Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

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.     

Risk factors for mental health diagnoses among children adopted from the public child welfare system

Children awaiting adoption through the child welfare system often have “special needs,” or characteristics that make securing an adoptive home for them challenging. A subset of these youth experiences significant psychiatric symptomatology, which may pose a problem for the stability of the adoptive placement. Clinicians and policymakers require information about precursors to mental health difficulties in order to plan effectively for the placement of these children.This study examines potential child and biological family risk factors for the presence of a DSM-IV mental health diagnosis among 368 children placed for adoption by a special needs adoption program between February 1997 and April 2005 using logistic regression within the Generalized Estimating Equations (GEE) framework. A significant proportion of the children and biological parents in our study experienced serious adversity prior to adoptive placement. Older age at adoptive placement, white race, male gender, having more than one placement, and a history of sexual abuse are significant predictors of the presence of a mental health diagnosis in the logistic regression model. Biological parent incarceration is significantly associated with the absence of a mental health diagnosis.Adoptive placement is a key transition for youth who have often experienced significant loss and trauma prior to placement. Support of the adoptive family and youth can be critical to ensuring placement stability and may be especially salient for youth with documented mental health diagnoses and corresponding behavioral problems, which put children at increased risk for placement disruption. More work is needed to understand the interplay of risk and protective factors for mental health difficulties among youth adopted from the child welfare system, including how these are affected by child welfare policies, informal procedures, and resources to produce varying outcomes for children in peril.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

Interactive Media for Child Care and Counselling: New Resources,New Opportunities

SUMMARY

A familiar children's story in the UK–Bruce's Story, about the adventures of a puppy moving into the unknown world as he grows up–is converted into a multimedia program designed to help children in out of home care talk (or write) about their own experiences coming into the child welfare system and into foster and adoptive families.     

Intergenerational Programming for Foster-Adoptive Families

Abstract

Generations of Hope serves foster and adoptive children, their adoptive families and older adults through an innovative program that is breaking new ground in the development of caring intergenerational communities. It was created in 1993 as a non-profit social service agency designed to improve the service delivery and policies of the child welfare system; it ended up helping not only foster and adopted children but senior citizens as well. This paper examines critical social issues facing both foster children and senior citizens in the United States and how this program created a neighborhood that combines several generations of kin-like support to meet the needs of these vulnerable groups. We describe how the Generations of Hope model brings together in tangible ways critical shifts in perspective regarding foster care and gerontology. The lessons we have learned speak to research, policy making and practice.     

Student Knowledge of and Attitudes toward Psychotropic Drugs

Abstract

Expanding social work roles in medication management and psychoeducation, especially in mental health, clearly require that students possess an enlarged knowledge base and a set of enlightened attitudes regarding psychotropic medications and their use. This article reports the results of a survey that investigated the knowledge of and attitudes toward psychotropic medications among a population of social work students. If the survey results were scored like a school exam, then the average student surveyed scored a “C !.” The article also suggests that both personal and professional experiences in the mental health field apparently influence knowledge of and attitudes toward psychotropic drugs. It is recommended that social work course content be expanded to include relevant information on psychotropic drugs.     

Descriptive Analysis of Foster Care Adoptions in New South Wales,Australia

This paper describes the population of children in care in New South Wales, Australia, who were adopted by their foster families (N?=?372) from 2003 to 2014. Data pertaining to 370 of these adoptees were available and obtained from administrative records accompanying adoption applications. Most of these children had been placed with their subsequent adoptive family during infancy. However, adoption orders occurred much later in their lives. According to the available information at the time of adoption, these children did not suffer the high levels of mental health problems typically identified in populations of children in foster care. Though the data do not include follow-up to determine if the contact agreed upon at the time of adoption orders translated into practice, the most frequently postadoption arrangement recorded was face-to-face contact, four times a year with mother and siblings. The high levels of openness and face-to-face contact in Australian adoptions from care are a significant point of difference with other adoption models, and presents a need for research in the area.

IMPLICATIONS

• Following the change of legislation in New South Wales, Australia, that prioritises open adoption over foster care, social workers in the field of child protection are well placed to assist in this process.

• Social workers can assess children entering care to identify those who will benefit from adoption in a timely manner; undertake casework and administrative aspects of the adoption process; work closely with the child, and birth and adoptive families by delivering pre- and post-adoption supports; and conduct longitudinal research on the outcomes for children adopted from care.

     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Developmental Outcomes of Vulnerable Youth in the Child Welfare System

Abstract

Adolescent development of youth in foster care holds great interest for society. This article examines a random sample of 200 adolescents currently placed in foster care on developmental outcomes. Using face-to-face interviews, the present study found that a majority of foster youth have biological families experiencing multiple problems and experience many developmental difficulties. A large percentage of the sample youth experience mental illness, school failure, substance abuse, and other antisocial behaviors. This paper considers implications from the study findings for policy and interventions designed to foster better developmental outcomes among youth in the child welfare system.     

The Role of a Psychiatric Pharmacist in College Health

Abstract

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.     

Preparing and Partnering with Families to Support the Adoption of Children from Foster Care

ABSTRACT

This investigation evaluated the effectiveness of a pre-placement education and preparation curriculum (PREP) for prospective foster/adoptive parents in improving attitudes toward children with prenatal substance exposure and their substance-using birth parent and increasing willingness to adopt these children. Participants included 1,836 prospective parents seeking adoption through foster care who received three 3-hour sessions of PREP. Prospective parents completed questionnaires assessing their knowledge about important issues involved in adopting a child from foster care, attitudes, and willingness to adopt children with a variety of characteristics. Changes from pre- to post-intervention were examined. Results indicated significant increases in self-reported knowledge; significantly more positive attitudes toward substance-abusing parents and children with prenatal substance exposure; and significantly increased willingness to adopt children with a variety of potential difficulties, including children with serious behavior problems, attention deficit hyperactivity disorder, and a biological history of mental illness. In sum, findings suggest that prospective adoptive parents who attended the PREP sessions felt better prepared by the end of training with regard to issues related to adoption of high-risk foster children with special needs, particularly those with prenatal substance exposure.     

The Impact of Historical Trauma and Mistrust on the Recruitment of Resource Families of Color

ABSTRACT

The Multiethnic Placement Act of 1994 and the Interethnic Adoption Provisions of 1996 (MEPA-IEP) require states to diligently recruit “potential foster and adoptive families that reflect the ethnic and racial diversity of children in the state for whom foster and adoptive homes are needed” (42 U.S.C. §622b(3)(9)). Nationally, 53% of the children in foster care and 55% of the children waiting to be adopted are children of color (Adoption and Foster Care Analysis and Reporting System, 2014). Recruitment of resource families of color has historically presented challenges. This article critically examines the diligent recruitment efforts of an urban county targeting Black/African American, Latino, and Native American communities through a critical race theory lens. Although there was an overall increase in resource families, the racial and ethnic representation of resource families to children in care within the county improved for Latinos yet declined for Black/African Americans and Native Americans. Theoretically, these results indicate that the historical mistrust of communities of color toward the child welfare system is a barrier to successful recruitment of resource families from these communities.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

Considering the best interests of infants in foster care placed separately from their siblings

This article offers a perspective on the child welfare practice of placing infants and their siblings in foster care using the theoretical frameworks of attachment and infant mental health. The authors highlight issues for child welfare workers to consider when determining if moving an infant or young child from one home to another for the purpose of placing him with his siblings would cause trauma or disruption; and also issues to consider when determining the infant or young child's best interest when separated from siblings. First, the authors summarize the literature regarding attachment relationships and attachment disruptions. Then, they review outcome studies of children residing in foster care who are placed with their siblings and of those who are placed separately. Finally, the authors conclude with specific recommendations for child welfare workers to aid in making such difficult decisions about placing infants in foster care.     

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.