Case file coding of child maltreatment: Methods,challenges, and innovations in a longitudinal project of youth in foster care

State social service agency case files are a common mechanism for obtaining information about a child's maltreatment history, yet these documents are often challenging for researchers to access, and then to process in a manner consistent with the requirements of social science research designs. Specifically, accessing and navigating case files is an extensive undertaking, and a task that many researchers have had to maneuver with little guidance. Even after the files are in hand and the research questions and relevant variables have been clarified, case file information about a child's maltreatment exposure can be idiosyncratic, vague, inconsistent, and incomplete, making coding such information into useful variables for statistical analyses difficult. The Modified Maltreatment Classification System (MMCS) is a popular tool used to guide the process, and though comprehensive, this coding system cannot cover all idiosyncrasies found in case files. It is not clear from the literature how researchers implement this system while accounting for issues outside of the purview of the MMCS or that arise during MMCS use. Finally, a large yet reliable file coding team is essential to the process, however, the literature lacks training guidelines and methods for establishing reliability between coders. In an effort to move the field toward a common approach, the purpose of the present discussion is to detail the process used by one large-scale study of child maltreatment, the Studying Pathways to Adjustment and Resilience in Kids (SPARK) project, a longitudinal study of resilience in youth in foster care. The article addresses each phase of case file coding, from accessing case files, to identifying how to measure constructs of interest, to dealing with exceptions to the coding system, to coding variables reliably, to training large teams of coders and monitoring for fidelity. Implications for a comprehensive and efficient approach to case file coding are discussed.     

Mentoring and social skills training: ensuring better outcomes for youth in foster care

Youth in foster care face significant life challenges that make it more likely that they will face negative outcomes (i.e., school failure, homelessness, and incarceration). While the reason(s) for out-of-home placement (i.e., family violence, abuse, neglect and/or abandonment) provide some context for negative outcomes, such negative outcomes need not be a foregone conclusion. In fact, interventions created to serve at-risk youth could ostensibly address the needs of youth in foster care as well, given that they often face similar social, emotional, and other challenges. Specifically, the author posits that supporting foster care youth through the use ofmentoring and social skills training could reduce the negative outcomes far too common for many of these youth.     

The role of therapeutic mentoring in enhancing outcomes for youth in foster care

Effective service interventions greatly enhance the well-being of foster youth. A study of 262 foster youth examined one such intervention, therapeutic mentoring. Results showed that mentored youth improved significantly in the areas of family and social functioning, school behavior, and recreational activities, as well as in the reduction of expressed symptoms of traumatic stress. Study results suggest that therapeutic mentoring shows promise for enhancing treatment interventions.     

Transition from care: status and outcomes of youth who age out of foster care

This study shows that a significant portion of youth exiting the foster care system face serious difficulty transitioning to life on their own. Many live on the streets, lack the money to meet basic living expenses, fail to maintain regular employment, are involved with the criminal justice system, are unable to obtain health care, and experience early pregnancies. Although youth reported exposure to independent living training while in care, few reported concrete assistance. Multiple placements while in care and less education correlated with more difficult postdischarge functioning. Training, services, positive supportive networks, and job experience in care are associated with more positive adjustments. The article advances implications for program and policy interventions.     

Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child–Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implemented with a racially diverse sample of youth ages 3–18 at six agencies. Culturally sensitive adaptations were made to treatment approaches to improve client retention and outcomes. Data analyses revealed no racial differences in retention in the program and no differences in outcomes between minority youth exposed to the intervention and other participants. All three evidence-based treatments were effective in reducing symptoms and improving functioning among minority youth. Implementation issues, including challenges and culturally competent accommodations, are discussed.     

Using the bridges transition framework for youth in foster care: Measurement development and preliminary outcomes

Youth in foster care often undergo multiple transitions before reaching adulthood, and these transitions often create significant stress and can exacerbate emotional and behavioral problems. A measurement instrument (the Youth Experience of Transitions, or YET) was designed to assess foster care youths' understanding of transitions, and this instrument was tested on a group of youth undergoing an intervention program designed to assist them in coping with the stress of these transitions while in foster care. The intervention was based on the Transitions Framework by William Bridges and was implemented in multiple community agencies with funding from the Andrus Family Fund. Using factor analysis, we found that the YET contained two factors representing (1) openness and (2) determination. For youth in the participating foster care programs, growth in openness from baseline to 6 months was linked to a significant decrease in internalizing symptoms; no significant links were found for externalizing symptoms. Implications for foster care intervention programs are discussed.     

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.     

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.     

Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood

Youth in the foster care system face considerable challenges during the transition to adulthood. However, there is significant variability within this population. This study uses person-oriented methods and a longitudinal dataset of youth aging out of foster care to examine differences in how subgroups of foster youth fare during the transition to adulthood. We identified four distinct latent classes, consistent with prior person-oriented studies of this population, and validated these classes by examining differences on additional relevant factors at age 17. After establishing these classes, we tested their predictive validity by examining differences in outcomes at age 19 in domains relevant to the transition to adulthood, including education and employment, problem behaviors, and mental health problems. Finally, given the importance of extended foster care in promoting better outcomes, we used survival analysis to prospectively examine whether class membership was associated with differences in the rates at which youth left foster care between ages 17 and 19. One large group of youth exhibited moderate behavior problems and left care quickly, while another large group of resilient youth had favorable outcomes and left care relatively slowly. A small group exhibited considerable behavior and mental health problems, but left care more slowly, and a very small group was characterized by a history of pregnancy. Findings suggest considerable variability in service need among older foster youth. Implications for service provision during the transition to adulthood are discussed.     

Can't do it alone: housing collaborations to improve foster youth outcomes

Research documents that youth transitioning out of the foster care system experience a variety of negative outcomes, including homelessness. Housing collaborations, which aim to comprehensively address resource and service needs for transitioning youth, including permanent connections, education, and employment, have resulted in innovative programming and forged new relationships among child welfare, social service and housing developers, and providers. This article describes the partners, models, and resources several collaborations used and their progress and outcomes; shares insights gained; and explores productive directions for future work.     

Continuity of care for youth in foster care with serious emotional disturbances

Continuity of mental health care has long been considered an essential component to the delivery of a high-quality mental health services, particularly for children with special needs. Unfortunately, discontinuities in care are common for children in foster care due in part to placement instability, disruptions in health coverage, and the fragmented health system. This retrospective cohort study examined factors associated with continuity of care for youth (aged 5–17 years) in foster care diagnosed with schizophrenia and bipolar disorder. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Continuity of care was defined as regularity of care—utilization of at least one outpatient mental health visit per month during the year. Multilevel modeling was used to assess the association between individual and contextual-level variables and continuity of care. Of the 952 youth in the study sample, 439 (46.1%) received regular monthly outpatient visits over the 1 year follow-up period. The odds of receipt of regular outpatient treatment were associated with prior outpatient care (odds ratio (OR): 7.43, 95% confidence interval (CI): 2.60–21.20), the presence of a chronic medical illness (OR: 1.45, 95% CI: 0.98–2.16), comorbid anxiety (Or: 1.76, 95% CI 1.22–2.53), or conduct disorder (OR: 1.57, 95% CI: 1.13–2.18), and the use of multiple psychotropic medications as compared to no medications (OR: 1.55, 95% CI: 1.08–2.23). The odds of receiving regular outpatient treatment were higher for youths who resided in suburban areas as compared to metropolitan areas (OR: 1.97, 95% CI: 1.04–3.73) and for those who resided in areas with greater supply of psychiatrists per capita (OR: 1.22, 95% CI: 1.02–1.45). Study findings underscore the need for quality improvement initiatives that improve access to care, care coordination, and continuity of care.     

Characteristics and trajectories of treatment foster care youth

Using cross-sectional analyses in conjunction with dynamic modeling (hierarchical linear modeling), the authors profiled 119 treatment foster care youth and constructed behavioral change trajectories for a subset of 97 children. Children generally showed improvements in internalizing and critical pathology problem domains but remained the same on measures of externalizing behaviors and total problem score. The number of previous out-of-home placements was positively associated with increased levels of psychiatric symptomatology and served as the most robust predictor for modeling treatment response trajectories across problem domains. Placement instability places the well-being of children at heightened risk, therefore, accurate assessment of child need and risk in relation to caregiver capacities is critical.     

Why youth run: Assessing run function to stabilize foster care placement

Youth running away from foster care placements is a serious problem that can significantly impact health and well-being. Given the severity of the problem, it is important to identify reasons youth run away because this information could help to identify effective intervention strategies. This paper describes results from focus groups conducted with child welfare providers, educational personnel, and youth with histories of running away from foster care placements. The qualitative analysis revealed that youth's motivation for running, or the function of running away, fell into two general categories: running “to” something (friends, activities, etc.) or running “away” from something (aversive placements, etc.). Suggestions are provided for how understanding the reason for running away could help in determining successful prevention and intervention strategies that result in stable placements.     

Increasing college access for youth aging out of foster care: Evaluation of a summer camp program for foster youth transitioning from high school to college

Young people who transition from the foster care system face many challenges including lack of support and other educational barriers. They are less likely to graduate from high school than their counterparts and go on to college yet despite challenges, many succeed and take advantage of higher education programs.In Michigan, a state with one of the highest percentage of youth in foster care, Michigan State University developed a small scale, targeted intervention to help transitioning foster youth achieve their goals of pursuing higher education. Led by the School of Social Work in collaboration with other colleges and disciplines, it was demonstrated that a campus based learning program for transitioning foster youth can help contribute toward a perceived increase in knowledge and information about college life, funding and admissions procedures. The educational process involved peer support, role modeling, mentoring and active learning sessions led by the faculty and students who were often foster care alumni themselves. Leaders and speakers came from a range of disciplines, institutions and organizations. This approach and curriculum contributed to perceptions of the camp as enhancing life skills, self-concept, empowerment and sense of purpose. Consequently, this program contributed to the resilience of those who attended and potentially helped build steps from care to higher education.     

Professional and youth perspectives on higher education-focused interventions for youth transitioning from foster care

Youth transitioning from foster care to adulthood access and succeed in college at much lower rates than the general population. A variety of services exist to support youth with their postsecondary goals, but few if any have evidence for their effectiveness. As part of a National Institute on Drug Abuse-funded intervention development project to design Fostering Higher Education, a structured, testable postsecondary access and retention intervention for youth transitioning from foster care to adulthood, focus groups were conducted with community stakeholders to collect recommendations for how to most effectively structure the intervention. Analyses of focus group findings resulted in four theme groups: (1) general recommendations for intervention development; (2) recommendations for an educational advocacy intervention component; (3) recommendations for a mentoring intervention component; and (4) recommendations for a substance abuse prevention intervention component. These themes offered a variety of important insights for developing interventions in a way that is usable for youth and feasible for communities to implement.     

Building evidence to promote educational competence of youth in foster care

Although the academic difficulties of students living in foster care are well documented, few studies have examined factors influencing academic achievement of youth in foster care. This article reports the results of a study of educational competence in a sample of 152 foster youth in one midwestern state. Using five standardized instruments, the study explored predictors of reading ability of youth in foster care. Multiple regression analyses indicated that four factors--aspiration for higher education, placement in kinship care, participation in extracurricular activities, and drug use--accounted for 39% of the variance in reading ability scores. The article discusses implications of these findings for practice, research, and policy development.     

Issues of shared parenting of LGBTQ children and youth in foster care: preparing foster parents for new roles

Foster parents have increasingly assumed new and challenging roles during the past decade. Meeting the developmental, attachment, and grieving needs of children and youth in out of home care is challenging by itself, but can become even more difficult with the issues that arise when the child is lesbian, gay, bisexual, transgender, or questioning (LGBTQ). Preservice and in-service foster parent training programs can strengthen shared parenting skills by focusing on the universal critical issues of safety, well being, and permanence for children and youth in foster care. This article will focus on these skill areas: (1) sharing parenting to promote healthy growth and development of LGBTQ youth in foster care, (2) threats to safety of LGBTQ youth in foster care, and (3) general challenges and strategies for preparing foster parents of LGBTQ youth to build support systems.     

Medical complexity and placement outcomes for children in foster care

ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ² tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes.     

From foster care to juvenile justice: Exploring characteristics of youth in three cities

Children placed in foster care are at risk for becoming involved with the juvenile justice system. This study documents the rates at which children involved with foster care enter the juvenile justice system (crossover or dually involved), and the factors associated with this risk. We utilize multiple birth cohorts and prospective, longitudinal data from birth to maturity separately in three major American cities. Analyses consider integrated administrative records from multiple birth cohorts representing populations in Cook County (Chicago; N = 26,003), Cuyahoga County (Cleveland; N = 10,284), and New York City (N = 13,065). Crossover rates ranged from 7 to 24%. African American males, and children who experienced congregate care were at highest risk for juvenile justice involvement. Older age at first foster care placement signaled progressively greater risk, as did more foster care spells for those first placed as infants. We discuss findings in terms of developmental theory, and as actionable intelligence to inform prevention, practice, and policy.     

Educational experiences and aspirations of older youth in foster care

This study documents the school experiences of 262 youth referred for independent-living preparation from the foster care system of one midwestern U.S. county. Of the youth, 73% had been suspended at least once since the seventh grade, and 16% had been expelled. In the past year, 58% had failed a class, and 29% had physical fights with students. Yet the group reported high educational aspirations: 70% wanted to attend college. Those in congregate care and family settings often had school behavior problems. The results support the need for a system of education advocates who work to maintain proper education placements for youth in foster care and help them receive the academic resources they need to graduate from high school and proceed to college.