A Literature Review Comparing the Outcomes of Residential Group Care and Therapeutic Foster Care

Both advocates of residential group care and therapeutic foster care claim that their programs serve the most troubled children and youth. Prior research, often limited to single sites and small numbers of subjects, have not confirmed such claims. The authors describe the evidence regarding these claims, the research literature pertaining to program effectiveness, and a means for empirically evaluating the impact of residential group care and therapeutic foster care.     

In Their Own Words: Challenges Facing Youth Aging Out of Foster Care

Since 1999 there has been a renewed effort addressing the challenges youth face exiting foster care in adolescence, yet outcomes for most youth are still indicating heartbreaking results and it is still not clear what more is needed. Presented is a study addressing what is needed for successful transition. Three major themes emerged; youth focused practice, need for collaboration and better communication with youth, and unmet needs and permanent connections.     

Psychometric properties of the Transitions from Foster Care Key Leader Survey

This study summarizes the development and piloting of the Transitions from Foster Care Key Leader Survey (TFC-KLS), an instrument designed to measure change in systems serving young people transitioning from foster care to adulthood. The Jim Casey Youth Opportunity Initiative’s logic model was used as a basis for instrument development. The instrument was piloted with 119 key leaders in six communities. Seven of eight latent scales performed well in psychometric testing. The relationships among the 24 measures of system change were explored. A CFA testing overall model fit was satisfactory following slight modifications. Finally, a test of inter-rater reliability between two raters did not find reliable reporting of service availability in a supplemental portion of the survey. The findings were generally positive and supported the validity and utility of the instrument for measuring system change, following some adaptations. Implications for the field are discussed.     

Girls in Foster Care: Risk and Promotive Factors for School Adjustment Across the Transition to Middle School

Girls in foster care may face difficulties across the transition to middle school. Latent growth curve modeling was employed to examine trajectories and predictors of academic competence and aggression from and against peers for 75 girls in foster care from the end of elementary school to the 2nd year of middle school. Across the transition to middle school, academic competence increased. Poor self-regulation was associated with decreased academic competence, and higher caregiver support was associated with increased academic competence. Frequency of aggression from peers decreased across the transition, with perceived school competence predicting smaller decreases. Aggression against peers dropped initially and then increased to pretransition levels by the end of the 2nd year of middle school. Lower caregiver support was associated with higher rates of aggression against peers at the end of the 1st year of middle school. The results are discussed in terms of implications for interventions for girls in foster care.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

Using Subsidies to Promote the Adoption of Children from Foster Care

Since 1978 the federal government has implemented a variety of programs to promote the adoption of children from foster care. A key part of these programs has been the use of subsidies to lower the cost of adopting and parenting children who have been in foster care. Although subsidies are a key part of federal policy, there has been little empirical research on the effect of subsidies on adoption rates. This paper uses data from the Adoption and Foster Care Analysis and Reporting System to estimate the impact of subsidy rates on adoption rates. Subsidies to families have a positive and statistically significant effect on adoption rates.

Youth Perspectives on Being Adopted from Foster Care by Lesbian and Gay Parents: Implications for Families and Adoption Professionals

ABSTRACT

This article presents findings from a qualitative study on the perspectives of youth who were adopted from the United States foster care system by lesbian and gay parents and includes focus group data from adopted persons and survey data from adoptive parents. This study fills a unique gap in the literature by hearing directly from the youth through focus groups. Findings indicated that children use a variety of strategies for sharing or not sharing that their parents are gay or lesbian and that many experience bullying and teasing that may be different than experienced by other children. The children adopted by lesbian and gay parents often perceive themselves as being more accepting of others, having more understanding of people, and being more compassionate toward people than those not raised by lesbian or gay parents. Suggestions are provided for training of adoption professionals and prospective families about the challenges and benefits for youth adopted by lesbian and gay parents.     

Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study

This study evaluated the intermediate and long-term effects of family foster care on adult functioning using a sample of 659 young adults from two public and one private child welfare agencies, case record reviews, structured interviews, and a survey response rate of 76%. Foster care alumni completed high school at a rate comparable to the general population, but a disproportionately high number of them completed high school via a GED. Alumni completion rates for postsecondary education were low. Consequently, many alumni were in fragile economic situations: one-third of the alumni had household incomes at or below the poverty level, one-third had no health insurance, and more than one in five experienced homelessness after leaving foster care. Two foster care experience areas were estimated to significantly reduce the number of undesirable outcomes in the Education outcome domain: positive placement history (e.g., high placement stability, few failed reunifications), and having broad independent living preparation (as exemplified by having concrete resources upon leaving care). For the Employment and Finances outcome domain, receiving broad independent living preparation (as exemplified by having concrete resources upon leaving care) was estimated to significantly reduce the number of undesirable outcomes.     

A logic model development for an adolescent based intervention to improve benefits from Therapeutic Residential Care (TRC)

There is a significant need to comprehensively describe and illustrate via a logic model what processes work for adolescents in residential treatment facilities and how to make improvements (Bean, White, Neagle & Lake, 2005).The purpose of this article is to highlight one Adolescent TRC’s journey to develop and implement a working Logic Model.     

Using Family-Oriented Treatment to Improve Placement Outcomes for Children and Youth in Residential Treatment

Abstract

Traditionally, caregivers of children with severe emotional and behavioral disturbances have been excluded from treatment planning, and service providers have often blamed caregivers for children's mental health problems. More recently, an approach to treatment based on Systems of Care has emphasized the importance of including caregivers in every aspect of treatment. This article describes a family-oriented residential treatment program in eastern North Carolina and reports initial results of a pilot study in which caregiver participation is valued and emphasized. Implications for practice, policy, and professional training are discussed.     

Residential Child Care Agencies as Learning Organisations: Innovation and Learning from Mistakes

The residential child care sector has been scrutinised via numerous inquiries following revelations of abusive and poor practice. These inquiries have made numerous recommendations which involve changes in practice and organisational culture, much of which is congruent with the features of a learning organisation. This article details research which evaluates the extent to which residential child care agencies exhibit the characteristics of a learning organisation. The research involved qualitative and quantitative methods, drawing on the experiences of a range of staff from the residential child care sector within Scotland. The findings revealed that residential child care agencies exhibit many features of a learning organisation, yet the extent to which these characteristics are perceived to exist differs significantly in line with the position staff occupy. Most significant were the findings that many staff do not feel supported to take risks nor encouraged to develop innovative practice; mistakes are not used as learning opportunities and a culture of blame is felt to exist. The implications of this are significant and this article identifies changes necessary to allow residential child care agencies to operate as learning organisations.     

Homelessness and Children's Use of Mental Health Services: A Population-Based Study

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.     

Children in Foster Care and the Development of Favorable Outcomes

Young foster children have invariably faced a variety of risks that are strongly linked to long-term deficits in functioning across multiple developmental domains. Despite these risks, however, some children demonstrate more favorable outcomes and exhibit adaptation and the development of assets. In the present study, the relationship of early childhood factors (e.g., maltreatment history, placement history, parenting practices, environmental stress, developmental status, and attachment behavior) to the development of favorable outcomes in middle childhood was examined in a sample of foster children who had been in foster care in preschool (N = 35). Favorable outcomes were defined as demonstrations of emotion regulation and school adjustment during middle childhood. Developmental status (particularly attention and executive functioning) and a lack of environmental stress during early childhood foster care experiences had a significant positive relationship with the development of emotion regulation and school adjustment in middle childhood.     

Enhancing the Quality of Care in Residential and Nursing Homes: More than Just a Professional Responsibility

ABSTRACT

This article highlights a range of issues considered essential to improving the quality of care received by older people in residential and nursing home settings. It is argued that improving such care represents a societal as well as a professional responsibility and that remedial action is needed at a number of levels. Five ‘routes’ to achieving quality are outlined, and it is suggested that these are not simply alternatives but that each requires attention if genuine progress is to be made.     

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.     

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.     

Prior Placements of Youth Admitted to Therapeutic Foster Care and Residential Treatment Centers: The Odyssey Project Population

Two samples of youth in the child welfare system were compared—youth entering residential treatment centers (RTCs) and youth entering therapeutic foster care (TFC). Three questions were addressed: (1) Where were youth living prior to the current placement? (2) Had youth been treated in other systems of care? (3) How many prior placements did youth have? Time 1 data of the national “Odyssey Project” developed by the Child Welfare League of America were used. The^.measure utilized was the child and family characteristics form (CFC). Results revealed that youth admitted to RTCs were more likely to be entering from other systems of care and stepping down to the RTC while youth entering TFCs were more likely to be entering from within the child welfare system and stepping up to a higher level of care. The results have implications for improving clinical practice and for the development of a cross-system perspective on serving troubled youth.     

Promoting the mental well-being of older people from black and minority ethnic communities in United Kingdom rural areas: Findings from an interview study

Drawing from 81 interviews with practitioners in social care and housing with care services in the United Kingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of the literature which provides evidence that BME older people are likely to be increasingly part of the populations of rural areas. Next it presents interview data revealing that while practitioners are aware of such demographic changes in general terms; some feel that they lack training and skills in adapting their professional practice to support all older people. Others express feelings of professional isolation in seeking to support older people from minority groups and are concerned that older people from minority groups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study's implications for rural practice, policy and research.