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Foster care placement instability, High-risk foster care children, Girls in foster care, Physical health



  1. Dowdell, Elizabeth B. PhD, RN, CRNP
  2. Cavanaugh, Deborah J. MA, MHC
  3. Burgess, Ann W. DNSc, RN, FAAN
  4. Prentky, Robert A. PhD


Purpose: To describe the characteristics of girls in foster care who have exhibited sexually abusive behavior.


Study Design and Methods: This was a chart review and a descriptive, exploratory study of 155 female children and adolescents (age 4-17 years) who were in foster care and had been evaluated for their sexual abusive and aggressive behaviors.


Results: Findings indicated that these girls had significant histories of maltreatment, chronic health issues, and foster care placement instability; 84% of the girls had been physically abused; 95% were victims of ongoing abuse by the biological parents (78%). Sexual abuse was reported by 81%, and 68% were sexually abused by more than one individual. Ninety-five percent were neglected; 51% of the neglect was classified as severe and chronic. All of the girls (100%) had been shown to exhibit sexually abusive and inappropriate behaviors toward other children, including exposing themselves to age-mates, violation of body space, sexually aggressive remarks, sexual touching without permission, and sexual touching of much younger children. Ninety-two percent of the girls had two or more changes in caregivers by age 16 years. Over one-third of the girls (39.2%) experienced four or more different living situations that lasted less than 1 month.


Clinical Implications: These girls demonstrated a variety of behavior problems that place them at high risk for multiple foster care placements, which can negatively impact upon their well-being and health. Whether in healthcare settings, schools, the workplace, community, in-patient, or psychiatric settings, nurses and other healthcare providers have access to children and their foster care caregivers. Nurses and other healthcare clinicians are in an ideal position to provide a safe clinical environment contributing to the health, education, and support to these girls.