Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Kin and non-kin foster care—findings from a National Survey

This article uses national data to look at the differences between children in kinship and non-kinship care arrangements. Three groups are compared: children in non-kin foster care, children in kinship foster care, and children in “voluntary” kinship care. Children in voluntary kinship care have come to the attention of child welfare services, are placed with kin, but unlike those in kinship foster care, these children are not in state custody. Findings suggest that children in the kin arrangements faced greater hardships than those in non-kin care. They more often lived in poor families and experienced food insecurity. They were more likely to live with a non-married caregiver who was not working and did not have a high school degree. And fewer kin than expected received services to overcome these hardships. In addition, nearly 300,000 children lived in voluntary kinship care arrangements; these children are of particular concern because they are not in state custody and therefore may or may not be monitored by a child welfare agency.     

Children discharged from kin and non-kin foster homes: Do the risks of foster care re-entry differ?

This study investigates whether the type of pre-discharge placement, kinship versus non-kinship foster care, has a net impact on children's likelihood of re-entering substitute care after controlling for possible selection biases through the use of regression adjustment and propensity score matching (PSM). Children in kin and non-kin foster care are compared on their rates of foster care re-entry, using bivariate comparisons and accelerated failure time (AFT) models. Lower rates of foster care re-entry after reunification from kinship homes are attributed to differences in child characteristics at removal, greater stability of kin placements, and gate-keeping functions that agencies and courts exercise over discharge and re-entry options. Children adopted from kinship and non-kinship homes exhibit similar re-entry rates, but the results for legal guardianship are mixed.     

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.     

Foster parent and teacher assessments of youth in kinship and non-kinship foster care placements: are behaviors perceived differently across settings?

With a growing number of children living in kinship foster care, it is important to understand how youths are faring in kinship care compared to youths in non-kinship care. In the present study, we first evaluate teacher ratings of problem behaviors exhibited in school by youths in kinship and non-kinship foster care. We then examine whether correspondences between parent and teacher ratings of problem behaviors across home and school settings differ by kinship status. The youths in the study represent an ethnically diverse sample (N = 185), with significantly more children of color in kinship placements. Across the majority of problem behavior scales on the Teacher's Report Form (TRF: Achenbach, 1991), teacher perceptions of youth behavior did not differ significantly according to kinship or non-kinship care placement. Furthermore, the youths in this study had elevated scores relative to general population norms on only a few TRF problem behavior scales. A sub-sample (N = 122) with foster parent assessments on the Child Behavior Checklist (CBCL: Achenbach, 1991) permitted comparison of perceptions of youth behavior across the home and school settings for youths in kinship and non-kinship placements. Correlations between the TRF and CBCL composite scale scores (internalizing, externalizing, and total problem behaviors) indicated slightly higher agreement between teacher and foster parent ratings for kinship placements. The non-kinship foster parents reported higher levels of problem behavior at home relative to school. The paper interprets these results and suggests implications for practice and future research directions.     

Academic engagement and performance: Estimating the impact of out-of-home care for maltreated children

Using data from the National Survey of Child and Adolescent Well-being II, the authors examined whether being placed in foster care was associated with school engagement and performance. The authors used propensity score matching to compare children who had similar demographic characteristics, maltreatment histories, and prior levels of school engagement. Children who were in foster care at wave 2 were found to have higher levels of cognitive engagement in school compared to children who were maltreated but never removed from their homes. It is recommended that children who are maltreated but remain in their familial home receive additional intervention related to their educational engagement.     

Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Kinship foster parenting; gender,class and labour-force participation

Objective: Knowledge about gender, class and labour-force participation of kinship foster parents in European countries is scarce. This study examines the gendered structure and generational pattern of kinship foster parenting in Norway and compares class components and labour-force participation of kinship foster mothers to the larger female population and to non-kinship foster mothers.

Method: The analysis is based on survey data on relationships between foster parents and child, social demographics and placement characteristics from 123 kinship and 88 non-kinship foster mothers of children in state custody. Labour Force Survey and Education Statistics from Statistics Norway were used to compare the kinship sample to the average female population.

Findings: Kinship foster care in Norway is gendered, in that it is women who assume the responsibility for relatives' children. Kinship foster care reflects class differences in that the educational level of kinship foster mothers and their household income are lower than the average female population and of non-kinship foster mothers in Norway. The labour-force participation of kinship foster mothers in Norway is comparable to that of the country's female population in general, except for women aged 35–55 with children under seven, among whom labour-force participation is lower than for the female population.     

Urban American Indian/Alaskan Natives compared to non-Indians in out-of-home care

Historically, American Indian/Alaskan Native (AI/AN) children have been disproportionately represented in the foster care system. In this study, nationally representative child welfare data from October 1999 was used to compare urban AI/AN children to non-Indian children placed into out-of-home care. Compared to non-Indian children, urban AI/AN children were older, were more often male, came from poorer homes, and were more frequently placed into group homes/ residential placements. Urban AI/AN caregivers had a greater prevalence of alcohol abuse and mental health problems compared with non-Indian caregivers.     

Post-adoption service need and access: Differences between international,kinship and non-kinship foster care

Post-adoption services are important to bolster a family's commitment to their adopted children, thus avoiding potential problems following adoption finalization. It is vitally important to assess post-adoption services in an effort to ensure families are provided with effective supports for successful family functioning. Few investigators have assessed service needs and access according to adoptive family type. This study focuses on international, foster care kin and foster care non-kin adoption types. Utilizing the National Survey of Adoptive Parents, this research investigated twelve post-adoption services. Two comparisons were made with respect to whether, according to the adoptive parents, post-adoption services were received or not received: 1) international and foster care non-kin adoptive families; and 2) foster care kin and foster non-kin adoptive families. International non-kin families were more likely to indicate they discussed post-adoption services than foster care non-kin families, particularly among those who were white, had adopted boys, had no other children in the home, and whose socio-economic background was lower. When comparing foster care non-kin families with kinship families, non-kin families tended to receive more desired services than kinship families, with kinship families indicating less need for services. Policy efforts and program design need to focus on reaching out to families and developing effective post-adoption services based on the expressed needs of families.     

The abuse of children in out of home care

SUMMARY: One of the major paradoxes in child protective services in the United States is that children removed from their homes on protective orders and placed in foster and group care face continued abuse. These children are reported at two to three times the rates of children living with their families. Investigations are performed by the very system that marks placements. In the US, some recommend resolving these problems by withdrawing from the active protection of children in care. Others hold that because children are in the care and custody of the state, and demand a higher standard of care, specialised prevention, identification. reporting and investigation initiatives are necessary to ensure their safety. This has important implications for other countries, especially the United Kingdom with its recent spate of inquiries into abuse in residential care.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.     

Early care and education arrangements and young children's risk of foster placement: Findings from a National Child Welfare Sample

A primary goal of the U.S. child welfare system (CWS) is to maintain children investigated for maltreatment in their parents' homes whenever safely possible. This study explores the possibility that early care and education (ECE) services (e.g., child care, preschool, day care) can help the CWS achieve this goal by using a nationally representative sample of children referred to CWS for suspected maltreatment to measure the relationship between ECE receipt and the likelihood that 0–5 year olds in the CWS will be placed in foster care approximately 18 months later. Specifically, logistic regression analyses explore the relationship between: (1) regular ECE participation (yes/no), and (2) type of ECE arrangement (Head Start, other center- or home-based ECE, family/friend/relative ECE, other ECE, and multiple types of ECE) and foster placement risk. After controlling for multiple socio-demographic characteristics and foster placement risk factors, children who received ECE (yes/no) were no less likely to be placed in foster care than children who received no ECE. However, when exploring type of ECE arrangement, children who received Head Start were 93% less likely to be placed in foster care than children with no ECE. Children who participated in multiple types of ECE were almost seven times more likely to be placed in foster care than children with no ECE. These results suggest that Head Start may help maltreated children avoid foster placement and that experiencing multiple types of ECE is a risk factor for foster placement. It is recommended that caseworkers routinely assess the ECE service history and needs of families with young children who come in contact with the CWS, paying attention to the type and number of ECE services used.     

Behavioral health service use and costs among children in foster care

This article compares behavioral health service use and cost for foster care versus nonfoster care children; children before, during, and after foster care placement; and successfully reunified versus nonsuccessfully reunified foster care children. Behavioral health service costs for children in foster care were higher than for children not in foster care. Children in foster care used more services during their foster care placement than before placement and after discharge. Nonsuccessfully reunified children received a significantly larger quantity of services than those successfully reunified.     

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.     

Comparison of suicidal ideation,suicide attempt and suicide in children and young people in care and non-care populations: Systematic review and meta-analysis of prevalence

Suicide in children and young people is a major public health concern. However, it is unknown whether individuals who have been in the care of the child welfare system are at an elevated risk. Care is presently defined as statutory provision of in-home care (e.g. child living with birth family but in receipt of legal order involving supervision by social workers) or out-of-home care (e.g. foster care, residential care and kinship care). This paper presents a systematic review and meta-analysis comparing the prevalence of suicidal ideation, suicide attempt and suicide in children and young people placed in care with non-care populations. A systematic search was conducted of 14 electronic bibliographic databases and 32 websites. Of 2811 unique articles identified, five studies published between 2001 and 2011 met the inclusion criteria. Studies reported on 2448 incidents of suicidal ideation, 3456 attempted suicides and 250 suicides. The estimated prevalence of suicidal ideation was 24.7% in children and young people in care compared to 11.4% in non-care populations. The prevalence of suicide attempt was 3.6% compared to 0.8%. Two studies reported on suicide. Suicide risk in children and young people in care was lower in one study (0% vs 0.9%) and higher in the second (0.27% vs 0.06%). The results of the systematic review and meta-analysis confirm that suicide attempts are more than three times as likely in children and young people placed in care compared to non-care populations. Targeted interventions to prevent or reduce suicide attempt in this population may be required. Further comparative studies are needed to establish if children and young people in care are at an elevated risk of suicidal ideation and suicide.     

The education of children and adolescents in out-of-home care: a problem or an opportunity? Results of a longitudinal study

The education of children in care is an issue that often falls into a no man’s land in which responsibility always seems to be attributed to the other ‘department’. Furthermore, all too often, teachers, educators and foster parents find themselves working with these children with no support, as if they were isolated cases. The aim of this study is to get to know the school situation of children in different types of out-of-home care: residential, kinship and non-kinship care. Systematic data on the school situation of 11–16-year-olds (on class attendance, school behaviour, academic results and guidance towards post-compulsory education) were gathered over a period of 5 consecutive school years. A 3-year longitudinal study on the same items (N?=?391) was made and time-series data were gathered for 5 years (N?=?1841). Results show that the in-care population is at a clear disadvantage and inequality of opportunities compared to the general population in relation to their educational pathways and outcomes; the most disadvantaged being the population in residential care. Recommendations are included, posing the challenge that what has to date been considered a ‘problem’ should become an opportunity for these children.     

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.