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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

On any given day, about half a million children in the U.S. live in foster care. Often they are victims of severe abuse and neglect by their parents, and many of the kids end up in foster care programs that have problems of their own.

We have several stories now on efforts to improve foster care and the people behind those efforts. First, a study published this week explores what it takes to create a successful foster care system, a system which helps children heal psychologically and physically.

The study appears in the Archives of General Psychiatry, and Michelle Trudeau has our story.

MICHELLE TRUDEAU: A child is placed in foster care only as a last resort, when parental maltreatment or neglect is extreme and unremitting. Such abuse has long-term consequences. Sociologist Ronald Kessler of Harvard Medical School investigated two groups of foster care children from Oregon and Washington State. They were adults who've been raised in foster care from childhood through their teenage years. One group had been placed in the state-run public foster care system and the other group was placed in a private program with expanded services.

Professor RONALD KESSLER (Harvard Medical School): We traced both groups of kids to see how they turned out as adults.

TRUDEAU: Both groups had similar social and economic backgrounds. They'd been placed in either the standard state program or the expanded private program, depending on space availability. Kessler says they turned out very differently.

Prof. KESSLER: The people who were alumni of the more intensive program had dramatically better mental health and physical health than the people who were in care in the conventional program.

TRUDEAU: Significantly less hypertension, heart disease, ulcers, chronic pain and headaches.

Prof. KESSLER: They had 50 percent lower rates of depression and anxiety disorders and substance disorders.

TRUDEAU: So what made the difference? A whole list of things, including that case workers in the private program were better trained, earned higher salaries, had lower caseloads. The kids got more services, such as mental health counseling, tutoring in school, summer camps. And the foster parents received more financial assistance and support, even some parent training. Of course these expanded services cost more - about 60 percent more. But Kessler says the benefits outweigh the cost.

Prof. KESSLER: The outcomes are more than 60 percent better. You really get a dramatic, dramatic increase in the quality of the outcomes for the kids in the model program.

TRUDEAU: But with the foster care system already costing the country well over $5 billion a year, it's perhaps more realistic, Kessler says, to target these expanded services at foster children who were particularly vulnerable.

Prof. KESSLER: We're now going in and digging in to the data and saying, is there some subset of kids who it really makes a big difference for, and others that it doesn't?

TRUDEAU: Research psychiatrist Charles Nemeroff at Emory University agrees, and suggests that the target group should be children who have experienced the trauma of parental abuse and inherited a genetic vulnerability to depression or anxiety. This group would be the most likely to suffer lasting health problems as adults and the most likely to benefit from an expanded encompassing foster care program.

For NPR News, I'm Michelle Trudeau.

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