Problematic Eating and Food-related Behaviours and Excessive Weight Gain: Why Children in Out-of-home Care Are at Risk

Emerging evidence suggests that abuse and neglect in childhood may play a role in subsequent development of obesity. One population group particularly at risk is children and young people living in out-of-home care (OOHC). Given this population is already a vulnerable group, identifying potential mechanisms by which childhood abuse and neglect increases risk for obesity is essential. A possible explanation is that problematic eating and food-related behaviours (i.e., emotional eating, compulsive eating, overeating, binge eating, stealing or hoarding food) might mediate the association between adverse childhood experiences and obesity. Hence, the overall goal of this paper was to provide a narrative review of eating and food-related difficulties for children in care and their possible association with unhealthy and excessive weight gain. This review revealed a shortage of existing empirical papers and signalled particular need for further examination of the mediating effects of problematic eating.     

Children with problematic sexualized behaviors in the child welfare system

This study assessed the utility of the Child Sexual Behavior Inventory (CSBI) in a child welfare sample. In this study, 97 children from ages 10 to 12 from either foster boarding homes or a residential treatment center participated. Researchers interviewed foster parents or primary therapists about children's sexual behavior, traumatic events, clinical symptoms, and their attitudes toward the child. Findings revealed that problematic sexualized behaviors were more prevalent in the residential treatment center (RTC) sample than they were in a normative sample. The pattern of associations between sexual behavior problems, traumatic events, and clinical syndromes in both the RTC and the foster boarding home (FBH) samples was similar to what has been found in samples in which biological custodial parents were the respondents. Analyses comparing youth who met the criterion for having problematic sexualized behaviors and youth who did not meet the criterion revealed that the two groups differed on clinical symptoms, prior traumatic events, and negative reports by caregivers. Results confirm the utility of the CSBI measure for this population and highlight several important clinical and programmatic concerns for addressing problematic sexual behavior in children in the child welfare system.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

A survey of problematic sexualized behaviors of children in the New York City Child Welfare System:estimates of problem, impact on services, and need for training

Forty-eight of 52 (92%) agencies contracted with the New York City Administration for Children's Services (ACS) responded to a survey about problematic sexualized behaviors (PSB) of children in different levels of care within the child welfare system. Results revealed that almost all agencies reported PSB within their foster boarding home and residential treatment centers. A majority of agencies perceived PSB to be a significant problem for which staff and families were not sufficiently trained. These findings highlight many avenues for advocacy, clinical intervention, and staff development.     

Black foster parents and agencies: Results of an eight state survey

This article reports results of research on characteristics of black foster parents and their relationship with child welfare agencies. The data come from the 1980 Survey of Foster Parents in Eight States, conducted by Westat, Inc., and are analyzed using bivariate and multivariate techniques. White foster parents are included for purposes of comparison. Major findings are that black foster parents differ from white foster parents in demographic characteristics, are somewhat more likely to care for children of relatives, and have somewhat more problematic relationships with child welfare and collateral agencies.     

Foster Parents’ Nutritional Strategies and Children’s Well-Being

Among their many responsibilities, foster parents are tasked with providing healthy food and proper nutrition to children with a variety of physical, psychological, and emotional needs. Using the lens of symbolic interactionism, this exploratory mixed methods study examined how foster parents attend to the nutritional needs of abused and neglected children. Methods used included both quantitative surveys and qualitative follow-up interviews. Surveys were completed by 23 foster parents in a large, Midwest metropolitan area. Parents reported they provided their children balanced meals, although one-third of households reported instances of food insecurity. During qualitative interviews, foster parents (N = 9) described how children arrived at their home with a variety of unhealthy eating habits, some severe in nature. Parents discussed strategies used to modify and improve eating patterns, including offering healthy food choices, having children plan meals, and gathering as a family for daily dinners. In general, parents understood the link between unhealthy eating and past childhood trauma, but also reported being unprepared for more serious eating problems like hoarding. Findings indicate that foster parents need food assistance to increase food security as well as training in assessing and responding a variety of unhealthy child eating behaviors.     

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.     

Young Children's Problematic Sexual Behaviors,Unsubstantiated Allegations of Child Sexual Abuse,and Family Boundaries in Child Custody Disputes

ABSTRACT

Allegations of child sexual abuse are sometimes alleged based on a child's problematic sexual behaviors. When the allegations are unsubstantiated, child custody evaluators are asked to make recommendations regarding custody. Historically, it has been believed that if a child engages in problematic sexual behaviors it is strong evidence of child sexual abuse. Recent research finds that there are many reasons, other than overt sexual abuse, for children to engage in problematic sexual behaviors. This article outlines these reasons and provides a methodology for the evaluation of the boundaries in both parents' homes to assist in determining the possible etiology of the problematic sexual behaviors of the child. Suggestions are made regarding visitation and reunification if boundary concerns are found.     

A Survey of Problematic Sexualized Behaviors of Children in the New York City Child Welfare System: Estimates of Problem,Impact on Services,and Need for Training

ABSTRACT

Forty-eight of 52 (92%) agencies contracted with the New York City Administration for Children's Services (ACS) responded to a survey about problematic sexualized behaviors (PSB) of children in different levels of care within the child welfare system. Results revealed that almost all agencies reported PSB within their foster boarding home and residential treatment centers. A majority of agencies perceived PSB to be a significant problem for which staff and families were not sufficiently trained. These findings highlight many avenues for advocacy, clinical intervention, and staff development.     

Understanding Responses to Foster Care: Theoretical Approaches

Foster children making the transition from birth to foster homes or from foster homes to foster homes often present problematic behaviors. Limitations of attachment theory and reactive attachment disorder are presented, and three alternative approaches for understanding behaviors exhibited in foster settings are presented: conservation of resources, child alienation model, and developmental trauma disorder.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.     

The Placement History Chart: A Tool for Understanding the Longitudinal Pattern of Foster Children's Placements

Despite growing concerns about foster placement instability, little information is available regarding the longitudinal patterns of placement histories among foster children. The purpose of the present study was to develop a charting system using child welfare records to facilitate a better understanding of longitudinal patterns of placement history for 117 foster children. The resulting Placement History Chart included all placements that occurred during the observed time period and accounted for various dimensions: number, length, type, and sequence of placements; timing of transitions; and total time in out-of-home care. The Placement History Chart is an effective tool for placing foster care experiences within a broader developmental context. As such, the Placement History Chart can be a valuable research tool for understanding various dimensions and variations of placement transitions among foster children by capturing sequences and cumulative risks over time. Furthermore, this chart can facilitate the development of intervention programs that are developmentally sensitive and effectively address particularly vulnerable subpopulations of foster children.     

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.     

Parent-child interaction therapy: application of an empirically supported treatment to maltreated children in foster care

One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.     

The Power of Information:

This article explores the interactions of African-American foster parents with child welfare agencies. Data from the 1980 Survey of Foster Parents in Eight States were used in assessing the information exchange patterns between two groups of foster parents-traditional and extended-and child welfare workers. Findings show that traditional foster parents request and receive more information about general agency policies and services as well as the role of foster parenting than the extended types of foster families. Implications of these findings are discussed in the context of recruitment and differences in expectations child welfare workers and foster parents have about the role and function of foster parents and the delivery of services in the child welfare field. Empowerment strategies are recommended to increase the power of foster parents, especially among related foster parents.     

Influence of Age on Transracial Foster Adoptions and Its Relation to Ethnic Identity Development

In the United States, ethnic minorities are disproportionately represented in the foster care system and underrepresented among potential adoptive parents. The need to find permanent homes for foster children has led to an increase in the controversial practice of transracial adoption (TRA), wherein ethnic minority children are placed in adoptive homes with Caucasian parents. While many child welfare scholars and dependency stakeholders support TRA as a positive alternative to foster care, others are concerned that such adoptions may inhibit the ethnic identity development of transracially adopted children. This article documents the large number of ethnic minority children who are adopted through TRA prior to the onset of ethnic identification and how age influences which children are adopted out of foster care. The findings indicate that young ethnic minorities are significantly more likely to be adopted through TRA compared to older children, an effect especially prominent among African Americans. Implications for the child welfare system are discussed.     

Placement Instability and Risky Behaviors of Youth Aging Out of Foster Care

Youth who age out of foster care are at risk of poor outcomes and risky behaviors in young adulthood. Yet, little is known about what child welfare workers can do to decrease these risks. The effect of foster care placement instability on substance use and risky sexual behaviors is examined using data from 114 young adults who aged out of care. When controlling for variables commonly associated with these behaviors, a history of foster care placement instability increased the young adults’ likelihood to use substances. Child welfare practitioners could potentially reduce the vulnerability of this population by providing them greater stability during adolescence.     

Administrative case reviews: Improving outcomes for children in out-of-home care

For nearly three decades foster care review has been required and practiced in the United States. It is well established that foster care review was designed with the intent to reduce the time children spend in foster care and increase permanent placements for children. This article presents that foster care review, as practiced in Colorado, is a social work intervention and quantitative results of this study demonstrate that as an intervention, timely administrative case review is an effective social work intervention related to improving child welfare outcomes for the children and families served in Colorado. The major findings show that timely administrative case review and increased levels of review attendance (mother, father, Guardian ad litem's, and foster parents) are predictors of the child welfare outcomes of permanency and length of time in out-of-home care. Bivariate results indicate a median length of stay approximately 10.76 months longer for children who do not consistently receive timely case reviews. Additionally, the results show that timely care review moderates the underlying casework process related to caseworker contacts, demonstrating that a child's length of stay differs depending on the level of timely case review. In essence, the administrative case review process in Colorado is effectively achieving its goal and is an effective intervention for improving the lives of children in foster care.     

Making visits better: the perspectives of parents,foster parents,and child welfare workers

Mothers of children recently placed in foster care, foster mothers, and child welfare workers participated in semistructured, clinical interviews focusing on the challenges of parent visitation with young children. Mothers described their feelings of grief, trauma, and rage about the forced separation from their children and stressed the importance of emotional expression and communication during visits. Child welfare workers described the complexities of supporting emotionally close parent-child interactions while monitoring and assessing parental behavior during visits. Foster mothers described the importance of preparing children for visits and the difficulties of supporting the children afterward. Implications of understanding mothers', foster mothers', and child welfare workers' perspectives on enhancing the quality of visits with young children are discussed.     

A Three-Pronged Approach to Addressing Racial Disproportionality and Disparities in Child Welfare: The Santa Clara County Example of Leadership, Collaboration and Data-Driven Decisions

Disproportionality and disparities in the treatment of children of color has been a growing concern in the child welfare system. System stakeholders have begun to recognize the problem through data, which help identify discrepancies within their jurisdictions. Nationally, the primary concern is the overrepresentation of African American children within the child welfare system, where African Americans represent proportions of the foster population at a level more than twice as high as they are represented in the community at large. In some jurisdictions, however, this is only one piece of the disproportionality concern. San Jose, for example, has both an overrepresentation of African American and an overrepresentation of Hispanic children in the child welfare system. Because San Jose’s child welfare population is unique, they have had to take a unique approach to addressing these concerns. This article outlines strategies and tools used to begin reducing disproportionality within the child welfare and juvenile dependency court system, using San Jose’s experience as an example. Some of the key approaches to addressing disproportionality include ensuring a systems approach (creating a Cross Agency Systems Team that prioritizes services for parents and children in various systems, e.g., mental health, substance abuse, etc.); addressing disproportionality from multiple perspectives and examining the roles’ of caseworkers, supervisors, service providers, judges, and attorneys; gaining community and system stakeholder buy-in by maintaining momentum and providing opportunities for dialogue about the complex issues facing families of color; using a data-driven approach to inform ongoing initiatives and changes in policy and practice (e.g., closely examining policies and practices such as the frequency of recommendations to by-pass reunification services); and implementing changes in practice at multiple levels including child welfare and on the bench. The examination of San Jose’s approach reveals challenges, successes, and lessons learned.