Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices

Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.     

The Impact of a Substance Abuse Disorder on the Well-Being of Family Caregivers of Adults With Mental Illness

ABSTRACT

The impact that substance use has on an individual with mental illness has been documented; however, little is known about the impact that this may have for a family caregiver. Data was collected in a cross sectional study using mailed questionnaires to a convenience sample of family members of persons with mental illness (n = 110). Hierarchical linear regression analysis was used to determine the impact of substance use status upon four measures of well-being within a stress-coping model. The variables within the model were able to account for a significant proportion of the variance in each of the measures: perceptions of burden, depression, anxiety and physical health status (R² = .419 to .202). However, substance use status was not a significant predictor in any of these equations. Symptomatology and a measure of specific social support were the most significant predictors of burden (β = .345, p < .001 and β = .330, p < .001). Perceptions of caregiver burden were found to be the most significant predictor in each of the other three analyses (β = .515, p < .000; β = .511, p < .000; β = ? .571, p < .000). Results of this study suggest that substance use may not be as important as the other predictors included in the model in determining the well-being of family caregivers.     

Kinship Care for Children of a Parent With a Mental Illness

Little is known about “hidden” kinship caregivers of children of a parent with a mental illness (COPMI). An exploratory study surveyed 56 COPMI caregiver members of a kinship center administered by a school of social work in a large public university. The COPMI sample was a subset of a larger kinship caregiver study. Nearly one in four caregivers was providing COPMI kinship care. The COPMI caregivers reported numerous child behavioral crises and decreased caregiver physical and emotional health since they began providing care. Practice, policy, and research require development to increase support for COPMI caregivers and their families.     

Kinship liaisons: A peer-to-peer approach to supporting kinship caregivers

Relative caregivers are invaluable to the child welfare system. Although most states have a preference for relative placement, the support and assistance provided to relatives during and beyond the initial child placement period are inadequate. Through a U.S. Children's Bureau System of Care Demonstration project, a peer-to-peer approach (based in social cognitive theory) which paired a new relative caregiver (n = 74) with a full-time, paid kinship liaison (a current or former relative caregiver) was studied. Findings show that kinship liaisons are extremely helpful to caregivers and reveal 27 support categories that caregivers find most useful. One of the most significant services (i.e., information and referral) provided by the liaisons increased caregivers' knowledge of accessing available services and the permanency process. Data results show significant increases in caregivers' coping abilities and willingness to become a permanent resource for the children in their care. Policy and practice insights are provided.     

Exploring the Relationship Between Adverse Childhood Experiences and Hope

ABSTRACT

To explore the relationship between adverse childhood experiences and hope, a convenience sample of caregivers bringing in children for medical investigation of child abuse at a regional child advocacy center were surveyed for adverse childhood experiences and dispositional hope. Hope in this sample had a significant negative correlation to the adverse childhood experiences subscale “abuse” (r = –.19; p < .05). The relationship between hope and the other adverse childhood experiences subscales “neglect” (r = –.14) and “dysfunctional family” (r = –.16) was not statistically significant. An analysis of variance was performed to determine if caregivers who have experienced both sexual and physical abuse (M = 29.67; SD = 15.96) have lower hope scores compared to those caregivers who have experienced neither physical nor sexual abuse (M = 42.64; SD = 18.44). This analysis (F (1, 84) = 5.28; p < 0.05) showed that caregivers who experienced both physical and sexual abuse scored significantly lower on hope compared to their counterparts who experienced no adverse events, with an estimated effect size of moderate strength (d = 0.70). Higher adverse childhood experiences scores are associated with lower hope. This result was especially true for those adult caregivers who reported experiencing both physical and sexual abuse when compared to adults who did not experience either form of child trauma. While the empirical literature continues to demonstrate the negative consequences of adverse childhood experiences across the life span, hope offers a compelling new line of inquiry in child maltreatment research especially for studies targeting prevention or intervention.     

Examining the Effects of a Service-Trained Facility Dog on Stress in Children Undergoing Forensic Interview for Allegations of Child Sexual Abuse

Disclosure of child sexual abuse can be a stressful experience for the child. Gaining a better understanding of how best to serve the child, while preserving the quality of their disclosure, is an ever-evolving process. The data to answer this question come from 51 children aged 4–16 (M = 9.1, SD = 3.5), who were referred to a child advocacy center in Virginia for a forensic interview (FI) following allegations of sexual abuse. A repeated measures design was conducted to examine how the presence of a service-trained facility dog (e.g. animal-assisted intervention (AAI) may serve as a mode of lowering stress levels in children during their FIs. Children were randomized to one of the two FI conditions: experimental condition (service-trained facility dog present-AAI) or control condition (service-trained facility dog not present- standard forensic interview). Stress biomarkers salivary cortisol, alpha-amylase, immunoglobulin A (IgA), heart rate, and blood pressure, and Immunoglobulin A were collected before and after the FI. Self-report data were also collected. Results supported a significant decrease in heart rate for those in the experimental condition (p = .0086) vs the control condition (p = .4986). Regression models revealed a significant decrease in systolic and diastolic blood pressure in the experimental condition (p = .03285) and (p = .04381), respectively. Statistically significant changes in alpha-amylase and IgA were also found in relation to disclosure and type of offense. The results of this study support the stress reducing effects of a service-trained facility dog for children undergoing FI for allegations of child sexual abuse.     

Evaluating Services for Kinship Care Families: A Systematic Review

Despite their needs, kinship care families receive less support and fewer resources than other foster care families. This study systematically reviews thirteen studies that evaluated services and programs for kinship caregivers and children. Studies evaluating the effectiveness of the Kinship Navigator Program, financial assistance, support services, and training/educational programs were identified and reviewed. The Levels of Evidence-Based Intervention Effectiveness (LEBIE) scale was used to evaluate the research designs. The findings indicate that although positive results are shown for enhanced well-being and permanency outcomes of children and kinship caregivers, the rigor of the research designs are low, making it difficult to draw any firm conclusions about the effectiveness of these programs. Recommendations for child welfare practice and future research include the need to develop services for informal caregivers and particular racial/ethnic groups. In addition, more rigorous research designs and qualitative research should be conducted to support the effectiveness or social validity of the services and to inform evidence-based practice.     

Identified Problems and Service Utilization Patterns Among Kinship Families Accessing Mental Health Services

Abstract

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.     

KinCareTech: Interactive,Internet-Based Software to Support Kinship Caregivers

Kinship care has advantages over traditional foster care, but kinship caregivers have fewer resources and receive less support or training. Technology may be one way to evaluate needs and provide support. KinCareTech is a collaboratively developed, single-session Internet-based program designed to promote early reading and/or parenting skills through an interactive, caregiver-focused brief intervention. KinCareTech was used by a group of 10 kinship caregivers who then provided quantitative and qualitative feedback regarding the acceptability and helpfulness of the software. Feedback from these kinship caregivers suggested that they saw the software as easy to use, helpful, and relevant to their concerns.     

Predicting Permanency Intentions Among Kinship Caregivers

This study examines kinship caregivers’ (n = 830) experiences and their perceptions of the children (n = 1,339) in their care in order to predict permanency intent. Permanency intent is a caregiver’s expressed intent to adopt the child in his or her care or to provide permanent, legal guardianship. The results of this study reveal that most caregivers’ permanency choice is guardianship and not adoption. However, binary logistic regression results uncovered six factors (i.e., thorough explanation of case plans, decreases in caregiver emotional stress, decreases in child depression, child lack of communication with birth parent, caregiver providing care for a sibling group, decreases in run-away behavior) that predict that a caregiver will adopt the child in his or her care. Policy, practice, and research implications are noted.     

Program evaluation of the CREST project: empirical support for kinship care as an effective approach to permanency planning

The number of children, especially from ethnic minority groups, in substitute care is growing rapidly even as the number of foster care homes is steadily decreasing. Kinship care has quickly become the permanency planning option of choice. This article describes a model kinship care project and the results of an extensive program evaluation. Results show that the project enhances functioning of relative caregivers and reduces the cost of care. Implications for contemporary permanency planning are presented.     

The Impact of Family Functioning on Caregiver Burden among Caregivers of Veterans with Congestive Heart Failure

A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden, objective burden, stress burden, and uplifts). Regression analyses indicated that the five dimensions of family functioning were significantly related (p < 0.01) to relationship burden (R ² = .27) and uplifts (R ² = .29). More specifically, increased relationship burden was associated with problems in family roles, and increased uplifts was related to higher levels of affective responsiveness.     

Financial well-being in family-based foster care: Exploring variation in income supports for kin and non-kin caregivers in California

Kinship foster parents have the same responsibilities as nonrelative foster parents and are held to the same standards of rehabilitative care. Nonetheless, their rights to financial supports and their access to other services vary across states depending on the federal eligibility of the child, and/or the licensing criteria caregivers may or may not meet. We know little about the financial supports, well-being, or services of kinship caregivers receiving differential payment schemes and whether or not these financial supports and services make any difference. More fundamentally, in states that operate two- or more -tiered funding schemes for kinship foster parents, we currently cannot even estimate what proportion of kin caregivers receive more, less, or nothing from the government, even though all are entitled to something. Kin and non-kin caregivers in two California counties responded to a written survey focused on the financial wellbeing and income supports available to families. Sources of support were associated with the availability and utilization of other child welfare services for caregivers and for children.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.     

Kinship care and service utilization: A review of predisposing,enabling, and need factors

Research has shown that relative caregivers are less likely to use formal supports and services than non-relative foster parents. However, less is known about factors influencing kinship caregivers' help-seeking behaviors and service use. This systematic review identified research studies examining factors associated with service use among kinship caregivers using key search terms in five computerized bibliographic databases and four journals. The search identified 337 potentially relevant studies. After screening and study eligibility assessments, a final sample of 13 studies was reviewed. Findings suggested that although children and their kinship caregivers were clearly in need of services, service use was low. Results suggested a need for more rigorous research designs and that the following factors may influence service use: child behavioral problems, caregiver mental health status, resources, provider characteristics, caregiver perceived need, and social support. More research examining help-seeking behaviors, perceptions of formal services, and effectiveness of kinship caregiver services in relation to child outcomes is needed to improve the wellbeing of kinship families in the child welfare system.     

Factors Associated with the Decision-Making Process in Kinship Diversion

During the past two decades, child welfare professionals have given kinship care priority as the preferred least restrictive, most family-like placement option when a child has to be removed from his or her family. However, the available literature lacks investigation into what factors drive the decision to use kinship care, specifically an understanding of why some children are diverted from child welfare system (CWS) into unpaid kinship arrangements while other children enter the traditional foster care system. This study uses baseline (Wave 1) data from the National Survey of Child and Adolescent Well-being II (NSCAW II), which provides information about children and caregivers in different types of kinship care. The data were analyzed using multinomial logistic regression based on the multiple imputed data files using NSCAW II weights. Results show important predictors of a child being diverted into private kinship care included the child’s age, caseworker’s educational background, and caseworker’s assessment of harm level. Important predictors of a child being diverted into voluntary kinship care included the maltreatment type, family structure, caseworker’s educational background, and caseworker’s assessment of risk level. Differentiating between the types of kinship diversion has important implications for practice and policy. Examining a variety of factors can help child welfare scholars develop a comprehensive understanding of the decision-making processes used in selecting kinship diversion for out-of-home placements.     

Role Perceptions of Foster Care in African American Kinship and Nonkinship Foster Parents: A Quantitative Analysis

This article reports on a study that examined a cohort of African American kinship (n = 57) and nonkinship (n = 53) foster parents' perceptions of their role responsibilities as a foster care provider. The Foster Parent Role Perception (FPRP) scale was used to measure perceived role responsibility. Results indicated that both the kinship and nonkinship foster parents perceived their primary role responsibilities as that of caring for the needs of the foster child(ren), while perceiving much less role responsibility for working with the biological family of the child(ren) or partnering with the agency. The implications of these findings for practice are discussed.     

The Effects of Subjective Age and Aging Attitudes on Mid- to Late-Life Sexuality

This study examined the effects of subjective age and attitudes about aging on frequency of sex and interest in sexual activity among middle-aged and older adults. Data were drawn from two waves of the Midlife in the United States (MIDUS) study (n = 1,170 adults, mean age Time 1 = 53.70 years, SD = 9.08). Regression analyses were used to investigate the effects of subjective age and attitudes about aging on three measures of sexuality: frequency of sex, perceived quality of sexual activity, and interest in sexual activity, over 10 years. The older participants felt and the less positive their views of aging, the less they rated sexual activity as enjoyable over time. Feeling older (though not attitudes about aging) also predicted less interest in sex. Subjective age and beliefs about aging did not have an impact on frequency of sex. Although frequency of sex was not predicted by subjective aging and aging attitudes, the results suggested that subjective age and stereotypic views on aging may shape the experience of sex in later life.     

Competencies and problem behaviors of children in family foster care: variations by kinship placement status and race

Formal kinship foster care is an increasingly common form of out-of-home placement, and several important distinctions between kinship care and non-relative foster care have been identified. The present study evaluated the behavior of kinship foster children in comparison to non-relative foster children and children in the general population. A geographically and ethnically diverse sample of foster children (N=240) was assessed for competence and problem behaviors using the Child Behavior Checklist (CBCL: Achenbach, 1991). Kinship foster children closely resembled children in the general population but differed significantly from their counterparts in non-relative foster care, who consistently scored lower on competence and higher on problem behaviors. Substantial proportions of non-relative foster children were in the clinical range on most CBCL measures, but kinship foster children were no more likely than children from the general population to score above clinical cut-offs. Differences between kinship and non-kinship foster children became less dramatic after accounting for child race and gender, which were both associated with kinship status. Child race had a strong main effect for almost all types of problem behaviors, with children of color showing significantly less problematic behavior. Discussion of these results centers on potential explanations for the observed variations in child behavior by kinship status and race.