Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

Professional judgements and decisions on placement in foster care and reunification in Portugal

This study aims to analyse professional judgements and decisions made in the Portuguese child care system in face of a case vignette of child maltreatment. Using the approach proposed by Benbenishty et al. [(2015). Decision making in child protection: An international comparative study on maltreatment substantiation, risk assessment and interventions recommendations, and the role of professionals’ child welfare attitudes. Child Abuse & Neglect, 49, 63–75. doi:10.1016/j.chiabu.2015.03.015], we assessed the decisions of professionals, such as to place the child in foster care or reunify her with her family, on the basis of a series of judgements (e.g. substantiation of alleged abuse and neglect, risk assessments) that are influenced by the characteristics of the case, the decision-making context, and mother's and child's wishes. We conclude that there are different approaches to the case based on different professionals' attitudes that can be classified in two groups: one more pro-removal and the other anti-removal. These groups presented different risk assessments and intervention recommendations, and their decisions where significantly influenced by the mother's and child's wishes. Furthermore, we have done comparisons with studies made in other countries, concluding that the country context can be an important factor that leads to different outcomes. Implications for both practice and research are presented.     

Socioemotional characteristics of minors in foster care: A comparison between the estimation of parents,teachers and children

During the child's first few years, it's of fundamental importance the presence of a strong emotional base as long as it creates the possibility to open themselves to physical and social world with confidence, and as it acts as a facilitator of cognitive development. For this reason, if the family cannot ensure such base, social services are forced to resort to foster care, a resource that has a lot of difficulties, leading to different implications in the development of the child and of the foster family. It is therefore important to analyze in depth the socio-emotional variables that characterize children who are in a situation of foster care in order to provide adequate assistance to optimize their development. For this 32 minors in foster care, 31 foster parents and 28 teachers from the city of Valencia, were administered the BASC. The results highlight that parents are evaluating children, in general, worse than tutors. Specifically they consider children more aggressive, they detect more behavioral and attention problems and recognize in them a greater tendency to externalize the problems, while the teachers consider these children as with more social and adaptive skills. There were no significant differences between the scores of parents, teachers and children. High levels of psychopathology (which are clinically significant in various cases) and the fact that host parents evaluate minors as more problematic, are indicators of parents' and minors' need of support from public organizations.     

Foster Parents' Understanding of Children's Problematic Attachment Strategies

ABSTRACT

Foster mothers and biological mothers were interviewed regarding their understanding of children's insecure attachment strategies and their knowledge of foster care issues. In addition, parent sensitivity was assessed and case workers in the foster care system reported on foster mothers' effectiveness. As expected, foster mothers reported significantly more attachment-related difficulties with their foster children than biological mothers reported with their natural children. Foster mothers were not significantly different from biological mothers in their understanding of attachment strategies, knowledge about foster care issues, or sensitivity. Case workers' reports of foster parent effectiveness were significantly related to foster parents' knowledge about foster care issues but were not significantly related to parents' understanding of attachment strategies. We discuss the importance of sensitivity to attachment issues among foster parents.     

Attitudes of special foster parents and residential staff towards children

This paper compares the attitudes of special foster parents and residential staff towards children in their care. The exercise was carried out as part of a comparative study of care practice in ‘special’ foster homes (accommodating children traditionally considered too old or difficult for fostering) and ordinary community or children's homes. Overall, care practice in the foster homes was significantly more child oriented than in the children's homes. This finding cannot, however, be explained in terms of attitudinal differences between foster parents and staff. Staff attitudes generally appeared more conducive to the provision of child oriented care than those of the foster parents.     

Foster parents' emotional investment and their young foster children's socio-emotional functioning

Emotional investment may be defined as a willingness to accept and become committed to a child, and being aware of influencing the child's development. Research in this field is limited, and has shown that commitment in particular is associated with foster children's socio-emotional functioning. Our aim was therefore to investigate 60 foster parents' acceptance, commitment and awareness of influence to their early placed foster children at 2 years, as well as to investigate the association between these three concepts and the foster children's social-emotional functioning (externalizing, internalizing, dysregulation and competence) at 2 (T1) and 3 (T2) years of age. The caregivers were interviewed with “This is My Baby”, and completed the questionnaire “Infant-Toddler Social and Emotional Assessment”. Results showed that on average the foster parents were rated quite high on emotional investment. Linear regressions, including one predictor and one outcome variable, revealed associations between emotional investment and foster children's socio-emotional functioning. Moreover, in regressions including all three predictors, commitment significantly negatively predicted externalizing behavior in the foster children at T1, while acceptance significantly negatively predicted dysregulation at T2. Lastly, among others for externalizing, the coefficient of commitment was significantly higher at T1 than at T2. Our results indicate a possible short-term influence of commitment on externalizing- and a possible long-term influence of acceptance on dysregulation behavior in foster children. We will therefore highlight the clinical importance of emotional investment in foster care, in order to help the young foster child towards a healthy social-emotional functioning.     

“It's really overwhelming”: Parent and service provider perspectives of parents aging out of foster care

Rates of pregnancy and parenthood among current and former foster youth are two to three times higher than non-foster youth peers. Repeat pregnancies among young mothers aging out of foster care also occur at higher rates than peers not involved with the child welfare system. Furthermore, mothers aging out of foster care demonstrate high levels of parenting stress and risk for child maltreatment. Indeed, this population is in significant need of help; however, beyond anecdotal evidence, little is known about the needs and day-to day experiences of this population. In order to tailor interventions to meet the needs of parents aging out, the perspectives of stakeholders must be taken into account. Using qualitative data gathered from separate small group interviews with parents aging out and service providers, this study examined participants' perceptions of parents' daily experiences, strengths, and needs. Findings indicated that parents aging out face overwhelming adversity and stress with little outside financial, emotional, or parenting support from family or friends. Yet, parents also expressed motivation to be good parents, resilience, and the desire to gain effective parenting skills. Although similar themes arose among parent and provider interviews, perceptions differed. Parents expressed hope and optimism in providing for their children while providers expressed systemic failure in preparing parents for independent living. Based on these findings, we conclude that parenting interventions specific to parents aging out may need to address three fundamental and key components: basic needs, social support, and effective parenting techniques.     

Explorative study into support needs of caregivers in short-term foster care regarding problem behaviour and dealing with biological parents

Family supporting foster care (FSFC) is a directly accessible, short-term and preventive form of foster care for children under the age of 12. Caregivers in this type of foster care need comprehensive support to deal with their complex tasks. In this contribution, the support needs arising from the behaviour of the foster child as well as concerning dealing with the biological parents of 85 Flemish FSFC-parents are examined, as these are areas FSFC-parents specifically ask support for. These support needs are evaluated for possible links with child and foster parent characteristics. More experienced foster parents and foster parents with a foster child showing more externalising problem behaviour ask for more support in managing the child's behaviour.     

Exploring the needs of parents for achieving reunification: The views of foster children,birth family and social workers in Spain

BackgroundFamily reunification refers to the process through which children and adolescents under a measure of temporary separation (foster care or residential) return to live with their biological families. The research has begun to reflect a paradigm change in intervention and support for these families that affects the consolidation of reunification and the prevention of new processes of separation and reentry into the protection system.ObjectivesThis article examines the needs of parents who are susceptible to an educational intervention from a positive focus that contributes to the consolidation of family reunification.MethodEighteen semi-structured interviews were conducted and 22 discussion groups were convened with 135 participants (63 protection-system professionals, 42 parents and 30 children and adolescents). The data were analyzed through content analysis and were subject to peer revision.ResultsA series of parents' specific educational needs when their children return home was recognized. These needs can be the objects of family intervention based on a positive focus directed toward highlighting parents' strengths and are related to awareness of family progress, emotional management, giving and receiving help from other families and social support. The participants' comments show that feelings of self-sufficiency and positive reinforcement are fundamental for consolidation of the process.ConclusionsSocial support through formal and informal networks may be a path to explore for providing more and better support after returning home. Empowering families so that they can be agents of support for other families can be a way to consolidate reunification, allowing families to be active agents in the reunification process. In addition, listening to children's voices can be a good strategy for family consolidation.     

Parental views of surveillance for early speech and language difficulties

Objective : To investigate parents' experiences of surveillance for early talking difficulties. Design : Qualitative study nested within a randomised controlled trial. Setting : Interviews with the parents of 20 children identified as having early difficulties. Results : Most parents were in favour of surveillance of children's language. Parents do not totally welcome surveillance, however, as it also potentially medicalises their children's early lives. The study also revealed that many of the parents felt stigmatised by their children's difficulties. Conclusions : Listening to parents' accounts can increase professionals' understanding of their responses to monitoring of their child's development and referral to specialist 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.     

Strategies for engaging foster care youth in permanency planning family team conferences

The present study examines strategies conference facilitators used to engage foster care youth in decision-making in the context of permanency planning family team conferences. Data collection included observations of permanency planning family team conferences, followed by interviews with foster care youth and conference facilitators. Data analysis focused on gaining a deeper understanding of how facilitators incorporate youth into decision-making, with a specific focus on the strategies they employed. Four strategies were identified in the analysis: creating a safe space, encouraging the youth voice, re-balancing power, and establishing a personal connection. The study's policy and practice implications, limitations and areas of further research are presented.     

The Family Context of Assent: Comparison of Child and Parent Perspectives on Familial Decision‐Making

Assent guidelines currently fail to include an assessment of a child's decision‐making ability, experience and interest. This paper summarises a two‐stage study, conducted in the United Kingdom, exploring perspectives on children's decision‐making power and ability within their family, as an indicator for overall decision‐making readiness. Children desired to make some decisions but knew their parents held ultimate authority. Parents believed their children could make some decisions and actively trained them through involvement in daily decisions. Researchers should strive to include children in enrolment decisions to some degree, based on a consideration of their expectations for involvement informed by their daily family context.     

Parenting stress and parenting behavior among foster mothers of foster children with externalizing problems

Foster children often have externalizing problems. Since foster parents are selected and trained, they are often expected to be able to handle the externalizing problems of these children. Very little is, however, known about foster parents' parenting stress and parenting behavior in the context of challenging foster caregiving. In this study, the parenting stress and parenting behavior of 39 foster mothers of recently placed foster children with externalizing problems were studied. By using standardized measures with normative data, foster mothers' scores on different parenting stress and parenting behavior subscales were compared to published norms. Foster mothers of children with externalizing problems experienced more parenting stress than the norm group. The parenting context, provided by these foster mothers, was similar to the parenting context provided by the norm group. The prevalence of specific dysfunctional parenting behaviors (e.g., less involvement in positive parenting) was small to moderate, but nearly half of the foster mothers could be classified as making dysfunctional adaptations to their parenting environment. Moreover, only the minority of foster mothers provided an adaptive parenting context (e.g., more than average involvement in positive parenting). The implications of these results for pre-service training and on-going support for foster parents are discussed.     

Parents' beliefs about the cause of parenting problems and relevance of parenting support: Understanding low participation of ethnic minority and low socioeconomic status families in the Netherlands

ObjectivesTo provide in-depth understanding of parents' beliefs about the causes of parenting problems, and the perceived relevance of parenting support in a sample of ethnic minority and low socioeconomic status (SES) families.MethodsCross-comparative analyses were performed on qualitative data from 61 parents (age child: 0–15 years) of two ethnic minority groups (Antillean-Dutch and Moroccan-Dutch) and one ethnic majority group (native Dutch) in the Netherlands. Methodology included in-depth qualitative interviews followed by focus groups. Atlas.ti software was used to manage and analyse data inductively.ResultsParenting support was perceived to be less relevant if parents related the cause of parenting problems to stress and external factors. Low-SES and ethnic minority parents more often emphasised unfavourable living conditions and living in two cultures as causes for parenting problems. Parents considered parenting support most relevant during periods of rapid change in their children, or in their parenting role.ConclusionResults indicate that beliefs regarding the cause and controllability of problems are important to understand parents' motivation to participate in parenting support. Notable differences were found regarding the period during the child's life that parenting support was perceived as most relevant. Motivation to participate was higher during various stages of transition, which ranged from the transition to parenthood, to toddlerhood, the age of seven, and adolescence.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

Estimating minimum adequate foster care costs for children in the United States

Although foster care homes play a crucial role in providing stable placements to children who enter the child welfare system due to maltreatment, there is currently no federal minimum rate nor standard methodology to establish adequate rates to support foster parents to meet these children's needs. Therefore, it is important to establish a model to estimate the real costs associated with caring for children to serve as a foundation for states to set adequate reimbursement rates. The objectives of this study are to: use the methodology of a 2007 study to establish foster care minimum adequate rates for children (MARC) based on the child's age and geographical location in every state; update the MARC with cost of living adjustments to 2016; examine changes in gaps between the MARC and the current foster care rates; and identify states that have made increases to their reimbursement rates, relative to the MARC over time. Results found that all but four states provide lower foster care reimbursement rates than the adequate costs in 2016. This study recommends that, at the federal level, enhanced precision in operational definitions of care categories could increase consistency in the way that states reimburse foster families. Additionally, findings provide policy suggestions to establish a national methodology standard and increase foster care rates to the level that will meet children's needs. This study will enhance the scant body of literature found on establishing an economic model to estimate foster care costs.