This legislation provided states flexibility in how
they design their program. States can choose one of
three approaches: (1) expand the current Medicaid
program, (2) create or expand a separate state chil-
dren’s health insurance program, or (3) use a combi-
nation of both approaches. The majority of states
created a non-Medicaid SCHIP program for at least
some of their SCHIP-eligible children. Fifteen states
created a non-Medicaid SCHIP program only, and
nineteen states created a state program in combina-
tion with a Medicaid expansion. The remaining nine-
teen states used SCHIP funds to expand Medicaid
only.
See also: HEALTH INSURANCE; POVERTY
Bibliography
American Academy of Pediatrics. State Approaches to Title XXI. Elk
Grove Village, IL: American Academy of Pediatrics, 2000.
Beth K. Yudkowsky
STEPFAMILIES
Each year approximately one million American chil-
dren and adolescents will experience their parents’
divorce. Most of their parents (70–75%) will remarry
or begin living with a new partner within three to five
years. These new families are labeled stepfamilies or
blended families. The 1996 United States census indi-
cated that 32 percent of African-American, 16 per-
cent of Hispanic, and 15 percent of Caucasian
children live in stepfamilies. Approximately one-
fourth of all American children will live in a stepfami-
ly before they reach adulthood. Most children and ad-
olescents who live in stepfamilies live with their
biological mother—17 percent of children are in the
father’s custody after the divorce. More than half of
second marriages end in divorce within the first five
years. Consequently, children in stepfamilies may ex-
perience a second divorce. Research indicates that
the more divorces children experience, the more they
are negatively affected.
Children’s and Adolescents’ Adjustment
in Stepfamilies
Children and adolescents in stepfamilies tend to
develop more problems than children and adoles-
cents in intact families. Children in stepfamilies are
more likely than children in intact families to have ac-
ademic problems, to have externalizing or internaliz-
ing disorders, to be less socially competent, and to
have problems with parents, siblings, and peers.
About a third of adolescents become disengaged from
their stepfamilies and consequently may be more like-
ly to become sexually active at an early age, to be in-
volved in delinquent activities, to be involved with
drugs or alcohol, and to drop out of high school.
When children or adolescents raised in stepfamilies
reach adulthood, they are more likely to divorce than
children raised in intact families. But it is important
to note that although children in stepfamilies are
more likely to have problems than children in intact
families, the majority of children in stepfamilies are
normally adjusted.
One would expect that children and adolescents
in stepfamilies would be better adjusted than children
and adolescents in single-parent divorced families.
Stepfamilies have more resources than single-parent
divorced families, including two parents to share
child rearing and more financial resources. Surpris-
ingly, a large body of research indicates that children
and adolescents in stepfamilies have the same level of
adjustment problems as children and adolescents in
divorced single-parent families. One reason for this
similarity between the adjustment of children in step-
families and single-parent divorced families may be
that stepfamilies experience significant stresses with-
in their family interactions. It may take five to seven
years for a new stepfamily to stabilize and begin to
function smoothly. From a family systems perspec-
tive, stepfamilies begin with a weak family system. In-
stead of a healthy family system (a strong, well-
established marital bond, strong child bonds to both
parents, and little outside interference), stepfamilies
typically begin with a new and relatively weak marital
coalition, a strong parent-child relationship, a weak
or conflicted stepparent-child relationship, and with
the outside involvement of the noncustodial parent.
In addition, children in stepfamilies may have to ad-
just to less attention from their biological parent, to
parenting from a new stepparent, and to new sibling
relationships.What Affects Children’s and Adolescents’
Adjustment to Stepfamilies?
Several factors may affect how well a child adjusts
to a stepfamily. First, the child’s gender is a factor.
Girls have more difficulty than boys adjusting to step-
family life. In stepfamilies that include the child’s bio-
logical mother and a stepfather, girls are more likely
than boys to be resistant to the stepfather. In single-
parent divorced families, mother-daughter relation-
ships often are exceptionally close; consequently,
when mothers remarry, girls may view new stepfa-
thers as threats to their previously close relationships
with their mothers. In contrast, boys’ overall adjust-
ment is likely to improve after their mothers’ remar-
riage. Mother-son relationships in single-parent
divorced families typically are conflicted and coer-386 STEPFAMILIES