AS A CHILD MENTAL-HEALTH professional, I dread encountering a child in the emergency room or on an inpatient unit who has a history of multiple out-of-home placements, in foster care and residential-treatment centers. Typically the case I dread looks like this: The child was removed from an abusive or neglectful biological family and placed in foster care; a family reunification plan was developed that led to the child’s going back to the biological family, but further abuse or neglect led to the state’s again taking custody and putting the child in (usually) a different foster family; the child begins to exhibit behavioral symptoms that are beyond the capacity of the foster family to manage, and the child is transferred to a residential treatment facility.

This cycle of reunification, foster care and residential treatment repeats itself in a downward spiral, punctuated by multiple crises and brief psychiatric hospitalizations. The further it cycles, the more abandoned, angry and unlovable the child feels, and his or her behavior reflects that sad state. Relationships — the building blocks of therapy — have less and less meaning for the child, who seems to be slipping away despite all of society’s good intentions and resource expenditure. Psychiatric involvement, in the form of hospitalizations and medications, is an inevitable component of the process and it is an awful feeling to know that, inadvertently, one is a part of the problem rather than the solution.

The foster-care system is designed to provide temporary care to children who are removed from their parents by state authority. Everyone recognizes that the limbo land of foster placement is undesirable for a developing child and that therefore time spent in it should be brief. The Adoption and Safe Families Act (ASFA) of 1997 sought to impose stricter time limits on reunification efforts, mandating that adoption proceedings should be under way for all children who have been in foster care for 15 of the last 22 months. Unfortunately, ASFA has made less of an impact than hoped: he nearly 800,000 children in foster care nationwide each year is only about 7,000 fewer than the “bad old days” when the law was passed.

In Rhode Island, according to a recent report from Kids Count RI, the percentage of children in care who were adopted in 24 months or less has decreased from 50 percent in 2003 to 31 percent in 2007, which is comparable to the national average of 32 percent. The longer children are in foster care, the more likely to occur is the dreaded cycle of behavior problems, failed placements and growing misery.

There are many factors that result in children languishing in the foster-care system. One critical problem is the lack of foster homes, especially those with minority foster parents. While no foster parents are in it for the money, the funding they receive in most states is less than what is required to provide for the child’s basic needs.

In Rhode Island, the monthly rate equals about $16 per day — less than people typically pay to kennel their dog during their vacation. Add to the poor remuneration, the significant bureaucratic hurdles for licensing, little preparation or training available and few support services provided for those fostering especially challenging children, it’s a wonder anyone signs up! Further, a shortage of foster parents means a shortage of adoptive parents, because nationwide foster parents adopt more than half of those who exit foster care due to adoption. In Rhode Island, that figure is close to 80 percent.

Another reason children stay too long in foster care is a societal unwillingness to terminate parental rights even when it is obvious that repeated episodes of abuse or neglect mean that some parents will never be minimally adequate, even if the resources to help them were limitless (which they never are). The wheels of justice turn too slowly for the children of such parents, weighed down by inefficient family court procedures and a naïve optimism regarding our capacity to fix damaged parents. Three years in care is not unusual, but it is half a lifetime for a six-year-old.

Two recent studies offer some hope amidst the bleakness and suggest that perhaps we can work toward building a better system.

One study reported a rigorous comparison of outcomes following placement with a foster family of relatives versus placement with an unrelated foster family. Three years after placement the researchers found serious behavior problems in 32 percent of those placed with relatives compared to 46 percent of those placed with unrelated foster families.

A second study, funded by the Casey Family Programs, found that adults who had been placed in private “Cadillac” foster-care systems as children had 50 percent lower rates of depression and substance abuse compared with adult foster-care alumni of a public, state-run foster-care system.

What a surprise: We get what we pay for! Except in this case, what we’re buying is hope for a decent life for society’s most vulnerable children.

Gregory K. Fritz, M.D., is academic director at the E.P. Bradley Hospital and editor of the Brown University Child and Adolescent Behavior Letter.