An extensive process preceeded the arrival of their first foster child, with training and background checks before nearly a year of waiting.

For Dr DeGarmo, the decision to help was simply second nature.

"After teaching in a rural high school in an area of high poverty, I saw so many children in need, so many children who were in difficult situations at home," he said.

The DeGarmos were living a stable lifestyle in John's native USA when they made the decision, returning there after spending the early part of their marriage in Dubbo.

Their first foster child entered their home when their biological children were aged five, three and two, affecting the entire household.

"Most days were difficult, as each foster child has his or her own emotional challenges they were sadly burdened with," Dr DeGarmo said.

The DeGarmos fostered children from as short a time as one day old to18 months, but most stayed with them between four and six months.

Dr DeGarmo said Fostering Love: One Foster Parent's Journey detailed the trials and tribulations, the laughs, and the tests throughout their daily lives.

"It is a book about children suffering from abuse, neglect, malnutrition, and even drug-related problems passed on from a mother's addiction," he said.

The varied experiences their foster children had been forced into were heartbreaking, and Dr DeGarmo said the fostering was the hardest thing he had ever done.

"There are so many - the four-year-old with cigarette burns on his tongue and genitals from his mother, others who have been severely beaten by parents," he said.

"Yet the most stressful experience was our 17-year-old.

"Her past was very difficult; her parents were killed when she was nine years old while living in Romania, her birth country.

"She was then adopted by three separate families over the next eight years, all who beat her, abused her, or treated her very poorly before all gave her back to the state government of their respective states.

"When she came to us, she had been through three families who told her they loved her, and then physically, sexually, or emotionally abused her and gave her away.

"She was in a very fragile state, and she could not accept our love to her and for her.

"She fought us every step of the way, and we were forced to place her in a home for youth.

"Now though, four years later, after much love, she calls us dad and mum and we have a family relationship with her.

"But it was very difficult."

Their resilience never wavered; they were instead inspired to establish a permanent reminder into the household.

In their happiest moment, John and Kelly adopted their fourth child after a 20-month process as a result of seeing those put through the system.

"She came to us when she was five days old, a product of a mother who was on crack," Dr DeGarmo said.

Currently a school media specialist in the state of Georgia, Dr DeGarmo decided to use his knowledge to write a doctoral dissertation on challenges foster children faced in US public schools.

"I wanted to make a positive difference, some sort of social change, in the lives of not only foster children, but for their foster parents, caseworkers, and any one who might work with foster children," he said.

"I hope to learn more about Australia; I know a little through my research. I am actually writing an article for a foster care magazine about the differences of foster care across the globe."

The DeGarmos still return to Dubbo to visit Kelly's family, which he thoroughly enjoys.

"Dubbo is a very special place to me, there is so much to offer," Dr DeGarmo said.

John and Kelly are also still active foster parents, currently caring for a six-week-old and a two-year-old.

"There is such a need, across the globe, to be a foster parent - so many children are in need of a loving family," Dr DeGarmo said.

"I hope that my book reaches out to people who are considering it, or who even would like to help out."

Fostering Love: One Foster Parent's Journey was released earlier this month and is available for purchase online.