The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Youth with disabilities in the United States Child Welfare System

Existing literature suggests that youth with disabilities are known to be at increased risk of maltreatment in the form of abuse and/or neglect. Little is known, however, about the experiences of youth with disabilities who are living in foster care or who are supervised by child protection authorities. This study establishes a baseline estimate of the prevalence of youth with disabilities living in foster care, documents reasons for child protection system involvement, identifies placement types while youth are in care and explores case outcomes. This cross-sectional, exploratory study draws on data from the 2012 Adoption and Foster Care Reporting System (AFCARS) for foster youth in 50 states, the District of Columbia and Puerto Rico. A sample of youth with disabilities (N = 36.492) and a comparison group without disabilities (N = 601.539) were identified. Findings about demographics, reasons for child removal, foster care placements, permanency planning goals and case outcomes are presented. Findings have implications for the prevention the removal of youth from caregivers, the need for family supports to prevent foster care involvement, the promotion of community inclusion of foster youth while in foster care and the need for inter-system collaboration at the transitional age stage.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

Sexual health programming for vulnerable youth: Improving knowledge,attitudes, and behaviors

PurposeAmong girls in foster care, 48% become pregnant at least once by age 19 (Dworsky & Courtney, 2010). Youth in or at-risk for foster care (YFC) report limited knowledge about, access to, and use of condoms; ambivalent attitudes towards teen parenting; and participation in other risky behaviors. For the current study, we adapted and supplemented an evidence-based sexual health program called SiHLE, using a systematic adaptation framework (ADAPT-ITT, Wingood & DiClemete, 2008), to address the unique and targeted needs of youth living in a temporary shelter due to lack of housing. Youth in this study were either in foster care and awaiting placement, or having serious family problems and were at-risk of entering the foster care system.MethodsThirty-six youth participated in SiHLE-YFC during their stay at a temporary shelter. Four 90-minute sessions focused on increasing sexual health knowledge, improving attitudes towards and self-efficacy of condom use, and developing core skills such as problem-solving and communication.ResultsAs hypothesized, youth showed high satisfaction with the intervention and significant improvement in sexual health knowledge from pre to post. At one-month follow-up, youth continued to show significant improvement in sexual health knowledge, along with a significant reduction in risky sexual behaviors. Though not significant, there were moderate effect sizes for changes in attitudes towards teen pregnancy and condoms. There were no changes in attitudes towards teen parenting.ConclusionTaken together, findings suggest that sexual health education directly targeting the unique needs of YFC may improve sexual health knowledge and behavior, and are discussed in the context of challenges associated with intervention and research with this population.     

The plans,goals, and concerns of pre-emancipated youth in foster care

This study focuses on the plans, goals, and concerns of foster care youth prior to leaving care. Participants were 179 pre-emancipated youth between the ages of 17 and 20 years old (M = 17.82, SD = 0.79) from a large metropolitan area in Southern California. Self-articulated immediate plans were grouped into 4 major categories and self-articulated life goals were grouped into 10 categories while also examining the prioritization of, estimated time frame for, and youth's sense of control over their life goals. Survey and interview data reveal the importance of educational and occupational life goals and their prioritization. Youth reported a high level of certainty in their immediate plans, but the youth were less explicit in describing their immediate plans for the year after foster care. Foster youth may have difficulty identifying concrete steps to make plans a reality despite their ideas for the future. Youths' worries and concerns about their post-emancipation plans and life goals typically centered around academics and finances. This study contributes to the limited literature on the life goals and plans for foster youth; these results reinforce the need for greater support in planning and goal setting prior to emancipation.     

Help-seeking and help-offering for teen dating violence among acculturating Mexican American adolescents

Help-seeking sources, motivations, and barriers concerning teen dating violence are rarely co-examined alongside help-offering processes and messages, and both are understudied among minority youth populations. This study sought the perspectives of Mexican American adolescents (ages 15 to 17) concerning their preferences and experiences with both help-seeking and help-offering. Twenty focus groups (N = 64 adolescents) were divided by gender and by acculturation level to allow for group comparisons. Friends and supportive family members were primary sources of help, although adolescents voiced a number of barriers to help-seeking. The most prominent barrier was fear they would be told to leave the relationship, an anticipated message that aligned with their tendency to tell others to do so. Help-seeking was viewed as a weakness, and help-offering was reserved for friends that asked for it. Recommendations for programs and practice with youth include promoting culturally and gender attuned teen dating violence services that emphasize confidentiality, and working at the family, peer, and school levels to foster healthy relationships.     

The role of fathers in reducing dating violence victimization and sexual risk behaviors among a national sample of Black adolescents

PurposeStructural equation modeling (SEM) was used to explore the impact of father-figures' involvement on reducing both dating violence and sexual risk among a national sample of Black American youth well as the possible mediating effect of dating violence on the relationship between father figure involvement and sexual risk behaviors.MethodsTo explore this phenomenon, sexually active Black adolescents between the ages of 13–21 with a romantic partner in the previous 18 months were selected (N = 422) from wave II of the National Longitudinal Study of Adolescent Health.ResultsThe analyses indicated that overall, perceived closeness to father figures reduced dating violence victimization among Black youth. When separated by gender, our hypothesis for male respondents was supported indicating that perceived closeness with their father figures resulted in a reduction in dating violence. However, the same hypothesis was not supported for female respondents. On the other hand, perceived closeness to father figures resulted in lower sexual risk behaviors for girls.ConclusionGiven the study's findings, researchers, practitioners, and policy makers should consider the importance of the father–child relationship in reducing problem behaviors among Black adolescents. In particular, emphasis should be given to the quality of the father–child relationship rather than general father involvement in reducing dating violence victimization and risky sexual behavior among sexually experienced Black adolescents.     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.     

Internalizing symptoms and safe sex intentions among adolescents in mental health treatment: Personal factors as mediators

Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.     

Re-entry among former foster youth in early adulthood: Findings from illinois

On January 1, 2010, the Foster Youth Successful Transition to Adulthood Act went into effect in the state of Illinois to legally permit former foster youth who are at least 18 years old and not yet 21 years old to voluntarily re-engage with child welfare agencies and juvenile court to receive Supporting Emancipated Youth Services. Not much is known about the number or characteristics of foster youth who have taken advantage of this new opportunity to receive support following a hardship. This study used administrative data from the Illinois Department of Children and Family Services (IDCFS) to describe foster youth who have legally re-entered out-of-home care after exiting through emancipation. Findings revealed that a low number of former foster youth re-entered out-of-home care. This article discusses possible explanations for why so few youth have re-entered out-of -home care when research suggests they may be at increased risk for making the transition to adulthood.     

‘To talk or not to talk?’: Foster youth's experiences of sharing stories about their past and being in foster care

Sharing stories about the past and about being in care, can help adolescents placed in foster families to make meaning of their experiences and connect with their conversation partner. However, what obstacles and opportunities for sharing stories are experienced by foster youth has not been researched, while this holds important implications for research and practice. In an episodic interview, thirteen adolescents and young adults (16–23 years) talked about their experiences with sharing their memories about their past and being in foster care. Using a thematic analysis, two themes were constructed, each containing three sub-themes. The theme ‘When’ included references to the prerequisites for talking and considerations made by participants, and contained the sub-themes ‘How often do I talk’, ‘Conditions’ and ‘Ownership of my story’. The theme ‘Why’ included references to the rationales for sharing or not sharing memories, which contained the sub-themes ‘Protection’, ‘Understanding’ and ‘Processing the past’. The stories of the participants highlight both the opportunities and obstacles for talking. Foster parents and foster care workers should be aware of the needs foster youth have with regard to conversations about their experiences and should try to facilitate the meaning-making processes, although some foster youth prefer managing their memories in a more private way.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Development & maintenance of social support among aged out foster youth who received independent living services: Results from the Multi-Site Evaluation of Foster Youth Programs

This study uses secondary data from the Multi-Site Evaluation of Foster Youth Programs, a randomized controlled trial of four independent living programs for youth in foster care. The subject of this investigation is the Life Skills Training Program (LST) of Los Angeles County, CA. We had three interrelated aims: (1) Evaluate the effectiveness of the LST program as compared to services as usual on the change in social support over time; (2) Examine the differences over time in social support by race and ethnicity among LST participants; and (3) Investigate the explanatory value of prosocial activities, educational involvement, current living arrangement, employment, victimization experiences, placement instability, and behavioral health symptomology on changes in social support over time among LST participants. We employed multilevel longitudinal modeling to estimate growth in social support over three time points (baseline, first follow-up, and second follow-up) among 482 youth (n = 234 LST; n = 248 control). We found a significant reduction in social support across the three time points. But, there was no difference in the social support trajectory between the LST and control groups. In addition, no racial/ethnic difference in the social support trajectory was detected. Results underscore the need to critically examine how independent living programming is intended to increase social support and whether modifying these practices can improve promotion and maintenance of social support for youth who age out of foster care.     

Emergency department use for injuries by adolescents in foster care

Youth in foster care are overrepresented with respect to their utilization of emergency department (ED) services. This study examines the ED utilization patterns of adolescents in foster care and evaluates the characteristics of injury related versus non-injury related visits. We found that adolescents in foster care have high rates of ED use (1.84 visits per year (95% CI 1.59, 2.12)), with 31.2% of ED visits being injury-related. Male gender was found to be the only independent predictor of having an injury related vs. non-injury related ED visit (odds ratio 2.22 (95% CI 1.27–3.87)). Regarding the mechanisms of injury, adolescent youth in group homes were significantly more likely to present with injuries inflicted by themselves or by others in their residence (p < 0.05 for both) but less likely to present with accidental injuries or injuries sustained during recreation (p < 0.05 for both). Resources and interventions targeted at both youth and group home staff related to behavioral health assessment, post-traumatic coping skills and conflict management may have beneficial effects.     

Extracurricular activity participation and educational outcomes among older youth transitioning from foster care

This study examined factors associated with extracurricular participation and whether participation in extracurricular activities is associated with completing high school and attending college among a sample of older youth transitioning from foster care (n = 312). Results indicated that better self-reported grades and greater educational aspirations were associated with extracurricular participation. Participation in extracurricular activities was associated with graduating from high school, but not starting college by age 19. Consistent with provisions of the Preventing Sex trafficking and Strengthening Families Act of 2014, results suggest that efforts that make extracurricular participation a normative aspect of the developmental experience of foster youth are important for their educational well-being.     

Youth participation in foster youth advisory boards: Perspectives of facilitators

Foster youth advisory boards (YAB) have the objective of promoting foster youth participation in decisions that are made about their lives. There is currently little known about how youth participation is conceptualized or implemented within or across boards. This qualitative study explored youth participation from the perspectives of 42 primary YAB facilitators in 34 states. The study's findings are derived from telephone interviews. A thematic analysis identified four primary approaches to youth participation, which we labeled as being, ‘Adult-Led’ (n = 2); ‘Adult-Driven Youth Input’ (n = 14); ‘50–50 Youth-Adult Partnership’ (n = 16); and ‘Youth-Led’ (n = 2). Within each of these approaches to youth participation, we present findings that explore facilitators' conceptualizations of youth participation, the strategies and program activities they use to enact youth participation, and the strengths and limitations of each of the approaches. Our discussion explores implications for YAB program activities, youth participation in child welfare systems, and future research.     

A randomized controlled trial of the effectiveness of the youth crime prevention program ‘New Perspectives’ (NP): Post-treatment changes and moderator effects

ObjectivesNew Perspectives (NP) aims to prevent that youth at onset of a criminal career will develop a more persistent criminal behavior pattern. The study aim was to examine whether NP was effective relative to care as usual in preventing and reducing (persistent) delinquency. Moreover, we examined improvements in secondary outcomes (e.g., peer and parent relationships and cognitive distortions) and other outcomes (e.g., substance use and self-esteem).MethodsAt-risk youth (N = 101) aged 12 to 19 years were randomly assigned to the intervention group (NP, n = 47) or control group (‘care as usual’, n = 54). The effects of the NP intensive phase (3 months after program start) and aftercare phase (6 months after program start) were analyzed.ResultsNP and care as usual did not differ on any of the outcome measures at both post-test occasions. The effects of NP were the same for boys and girls, different age groups, and ethnic groups.ConclusionsThe overall null-effects are discussed, including implications for further research, policy, and practice.     

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family.MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care.ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR = 1.05, CI = 1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR = 1.84, CI = 1.04–3.24). Child's psychosocial care use was more likely among older children (OR = 1.94, CI = 1.20–3.15); greater social support by family and friend (OR = 1.03, CI = 1.00–1.06); more psychosocial problems (OR = 1.75, CI = 1.04–2.97); and when there were more parenting concerns (OR = 1.19, CI = 1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR = 1.27, CI = 1.17–1.38, and OR = 1.39, CI = 1.25–1.55).ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.     

Foster home licensing and risk of reentry to out-of-home care following family reunification

Family reunification without subsequent reentry is the primary permanency goal for children placed in foster care. While a number of placement-level factors have been examined for their effect on subsequent reentry to care, no study to date has considered foster care licensing. The current study uses statewide administrative data to construct a cohort of foster care youth who entered care between 2009 and 2012 and were reunified by the start of 2013 (N = 7752) to investigate the association between types of foster care and the probability of reentry to foster care up to two years following reunification. We focus specifically on the licensing status of foster homes, and employ propensity score analysis to address selection bias in placement type. A propensity-weighted cox proportional hazard model revealed that youth placed in licensed relative care (LRC) homes and licensed non-relative care (LNC) homes were more likely to reenter foster care than those youth placed in unlicensed relative care (URC) homes during their first spell of foster care.