Underserved parents,underserved youth: Considering foster parent willingness to foster substance-using adolescents

Adolescents involved with foster care are five times more likely to receive a drug dependence diagnosis when compared to adolescents in the general population. Prior research has shown that substance use is often hidden from providers, negating any chance for treatment and almost guaranteeing poor post-foster care outcomes. There are virtually no studies that examine the willingness (and its determinants) to foster youth with substance abuse problems. The current study conducted a nationally-distributed survey of 752 currently licensed foster care parents that assessed willingness to foster youth overall and by type of drug used, and possible correlates of this decision (e.g., home factors, system factors, and individual foster parent factors such as ratings of perceived difficulty in fostering this population). Overall, willingness to foster a youth involved with alcohol and other drugs (AOD) was contingent upon the types of drugs used. The odds that a parent would foster an AOD-involved youth were significantly increased by being licensed as a treatment foster home, having fostered an AOD-involved youth in the past, having AOD-specific training and past agency-support when needed, and self-efficacy with respect to positive impact. Surprisingly, when religion played a large part in the decision to foster any child, the odds of willingness to foster an AOD-involved youth dropped significantly. These results suggest that a large proportion of AOD-involved youth who find themselves in the foster care system will not have foster families willing to parent them, thereby forcing placement into a variety of congregate care facilities (e.g., residential treatment facilities, group homes). Specific ways in which the system can address these issues to improve placement and permanency efforts are provided.     

Gender differences in perceptions of aftercare supports and services

Youth depart residential care with many continued risk factors, unique needs, and challenges as they reintegrate into the home, school, and community settings. Currently, there is limited research on needs and best practices in aftercare services and supports for youth departing from residential settings and even less is known about how these differ by gender. While preliminary studies have explored perceptions of need during reintegration and aftercare by youth and caregivers, little is known about how these may differ by gender or if perceptions change over time after experiencing the initial transition period. One way to address this knowledge gap is to identify how prepared males and females feel for reintegration in critical life domains, their beliefs about aftercare, and preferences regarding potential services or supports to aide in the reintegration at discharge. Therefore, the purpose of this study was to explore if males and females differ on preparedness for reintegration across critical life domains, beliefs about aftercare, and preferences regarding potential services or supports to aide in the reintegration at departure from a residential treatment facility (N = 132). Overall, very few differences were found between males and females at departure. Implications, limitations, and future research are discussed.     

The voice of troubled youth: Children's and adolescents' ideas on helpful elements of care

This article presents the findings of a qualitative study in a Flemish centre for children and adolescents with emotional and behavioural disorders. The aim of this study was twofold. First, we wanted to examine how youth reflect on their own behaviour and that of their peers'. Secondly, we wanted to know what, according to the youth, are the most significant helpful elements of treatment. Analysis shows a continuum of negative behaviour, ranging from relatively ‘normal’ disruptive behaviour such as arguing, up to serious disruptive behaviour such as physical aggression. This behaviour has a negative influence on the climate of the organization. ‘Availability of staff’, ‘nearness of staff’, ‘a clear set of rules and boundaries’, and ‘some time on my own/some alone time’ are perceived as helpful elements of treatment. ‘Strictness’, ‘not listening’, and ‘inappropriate staff attitudes and interventions’ are perceived as counterproductive elements of treatment. Results are discussed and recommendations both on the orthopedagogical as well as on the scientific level are formulated.     

Accomplishing family reunification for children in care: An Australian study

Whilst child protection systems are concerned with removal of children from their families in the interests of safety, the capacity of child welfare systems to return children safely to their families of origin is of central importance. The multidimensional standardised assessment tool, the North Carolina Family Assessment Scale—Reunification (NCFAS-R) was used by practitioners to assess family strengths and needs in case planning and reunification decision making. The current paper examined (1) whether NCFAS-R domain ratings at intake and closure differ by characteristics of parents and children; and (2) whether reunification is predicted by NCFAS-R score at closure.     

Causal effects of foster care: An instrumental-variables approach

This paper describes the use of instrumental-variables (IV) to estimate causal effects of foster care on long- and short-term outcomes. This estimation strategy provides a tool to evaluate what are known as “natural experiments”: settings that mimic randomization usually associated with a controlled trial. The proposed natural experiment involves the effective randomization of investigators to child-protection cases. The results suggest that foster care placement increases like likelihood of delinquency and emergency healthcare episodes. Care must be taken when interpreting IV estimates. The results apply to cases that are part of the natural experiment—“marginal cases” where the investigators may disagree about the placement recommendation.     

Have child maltreatment and child placement rates declined?

It is argued that the actual incidence of child maltreatment remains elusive and is, in fact, indeterminate. Factors that might be reflected in variations in child maltreatment rates, other than child harm or endangerment at least partially attributable to caretakers, are explored. But since most children residing in foster care in the United States have been placed there for the alleged reasons of child abuse and neglect, we might expect trends over time in the rate of alleged maltreatment to have some bearing on the out-of-home placement population rate. On the contrary, it is shown that the child placement population rate has risen in recent years, even though the overall child maltreatment rate has not. Based on existing data, the child placement population in the United States is calculated to have been nearly one million children on any given day in 2011, higher than at any point throughout the previous century. Brief comparisons are made with child maltreatment and child placement trends in other countries.     

Trauma-informed care training in a child welfare system: Moving it to the front line

The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. We evaluated the impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (Caseworkers, Program Assistants and Other front-line staff). Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. We also found a significant increase in staff use of trauma-informed care practices at the three-month follow-up with little difference observed across staff groups. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed.     

Medicaid Funding for Assisted Living Care: A Five-State Examination

Medicaid waiver programs financing assisted living care are examined in five states to gain insights about program implementation, accomplishments, and challenges. Documents, augmented with stakeholder interviews, are used to describe income eligibility, options for supplementing payments to facilities, risk adjustment payment levels, and participation. Needs determination and waiver-based payments are in place. Eligibility and funding levels are complicated by room and board allocations that are linked to the federal benefit rate for Supplemental Security Income. Provider participation may be diminishing. Many recipients have to accept shared occupancy as program payments are insufficient for single units.     

Eight Years of Data on Residents in Small Dementia-Care Settings Suggest Functional Performance Is Maintained

Eight years of data analysis on residents’ status from three small Alzheimer care centers suggest notable stability in function. Individuals’ functional ability was best in their first year, but their year-to-year decline was mostly not significant. Cognitive abilities also were best in the resident's first year, but first-, second-, and third-year cognitive scores were not significantly different. We compared the residents’ dementia progression rate to the true rate of natural disease progression. This study, like others on small homelike settings, suggests that appropriate homelike environments maintain persons with dementia at an optimum level longer.     

An ICT-Driven Hybrid Automation System for Elderly Care Support: A Rehabilitation Facility Study Case

Abstract

The demographic statistics in developed countries suggest growth in the elderly segment of the population. At the same time, other studies forecast a shortage of nurses, increasing the pressure on hospitals to provide treatment for longer periods of time. These trends suggest a need for new ways of taking care of the elderly population that support safe, comfortable, and independent living. Meanwhile, prominent advances in information and communications technology (ICT) have enabled new systems that address various needs of the elderly. This article presents a case study of a rehabilitation facility located in Tampere, Finland, that uses an automation system in which ambient assisted living (AAL) and building automation (BA) system functionalities are combined. It details a field study summarizing the needs of the users, describes functional scenarios supported by the system, and reports the results of the first usability tests suggesting acceptance of a new technology by residents and caregivers. The unique combination of ambient assisted living and building automation offers a safer and more comfortable environment for the elderly as well as helps caregivers on-site in managing their workloads.