commonly reported barrier is not availability or cost but families being reluctant to ask. Start with your child's caseworker.

Older youth and leaving care

Every number here is jurisdictional and changes often.

Around 18,500 young people left US foster care as adults without a permanent family in 2022. The long-term outcomes, from the Midwest Evaluation which followed young people to age 26, are stark: median annual earnings of $8,950 against $27,310 for a comparison group; only 8% holding a post-secondary degree; 31% having been homeless or couch surfing.

US support: the Chafee programme covers young people aged 14 to 23, and Education and Training Vouchers provide up to $5,000 a year for up to five years.

Canada: British Columbia waives tuition for current and former youth in care, and its SAJE programme runs support to age 27. Ontario's Ready, Set, Go replaced the previous scheme in July 2024, covering ages 18 to 23 with direct monthly payments that step down with age, plus an additional amount for post-secondary participation. Transition planning starts at 13. Across Canada, extended support ends somewhere between 21 and 27 depending where you are.

Getting help where you live

Much of what is on this page has a local answer as well as a general one, and we keep track of both. Asking early is easier than asking in a crisis, so bring us the question while it is still a question.

Talk to us first. Tell us which state or province you are in and what you are trying to decide, and we will explain what applies where you live, what the next step is, and what to expect from it. There is no cost and no obligation. Contact Foster Care Adoption Home, or start your application when you are ready.

Everything on this page is checked against the official source for each jurisdiction, and those sources are listed below so you can read the wording for yourself. We would rather you have both: our explanation of what it means, and the original to confirm it against.

United States. AdoptUSKids publishes a page for every state, plus DC, Guam, Puerto Rico, the US Virgin Islands and Cherokee Nation, naming the responsible agency in each. Read the state pages.

Canada. There is no national system, so the rules are published province by province:

If your province is not listed here we have not finished verifying it, and we would rather say so than guess. Ask us and we will find the current answer for you. The Adoption Council of Canada is the national umbrella body, though it is not a regulator.

Sources

Facts on this page were checked against the sources above on 20 August 2026. Rules change. If you are making a decision, confirm the detail with the agency responsible for your area.